Hemorragia adrenal bilateral en paciente recuperado de neumonía COVID-19 Grave: caso Radiológico / Bilateral adrenal hemorrhage after severe COVID-19 infection: report of one case

We report a 47-year-old male with a severe disease caused by COVID-19, who required mechanical ventilation for 18 ays. During the hospital stay he received dexamethasone and anticoagulation with heparin. After discharge a new chest CT scan showed homogeneous hypo vascular enlargement of both adrenal glands, not present in the initial imaging studies. It was interpreted as a subacute bilateral adrenal hemorrhage. The patient remained stable and without any complaint.

Imaging study of second sacral alar-iliac screw placement in adult degenerative scoliosis / 中华骨科杂志

Objective@#To discuss the imagingcharacteristics of S2AI screw trajectory in ADS patients.@*Methods@#Forty patients with degenerative scoliosis were scanned with Simens Sliding 40-slice spiral CT scanner. Three-dimensional scanning and reconstruction were performed in these patients with the scanning range including thoracolumbar spine, lumbar spine, lumbosacral region, pelvis and bilateral hip joints. The base of the lateral sacral crest on the midline between the lower edge of S1 dorsal foramina and the upper edge of S2 dorsal foramina was the starting point. The placement plane of S2AI screw trajectory was determined from the starting point to the lower margin of anterior inferior iliac spine. A 10mm diameter screw was the design template. A circle with a diameter of 5 mm as the center of the lowest point of the ilium inner cortex was made, and a tangent line from the starting point to the outer diameter of the circle (the inner part of the ilium) was selected as the axis of the screw trajectory. The lateral angle and the length of the axis of the screw trajectory and iliac width were measured in transverse plane. The caudal angle, the distance from the axis of the screw trajectory to iliosciatic notch, and the caudal angle, the distance from the axis of the screw trajectory to the upper edge of the acetabulum were measured in sagittal plane. These parameters were recorded and analyzed.@*Results@#The trajectory length of S2AI screw in ADS patients was 12.00±0.99 cm, the lateral angle was 41.24°±3.92°, the caudal angle was 27.73°±6.45°, and the distance from the axis of the screw trajectory to iliosciatic notch was 1.05±0.81 cm, the distance from the axis of the screw trajectory to the upper edge of the acetabulum was 1.85 ± 0.33 cm, and the iliac width was 2.12±1.65 cm. The trajectory length, lateral angle, caudal angle, distance from the axis of the screw trajectory to iliosciatic notch, distance from the axis of the screw trajectory to the upper edge of the acetabulum and iliac width of S2AI screw was respectively 12.40±0.83 cm, 39.47°±1.76°, 28.00°±6.39°, 1.08±0.32 cm, 1.76±0.34 cm, 2.26±0.25 cm in male patients, and was respectively 11.75±1.01 cm, 42.30°±4.48°, 27.56°±6.61°, 1.21±1.00 cm, 1.90±0.32 cm, 2.04±0.18 cm in female patients. The screw length and lateral angle had statistically difference between male and female patients(P<0.05). Compared with non-ADS patients in previous studies, female patients with ADS had significant differences in increased lateral angle and decreased caudal angle of S2AI screw.@*Conclusion@#There is ideal trajectory of S2AI screws in ADS patients. There was no significant difference of the length of S2AI screws between ADS patients and non-ADS population. Different direction was noticed in the placement of S2AI screws, especially in female patients. Increased lateral angle and decreased caudal angle would be obtained in the procedure of placing S2AI screws in female ADS patients during operation.

Usefulness of Blood Cultures and Radiologic Imaging Studies in the Management of Patients with Community-Acquired Acute Pyelonephritis

BACKGROUND: The objective of this study was to examine the usefulness of blood cultures and radiologic imaging studies for developing therapeutic strategies in community-acquired acute pyelonephritis (CA-APN) patients. MATERIALS AND METHODS: We prospectively collected the clinical data of CA-APN patients who visited 11 hospitals from March 2010 to February 2011. RESULTS: Positive urine and blood cultures were obtained in 69.3% (568/820) and 42.7% (277/648), respectively, of a total of 827 CA-APN patients. Blood culture identified the urinary pathogen in 60 of 645 (9.3%) patients for whom both urine and blood cultures were performed; the organisms isolated from urine were inconsistent with those from blood in 11 and only blood cultures were positive in 49 patients. Final clinical failure was more common in the bacteremic patients than the non-bacteremic ones (8.0% vs. 2.7%, P = 0.003), as was hospital mortality (3.6% vs. 0.3%, P = 0.003). Likewise, durations of hospitalization and fever were significantly longer. Bacteremia was independent risk factor for mortality (OR 9.290, 1.145-75.392, P = 0.037). With regard to radiologic studies, the detection rate of APN was 84.4% (445/527) by abdominal computed tomography and 40% (72/180) by abdominal ultrasonography. Eighty-one of 683 patients (11.9%) were found to have renal abscess, perinephric abscess, urolithiasis, hydronephorosis/hydroureter or emphysematous cystitis, which could potentially impact on clinical management. Patients with Pitt score ≥ 1, flank pain or azotemia were significantly more likely to have such structural abnormalities. CONCLUSION: Blood cultures are clinically useful for diagnosis of CA-APN, and bacteremia is predictive factor for hospital mortality. Early radiologic imaging studies should be considered for CA-APN patients with Pitt scores ≥1, flank pain or azotemia.

Accuracy of mandibular measurements of sexual dimorphism using stabilizer equipment

Abstract The objective of this investigation was to compare the accuracy of mandibular measurements using a stabilizer (MS) with gold standard computed tomography (GS) images. Sixty mandibles were studied. Werth TomoScope HV Compact® was used to obtain CT images (GS), and the MS was also used. Analysis of the CT scans was performed using the VG Studio Max software® (Volume Graphics GmbH, Heidelberg, Germany), and MS was used after the proper positioning of the mandible. Descriptive and paired t test measures were used, and a ROC curve was calculated, as well as sensibility and specificity. MedCalc and STATA 13.0® were used (95% level of significance). Bicondylar breadth, bicoronoid breadth and minimum ramus breadth reached the highest concordance correlation coefficients at 0.99 (0.99-1.00), 0.99 (0.99–1.00) and 1.00 (0.99–1.00), respectively. Comparing observers with GS, the lowest accuracy was noted for the maximum mandibular length [0.59 (0.45–0.69), 0.64 (0.51–0.74)], the breadth of the right (0.14 (0.04–0.23), 0.14 (0.004–0.24)) and left mandibular body [0.14 (0.03–0.24), 0.16 (0.05-0.26)], and the right [0.58 (0.45–0.69), 0.63 (0.51–0.73) and left (0.59 (0.45–0.70), 0.59 (0.46–0.69)] mandibular angle. Various measurements exhibited good sensibility for males using MS: maximum mandibular length (78.12), bicondylar breadth (78.12), left mandibular notch breadth (84.37), and the left height of the mandibular body at the mental foramen (75.00). High specificity in discriminating females was observed for the left maximal ramus height (85.19), mandibular length (85.71), bicoronoid breadth (96.43), right height of the mandibular body at the mental foramen (82.19), bimental breadth (78.57), breadth right (92.86) and left (96.43) mandibular body, minimum ramus breadth (89.29), and left mandibular angle (85.71). MS was able to discriminate sexual dimorphism.

Craniopharyngiomas : Radiological Differentiation of Two Types

OBJECTIVE: To determine imaging features that may separate adamantinomatous and papillary variants of craniopharyngiomas given that tumors with adamantinomatous signature features are associated with higher recurrence rates, morbidity, and mortality. We specifically reviewed calcification on CT, T1 bright signal intensity, and cystic change on T2 weighted images for differentiating these two types. METHODS: We retrospectively reviewed the MRI and CT studies in 38 consecutive patients with pathologically proven craniopharyngiomas between January 2004 and February 2014 for the presence of calcification on CT scans, bright signal intensity on T1 weighted images, and cystic change on T2 weighted images. RESULTS: Of the 38 craniopharyngiomas, 30 were adamantinomatous type and 8 were papillary type. On CT scans, calcification was present in 25 of 38 tumors. All calcified tumors were adamantinomatous type. Twenty four of 38 tumors had bright signal intensity on T1 weighted images. Of these 24 tumors, 22 (91.7%) were adamantinomatous and 2 were papillary type. Cystic change on T2 weighted images was noted in 37 of 38 tumors; only 1 tumor with papillary type did not show cystic change. CONCLUSION: T1 bright signal intensity and calcification on CT scans uniformly favor the adamantinomatous type over papillary type of craniopharyngioma in children. However, these findings are more variable in adults where calcification and T1 bright signal intensity occur in 70.6% and 58.8% respectively of adult adamantinomatous types of craniopharyngiomas.

Right-sided reverse T composite arterial grafting to complete revascularization of the right coronary artery / Enxerto arterial composto reverso T do lado direito para completar a revascularização da artéria coronária direita

Complete arterial revascularization for the right coronary artery is underused mainly due to technical issues. Herein we report on a new approach for complete arterial revascularization of arterial revascularization for the right coronary artery branches. Complete arterial revascularization for the right coronary artery revascularization was performed in 8 patients using a reverse T composite arterial graft. None of the patients suffered perioperative myocardial infarction. All patients underwent noninvasive coronary imaging, displaying an early patency rate of 100%. Complete arterial arterial revascularization for the right coronary artery revascularization using a reverse T graft offers a new paradigm with enhanced technical flexibility in performing all arterial myocardial complete revascularizations in selected patients.

Revascularização arterial completa para a artéria coronária direita é subutilizada, principalmente devido a problemas técnicos. Nós relatamos uma nova abordagem para a revascularização arterial completa para os ramos da artéria coronária direita. Revascularização arterial completa da artéria coronária direita foi realizada em 8 pacientes usando um enxerto T arterial composto inverso. Nenhum dos pacientes sofreu infarto do miocárdio perioperatório. Todos os pacientes foram submetidos a exame de imagem não invasivo coronária não invasiva, exibindo taxa de patência precoce de 100%. Revascularização arterial completa da artéria coronária direita com enxerto inversa T oferece um novo paradigma com maior flexibilidade técnica na execução todas as revascularizações arteriais completas do miocárdio em pacientes selecionados.

Imaging diagnosis of bone tumor and tumor-like lesion in the talus / 中华骨科杂志

Objective To research the variety and the imaging features of bone tumor and tumor-like lesions in the talus.Methods The imaging features of 33 cases of tumor and tumor-like lesions in the talus were reviewed retrospectively.All cases were confirmed by operation and pathology,All of 33 cases were performed X-ray examination,23 cases were examined by CT,and 11 cases were taken by MR.Results In 33 cases,24 cases were males,9 cases were females; including 7 cases of chondroblastoma(21.2％),7 cases of giant cell tumor(21.2％)(1 case of recurrence),6 cases of osteochondroma(18.2％),2 cases of osteoid osteoma(6.1％),7 cases of adjacent joint bone cyst(21.2％,2 cases of fibrous dysplasia of bone(6.1％),1 case of bone cyst(3％),1 case of malignant fibrous histiocytoma(MFH) of bone(3％).6 cases showed pathological fractures.The X-ray and CT imaging features of chondroblastoma,giant cell tumor,adjacent joint bone cyst,fibrous dysplasia of bone,bone cyst demonstrated cystic bony destruction.The common location of chondroblastoma were the posterior of talus(57％),expanding growth slightly,margin were mild osteosclerosis.The margin were osteosclerosis irregularly and osteal ridges showed in giant cell tumor.MRI features were different on pathologic basis,isointense and hypointense signal on T1WI and hyperintense signal on T2WI usually.The osteochondroma showed osseous protuberance connecting the talus,some cases showed calcification in the cap.The imaging of MFH in the talus X-ray and CT showed ill-defined osteolytic bony destruction,soft tissue-mass,no periosteal reactions and bone formation.MRI showed isointense and hypointense signal on T1WI and isointense and hyperintense signal on T2WI.The extent of tumour invasion clearly displayed.Conclusion Tumor and tumor-like lesion in the talus were rare.But there are great varieties.The benign tumor was more common than malignant tumor.Chondroblastoma,giant cell tumor,osteochondroma,osteoid osteoma and adjacent joint bone cyst were relatively common and had some imaging features.Malignant tumor rarely happened in the talus,but it is possible.

The application of lung perfusion imaging in radiotherapy of patients with non-small-cell lung cancer / 中华老年医学杂志

Objective To observe the changes of lung function before and after radiotherapy with the lung perfusion of single-photon emission computed tomography and compare the difference between radiotherapy plans conducted by functional imagines and anatomical imagines in radiotherapy of patients with non-small-cell lung cancer.Methods A total of 36 patients (26 males and 10 females,aged 36-80 years) with lung cancer diagnosed as stage Ⅰ to stage Ⅲ non-small cell lung cancer confirmed by histological proof were selected.The lung perfusion image was delivered to radiotherapy planning system and the two plan (plan1 and plan 2) were made by lung perfusion image fusion.Plan 1 was only based on the anatomical informations and no lung perfusion images of SPECT considering.Plan 2 was optimized based on the lung perfusion image to reduce the irradiation dose of the normal tissues.The differences of protecting lung function between plan 1 and plan 2 were compared.Results 36 patients were stratified for clinical stage.FV10,fV20,fV30,MLD and PTV90/fV20 were decreased significantly after optimized with IMRT (all P =0.000).FV20,fMLD were decreased by (4.89±2.0) ％,(1.74 ±0.9)％.The IMRT plan based on the lung perfusion fusion images of SPECT could reduce the irradiation dose of normal lung tissues and the incidence of radiation pneumonitis.Conclusions Radionuclide pulmonary perfusion imaging can assess effectively the effect of tumor to regional pulmonary artery perfusion function before radiotherapy and reduce the irradiation dose of normal lung tissue in lung cancer patients undergoing IMRT.

Study on utilization, reasons/indications for usage and determination of direct costs of the computed tomographic (C.T) scanner at the radiology department National hospital of Sri Lanka

A descriptive cross sectional study was done to study the utilization pattern,reasons/indications for its use,determination of direct costs incurred by the state and clinician's knowledge and skills on computed tomography and its applications.The commonest clinical problems,which necessitate computed had a poor knowledge.tomograpic examinations were identified as cerebro-vascular accident and acute severe headache;both contributed to 33.2 of total studies.Almost 55.9 studies were contrast studies,and 85.6 of routine studies were done with contrast enhancement.Withregard to knowledge and skills of prescribing medical officers to prescribe and interpret the procedure as an investigative method,61.2

Evaluación prospectiva de la venografía mediante angioTC en el diagnóstico de enfermedad tromboembólica / Diagnostic yield of CT pulmonary angiography and venography for thromboembolic disease

Background: CT pulmonary angiography is the diagnostic procedure of choice for non-massive pulmonary embolism. Aim: To assess the diagnostic yield for thromboembolic disease of CT pulmonary angiography and venography using a 64- slice multidetector tomography. Material and Methods: Prospective study of patients with a clinical suspicion of thromboembolic disease, subjected to CT pulmonary angiography and venography. The presence and location of pulmonary thromboembolism, of isolated or concomitant deep venous thrombosis and of other significant radiological findings, were registered. Results: A 64-MDCT scanner was performed to 893 patients and thromboembolic disease was demonstrated in 240. Pulmonary thromboembolism was diagnosed in 218 patients. It was concomitant with deep venous thrombosis in 79 patients (36 percent) and isolated in the rest. Thirty fve of the 218 patients with pulmonary thromboembolism had radiological evidence of right ventricular overload. Twenty two patients (10 percent) had an isolated deep venous thrombosis. In 65 patients with pulmonary thromboembolism (30 percent) a possibly new or old malignant lesion, was observed. Seventy one of 653 patients without evidence of thromboembolic disease had potentially pathological findings on CT. Conclusions: The combined use of CT pulmonary arteriography and venography using a 64 MDCT scanner increases the diagnostic yield of the procedure for thromboembolic disease. It also allows the diagnosis of other related conditions, specially malignant tumors.

VIPoma pancreático: Caso clínico / Pancreatic VIPoma: Report of one case

Neuroendocrine tumors are uncommon, including VIPoma that produces vasoactive intestinal polypeptide. We report a 45-year-old female presenting with a history of diarrhea lasting three months. An abdominal CAT scan showed a solid tumor in the body of the pancreas. A fine needle aspiration biopsy of the tumor was compatible with a neuroendocrine tumor. The patient was subjected to a partial pancreatectomy, excising a 4 cm diameter tumor. The pathological study was compatible with a neuroendocrine carcinoma. There was no regional lymph node involvement. During the postoperative period the results of serum vasoactive intestinal polypeptide were received. These were 815.9 pg/ml before surgery and normalized after the operation.

Tromboembolismo pulmonar masivo con respuesta exitosa a trombolisisfarmacológica: Caso clínico / Massive pulmonary thromboembolism treated successfully with streptokinase: Report of one case

Massive pulmonary thromboembolism has a high mortality. Early thrombolysis is the treatment of choice. We report a 79-year-old man admitted in shock. A chest angio-CAT scan showed a massive pulmonary thromboembolism. A transthoracic echocardiography showed a right cardiac dysfunction. Although the patient was in hemodynamic instability, he was subjected to thrombolysis with streptokinase, assisted with noradrenaline support and invasive mechanical ventilation. Parenteral anticoagulation was started thereafter. A second echocardiography, performed 72 hours later showed an improvement in right ventricular function. The patient had a nosocomial pneumonia that was treated. Noradrenalin and mechanical ventilation were discontinued nine and 15 days after thrombolysis. A new angio-CAT scan, 23 days after the procedure, was normal. The patient was discharged in good conditions 27 days after admission.

Subclinical Coronary Artery Disease as Detected by Coronary Computed Tomography Angiography in an Asymptomatic Population

BACKGROUND AND OBJECTIVES: Primary prevention of coronary artery disease (CAD) has become a public health issue, according to increasing awareness of the substantial risks posed by asymptomatic atherosclerosis. The aims of this study were to determine the prevalence and characteristics of subclinical CAD using coronary computed tomography angiography (CCTA), and to evaluate the role of this advanced technology in identifying subclinical CAD in asymptomatic Korean individuals, compared with conventional risk stratification. SUBJECTS AND METHODS: We enrolled 4,320 consecutive asymptomatic individuals (61% males, aged 50+/-9 years), who underwent 64-slice CCTA during a routine health check. RESULTS: Coronary artery plaques were present in 1,053 (24%) individuals. Significant stenosis (diameter stenosis > or =50%) was identified in 139 (3%) subjects, and most of the significant lesions (87%) were located in the left anterior descending artery. CCTA revealed noncalcified plaques in 5% of subjects with a coronary calcium score of zero (n=801). Although 25% (n=10) of those with noncalcified plaque had significant stenosis, most of them (90%) were classified into low- or moderate-risk groups according to National Cholesterol Education Program risk stratification guidelines. In a young population (age < or =55 years for males, < or =65 years for females), 30% of subjects with significant stenosis were classified into a low-risk group and 60% had low (0 to 100) calcium scores. CONCLUSION: Subclinical CAD in asymptomatic individuals cannot be ignored for its considerable prevalence, CCTA may be helpful in identifying at-risk subclinical CAD in a noninvasive manner, especially in the young and traditionally low-risk population.

The diagnosis value of intestinal obstruction by Multislice computed tomography / 中国基层医药

Objective To evaluate the role of Muhislice computed tomography(MSCT) in the diagnosis of acute ileus.Methods 50,cases with suspected of intestinal obstruction were scanned using MSCT.The diagnostic resuits of MSCT were compared with operation and pathology.Results The existence of ileus was diagnosed in 96% (48 of 50 cases) on MSCT scans,the sensitivity was 95% (41 of 43 cases),the specificity was 92% (46 of 50 cases).The accurate rate of X-Ray plain film in the diagnosis of ileus in this study was 66% (33 of 50 cases),the sensitivity was 76% (33 of 43 cages),the specificity was 68% (34 of 50 cases).The accuracy of etiological diagnosis of ileas made by MSCT in 17 cases proved by operation or clinical follow-up was 82% (14 of 17 cases),and the accuracy of location was 88% (15 of 17cases).The rate of diagnosis accord of CT and surgery in intestinal were no significant differenco(X~2=2.78,P＞0.05);The rate of in line with diagnosis of CT and surgery in intestinal were no significant difference;The rate of in line with diagnosis of CT and surgery in colon were significant(X~2=23.95,P＜0.05).Conclusion Intestinal obstruction is more clearly revealed by MPR of MSCT,which improves the diagnostic ability of acute intestinal obstruction.

Diagnostic:value of 16-SCT manifestation in Acute appendicitis / 中国基层医药

Objective To evaluate 16-SCT in diagnosing aeute appendicitis.Methods The CT findings of 34 cases were retrospectively analyzed.These cases were all proved acute appendicitis by surgical-pathology.Results 30 cases were confirmed by CT,with accuracy 88% (30/34).The diameter of 28 appendix was more than 6mm;2 collapsed with thickening wall.Periappendiceal fat stranding could be seen in 25 cases.Perforated appendicitis happened in 4 cases.Abscess performed in 2 cases.3 cases were missed,1 misdiagnosed.Conclusion 16-SCT could confirm acute appendicitis and its complication timely and accurately.

Clinical value of 64-row CT angiography in detection of carotid atherosclerotic plaque / 中华全科医师杂志

Objective To explore clinical significance of muhidetector(64-row)computed tomography carotid atherosclerosis angiography(MDCTA)in detecting carotid atherosclerotic plaque.Methods Data of 116 patients with carotid atherosclerosis undergone with MDCTA stayed at Huashan Hospital,Shanghai from January to August,2008 were analyzed retrospectively.Results Three hundred and seventy-seven plaques were identified among all the 116 patients in the study,with an incidence of calcified plaque of 63.40 percent,and more detected at the common carotid artery(27.85%).the carotid bifurcation(39.78%)and the internal carotid artery (21.48%).There was significantly statistical difference in plaque types between those with mild,moderate and severe carotid stenosis(P=0.000)and between those aged equal to or lower than 50 years and equal to or greater than 70 years(P=0.005).Plaque types at the common carotid artery were significantly difierent from those at the carotid bifurcation(P=0.000)and at the internal carotid artery(P=0.000).Results of regression analysis showed a positive and significant association between carotid occlusion and clinical symptomatology(with a coefficient of correlation of 1.080.P=0.023)and inverse association between calcified plaque and clinical symptomatology(with a coefficient of correlation of 0.688,P=0.006).Conclusions Not only imaging characteristics of carotid atherosclerotic plaque can be accurately assessed by MDCTA,but also measurement of its stenosis degree.Assessment of plaque type,degree of stenosis and distribution of plaque in different Vascular segments with MDCTA can be used to predict clinical occurrence of cerebevaseular events in patients with carotid atherosclerosis.

Apendicitis aguda sin dolor o El paraíso de los tontos: caso clínico / Painless acule appendicitis: The fools´ paradise: report of two cases

The diagnosis of acute appendicitis has been based on the presence of ríght lower quadrant pain and guarding. Occasionally, the pain disappears, even in the presence of a continuing appendicular process. This phenomenon is called "the fools' paradise". We report two male patients aged 19 and 17 years with an acute appendicitis confirmed by an abdominal ultrasound in one and an abdominal CAT sean in the other, in whom the abdominal pain disappeared during the evolution. Despite of the absence of pain, both were operated, based on imaging and laboratory studies, confirming the presence of an inflamed appendix.

Relationship between trabecular strength and three-dimensional architecture in the pig mandible using microcomputed tomography / 대한구강악안면방사선학회지

PURPOSE: To investigate the relationship between three-dimensional (3D) bone imaging parameters and trabecular strength in the mandible. MATERIALS AND METHODS: Bone specimens were obtained from the mandibles of five male pigs weighing around 110 kg each. Of those, 43 samples were selected for 3D analysis and measured by micro-computed tomography. The five morphometric parameters were trabecular thickness (Tb.Th), bone specific surface (BS/BV), percent bone volume (BV/TV), structure model index (SMI) and degree of anisotropy (DA). Through destructive mechanical testing, strength parameters were obtained. RESULTS: BV/TV, SMI, BS/BV, and Tb.Th showed significant correlations with strength parameters. DA did not show any correlation with the other parameters. In multiple linear regression analysis, BV/TV alone explained 43% of the variance in Young's modulus. By stepwise inclusion of SMI, the variance in the Young's modulus was better explained up to 52%. CONCLUSIONS: Predicting trabecular strength in the mandible through architectural analysis would be possible. Further study is needed to establish the tendency and variety of trabecular architecture and strength according to the locations within the mandible.

CLINICAL APPLICATION OF THREE DIMENSIONAL QUANTITATIVE MEASUREMENT ON THE SURGERY OF THE BASE OF THE MIDDLE CRANIAL FOSSA / 解放军医学杂志

0.05). It suggested that the 3 D quantitative measurement is a useful technique for the diagnosis of diseases in the base of the middle cranial fossa region,so that it is useful for surgical planning.