Multiplanar CT reconstructions allow optimization of the laparoscopic surgical approach for liver lesions.

PURPOSE: Resection of hepatic lesions can be difficult and requires careful analysis of pre-operative imaging. The aim of this study is to highlight the use of multiplanar CT reconstruction in liver surgery, which helps to anticipate intra-operative technical difficulties. METHODS: We retrospectively selected the imaging of several patients managed for liver lesions in specific locations: liver dome (IVa, VIII), the left lobe (intra-parenchymal, left edge), and the antero-inferior edge of segment VI. The IWATE classification was used to grade the difficulty of these resections. RESULTS: Multiplanar analysis has made it possible to change the level of difficulty of liver resection and to anticipate intra-operative difficulties. Frontal and/or sagittal section in addition to axial sections analysis increased the IWATE score. CONCLUSION: Multi-planar reconstruction must be a tool used by the liver surgeon pre-operatively in order to limit intra-operative complications.

Development of an automatic multiplanar reconstruction processing method for head computed tomography.

BACKGROUND: Head computed tomography (CT) is a commonly used imaging modality in radiology facilities. Since multiplanar reconstruction (MPR) processing can produce different results depending on the medical staff in charge, there is a possibility that the antemortem and postmortem images of the same person could be assessed and identified differently. OBJECTIVE: To propose and test a new automatic MPR method in order to address and overcome this limitation. METHODS: Head CT images of 108 cases are used. We employ the standardized transformation of statistical parametric mapping 8. The affine transformation parameters are obtained by standardizing the captured CT images. Automatic MPR processing is performed by using this parameter. The sphenoidal sinus of the orbitomeatal cross section of the automatic MPR processing of this study and the conventional manual MPR processing are cropped with a matrix size of 128×128, and the value of zero mean normalized correlation coefficient is calculated. RESULTS: The computed zero mean normalized cross-correlation coefficient (Rzncc) of≥0.9, 0.8≤Rzncc < 0.9 and 0.7≤Rzncc < 0.8 are achieved in 105 cases (97.2%), 2 cases (1.9%), and 1 case (0.9%), respectively. The average Rzncc was 0.96±0.03. CONCLUSION: Using the proposed new method in this study, MPR processing with guaranteed accuracy is efficiently achieved.

Diagnostic Performance of Multi-Direction Adjusted Multi-Planar Reconstruction with Helical CT for Evaluating Continuity of the Anterior Cruciate Ligament.

RATIONALE AND OBJECTIVES: To analyze the diagnostic performance of MDA-MPR with CT for evaluating ACL structural continuity. METHODS: A total of 145 patients with highly suspected ACL injury admitted to our hospital between January 2016 and May 2021 were retrospectively enrolled. All patients had undergone examination with MRI, CT, and arthroscopy. Taking arthroscopy results as the gold standard, the diagnostic accuracy for identifying ACL rupture by MRI and MDA-MPR with CT were compared. RESULTS: The receiver operator characteristic curves demonstrated that both MRI and MDA-MPR with CT performed well in the diagnosis of ACL tears. The sensitivities of MRI and MDA-MPR with CT for diagnosing complete ACL tears were 95.16% (59/62) and 90.32% (56/62), respectively. Their specificities in this regard were 77.11% (64/83) and 84.34% (70/83), respectively. MRI had a higher sensitivity but MDA-MPR with CT had a higher specificity for detecting complete ACL tears, and the differences were statistically significant (p <.05). The sensitivities of diagnosing partial ACL tears using MRI and MDA-MPR with CT were 78.79% (26/33) and 75.76% (25/33), respectively, while the specificities were 86.61% (97/112) and 90.18% (101/112), respectively. These differences were non-significant (p >.05). CONCLUSION: MDA-MPR with CT has high diagnostic efficiency for ACL injuries, especially in the diagnosis of complete ACL tears.

A novel view of computed tomography images similar to the visual field of otologic surgeons.

OBJECTIVES: In preparation for endoscopic sinus surgery (ESS), the most important computed tomography (CT) image for otolaryngologists is the coronal plane image because it has a viewpoint similar to that of the surgical visual field. Contrastingly, otologic surgeons refer to axial and coronal plane images before ear surgery and must imagine the anatomical structure of the temporal bone by reconstructing three-dimensional (3D) images in their minds. We propose a "surgical position view (SPV) image," a novel viewpoint of CT images that enables otologic surgeons to see a perspective similar to the surgical visual field. METHOD: Sagittal plane CT images of the temporal bone were created from axial plane images with multi-planar reconstruction (MPR). Then, the SPV image was obtained by rotating it 90° to the supine position. The entire process can be performed anywhere in the hospital within 1 minute using the electronic medical record computer's image viewer. RESULTS: SPV images show anatomical structures of the temporal bone, external ear canal, mastoid cavity, sigmoid vein, facial nerve, ossicles, and cochlea, in a similar view to the actual ear surgery. Soft tissue such as cholesteatoma is depicted in the same concentration as the normal CT image. CONCLUSION: The SPV image enables an otologic surgeon to see the temporal bone CT image from the actual ear surgery viewpoint simply and quickly. It helps to visualize the 3D anatomical structure of the temporal bone and can be useful for ear surgery planning. LEVEL OF EVIDENCE: 5.

Prediction of Left Double-Lumen Tube Size by Measurement of Cricoid Cartilage Transverse Diameter by Ultrasound and CT Multi-Planar Reconstruction.

Background: Currently, there is no uniform standard for selecting the left double lumen tubes (LDLT). Advantages, such as safety and convenience of the ultrasonic technology, and measurement accuracy, make it more widely applied in the clinical anesthesia, and computed tomography (CT) multi-planar reconstruction (MPR) technology will certainly provide a more accurate measurement. For better application for thoracic surgery choice LDLT, relieving the injury to patients, and reducing the complications, this study will compare the two approaches. Methods: The first part, 120 cases of patients were selected according to the height and gender; recording the patient's optimum LDLT and measurement the transverse diameter of the cricoid cartilage (TD-C) by ultrasound and CT MPR, and then obtained the TD-C range measurement by ultrasound and CT MPR corresponding to different types of LDLT. The second part, total of 102 patients were divided into the ultrasound group and the CT MPR group. In the ultrasound group, TD-C was measured by ultrasound, the corresponding size for intubation was selected based on the conclusions derived from the first part. In the CT MPR group, TD-C was measured by CT MPR, the corresponding size of LDLT based on the conclusions derived from the first part. Results: In the first part, 120 patients were no significant difference in the basic characteristics (P > 0.05). The accuracy of selecting the LDLT by conventional experience, namely height and gender was 58.3%. Ultrasonic measurement TD-C range was as follows: 32 Fr <15.88, 35 Fr: 15.88-16.80, 37 Fr: 16.75-17.81, and 39 Fr > 17.80. CT MPR measurement TD-C range was as follows: 32 Fr <15.74, 35 Fr: 15.74-16.65, 37 Fr: 16.56-17.68, and 39 Fr > 17.65. In the second part, there was no significant difference in the basic characteristics between the two groups (P > 0.05). The accuracy of intubation in the ultrasound group was 90.2% and the corresponding in the CT MPR group was 94.1% (P > 0.05). Conclusions: The accuracy of selecting the LDLT based on TD-C is significantly higher than conventional experience; it can significantly reduce the post-operative complications and there was no statistical significance in the accuracy of LDLT selected for TD-C measurement by ultrasound vs. CT, and both of them could be safely used for the evaluation before intubation under anesthesia in thoracic surgery.

Stepwise manipulation of cardiac computed tomography multi-planar reconstruction to mimic transesophageal echocardiography.

Cardiac computed tomography (CT) is increasingly used to plan transcatheter structural heart interventions. However, intraoperative guidance relies on transesophageal echocardiography (TEE) and fluoroscopy. This study sought to develop a stepwise CT multi-planar reconstruction manipulation method to mimic TEE, bridging the gap between preoperative planning and intraoperative guidance tools. This CT manipulation reproduced similar configurations as TEE views in the mid-esophageal left ventricle (LV) views, transgastric LV 2-chamber views for mitral apparatus, and other miscellaneous views. Stepwise cardiac CT manipulation to mimic TEE is the final piece of the puzzle in the mental co-registration of these three crucial imaging modalities. Now, we can predict the TEE images and fluoroscopy projections in a preoperative rehearsal, thus improving the intraoperative accuracy of interventions.

Application of three dimensional (3D) curved multi-planar reconstruction images in 3D printing mold assisted eyebrow arch keyhole microsurgery.

OBJECTIVE: The application of multi-planar reconstruction of three dimensional (3D) curved surface in microsurgery of 3D printing mold assisted eyebrow arch keyhole approach was studied. METHODS: Eighty patients with intracranial aneurysms who underwent treatment at our hospital were enrolled. The patients were divided into two groups: the traditional eyebrow keyhole approach microsurgery group (38 cases in the conventional treatment group) and the three-dimensional curved surface multi-plane reconstruction image combined with 3D printing technology assisted eyebrow keyhole approach microsurgery group (42 cases in the 3D printing assisted treatment group). The Hunt-Hess classification was used to make a preliminary estimation of the patient's condition. The 3D curved multi-planar reconstruction method was used to assist the surgical plan; CT scan was used to establish a 3D printing mold, and the patient's condition and surgical plan were accurately analyzed before surgery. The operative time and the size of the incision area were recorded; postoperative GOS score and postoperative complications were statistically investigated. RESULTS: The 3D printing assisted treatment group (70.13 ± 15.56), (411.26 ± 10.38) mm2 , the operative time and incision area were significantly shorter than the conventional treatment group (120.35 ± 20.46), (663.55 ± 13.54) mm2 , p < .05); the GOS score showed that the 3D printing-assisted treatment group was significantly higher than the conventional treatment group (p < .05). The postoperative complication rate was significantly lower in the 3D print-assisted treatment group (9.52%) than in the conventional treatment group (47.36%, p < .05); the cure of intracranial aneurysms in the 3D printing assisted treatment group was more thorough than that in the conventional treatment group, and the difference was significant (p < .05). CONCLUSION: Compared with the conventional eyebrow arch-hole approach microsurgery, the 3D surface multi-planar reconstruction image combined 3D printing assisted technology was safer and more effective, and the postoperative recovery was better and the incidence of complications was lower.

Assessment of image quality in abdominal computed tomography: Effect of model-based iterative reconstruction, multi-planar reconstruction and slice thickness on potential dose reduction.

PURPOSE: To determine the effect of tube load, model-based iterative reconstruction (MBIR) strength and slice thickness in abdominal CT using visual comparison of multi-planar reconstruction images. METHOD: Five image criteria were assessed independently by four radiologists on two data sets at 42- and 98-mAs tube loads for 25 patients examined on a 192-slice dual-source CT scanner. Effect of tube load, MBIR strength, slice thickness and potential dose reduction was estimated with Visual Grading Regression (VGR). Objective image quality was determined by measuring noise (SD), contrast-to-noise (CNR) ratio and noise-power spectra (NPS). RESULTS: Comparing 42- and 98-mAs tube loads, improved image quality was observed as a strong effect of log tube load regardless of MBIR strength (p < 0.001). Comparing strength 5 to 3, better image quality was obtained for two criteria (p < 0.01), but inferior for liver parenchyma and overall image quality. Image quality was significantly better for slice thicknesses of 2mm and 3mm compared to 1mm, with potential dose reductions between 24%-41%. As expected, with decrease in slice thickness and algorithm strength, the noise power and SD (HU-values) increased, while the CNR decreased. CONCLUSION: Increasing slice thickness from 1 mm to 2 mm or 3 mm allows for a possible dose reduction. MBIR strength 5 shows improved image quality for three out of five criteria for 1 mm slice thickness. Increasing MBIR strength from 3 to 5 has diverse effects on image quality. Our findings do not support a general recommendation to replace strength 3 by strength 5 in clinical abdominal CT protocols. However, strength 5 may be used in task-based protocols.

In vivo measurement of esophageal hiatus surface area using MDCT: description of the methodology and clinical validation.

PURPOSE: Accurate estimation of esophageal hiatus surface area (HSA) prior to surgical repair of hiatal hernia is difficult. The ability to do so may assist with following progression of hiatal hernias, choosing the optimal surgical approach and post-surgical evaluation. We developed a method for measurement of HSA using multi-planar reconstruction (MPR) of multi-detector computed tomography (MDCT) scans and sought to validate our method using intra-operative HSA measurements. METHODS: Patients with thoracic or abdominal CT scans who were scheduled to undergo hiatal hernia repair were identified. A radiologist performed MPR of each MDCT scan to obtain the measured HSA (mHSA). Estimated HSA (eHSA) was obtained using intra-operative measurements of crura length and distance between crural edges. The association between eHSA and the corresponding mHSA was assessed using Pearson correlation. The intra-class correlation coefficient was calculated to assess both intra-observer and inter-observer agreement for the MDCT-MPR technique. RESULTS: Of 30 subjects included, 16 (53.3%) were female and the median age was 68.5 years. All patients underwent robotic-assisted laparoscopic hiatal hernia repair. The median HSA was 8.1 cm2 based on intra-operative measurements and 9.9 cm2 based on CT measurements. The correlation coefficient for eHSA and corresponding mHSA was 0.83 (p < 0.001). The intra-class correlation coefficient was 0.97 (p < 0.001) for intra-observer agreement and 0.97 (p < 0.001) for inter-observer agreement. CONCLUSION: We developed a MDCT-MPR technique that measures HSA in vivo. This technique is reproducible and can be used for pre-operative planning and post-operative follow-up of patients with symptomatic hiatal hernia.

CT multiple-level reconstruction for preoperational estimation of facet joint violation in lumbar percutaneous pedicle screw placement / 中国组织工程研究

BACKGROUND: Percutanoues pedicle screw internal fixation is widely used for treating lumbar disease. Because the surgery is guided by the C-arm, it is hard to control the position between screws and facet joint to cause the facet joint violation completely. Body mass index > 29.9 kg/m2, facet joint angle > 35°and age < 65 years old are considered as the high risk factors for percutaneous pedicle screw injury of articular processes. Due to the different positional relationship between the pedicle axis of the lumbar spine and the articular process joint, there is no related report on whether the destruction of the articular process joint by screws is different. OBJECTIVE: To investigate the significance of lumbar CT multi-planar reconstruction for preestimating facet joint violation in lumbar percutaneous pedicle screw placement. METHODS: One hundred patients with lumbar fracture and degenerative disease who underwent percutaneous pedicle screw placement were selected. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. The position line of the oblique axial view, oblique sagittal view and oblique coronal view was adjusted to reconstruct the section of pedicle. A circle with the 6.5 mm of position line of the oblique coronal view as its center to check the relationship between the circle and facet joint served as preoperation group. CT examination was performed after surgery for evaluating the degree of facet joint violation by screws and served as postoperation group. The amount of screws which damage the facet joint of different vertebrae between two groups and the damage rate among vertebrae in each group were compared. RESULTS AND CONCLUSION: (1) Totally 478 screws were placed, 109 (22.8%) screws violated facet joints in the preoperation group, and the amount of circles which violated facet joint was 6 (6.8%), 9 (10.5%), 19 (18.3%), 30 (30.0%), and 45 (45.0%) from L1-L 5. (2) 115 (24.1%) screws violated facet joints in the postoperation group, the amount of circles which violated facet joint was 10 (11.4%), 7 (8.1%), 15 (14.4%), 26 (26.0%) and 41 (41.0%) from L1-L 5. (3) The P values of McNamara test of different vertebrae were 0.08 (L1), 0.22 (L2), 0.20 (L3), 0.05 (L4) and 0.08 (L5). There was no significant difference between two groups. (4) The results of Kappa test were 0.67 (L1), 0.80 (L2), 0.80 (L3), 0.87 (L4) and 0.92 (L5). The damage rate among vertebrae in each group had significant differences (P=0.000). (5) To conclude, the relationship between percutanoues pedicle screw and facet joint could be recognized by lumbar CT multiple level reconstruction, which provides a reliable method for preestimating the possibility of facet joint damage caused by the percutanoues pedicle screw.

Classification and distribution of fracture areas in fresh osteoporotic vertebral compression fractures based on CT multi-planar reconstruction and MRI / 中国组织工程研究

BACKGROUND; Some scholars have classified osteoporotic vertebral compression fractures based on X-ray and MRI findings. However, little is reported on the morphological types and distribution rules of fracture areas in osteoporotic vertebral compression fractures. OBJECTIVE; To investigate and summarize the morphological types and distribution of fracture areas in fresh osteoporotic vertebral compression fractures based on CT multi-planar reconstruction and MRI. METHODS; Clinical data from 352 patients with osteoporotic vertebral compression fractures, 73.07 years of age, including 69 males and 283 females admitted at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from September 2011 to June 2017 were retrospectively reviewed. After admission, CT multi-planar reconstruction, MRI and bone mineral density measurements were conducted in each patient. Fresh osteoporotic vertebral compression fractures were confirmed in 477 vertebrae according to clinical manifestations and imaging findings. Fracture areas were defined as shade compact or bright line based on CT multi-planar reconstruction or bone marrow edema on the MRI. Morphological type and distribution of fracture areas were recorded by two experienced spinal surgeons and one senior radiologist independently. The study protocol was approved by the Ethic Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine in China with an approval No. ZYYECKYJ[2017]057. RESULTS AND CONCLUSION: Fracture areas of 472 vertebrae were indicated distinctly on the MRI, whereas the fracture areas of 5 vertebrae were unclear. Meanwhile, fracture areas of 469 vertebrae were shown clearly on the CT multi-planar reconstruction, but the areas of 8 vertebrae were obscure on the CT. Fracture areas of 5 vertebrae were unclear in both CT and MRI. There was no significant difference between CT and MRI in the observation of fracture areas (P=0.402). Finally, fracture areas of 8 vertebrae could not be described accurately on CT, MRI or both. In the sagittal plane of CT and MRI, morphological types of fracture areas of 469 vertebrae were divided into impacted fracture area (n=311, 66.31%) and cleft fracture area (n=158, 33.69%). Of the 158 cleft fracture areas, 26 vertebrae contained gas, 28 vertebrae contained liquid, and 7 vertebrae included both gas and liquid. Of the 469 vertebrae, the location of fracture areas was divided into 5 types: Superior (n=238, 50.75%), inferior (n=80,17.06%), anterior (n=21, 4.48%), central (n=110, 23.45%) and mixed (n=20, 4.26%). These findings indicate that the morphological types and distribution of fracture areas in fresh osteoporotic vertebral compression fractures can be effectively distinguished by CT multi-planar reconstruction and MRI, which is important for early diagnosis and further treatment of fresh osteoporotic vertebral compression fractures.

Clinical value of CT axial scan combined with multiplanar reconstruction imaging in preoperative diagnosis of elderly patients with intestinal perforation / 中国基层医药

Objective@#To evaluate the clinical value of CT axial scan combined with multiplanar reconstruction(MPR) imaging in preoperative diagnosis of elderly patients with intestinal perforation.@*Methods@#From March 2017 to March 2019, 127 patients with suspected intestinal perforation in Dajiangdong Hospital were enrolled.The patients were examined by CT axial scan and MPR, 119 patients confirmed intestinal perforation by postoperative pathological diagnosis.According to the requirements of this study, one radiologist analyzed the CT axial scan image independently, and the other analyzed the CT axial scan combined with the MPR image also.The positive rate of CT axial scan analysis and the positive rate of CT axial scan combined with MPR image analysis were calculated.The pathological diagnosis was used as the gold standard, the positive rate of CT axial scan and the real perforation rate were compared, the positive rate of CT axial scan combined with MPR and the real perforation rate were compared, the positive rates of CT axial scan and CT axial scan combined with MPR were compared.The positive predictive values, negative predictive values, sensitivity, specificity and accuracy of CT axial scan and CT axial scan combined with MPR were calculated.@*Results@#Of 127 patients with suspected intestinal perforation, 86 cases were diagnosed and located by CT axial scan, with the positive rate 67.72%, 113 cases were diagnosed and located by CT axial scan and MPR, with the positive rate 88.98%.Finally, 119 cases were confirmed by pathological diagnosis, with the positive rate 93.70%.The difference between the positive rate of CT axial scan and the perforation rate of pathological diagnosis was statistically significant (67.72% vs.93.70%, χ2=27.537, P<0.001). There was no statistically significant difference between the positive rate of CT axial scan combined with MPR and the perforation rate of pathological diagnosis(88.98% vs.93.70%, χ2=1.792, P=0.181). The positive rate of CT axial scan was 67.72%, and the positive rate of CT axial scan combined with MPR was 88.98%, the difference was statistically significant (χ2=16.918, P<0.001). The positive predictive rate of CT axial scan was 95.35%, the negative predictive rate was 9.76%, the sensitivity was 68.91%, the specificity was 50.00%, and the accuracy was 67.72%.The positive predictive rate of CT axial scan combined with MPR was 99.12%, the negative predictive rate was 50.00%, the sensitivity was 94.12%, the specificity was 87.50%%, and the accuracy rate was 93.70%.@*Conclusion@#The combination of CT axial scan and MPR can improve the accuracy of preoperative diagnosis in elderly patients with intestinal perforation, which is worthy of clinical application.

The safety and efficacy of MPR-CTU combined with precise intraoperative ultrasonography guided flexible ureteroscope in the treatment of renal cystic disease.

The safety and efficacy of multi-planar reconstruction (MPR) image post-processing technique-computed tomography (CT) urography (CTU) combined with precise intraoperative ultrasonography guided flexible ureteroscope in renal cyst incision and drainage in the treatment of cystic diseases of kidney were evaluated. A total of 68 patients were randomly divided into control and observation group (n=34). All the patients were treated with renal cyst incision and drainage under flexible ureteroscope. The control group was under ultrasound guidance. The observation group was combined with MPR-CTU, the safety and efficacy was compared. There was no significant difference between the two groups in the success rate and the time of cyst treatment (P>0.05). The incidence of intraoperative and postoperative complications of the observation group was significantly lower than that of the control group. After 1 month follow-up, the total effective rate of the observation group was significantly higher than that of the control group, the difference was statistically significant (P<0.05). Conclusion MPR-CTU technique combined with intraoperative ultrasonography to guide cyst incision and drainage under flexible ureteroscope for renal cystic disease has a high safety and efficacy, and it is worthy of clinical application.

Diagnostic values of X-ray and CT examinations for traumatic diaphragmatic rupture / 医疗卫生装备

Objective To explore the diagnostic values of X-ray and CT examinations for the traumatic diaphragmatic rupture. Methods Totally 17 patients with traumatic diaphragmatic rupture were retrospectively analyzed, who underwent X-ray chest radiograph and 64-slice spiral CT examinations as well as coronal and sagittal imaging by multi-planar reconstruction with GE ADW 4.6 workstation. Results Of the 17 patients, there were 15 ones had the rupture occurred on the left side (93.7%), one case on the right side (6.3%) and the remained one had no diaphragmatic injury;there were 10 ones of diaphragmatic contour discontinuity, 6 ones of intrathoracic hernia, 2 ones of cervical stenosis, one case of hanging sign and two cases of falling viscera sign. Conclusion Routine chest X-ray radiography has difficulty in diagnosing diaphragmatic rupture, while CT multiplanar imaging contributes to determining traumatic diaphragmatic rupture. Diaphragmatic rupture may occur after multiple trauma, and CT with multiplanar reformations has to be used as the routine examination for diagnosing diaphragmatic rupture.

Application value of multi-slice spiral CT based on low dose technique in the diagnosis of ;rib fracture / 中国医学装备

Objective: To explore the application value of multi-slice spiral CT based on low dose technique in diagnosis of rib fracture. Methods: 58 patients with highly suspected rib fracture patients were examined by DR and multi-slice spiral CT. 3D reconstruction were finished after MSCT examination at the workstation, including MPR(multi-planar reconstruction), and volume rendering technique(VR). And the results were compared between DR and CT. Results:58 patients all successfully completed the chest X-ray film and multi-slice spiral CT examination. Multi-slice spiral CT image quality fully met the requirements of clinic. It can not only diagnose, but also display the number, location and morphology of rib fracture. 45 cases were diagnosed with chest DR rib fracture and suspected fracture, and the positive rate was 77.59%(45/58). 56 cases were definitely diagnosed with multi-slice spiral CT scanning and three-dimensional reconstruction rib fracture, and the positive rate was 96.55%. Conclusion: The patients can receive lower dose and the tube can be used for a longer time by low dose technique. 3D reconstruction techniques of multi-slice spiral CT not only improve the accuracy of diagnosis, but also display rib fracture morphology clearly, so its clinical value is much higher than DR.

The application value of MSCT in the diagnosis of carotid cavernous fistula / 实用放射学杂志

Objective To evaluate the application value of MSCT in the diagnosis of carotid cavernous fistula(CCF).Methods The data of 10 patients who had been confirmed with CCF by DSA were retrospectively analyzed to compare the imaging features of MSCT plain scan,CTA,post reconstruction imaging and other examination ways.Results 10 patients with CCF which were manifested by superior ophthalmic vein enlargement in CT plain scan,early appearance of superior ophthalmic vein and cavernous sinus enlargement in CTA were studied.The orificium fistulae can be displayed through the multi planar reconstruction (MPR)and the curved planar reconstruction (CPR).The focal region can be well displayed through the volume rendering (VR)and the maximum intensity projection (MIP). CT,MRI,DSA and color doppler ultrasonography have both advantages and limitations in the diagnosis of CCF.Conclusion MSCT can achieve characteristic imaging findings through scan,CTA technology and various post reconstruction methods,it has significant value in the early diagnosis and treatment of CCF.

Objective and subjective image quality with prospectively gated versus ECG-controlled tube current modulation using 256-slice computed tomographic angiography.

INTRODUCTION: Radiation exposure is one of the major limitations of computed tomographic coronary angiography (CTA). The purpose of this study was to compare the objective and subjective image quality and radiation dose using prospective ECG gating (PGA) versus ECG-controlled tube current modulation (ECTCM) scanning techniques. METHODS: A prospective, single-center study was performed at Prince Sultan Cardiac Centre, Qassim, Saudi Arabia. A total of 104 patients with low-to- intermediate probability of coronary artery disease (CAD) underwent CTA with either PGA or ECTCM acquisition. PGA was performed during the study period and compared with the last 50 CTAs previously done using ECTCM. A 4-point scale was used to assess the image quality subjectively. Objective image quality was assessed using image signal, noise, and signal-to-noise ratio (SNR). RESULTS: Patient's Baseline characteristics were not different between the two scanning protocols. The 4-point score of subjective image quality showed no significant differences between the PGA and ECTCM scans (2.9 ± 0.7, 2.96 ± 0.7, respectively; p = 0.87). The objective image quality showed significantly higher noise and lower SNR with PGA compared with ECTCM (31 ± 9, 27 ± 9, respectively; p < 0.001 for noise) and (15 ± 5, 17 ± 7, respectively; p < 0.001 for SNR), with no statistical difference in the image signal (434 ± 123, 425 ± 103 HU, respectively, p = 0.7). Radiation exposure was significantly lower with PGA than with ECTCM. The dose-length product (DLP) for PGA was 334 ± 130 mGy, compared with 822 ± 286 mGy for the ECTCM. This corresponds to a 59% reduction in radiation exposure (p < 0.0001). CONCLUSIONS: Although prospective ECG-triggered axial scanning increased image noise, it maintained subjective image quality and was associated with a 59% reduction in radiation exposure when compared with ECTCM.

Defining the anterior nucleus of the thalamus (ANT) as a deep brain stimulation target in refractory epilepsy: Delineation using 3 T MRI and intraoperative microelectrode recording.

BACKGROUND: Deep brain stimulation (DBS) is a minimally invasive and reversible method to treat an increasing number of neurological and psychiatric disorders, including epilepsy. Targeting poorly defined deep structures is based in large degree on stereotactic atlas information, which may be a major source of inconsistent treatment effects. AIM OF THE STUDY: In the present study, we aimed to study whether a recently approved target for epilepsy (anterior nucleus of thalamus, ANT) is visualized in clinically established 3 T MRI and whether ANT is delineated using intraoperative microelectrode recording (MER). We have especially focused on individual variation in the location of ANT in stereotactic space. We also aimed to demonstrate the role of individual variation in interpretation of MER data by projecting samples onto AC-PC (anterior and posterior commissure) and ANT-normalized coordinate systems. METHODS: Detailed analysis of ANT delineations in 3 T MRI short tau inversion recovery (STIR) images from eight patients undergoing DBS for refractory epilepsy was performed. Coronal and sagittal cross-sectional models of ANT were plotted in the AC-PC coordinate system to study individual variation. A total of 186 MER samples collected from 10 DBS trajectories and 5 patients were analyzed, and the location of each sample was calculated and corrected accordingly to the location of the final DBS electrode and projected to the AC-PC or coordinate system normalized to ANT. RESULTS: Most of the key structures in the anatomic atlas around ANT (mammillothalamic tract and external medullary lamina) were identified in STIR images allowing visual delineation of ANT. We observed a high degree of anatomical variation in the location of ANT, and the cross-sectional areas overlapped by study patients decreased in a linear fashion with an increasing number of patients. MER information from 10 individual trajectories correlated with STIR signal characteristics by demonstrating a spike-negative zone, presumably white matter layer, at the lateral aspect of ANT in ANT-normalized coordinate system as predicted by STIR images. However, MER information projected to the AC-PC coordinate system was not able to delineate ANT. CONCLUSIONS: ANT is delineated in 3 T MRI by visualization of a thin white matter lamina between ANT and other nuclear groups that lack spiking activity. Direct targeting in the anterior thalamic area is superior to indirect targeting due to extensive individual variation in the location of ANT. Without detailed imaging information, however, a single trajectory MER has little localizing value.

The diagnosis value of hypotonic water filling method and CT multi planar reconstruction in stomach tumors / 实用放射学杂志

Objective To investigate the value in the diagnosis of tumor of the stomach by hypotonic water filling method com-bined with CT multi planar reconstruction (MPR).Methods CT image data of 21 5 cases with gastric tumor confirmed by operation and pathology in our hospital were analysed retrospectively.Conventional CT enhanced scan was obtained in patients with the stom-ach hypotonic water filling condition,and MPR CT characteristics of lesions were observed.Results In the 21 5 cases of gastric be-nign or malignant lesions,MPR showed 5 pathological types in 210 cases.In the conventional CT examination,the tumor diagnosis rate had obvious improvement in different gastric parts and types of the stomach tumors through CT MPR.Conclusion There is high detection rate in the diagnosis of gastric tumors using hypotonic water filling method with MPR,which can accurately display invasion and metastasis,and reduce the misdiagnosis and missed diagnosis in gastric tumor.

Evaluation of Patients with Obstruction of Biliary Tract by Multi-Detector Row CT Using Reconstruction Techniques / 中国医学影像学杂志

Purpose:To evaluate the role of multi - detector row CT(MDCT) using reconstruction techniques in the assessment of patients with obstructed diseases of biliary tract.Materials and Methods: 47 Patients with obstructed diseases of biliary tract confirmed clinically underwent MDCT and their reconstructed images of biliary tract including multi-planar reconstruction (MPR) images and curved planar reconstruction(CPR) images were compared with those of 50 patients without obstruction and dilatation of biliary tract.The display effect of biliary duct structure and biliary duct wall and the display ability of biliary tract by MPR and CPR images between the 2 groups were compared and analysed.The reconstruction images of biliary tract were analysed retrospectively to evaluate the location and possible causes of biliary obstruction.Results: The display effect of biliary duct structure and biliary duct wall in MPR and CPR images of the group with biliary obstruction is better than that of control group,and the display ability of biliary tract in CPR images of the group with biliary obstruction is also better than that of control group.The accuracy of localization and cause evaluation of obstruction by MPR and CPR images is 100% and 89.4% respectively.Conclusions: The MPR and CPR images of MDCT provide a good display of biliary duct structure,biliary duct wall and an accurate evaluation of obstruction localization.The reconstruction technique of MDCT such as MPR and CPR should be widely applied in the evaluation of biliary obstruction.