Morphological concordance between CBCT and MDCT: a paranasal sinus-imaging anatomical study

Purpose

Cone-beam computed tomography (CBCT) is an imaging technique, first developed for use during oral and pre-implant surgery. In sinonasal surgery, CBCT might represent a valuable tool for anatomical research given its high spatial resolution and low irradiation dose. However, clinical and anatomical evidence pertaining to its efficacy is lacking. This study assessed the morphological concordance between CBCT and multislice detector computed tomography (MDCT) in the context of sinonasal anatomy.

Methods

We performed an anatomical study using 15 fresh cadaver heads. Each head underwent both CBCT and MDCT. Two independent reviewers evaluated 26 notable anatomical landmarks. The primary outcome was the overall morphological concordance between the two imaging techniques. Secondary objectives included assessment of inter-rater agreement and comparison of the radiation doses received by different parts of the anatomy.

Results

Overall morphological concordance between the two imaging techniques was excellent (>98 %); the inter-rater agreement for CBCT was approximately 97 %, which is highly similar to MDCT, but achieved using a significantly decreased irradiation dose.

Conclusion

Our preliminary study indicates that CBCT represents a valid, reproducible, and safe technique for the identification of relevant sinonasal anatomical structures. Further research, particularly in pathological contexts, is required.

     

Prevalence and variance of the sternalis muscle: a study in the Chinese population using multi-detector CT

Objective

To analyze the prevalence, anatomical features, as well as variance of the sternalis muscle in the Chinese population using multi-detector computed tomography (MDCT).

Methods

We retrospectively reviewed 6,000 adult axial MDCT images to determine the overall and gender prevalence of the sternalis muscles. We also analyzed the side prevalence and anatomical features, including shape, size, location and course.

Results

The sternalis muscle was present in 347 (5.8 %) of 6,000 adults. This muscle was more common in males (6.0 %, 187/3091) than in females (5.5 %, 160/2909). Among the 347 adults, 118 (34.0 %) had bilateral sternalis muscles; 148 (42.7 %) had right sternalis muscles; and 81 (23.3 %) had left sternalis muscles. The sternalis muscle was either flat or nodular and located superficial to the major pectoral muscles on CT axial transverse images. According to the muscle morphology and course, we classified sternalis muscles as three different types and nine subtypes. The muscles appeared with a single head and single belly in 58.5 %, double or multiple heads in 18.1 %, and double or multiple bellies in 23.4 %. The mean length, width and thickness were 111.1 ± 33.0, 17.7 ± 9.9 and 4.1 ± 1.7 mm measured on MDCT.

Conclusion

The sternalis muscle was highly prevalent in normal Chinese adults. MDCT is an effective method to demonstrate this muscle in vivo.     

Small bowel enteroclysis with magnetic resonance imaging and computed tomography in patients with failed and uncertain passage of a patency capsule

Background

Leading-edge technology such as magnetic resonance imaging (MRI) or computed tomography (CT) often reveals mammographically and ultrasonographically occult lesions. MRI is a well-documented, effective tool to evaluate these lesions; however, the detection rate of targeted sonography varies for MRI detected lesions, and its significance is not well established in diagnostic strategy of MRI detected lesions. We assessed the utility of targeted sonography for multidetector-row CT (MDCT)- or MRI-detected lesions in practice.

Methods

We retrospectively reviewed 695 patients with newly diagnosed breast cancer who were candidates for breast conserving surgery and underwent MDCT or MRI in our hospital between January 2004 and March 2011. Targeted sonography was performed in all MDCT- or MRI-detected lesions followed by imaging-guided biopsy. Patient background, histopathology features and the sizes of the lesions were compared among benign, malignant and follow-up groups.

Results

Of the 695 patients, 61 lesions in 56 patients were detected by MDCT or MRI. The MDCT- or MRI-detected lesions were identified by targeted sonography in 58 out of 61 lesions (95.1%). Patients with pathological diagnoses were significantly older and more likely to be postmenopausal than the follow-up patients. Pathological diagnosis proved to be benign in 20 cases and malignant in 25. The remaining 16 lesions have been followed up. Lesion size and shape were not significantly different among the benign, malignant and follow-up groups.

Conclusions

Approximately 95% of MDCT- or MRI-detected lesions were identified by targeted sonography, and nearly half of these lesions were pathologically proven malignancies in this study. Targeted sonography is a useful modality for MDCT- or MRI-detected breast lesions.     

Air column in esophagus and symptoms of gastroesophageal reflux disease

Background

During imaging of the normal esophagus, air is often detected. The purpose of this study was to determine the correlation between the appearance of air bubbles on imaging and Gastroesophageal Reflux Disease (GERD) symptoms.

Methods

The cross-sectional imaging study was conducted at Rasole Akram Hospital, Tehran, Iran. A total of 44 patients underwent X-ray computed tomography (CT) scanning; the presence of air in the esophagus and visible on CT imaging was scrutinized.

Results

The average age of the subjects was 59 and the male to female ratio was 0.83. We found a significant relationship between the presence of GERD symptoms, the size of air bubbles and esophageal dilation (ED) on the CT scan.

Conclusions

Air bubbles in the esophagus may be seen frequently in CT scans, but their size and location can vary. The GERD symptoms can arise when a small diameter air column is present within the esophagus, especially in the middle and lower parts.     

The demonstration of the number, course, and the location of nutrient artery canals of the femur by multidetector computed tomography

Purpose

The aim of this study was to evaluate the number, course, width and location of nutrient artery canals of the femur by using multidetector computed tomography (MDCT).

Methods

Sixty-six adult (35 right and 31 left) dry femurs were included in this study and scanned by MDCT. Nutrient artery canals were evaluated on the multi-planar reformatted and volume rendered images which were reproduced on the basis of axial images.

Results

The median value of nutrient artery canals was two (minimum 1 and maximum 6). We determined that there was a negative correlation between the number of nutrient canals and the canal diameters. The outer ostia of the nutrient artery canals were most frequently located at the middle third segment of femoral diaphysis (65%). While the vast majority of the canals were showing upward courses (95%), only a few canals were having transverse (3%) or downward (2%) courses. Most encountered location of outer ostia of the canals according to linea aspera was the medial lip of the linea aspera (44%). Various variations were demonstrated in the number, course, and location of nutrient artery canals using MDCT.

Conclusions

In conclusion, the knowledge of the topographic features of the nutrient artery canals may be useful in various clinical implications such as bone grafting or radiologic evaluation for the fracture lines.     

Rotation of the osseous spiral lamina from the hook region along the basal turn of the cochlea: results of a magnetic resonance image anatomical study using high-resolution DRIVE sequences

Purpose

To define the rotational anatomy of the osseous spiral lamina (OSL) at the hook region and along the basal turn of the cochlea and to illustrate the potential utility of high-resolution MRI images to study inner ear ultrastructure.

Methods

Retrospective review of high-resolution temporal bone MRI images in 20 consecutive adult patients referred for imaging unrelated to hearing loss. The main outcome measure utilised images in an oblique sagittal plane to measure the rotation of the OSL relative to the vertical axis in the hook region and along the basal turn of the cochlea.

Results

The right OSL is noted to rotate in a clockwise direction as one proceeds anteriorly; over the same distance, the left OSL rotates in an anti-clockwise direction. The average overall rotation for all subjects as measured over a distance of 1–7?mm from the posterior margin of the round window was 25.95°. Inter-subject variability was noted.

Conclusions

Prominent rotation of the OSL was noted in the hook region, this being most pronounced in the proximity to the round window. This concept may have implications for cochleostomy site selection with implant surgery. The study highlights the feasibility of high-resolution MRI to be used to systematically study variations in intra-cochlear anatomy.     

Brain computer tomography in critically ill patients - a prospective cohort study

Background

The advantages of multi-detector computed tomography (MDCT) have made it the imaging modality of choice for some patients with suspected cardiothoracic disease, of which pulmonary embolism (PE) is an exponent. The aim of this study was to assess the incidence of PE in patients with clinical suspicion of acute PE using MDCT in a sub-Saharan setting, and to describe the demographic characteristics of these patients.

Methods

Consecutive records of patients who underwent MDCT pulmonary angiography for suspected acute PE over a two-year period at the Radiology Department of a university-affiliated hospital were systematically reviewed. All MDCT pulmonary angiograms were performed with a 16-detector computed tomography (CT) scanner using real-time bolus tracking technique. Authorization for the study was obtained from the institutional authorities.

Results

Forty-one MDCT pulmonary angiograms were reviewed of which 37 were retained. Of the 4 excluded studies, 3 were repeat angiograms and 1 study was not technically adequate. Twelve of 37 patients (32.4%) had CT angiograms that were positive for PE, of which 7 were males. The mean age of these patients was 47.6±10.5 years (age range from 33 to 65 years). Twenty five patients out of 37 (67.6%) had CT angiograms that were negative for PE. Eleven PE-positive patients (91.7%) had at least 1 identifiable thromboembolic risk factor whilst 5 PE-negative patients (20%) also had at least a thromboembolic risk factor. The relative risk of the occurrence of PE in patients with at least a thromboembolic risk factor was estimated at 14.4.

Conclusion

Acute PE is a reality in sub-Saharan Africa, with an increased likelihood of MDCT evidence in patients with clinical suspicion of PE who have at least a thromboembolic risk factor. The increasing availability of MDCT will help provide more information on the occurrence of PE in these settings.     

Human body exhibitions: public opinion of young individuals and contemporary bioethics

Purpose

The exhibitions of plastinated cadavers and organs have attracted millions of visitors globally, while raising serious controversy about their content and purpose of implementation.

Methods

We performed a survey based study on 500 randomly chosen individuals, aged 18- to 35-year old, in order to access their opinion regarding the conduction of such shows as well as body donation for scientific purposes.

Results

We found that 46.3% of the participants had moral concerns, and 46.1% did not. Religious and philosophical beliefs concerned 21.8% of the sample, while 28% believed that the exhibits may affect visitors’ mental health. Human dignity violation was stressed by 21.6%, whereas 26.6% disagreed with body donation to science.

Conclusions

The desire for qualitative-guided anatomy education is evident from the highly popular plastinated body and specimen exhibitions. Hence, additional focused effort could be provided to educate the public about normal and pathological anatomy in order to amend their life-style. This could be effected by certified anatomy demonstrators in graduated steps according to the cohort’s age, education, occupation, and health status.     

Correspondence between left ventricular 17 myocardial segments and coronary anatomy obtained by multi-detector computed tomography: an ex vivo contribution

Purpose

The aim of this study was to investigate the correspondence between the coronary arterial anatomy and the supplied myocardium based on the proposed American Heart Association (AHA) 17-segment model.

Methods

Six human cadaveric hearts without signs of infarct were selectively injected with colored contrasted gelatin in the three major coronary arteries. After injection, the hearts were scanned by computed tomography (64-detector scanner LightSpeed VCT, GE Healthcare) with a collimation of 64?×?0.625?mm. Reconstructed image data were analyzed in order to evaluate the blood supply of each myocardial segment.

Results

Coronary artery territory varies due to anatomy variations. Left anterior descending coronary artery (LAD) was the main vessel responsible for the myocardium blood supply in 11 segments. LAD contributed to the blood supply of all apical segments. Left circumflex (LCx) was the main coronary artery for the infero-anterior wall. Right coronary artery (RCA) contributed in all hearts for the blood supply of infero-septal segments. There was an important overlap between LAD and RCA territories at the infero-septal region and between LAD and LCx territories at the antero-lateral region.

Conclusions

In our experiment, LAD territory was larger than the AHA-proposed 17-segment model. The most specific segments were located at the anterior wall and supplied exclusively by LAD. No specific segment could be exclusively attributed to RCA or to LCx. Sometimes, LCx can be the most important artery for the blood supply of the inferior wall even if the origin of the posterior descending artery is the RCA.     

Risk assessment of inferior alveolar neurovascular bundle by multidetector computed tomography in extractions of third molars

Purpose

This study aimed to assess the reliability of multidetector computed tomography (MDCT) in determining the surgical risk of the inferior alveolar neurovascular bundle in extractions of third molars.

Methods

The sample comprised thirty-three individuals (63 third molars) who underwent preoperative evaluation by MDCT before extraction of impacted mandibular third molars. MDCT was used to determine the relationship between the roots of the third molars and the mandibular canal, and the course of the mandibular canal. Inferior alveolar nerve (IAN) exposure and the presence of hemorrhage were analyzed after removal of the teeth. IAN neurosensory deficit was recorded after 7?days. Clinical and MDCT findings were compared using Fisher’s exact test (P?Results There was a statistically significant association between IAN exposure and the tomographic relationship between the roots of third molars and the mandibular canal (P?=?0.015). Conventionally, all cases of IAN neurosensory deficit and hemorrhage occurred when the roots of the third molar presented in an at-risk relationship with the mandibular canal, however, this association was not statistically significant (P?>?0.05). A statistically significant association was found between the lingual course of the mandibular canal and IAN exposure (P?=?0.03).

Conclusions

MDCT is an effective tool for determination of the surgical risk to the inferior alveolar neurovascular bundle in extraction of mandibular third molars.     

Multidetector-row computed tomography for evaluating the branching angle of the celiac artery: a descriptive study

Background

We performed this study in order to investigate the shape of the origin of the celiac artery in maximum intensity projection (MIP) using routine 64 multidetector-row computed tomography (MDCT) data in order to plan for the implantation of an intra-arterial hepatic port system.

Methods

A total of 1,104 patients with hepatocellular carcinoma were assessed with MDCT. In the definition of the branching angle, the anterior side of the abdominal aorta was considered the baseline, and the cranial and caudal sides were designated as 0 and 180 degrees, respectively. The angles between 0 and 90 degrees and between 90 and 180 degrees from the cranial side were considered upward and downward, respectively, and the branching angle of the celiac artery was classified every 30 degrees. The subclavian arterial route was used for the implantation of an intra-arterial hepatic port system in patients with branching angles of 150 degrees or more (sharp downward).

Results

The median branching angle was (median ± standard deviation) 135?±?23 (range, 51–174) degrees. The branching was upward in 77 patients (7%) and downward in 1,027 patients (93%). The branching was downward with an angle of 120 to150 degrees in most patients (n?=?613). The branching was sharply downward with an angle of 150 degrees or more in 177 patients (16%). A total of 10 patients were referred for interventional placement of an intra-arterial hepatic port system. The subclavian arterial route was used for implantation of an intra-arterial hepatic port system in 2 patients with sharp downward branching.

Conclusions

The branching angle of the celiac artery can be easily determined by the preparation of MIP images from routine MDCT data. MIP may provide useful information for the selection of the catheter insertion route in order to avoid a sharp branching angle of the celiac artery.     

The use of ultrasound improves the accuracy of epidural needle placement in cadavers

Purpose

To investigate whether epidural-prepuncture ultrasound imaging improves the accuracy and quality of epidural needle placement or not?

Methods

By recruiting 15 cadavers, a total of 90 epidural needle punctures to access epidural space in study group with the help of ultrasound imaging at lumbar and thoracic spinal segments were attempted. A similar number of punctures in a control group were also performed without ultrasound imaging involving the intervertebral spaces adjacent to the ones used for ultrasound guided punctures. The accuracy of needle tip placement was ascertained with the help of computed axial tomography. Six variables: puncture depth and needle angle, procedure time, number of attempts per space, steps in needle advances, number of bony contacts and number of spaces attempted, were studied and compared among the groups.

Results

The accuracy of epidural needle placement and quality of the procedure in study group were superior to the control group.

Conclusions

The pre-procedure ultrasound imaging enhances the accuracy and quality of epidural needle placement.     

Role of ovarian artery-to-uterine artery anastomoses in uterine artery embolization: initial anatomic and radiologic studies

Purpose

To explore the anatomic features of normal human ovarian artery-to-uterine artery anastomoses and their impact on uterine artery embolization (UAE).

Methods

Using slice computed tomography (CT) scanning and vascular casting; models of the uterine arterial vascular network were constructed using five sets of uterus, bilateral adnexa and vagina from normal adult females. The anatomy and characteristics of these models were then studied.

Results

Both the casting specimen and the CT-reconstructed model showed the ovarian artery-to-uterine artery anastomoses clearly. Each was composed of the ovarian branch of the uterine artery and the ovarian branch of the ovarian artery. All 10 ovarian artery-to-uterine artery anastomoses were formed by direct connection between the ovarian branch of the uterine artery and the ovarian branch of the ovarian artery.

Conclusions

Thin slice CT scanning combined with vascular casting is a useful method to study the small arterial network. The anastomoses between the ovarian branch of the uterine artery and the ovarian branch of the ovarian artery were formed mainly by direct connection. The implications of the ovarian artery-to-uterine artery anastomoses on UAE are unclear; further function assessments are needed.     

Teaching medical anatomy: what is the role of imaging today?

Purpose

Medical anatomy instruction has been an important issue of debate for many years and imaging anatomy has become an increasingly important component in the field, the role of which has not yet been clearly defined. The aim of the paper was to assess the current deployment of medical imaging in the teaching of anatomy by means of a review of the literature.

Materials

A systematic search was performed using the electronic database PubMed, ScienceDirect and various publisher databases, with combinations of the relevant MeSH terms. A manual research was added.

Results

In most academic curricula, imaging anatomy has been integrated as a part of anatomical education, taught using a very wide variety of strategies. Considerable variation in the time allocation, content and delivery of medical imaging in teaching human anatomy was identified. Given this considerable variation, an objective assessment remains quite difficult.

Discussion

In most publications, students’ perceptions regarding anatomical courses including imaging anatomy were investigated by means of questionnaires and, regardless of the method of teaching, it was globally concluded that imaging anatomy enhanced the quality and efficiency of instruction in human anatomy. More objective evaluation based on an increase in students’ performance on course examinations or on specific tests performed before and after teaching sessions showed positive results in numerous cases, while mixed results were also indicated by other studies.

Conclusion

A relative standardization could be useful in improving the teaching of imaging anatomy, to facilitate its assessment and reinforce its effectiveness.

     

Demonstration of different histological layers of the pachygyria/agyria cortex using diffusion tensor MR imaging

Purpose

Pachygyria/agyria are congenital brain malformations characterized by presence of a few broad, flat gyri with thickened cortex, resulting from arrest of neuronal migration in early gestation. We are hereby describing diffusion tensor imaging findings in different histological layers of lissencephaly cortex in two children.

Method

DTI in addition to conventional MR imaging was performed in two children on a 3 T MRI and post-processed with vendor supplied software to generate the fractional anisotropy, mean diffusivity and trace maps. Tractography was also performed to identify presence of tracts in the thickened cortex.

Results

DTI demonstrated the dysplastic multilayered cortex in cases of pachygyria/agyria; the thickened fourth layer and superficial layer demonstrated high anisotropy on diffusion tensor imaging.

Conclusion

DTI is a useful tool for identifying gross histological features of pachygyria–agyria complex. Superficial layer and thickened fourth layer demonstrate high anisotropy. Identification of anisotropy in the superficial layer has not been described in previous reports.     

Applied anatomy of a minimally invasive muscle-splitting approach to posterior C1–C2 fusion: an anatomical feasibility study

Purpose

To describe the applied anatomy of a minimally invasive muscle-splitting approach used to reach the posterior aspect of the C1–C2 complex.

Summary of background data

Atlantoaxial fusion using a midline posterior approach and polyaxial screw and rod system is widely used. Although minimally invasive variations of this technique have been recently reported, the complex applied anatomy of these approaches has not been described. The C1–C2 complex represents an unique challenge because of its bony and vascular anatomy. In this study, the applied anatomy and feasibility of this technique are examined on cadavers.

Methods

The microsurgical anatomy of the upper cervical spine is examined on a formalin-fixed and on a fresh cadaver. The muscle-splitting approach is performed on 12 fresh cadavers using this technique.

Results

The minimally invasive muscle-splitting approach is described in detail. Relevant anatomy and bony landmarks that aid screw placement in C1 and C2 could be well visualized. Using this approach, we were able to reach the lateral mass of the atlas and the inferior articular process and pars interarticularis of the axis in all of the nine cadavers. We placed mini polyaxial screws in C1 lateral mass and C2 pars interarticularis in four cadavers according to the technique described by Harms and Melcher.

Conclusions

Using this approach, it was possible to reach the posterior aspect of C1 and C2; the relevant anatomy needed to perform a C1–C2 fusion could be well visualized.     

Anatomy learning styles and strategies among Jordanian and Malaysian medical students: the impact of culture on learning anatomy

Purpose

The study aims to investigate anatomy learning styles and strategies of Jordanian and Malaysian medical students at the Jordan University of Science and Technology.

Methods

The study is a cross-sectional questionnaire-based study. Students’ responses for the questionnaire were numerically coded, and the results were analyzed to reveal statistically significant differences between Jordanian and Malaysian students.

Results

The results showed that Jordanian medical students were less interested in using cadavers in learning anatomy than Malaysian medical students. However, similar to their Malaysian counterparts, they prefer to employ other tools to learn anatomy like plastinated models and Internet-based resources. In addition to the aforementioned tools, Malaysian students were more interested in using cross-sectional images and making their own revision cards. Both Jordanian and Malaysian medical students were more interested in learning anatomy through clinical cases, and by system rather than by region. Moreover, it was revealed that Jordanian medical students learn anatomy more efficiently when they formulate a general view of a particular topic. Both Jordanian and Malaysian medical students also relied on reciting definitions and memorizing facts to learn anatomy. The study also reported significant differences between Jordanian and Malaysian students’ perspectives on learning anatomy.

Conclusions

The findings of the study suggest that Jordanian and Malaysian medical students posses different cultures of learning. Jordanian anatomy instructors need to consider these different learning cultures when they prepare their instructional methods and teaching materials to fulfill the educational needs of their culturally diverse students.