The scapular glenopolar angle: standard values and side differences.

Is radiograph glenopolar angle accurate for extraarticular scapular neck fractures?

Subxiphoid video-assisted thoracoscopic surgery (VATS) is considered a safe and feasible operation for anterior mediastinal mass resection. However, diaphragmatic injury, presented as tearing or puncturing, may occur during subxiphoid VATS despite of low incidence. This study aims to explore risk factors for diaphragmatic injury in subxiphoid VATS, as well as strategies to reduce occurrence of the injury. We retrospectively reviewed clinical records of 44 consecutive adult patients who underwent subxiphoid VATS. These patients were divided into two groups: diaphragmatic injury group and non-injury group. Perioperative outcomes and anatomic features derived from 3D CT reconstructions were compared between the two groups. Significant differences were observed in operation time (223.25 ± 92.57 vs. 136.28 ± 53.05, P = 0.006), xiphoid length (6.47 ± 0.85 vs. 4.79 ± 1.04, P = 0.001) and length of the xiphoid below the attachment point on the diaphragm (24.86 ± 12.02 vs. 14.61 ± 9.25, P = 0.029). Odds ratio for the length of the xiphoid below the attachment point on the diaphragm was 1.09 (1.001-1.186), P = 0.048 by binary logistic regression analysis. We identified the length of the xiphoid below the attachment point on the diaphragm as an independent risk factor for diaphragm injury during subxiphoid VATS. Prior to subxiphoid VATS, a 3D chest CT reconstruction is recommended to assess the patients' anatomic variations within the xiphoid process. For patients with longer xiphoid process, a higher incision at the middle and upper part of the xiphoid process, and partial xiphoid process resection or xiphoidectomy is preferred.

Does 3D CT reconstruction help the surgeon to preoperatively assess calcaneal fractures?

Both conservative and operative forms of treatment have been recommended for patients with a 'floating shoulder'. We compared the results of conservative and operative treatment in 25 patients with this injury and investigated the use of the glenopolar angle (GPA) as an indicator of the functional outcome. A total of 13 patients (ten male and three female; mean age 32.5 years (24.7 to 40.4)) were treated conservatively and 12 patients (ten male and two female; mean age 33.67 years (24.6 to 42.7)) were treated operatively by fixation of the clavicular fracture alone. Outcome was assessed using the Herscovici score, which was also related to changes in the GPA at one year post-operatively. The mean Herscovici score was significantly better three months and two years after the injury in the operative group (p < 0.001 and p = 0.003, respectively). There was a negative correlation between the change in GPA and the Herscovici score at two years follow-up in both the conservative and operative groups, but neither were statistically significant (r = -0.295 and r = -0.19, respectively). There was a significant difference between the pre- and post-operative GPA in the operative group (p = 0.017). When compared with conservative treatment, fixation of the clavicle alone gives better results in the treatment of patients with a floating shoulder. The GPA changes significantly with fixation of clavicle alone but there is no significant correlation between the pre-injury GPA and the final clinical outcome in these patients.

Purpose: To measure the normal size of the styloid process using 3D (three-dimensional) reconstruction CT. Materials and Methods: We retrospectively analyzed 3D reconstruction images obtained after coronal and axial CT scanning of the temporal bone or neck of 115 patients. The length and shape of both sides of the styloid process, the location of its tip, and calcification of the stylohyoid ligament were retrospectively analysed. Results: The mean length of the styloid process was 26.6 (7.9)mm on the right side, and 26.4(8.3)mm on the left, a statistically insignificant difference (p=0.694). Its mean length was 26.2 (8.5)mm in men and 26.7 (7.2)mm in women, a statically in significant difference (p=0.733). As for variation with age, mean length tended to increase until the third decade, but not beyond. Segmental type (104/230, 45.2%) and fragmental type (73/230, 31.7%) were more commonly seen in shape of styloid process, and tapering tip of styloid process (156/230, 67.9%) is more commonly seen than clubbing tip of it (74/230, 32.1%). The process was angulated in six cases (2.6%); its tip was more frequently located between the internal and external carotid artery (211 cases, 91.7%) than more medially (19 cases, 8.3%). In the former location, the length of the process was 26.2( 7.2)mm, and in the latter, 37.0(6.0)mm. The difference was statistically significant (p=0.000). Calcification had occurred in 33 cases (14.3%). Conclusion: The length of a normal styloid process was 18-32 mm. There were no statistically significant differences between its two sides, or between the sexes. Length tended to increase until the third decade, but not beyond. Predominantly the tip was located between the internal and external carotid artery, though the process was longer when its tip was located medially.

Objective A lot of problems have been encountered in percutaneous nephrolithotomy in treatment of staghorn calculi, 3D CT reconstruction technique could construct the real staghorn calculi and kidney 3D image, which help us in the operations to make sure the best percutaneous renal channel, and improve the success rate of puncture by B-ultrasound localization. Methods Twenty-five patients with staghorn calculi who underwent urinary CT scan and 3D reconstruction were enrolled into CT reconstruction group. Through 3D rotation display, we designed the shortest distance channel, which directed to renal pelvis, with the most widely and convenient operating angle. Thirty patients only underwent urinary CT scan, and designed the operating channel with multiplanar CT film, who were enrolled into CT group. All of them underwent 16 F channel PCNL procedures in lateral semisupine lithotomy position, treated by nephroscope Holmium laser lithotripsy. While we discussed 2 typical cases of staghorn calculi cases. Results There were statistical significances in blood loss [(108±24) ml vs (156±45) ml], operative time [(109±20) min vs (121±23) min], stone-free rate (91.21% vs 85.73%), blood transfusion (0 vs 6.67%), and massive hemorrhage post-operative cured by selective embolism of renal artery(0 vs 6.67%) between the two groups. Besides, there were no differences in the nephrostomy tube remaining time [(6.5±1.9) d vs (7.7±1.7) d] and hospital stay duration [(13.0±1.8) d vs (14.5±3.0) d]. Conclusions 3D CT reconstruction technique could construct the real staghorn calculi and kidney 3D image, which provided a more accurate percutaneous renal channel, it's safe and effective for PCNL. Key words: CT reconstruction; Renal; Percutaneous nephrolithotomy

Objective: To discuss the CT findings after inferior vena cava(IVC) filter placement, and their value in evaluating the status of IVC filters after placement and related complications. Methods: Pertinent data of 31 cases with IVC filter placement who underwent abdominal CT plain scan, contrast-enhanced scan and 3D reconstruction from January 2011 to May 2016 was collected for this study. The location, morphology and complications of IVC filters were evaluated on CT images. Results: (1) CT and 3D reconstruction images can clearly display the IVC filter and determine its type. Among the 31 cases, 12 cases of Ease type (including the retrievable Opt type) showed six-diamond shape, and 6 struts converging at the upper and lower apex of the filter formed the symmetric double baskets, with a retrieval hook in the bottom of OptEase filter; 7 cases of Vena Tech showed a cone shape formed by 6~8radial prongs, with vertical stabilizing struts around; 6 cases of Gunther Tulip presented as inverted tulip shape, with a hook at the top and 4 struts below; 4 cases of Simon Nitinol presented as overlapping umbrellas , with 8 partially overlapping loops forming the top umbrella , and 6 diverging legs forming the lower umbrella ; 2 cases of temporary retrivable filter Tempofilter II showed long-arm umbrella shape, with 8 struts forming the cone-shaped basket, connected with long retrieval handle located in the course from internal jugular vein to inferior vena cava. (2) In 28 cases the filters were located in the infrarenal IVC, which was the conventional position, while 3 cases were in the suprarenal IVC, all of which formed suprarenal IVC thrombus before filter placement. (3) 10 cases showed obvious thrombus in the filters and above IVC, 1 of which also showed IVC stenosis, while no thrombus was found in the remaining 21 cases. (4) None of the 31 cases showed rupture of the main body or struts of IVC filters. 1filter migrated to the hepatic IVC and penetrated to liver parenchyma; the other 30 cases were classified into four grades according to IVC filter strut interactions with IVC wall. There were 7 cases classified as Grade 0, 13 cases as Grade 1, 3 cases as Grade 2, and 7 cases as Grade 3 (3 cases penetrating to the aortic wall and lumbar vertebrae, 1 case to the right psoas major and ileum, and 1 each to the aortic wall, anterior lumbar, and right diaphragmatic crura). The filters were significantly tilted in 7 cases, with the angle between the central longitudinal axis of the filter and the IVC being more than 15°, which showed the best result with coronal and sagittal reconstruction. Conclusion: CT can clearly show the shapes, location and complications of IVC filters, which can provide a good way for retrieval of filters and treatment of complications. Key words: Inferior vena cava filter; Tomography, X-ray computed; 3D reconstruction; Complications

Cerebral air embolism may be caused by iatrogenic or post-traumatic introduction of air into arterial or venous systems. It is usually revealed by computerized tomography. In this paper, we report a case with thorax trauma and loss of consciousness, in whom cerebral massive air embolism was detected and its distribution was demonstrated by using 3D spiral CT reconstruction. To our knowledge, this is the first case in whom 3D spiral CT reconstruction was used for demonstration of cerebral arterial air embolism.

Conventional two dimensional computed tomography has provided significant advancement in clinical diagnosis with information on cross-sectional anatomy of various parts of the body. However, three dimensional representations are not directly available. This is now made possible by recent development of CAD software and CT equipments and technique such as multiplanar reformation capable of providing 3D reconstruction using 2D CT data. This article evaluates the accuracy of measurements and dimensions in 3D CT reconstruction.

A comprehensive method for studying pore structure and seepage characteristics of coal mass based on 3D CT reconstruction and NMR

Aim To study the application value of ankle fracture classification and diagnosis. In this paper, the clinical data of 100 cases of ankle fracture patients admitted from May 2020 to May 2021 were analyzed by CT 3D reconstruction. All patients received surgical treatment and underwent spiral CT 3D reconstruction and X-ray examination before surgery. The results showed that 20 cases (20.00%) of the 100 cases were PER, 24 cases (24%) of the 100 cases were PAB, 31 cases (31%) of the 100 cases were SER, and 25 cases (25%) of the 100 cases were SAB, respectively. Conclusion The diagnostic accuracy of CT 3D reconstruction for different types of ankle fracture is higher than that of X-ray, and the differences are statistically significant (P < 0.05). CT 3D reconstruction is applied in the early diagnosis of ankle fracture, which can accurately detect the classification of patients. It has important clinical application value and can be used as the first choice for the early classification diagnosis of ankle fracture.

IntroductionPulmonary segmentectomy, when combined with hilar and mediastinal lymphadenectomy, is currently considered the gold standard treatment for early-stage lung tumors (NSCLC) smaller than 2 cm in diameter. The preoperative planning for segmentectomies usually includes a contrast-enhanced CT with 2D reconstructions (axial, coronary, and sagittal). Recent technological advances allow 3D (volume rendering) reconstructions of preoperative CT scans, intended to improve the surgeon’s understanding of the segmental anatomy.The study aims to investigate the added value of 3D reconstruction in enhancing the surgeon’s understanding of anatomical structures, thus facilitating surgical planning and improving oncological outcomes.Methods and analysisThis is a prospective, randomized, controlled study.Patients will be randomized into two groups:1. Group 2D: the preoperative workup for these patients will consist of a contrast-enhanced chest CT with two-dimensional (2D) reconstructions (axial, coronary, and sagittal);2. Group 3D: the preoperative workup for these patients will consist of a contrast-enhanced chest CT with two-dimensional (2D) reconstructions (axial, coronary, and sagittal) and a 3D reconstruction (volume rendering) of the same chest CT employing dedicated software.The primary endpoints will be negative margin (R0) resection rate, resection margin (staple line-to-tumor distance), and thoracotomy conversions.We will use Fisher’s exact test for binary outcomes and Mann–Whitney U test for continuous outcomes. For subgroup analyses, we will use regression. Multivariable analyses will be based on logistic regression for binary outcomes and linear regression for continuous outcomes.Ethics and disseminationThe protocol and the model informed consent forms have been reviewed and approved by the ethics committee (N.: 1–2023) concerning scientific content and compliance with applicable research and human subject regulations.A Subcommittee on Publications was established to review all publications and report its recommendations to the steering committee. The anonymized participant-level dataset and statistical code for generating the results will not be publicly available.Trial registrationThe protocol was registered at ClinicalTrials.gov (ID: NCT05716815; Prospective rAndomized sTudy efficaCy tHree-dimensional rEconstructions Segmentectomy - Full-Text View - ClinicalTrials.gov). Jan 19, 2023.

The recent progress in understanding the biomedical basis for temporomandibular joint. (TMJ) therapy as well as in computer and imaging technologies is beginning to provide novel insights into TMJ reconstruction, rational diagnostic and therapeutic strategies. Several methods are available for imaging the TMJ. These include basic radiography (such as panorexes and corrected tomograms), ultrasonography, magnetic resonance imaging, and spiral or conebeam computed tomography. The latter technologies allow the joint to be visualized as sections in different planes and can also be rendered as 3 D volumetric reconstructions to enhance diagnostic capabilities. The aim of the study is demonstrate patient's therapy including 1 year recall. This contribution deals with 3D analysis of the mathematical and computer modeling of biomechanics of the jaw. Case report monitors step by step treatment plan, preprosthetic surgery, mandibular reconstruction and process of healing. 3D- CT was used to monitor the patient with dental cysts. The mathematical and computer TMJ models analysis using overlapping of 3D CT before and after 1 year therapy shows the stability of TMJ partial prosthesis reconstruction. Mathematical modeling and mathematical simulation of the reconstruction of patient jaw and/or patient TMJ may predict the joint loading of the reconstructed condyle. Our study demonstrated practical use of 3D images during TMJ therapy. Although many of the disorders involving the temporomandibular joint and associated structures can be diagnosed clinically on the basis of the history and physical findings, there are others that require the use of various imaging techniques to make an accurate diagnosis or to determine the extent of involvement. Imaging the hard and soft tissues of the temporomandibular joint can be used not only for treatment planning but also long-term treatment evaluation.

Despite the advancement of the deep neural network, the 3D CT reconstruction from its correspondence 2D X-ray is still a challenging task in computer vision. To tackle this issue here, we proposed a new class-conditioned network, namely CCX-rayNet, which is proficient in recapturing the shapes and textures with prior semantic information in the resulting CT volume. Firstly, we propose a Deep Feature Transform (DFT) module to modulate the 2D feature maps of semantic segmentation spatially by generating the affine transformation parameters. Secondly, by bridging 2D and 3D features (Depth-Aware Connection), we heighten the feature representation of the X-ray image. Particularly, we approximate a 3D attention mask to be employed on the enlarged 3D feature map, where the contextual association is emphasized. Furthermore, in the biplanar view model, we incorporate the Adaptive Feature Fusion (AFF) module to relieve the registration problem that occurs with unrestrained input data by using the similarity matrix. As far as we are aware, this is the first study to utilize prior semantic knowledge in the 3D CT reconstruction. Both qualitative and quantitative analyses manifest that our proposed CCX-rayNet outperforms the baseline method.

Objective: To investigate the value of CT 3D reconstruction in the diagnosis and treatment of incisional hernia and the related factor of abdominal cavity volume.Methods: Abdominal wall defect and herniary volume were measured using 3D reconstruction based on plain CT scans in 17 patients with incisional hernias.Results: The herniary diameter, area and volume could be measured in the 17 patients and the abdominal cavity volume was also measured in 10 patients using the 3D reconstruction technique. The correlation indices of the abdominal cavity volume with the patient's height, weight and body mass index (BMI) were all less than 0.01.Conclusion: Herniary area and volume and abdominal cavity volume can be accurately calculated through CT 3D reconstruction. The patch area should be more than 5 times as large as the defect area; combined with the perioperative overlap margin measurement method, this results in more scientific surgical management. The ratio of the herniary volume to the abdominal cavity volume may be conducive to preoperative assessment of the risk of abdominal compartment syndrome (ACS); however, the ratio that may lead to postoperative ACS remains to be determined. There are correlations of abdominal cavity volume with patient height, weight and BMI, especially with weight. We therefore propose that the abdominal cavity volume should be evaluated with internationally accepted indices.