Use of computed tomography for shoulder arthroplasty: A systematic review.

Introduction: The prevalence of total shoulder arthroplasties is on the rise annually. Improvements in implant quality, construct stability, and surgical techniques have notably enhanced post-operative results, prompting an expansion of indications for shoulder arthroplasty. Despite its high success rate, opportunities for enhancement remain, especially in preoperative planning and intraoperative execution. Advanced imaging technologies offer significant potential in optimizing implant placement, thus improving the longevity of the procedure. To our knowledge, a comprehensive review examining the impact of advanced imaging on shoulder arthroplasty has yet to be conducted. This systematic review aims to investigate the benefits of advanced imaging technologies in this context, focusing on their application in preoperative planning, osteoarthritis assessment, intraoperative adjustments, patient-specific instrumentation, and navigational aids. Methods: This review utilized a comprehensive search of PubMed to identify relevant studies published from 2000 to 2024, focusing on the application of various imaging techniques in shoulder arthroplasty. The search was conducted by two authors and centered on plain radiography, CT scans, and MRI. The selection criteria included availability of full-text articles, English language, direct comparison of imaging techniques, and a focus on patient outcomes, including discussions on broader applications such as intraoperative navigation and patient-specific instrumentation development. Results: Enhanced imaging techniques, particularly CT scans and MRIs, have been shown to significantly improve outcomes in shoulder arthroplasty. While plain radiographs remain standard, CT scans provide superior bony detail, crucial for evaluating glenoid wear and determining augmentation needs. Preoperative CT imaging has been demonstrated to enhance implant placement accuracy. Moreover, intraoperative technologies based on CT imaging, such as patient-specific instrumentation and navigation systems, contribute to better surgical results. Conclusion: The benefits of CT imaging in shoulder arthroplasty significantly outweigh the associated costs. Current literature strongly supports the adoption of CT imaging in these procedures, particularly when used alongside modern operative technologies.

Evaluation of conventional and CT-based radiostereometric analysis for inducible displacement measurements after total hip arthroplasty.

Though radiostereometric analysis (RSA) is the gold standard for migration tracking, computed tomography-based RSA (CT-RSA) does not require marker beads and is available for clinical adoption. This study investigated CT-RSA in comparison to RSA for assessing hip implant stability with inducible displacement (ID) examinations. Patients (n = 48) from a previous study returned to be re-examined for femoral stem stability with CT-RSA and RSA imaging. Implant migration since patients last follow-up was calculated as a measure of stability. ID was assessed between alternated leg rotation scans for CT-RSA and between supine and weight-bearing scans for RSA. Measurements from ID and double examinations were compared between CT-RSA and RSA. All stems were well-fixed with migration <0.2 mm/year. ID measurements were lower with CT-RSA than RSA for distal translation (mean difference = 0.122 mm, p < 0.0001), total translation (mean difference = 0.158 mm, p < 0.0001), and total rotation (mean difference = 0.449°, p < 0.0001). The ID and double exam were significantly different for total translation and total rotation for CT-RSA, and significantly different for medial, distal, and total translation, and total rotation for RSA. Precision ranged from 0.049 to 0.130 mm in translation and 0.061° to 0.220° in rotation for CT-RSA, and from 0.108 to 0.269 mm in translation and 0.151° to 0.670° in rotation for RSA. ID measurements from both CT-RSA and RSA were minimal, consistent for a cohort with well-fixed stems. CT-RSA demonstrated superior precision in all axes compared to RSA. Clinical Significance: Future work should explore the use of CT-RSA in patients with suspected loosening as a potential diagnostic tool.

The relationship between the extent of posterior limb of the internal capsule damage measured by non-contrast computed tomography and clinical outcomes after basal ganglia hemorrhage.

Assessing the extent of damage to the posterior limb of the internal capsule (PLIC) is important for early prediction of clinical outcomes in intracerebral hemorrhage (ICH) patients. Currently, using MRI to reconstruct the extent of damage to PLIC is not suitable for quick assessment of prognosis in emergency settings. We aimed to investigate whether the PLIC damage quantified by non-contrast computed tomography (NCCT) is associated with clinical outcomes after basal ganglia intracerebral hemorrhage (BG-ICH). This study retrospectively included 146 BG-ICH patients from the Department of Neurosurgery at the Second Affiliated Hospital of Chongqing Medical University. The damage to the PLIC was quantified using Tangency X measured by NCCT. The importance of features is determined using the Boruta algorithm and Least Absolute Shrinkage and Selection Operator (LASSO) regression. Multivariate logistic regression models were established to examine the impact of PLIC damage on outcomes. Restricted Cubic Splines (RCS) were used to explore potential nonlinear relationships, and Receiver Operating Characteristic (ROC) curves were used to compare the predictive performance of Tangency X with other scoring systems for 6-month neurological outcomes (poor outcomes [mRS: 3-6]). In the multivariate logistic regression adjusting for all covariates, Tangency X was independently associated with an increased risk of poor outcomes (OR = 1.32, 95% CI: 1.17-1.52) in BG-ICH patients. There is a nonlinear relationship between Tangency X and poor outcomes. Specifically, the risk of poor outcomes increases by 1.29 times (OR = 1.29, 95% CI: 1.09-1.67) for each additional 1 mm increase in Tangency X beyond 4 mm. We next observed that the AUC for Tangency X in predicting poor outcomes is 0.8511. The extent of PLIC damage measured by NCCT may represent a promising predictor of poor outcomes after BG-ICH.

A clinical comparative study of an outpatient treatment group and an endoscopic sinus surgery group for maxillary sinus fungus ball.

PURPOSE: This study aimed to clarify the differences in the pathophysiology of maxillary sinus fungus balls (FB) among different case groups and to identify which patients with maxillary sinus FB would be suitable for outpatient procedures. METHODS: Thirty-four patients diagnosed with maxillary sinus FB between January 2017 and December 2021 were divided into two groups (O and S). We retrospectively compared the clinical and imaging characteristics, and the treatment outcomes between the groups. Group O comprised 12 patients (13 sides) treated in an outpatient clinic and Group S comprised 15 patients (16 sides) treated with endoscopic sinus surgery (ESS). RESULTS: Compared to Group S, Group O had more patients with an enlarged maxillary sinus membranous portion, and shadows indicative of fungal masses (P < 0.01 and P < 0.05, respectively). In particular, the anteroposterior ratio of the open maxillary sinus membranous area was 0.68 ± 0.16 in Group O and 0.5 ± 0.12 in Group S. After surgery, Group O exhibited greater anteroposterior expansion of the maxillary sinus membranous portion compared to Group S (P < 0.01). Additionally, Group O had more patients with shadows in sinuses other than the maxillary sinus (P < 0.01) and medial displacement of the uncinate process (P < 0.01) than Group S. In addition, Group O required fewer procedures and hospital visits than Group S (P < 0.001 and P < 0.01, respectively). CONCLUSIONS: Determining the indications for outpatient procedures while considering the pathophysiology of maxillary sinus FB can significantly benefit patients and medical professionals in terms of safety and medical costs.

Machine learning models based on CT radiomics features for distinguishing benign and malignant vertebral compression fractures in patients with malignant tumors.

BACKGROUND: Radiomics has become an important tool for distinguishing benign and malignant vertebral compression fractures (VCFs). It is more clinically significant to concentrate on patients who have malignant tumors and differentiate between benign and malignant VCFs. PURPOSE: To explore the value of multiple machine learning (ML) models based on CT radiomics features for differentiating benign and malignant VCFs in patients with malignant tumors. MATERIAL AND METHODS: This study retrospectively analyzed 78 patients with malignant tumors accompanied by VCFs, 45 patients with benign VCFs, and 33 patients with malignant VCFs. A total of 140 lesions (86 benign lesions, 54 malignant lesions) were ultimately included in this study. All patients were divided into training sets (n = 98) and validation sets (n = 42) according to the 7:3 ratio. The radiomics features were screened and dimensioned, and multiple radiomics ML models were constructed. The receiver operating characteristic (ROC) curve was performed to assess the diagnostic performance. RESULTS: Five radiomics features were included in the model. All the ML models built have good diagnostic efficiency, among which the support vector machine (SVM) model performs better. The area under the curve (AUC), sensitivity, specificity, and accuracy in the training set were 0.908, 0.816, 0.883, and 0.857, respectively, while those in the validation set were 0.911, 0.647, 0.92, and 0.81, respectively. CONCLUSION: A variety of ML models built based on CT radiomics features have good value for differentiating benign and malignant VCFs in malignant tumor patients, and the SVM model has a better performance.

Admission chest CT scan of intensive care patients with interstitial lung disease: Unveiling its limited predictive value through visual and automated analyses in a retrospective study (ILDICTO).

BACKGROUND: Clinical course prediction of patients with interstitial lung disease (ILD) admitted to the intensive care unit (ICU) for acute respiratory failure (ARF) can be challenging. This study aimed to characterize the prognostic value of admission chest CT-scan in this situation. METHODS: We retrospectively included ILD patients admitted to a French ICU for acute respiratory failure requiring oxygen. Patients with lymphangitis carcinomatosis and ANCA vasculitis were excluded. We analyzed every admission chest CT-scan using two different approaches: a visual analysis (grading the extent of traction bronchiectasis, ground glass and honeycomb) and an automated analysis (grading the extent of ground glass and consolidation with a dedicated software). The primary outcome was ICU mortality. RESULTS: Between January 2014 and October 2020, 81 patients presented an acute respiratory failure with ILD on the admission chest CT-scan. In univariate analysis, only the main pulmonary artery diameter differed between patients who survived and those who died in ICU (30 vs 32 mm, p = 0.021). In multivariate analysis, none of the radiological funding was associated with ICU mortality. Visual and automated analyses did not yield different results, with a strong correlation between the two methods. However, the identification of an UIP pattern (and the presence of honeycomb) was associated with a poorer response to corticosteroid therapy. CONCLUSION: Our study showed that the extent of radiological findings and the severity of fibrosis indices on admission chest CT scans of ILD patients admitted to the ICU for ARF were not associated with subsequent deterioration.

Ultra-high resolution spectral photon-counting CT outperforms dual layer CT for lung imaging: Results of a phantom study.

PURPOSE: The purpose of this study was to compare lung image quality obtained with ultra-high resolution (UHR) spectral photon-counting CT (SPCCT) with that of dual-layer CT (DLCT), at standard and low dose levels using an image quality phantom and an anthropomorphic lung phantom. METHODS: An image quality phantom was scanned using a clinical SPCCT prototype and an 8 cm collimation DLCT from the same manufacturer at 10 mGy. Additional acquisitions at 6 mGy were performed with SPCCT only. Images were reconstructed with dedicated high-frequency reconstruction kernels, slice thickness between 0.58 and 0.67 mm, and matrix between 5122 and 10242 mm, using a hybrid iterative algorithm at level 6. Noise power spectrum (NPS), task-based transfer function (TTF) for iodine and air inserts, and detectability index (d') were assessed for ground-glass and solid nodules of 2 mm to simulate highly detailed lung lesions. Subjective analysis of an anthropomorphic lung phantom was performed by two radiologists using a five-point quality score. RESULTS: At 10 mGy, noise magnitude was reduced by 29.1 % with SPCCT images compared to DLCT images for all parameters (27.1 ± 11.0 [standard deviation (SD)] HU vs. 38.2 ± 1.0 [SD] HU, respectively). At 6 mGy with SPCCT images, noise magnitude was reduced by 8.9 % compared to DLCT images at 10 mGy (34.8 ± 14.1 [SD] HU vs. 38.2 ± 1.0 [SD] HU, respectively). At 10 mGy and 6 mGy, average NPS spatial frequency (fav) was greater for SPCCT images (0.75 ± 0.17 [SD] mm-1) compared to DLCT images at 10 mGy (0.55 ± 0.04 [SD] mm-1) while remaining constant from 10 to 6 mGy. At 10 mGy, TTF at 50 % (f50) was greater for SPCCT images (0.92 ± 0.08 [SD] mm-1) compared to DLCT images (0.67 ± 0.06 [SD] mm-1) for both inserts. At 6 mGy, f50 decreased by 1.1 % for SPCCT images, while remaining greater compared to DLCT images at 10 mGy (0.91 ± 0.06 [SD] mm-1 vs. 0.67 ± 0.06 [SD] mm-1, respectively). At both dose levels, d' were greater for SPCCT images compared to DLCT for all clinical tasks. Subjective analysis performed by two radiologists revealed a greater median image quality for SPCCT (5; Q1, 4; Q3, 5) compared to DLCT images (3; Q1, 3; Q3, 3). CONCLUSION: UHR SPCCT outperforms DLCT in terms of image quality for lung imaging. In addition, UHR SPCCT contributes to a 40 % reduction in radiation dose compared to DLCT.

Fractal Dimension and Lacunarity Analysis in the Dentulous and Edentulous Mandibular Posterior Region Using Cone-beam Computed Tomography: A Cross-sectional Retrospective Study.

AIMS: This cross-sectional retrospective study was conducted to assess the differences in the microarchitecture of the trabecular bone of the posterior mandibular region at dentulous and edentulous sites with the help of fractal dimension (FD) and lacunarity using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Ninety CBCT scans were analyzed for the purpose of the present study. Inclusion criteria included subjects with unilaterally missing mandibular molars or premolars and an with intact contralateral opposing tooth. The coronal view of the dentulous and edentulous sites was used, and the region of interest (ROI) was selected 2.6 mm below the apex of the tooth present. These images were then transferred to ImageJ Software, and fractal analysis was done using the box-counting method of the FracLac plug-in. A paired samples t-test was performed to compare the means of FD and lacunarity, and a Kendall correlation was performed to check correlations. A p-value less than 0.05 was considered to indicate statistical significance. RESULTS: Statistical analysis revealed that the mean FD of the edentulous side was significantly greater than that of the dentulous side (p-value = 0.011). Additionally, the mean lacunarity of the edentulous side was marginally significantly greater than that of the dentulous side (p-value = 0.089). A significant negative correlation was detected between the FD and lacunarity of the edentulous region (p-value = 0.017), and a marginally significant negative correlation was detected between edentulous lacunarity and dentulous lacunarity (p-value = 0.081). CONCLUSION: The differences in occlusal forces exerted in dentulous and edentulous regions can lead to a change in the trabecular pattern of the bone in these regions. This change in the microarchitecture of bones can be detected by FD and lacunarity, which can further help us assess changes pre- and post-implant. CLINICAL SIGNIFICANCE: The advanced technology, the assessment of microarchitecture of the bone has been made easy, using FD and lacunarity, as done in the present study. This analysis can further aid us in both pre- and post-implant analysis to prevent failure of the implant. How to cite this article: Bhoraskar M, Denny C, Srikant N, et al. Fractal Dimension and Lacunarity Analysis in the Dentulous and Edentulous Mandibular Posterior Region Using Cone-beam Computed Tomography: A Cross-sectional Retrospective Study. J Contemp Dent Pract 2024;25(6):581-587.

Efficacy of Mastoid Morphometry in Sex Determination Using Cone-beam Computed Tomography: A Retrospective Analysis in Dakshina Kannada Population.

AIM: To evaluate the morphology of the mastoid process and its role in sex determination with the help of cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A retrospective study was conducted on 200 adults who were subjected to full FOV CBCT scans (100 males and 100 females). Eight parameters of the mastoid process were assessed for sex determination. The study measured eight parameters of the mastoid process, including mastoid length (ML), mastoid width, mastoid height (MH), intermastoidale distance (IMD), intermastoidale lateral surface distance (IMLSD), mastoid medial convergence angle, mastoid size (MS), and mastoid surface area (MSA). Data were recorded and statistically analyzed. RESULTS: Statistics revealed a significant value for MH (p < 0.001), IMD (p < 0.001), IMLSD (p < 0.001), MSA (p < 0.001), MS (p < 0.001), and ML (p = 0.032). A highly significant value was noted for MH (p < 0.001), IMD (p < 0.001), IMLSD (p < 0.001), MSA (p < 0.001), MS (p < 0.001), followed by ML, all of which were found to be greater in males. Out of the eight parameters, IMD was found to be the best sex determinant among all the eight parameters, with an accuracy of 70%. The study showed a significant difference between the mastoid process morphometric measurements for males and females. CONCLUSION: It can be concluded from the present study that IMD can be used as a good index for sex determination. The combined parameters that were found to be the most accurate were right MH, left ML, and IMLSD, with an accuracy of 75%. CLINICAL SIGNIFICANCE: The three-dimensional imaging techniques can contribute significantly towards disaster victim identification and sex determination in the fields of forensic odontology and anthropology. For the recognition of victims, sex determination becomes one of the most difficult parameters to assess. In such events, the mastoid process can become an important anatomical landmark for the estimation of sex. This is due to the condensed nature of the petrous bone and its protected position in the skull. How to cite this article: Ahmed J, Saha A, Muralidharan A, et al. Efficacy of Mastoid Morphometry in Sex Determination Using Cone-beam Computed Tomography: A Retrospective Analysis in Dakshina Kannada Population. J Contemp Dent Pract 2024;25(5):453-458.

Morphometric Evaluation of the Thoracic and Lumbar Vertebral Canal and Spinal Cord Using Computed Tomography in Healthy Korean Shorthair Cats.

This study aimed to evaluate the spinal morphometry of the thoracic and lumbar regions in normal Korean Shorthair cats using computed tomography (CT) and to investigate the relationship with variables such as sex, age and body weight. Fifteen clinically healthy Korean Shorthair cats (eight males, seven females) from Seoul National University Veterinary Medical Teaching Hospital were included in this retrospective study. Measurements of the height, width and area of the vertebral canal and spinal cord on CT images were taken at the cranial, middle and caudal points of the thoracic and lumbar vertebrae by three observers, and the ratios of the spinal cord area to the vertebral canal area were calculated. The significance of the differences in measurements between sexes and correlations with age and body weight were analysed. The mean age of the cats was 7 years (range: 2-12 years), with a mean weight of 5.27 kg (range: 2.6-8.3 kg). The height, width and area of the vertebral canal and spinal cord were significantly greater in males than in females (p < 0.05). The ratios of the spinal cord area to the vertebral canal area showed no significant difference between sexes (p > 0.05), and no significant correlations were found between the ratios of the spinal cord area to the vertebral canal area and age or body weight. This study provides useful reference intervals for spinal morphometry in the thoracic and lumbar regions of healthy Korean Shorthair cats and investigate the relationship with variables such as sex, age and body weight. This anatomical information may assist in the diagnosis and prognosis of thoracic, lumbar vertebral and spinal cord diseases using CT.

Maximum standardized uptake value for parotid and submandibular glands in patients with Sjögren's syndrome and submandibular sialolithiasis using salivary gland SPECT/CT.

Recently, SPECT/CT plays an important role in assessing patients with head and neck lesions. The aim of this study was performed to investigate the maximum standardized uptake value (SUVmax) for parotid and submandibular glands in patients with Sjögren's syndrome and submandibular sialolithiasis using salivary gland SPECT/CT. A prospective study was performed in 45 patients with 32 Sjögren's syndrome and 13 submandibular sialolithiasis who underwent salivary gland SPECT/CT. The SUVmax of parotid and submandibular glands was obtained using a workstation and software. The salivary secretion function of parotid and submandibular glands was defined as ratio of pre- to post-stimulation on SUVmax. A p value lower than 0.05 was considered as statistically significant. The SUVmax for parotid glands in patients with Sjögren's syndrome at pre-stimulation (18.0 ± 14.3), post-stimulation (12.0 ± 9.4), and ratio of pre- to post-stimulation (1.46 ± 0.52) were significantly lower than those of submandibular sialolithiasis (44.9 ± 8.4 (p < 0.001), 17.8 ± 6.5 (p < 0.001), and 2.75 ± 0.79 (p < 0.001), respectively). The SUVmax for submandibular glands in patients with Sjögren's syndrome at pre-stimulation (16.9 ± 18.7) were significantly lower than those with sialolithiasis (36.7 ± 27.8, p = 0.004) and without sialolithiasis (39.7 ± 16.0, p = 0.001) in patients with submandibular sialolithiasis. The salivary gland SPECT/CT SUVmax can be useful in clinical practice for the quantitative management of parotid and submandibular glands in patients with Sjögren's syndrome and submandibular sialolithiasis.

Dual-tracer subtraction scintigraphy combined with SPECT/CT in preoperative patients with primary hyperparathyroidism.

Abstract.

Personalized prediction of immunotherapy response in lung cancer patients using advanced radiomics and deep learning.

BACKGROUND: Lung cancer (LC) is a leading cause of cancer-related mortality, and immunotherapy (IO) has shown promise in treating advanced-stage LC. However, identifying patients likely to benefit from IO and monitoring treatment response remains challenging. This study aims to develop a predictive model for progression-free survival (PFS) in LC patients with IO based on clinical features and advanced imaging biomarkers. MATERIALS AND METHODS: A retrospective analysis was conducted on a cohort of 206 LC patients receiving IO treatment. Pre-treatment computed tomography images were used to extract advanced imaging biomarkers, including intratumoral and peritumoral-vasculature radiomics. Clinical features, including age, gene status, hematology, and staging, were also collected. Key radiomic and clinical features for predicting IO outcomes were identified using a two-step feature selection process, including univariate Cox regression and chi-squared test, followed by sequential forward selection. The DeepSurv model was constructed to predict PFS based on clinical and radiomic features. Model performance was evaluated using the area under the time-dependent receiver operating characteristic curve (AUC) and concordance index (C-index). RESULTS: Combining radiomics of intratumoral heterogeneity and peritumoral-vasculature with clinical features demonstrated a significant enhancement (p < 0.001) in predicting IO response. The proposed DeepSurv model exhibited a prediction performance with AUCs ranging from 0.76 to 0.80 and a C-index of 0.83. Furthermore, the predicted personalized PFS curves revealed a significant difference (p < 0.05) between patients with favorable and unfavorable prognoses. CONCLUSIONS: Integrating intratumoral and peritumoral-vasculature radiomics with clinical features enabled the development of a predictive model for PFS in LC patients with IO. The proposed model's capability to estimate individualized PFS probability and differentiate the prognosis status held promise to facilitate personalized medicine and improve patient outcomes in LC.

Wandering spleen combined with pedicle torsion and splenic infarction: a rare case report and literature review.

Wandering spleen (WS) concurrent with splenic pedicle torsion and infarction has been described rarely. We reported our experience in diagnosing and treating such a condition in a 16-year-old girl with acute abdominal pain. A plain CT scan showed the wandering of the spleen from the left upper quadrant. Contrast-enhanced CT indicated dilatation and distortion in the splenic vein, a counterclockwise "whirl sign" in the splenic pedicle, pancreatic tail torsion, and splenic infarction. The patient was diagnosed with WS combined with splenic pedicle torsion and splenic infarction and underwent splenectomy for treatment. She showed a satisfactory outcome during the follow-up. To enhance our understanding of it, we performed a comprehensive literature research to summarize the clinical manifestations, treatment options, and outcomes among adolescent patients.

Evaluation of Maxillary Sinus Septa Using Cone Beam Computed Tomography (CBCT): A Retrospective Study.

BACKGROUND: Maxillary sinus septa, which are bony structures dividing the sinus cavity, can pose challenges during sinus lift or implant surgeries by potentially causing perforation of the Schneiderian membrane. This study aimed to estimate the prevalence, height, location, orientation, and risk of perforation of the maxillary sinus septa using cone beam computed tomography (CBCT). MATERIALS AND METHODS: This retrospective, cross-sectional study utilized CBCT (NewTom CBCT machine, of which the scan parameters were 90 KvP, 8 mAs, and 14 s exposure with a field of view (FOV) of 8×8 cm and a 0.2 mm3 voxel size) images of 300 maxillary sinuses from patients aged >18 years, obtained from Swami Devi Dyal Hospital and Dental College in Panchkula, India. Scans were analyzed for the presence, height, location, orientation, and risk of septal perforation. The data were categorized based on age, sex, and dentition status. Statistical analyses were performed to assess the prevalence, configuration, and risk factors. RESULTS: The prevalence of maxillary sinus septa was 21.33%, with the majority showing a single septum (90.63%). Septa were predominantly found in the middle region (48.44%), with bucco-palatal orientation (93.75%) being more common than anteroposterior. The mean septa height was 6.16 mm. The perforation was classified as moderate (48.4%), low (46.8%), or high (4.6%). Class III septa were associated with the highest risk of perforation. CONCLUSION: This study highlights a significant prevalence of maxillary sinus septa with variations in height, orientation, and location. The risk of perforation varies with the septa configuration and orientation. CBCT is essential for identifying these anatomical features to minimize surgical complications and to guide preoperative planning.

Computed Tomography Optic Nerve Sheath Diameter-to-Eyeball Transverse Diameter Ratio as a Novel Noninvasive Parameter for Prognostication in Traumatic Brain Injury.

Background Traumatic brain injury (TBI) remains a foremost cause of death and disability globally, with elevated intracranial pressure (ICP) being a crucial factor in patient outcomes. While invasive monitoring is the gold standard for assessing ICP, it carries risks and is not always feasible. This study proposes a novel noninvasive parameter using computed tomography (CT) imaging. Aims and objectives The study aims to determine the efficacy of the optic nerve sheath diameter (ONSD)-to-eyeball transverse diameter (ETD) ratio from CT scans in predicting TBI patients' prognosis. The primary objective is to study the ONSD/ETD ratio's efficacy in assessing TBI's severity. The secondary objective is to correlate the ONSD/ETD ratio with the Glasgow Coma Scale (GCS) and Rotterdam computed tomography scoring (RCTS) and assess its clinical benefit. Materials and methods This combined retrospective and prospective analytical study included 308 consecutive patients who underwent CT imaging for TBI at a tertiary care center with a dedicated trauma and neurosurgical unit. We evaluated bilateral ONSD and ETD using axial CT scans. The ONSD/ETD ratio correlated with the GCS, RCTS, and clinical outcomes. Results The cut-off values for elevated ICP were ONSD of >5.17 mm, ETD of <22.2 mm, and ONSD/ETD ratio of >0.21. Variables between GCS (<12 and >12) and the ONSD/ETD ratio (<0.21 and >0.21) were statistically significant (chi-square {χ2} = 18.52, p = 0.000). The ONSD shows a strong positive correlation with RCTS (r = 0.82, p = 0.01), ETD shows a moderate negative correlation with RCTS (r = -0.50), and the ONSD/ETD ratio shows a strong negative correlation with GCS (r = -0.783, p = 0.01). The area under the curve for the ONSD/ETD ratio (0.920) was higher than that for ONSD (0.932) and ETD (0.490). The ONSD/ETD ratio's sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 95.6%, 72.0%, and 100%, respectively, demonstrating that it is an excellent predictor of raised ICP. Conclusion The CT-ONSD/ETD ratio correlates with the severity of TBI as assessed by GCS and RCTS. It could serve as a noninvasive parameter for monitoring ICP and guiding the need for sequential CT in TBI patients, potentially aiding in prognostication and clinical management.

Open surgical repair of an isolated aneurysm of the arc of Riolan with celiac artery occlusion and severe superior mesenteric artery stenosis.

The arc of Riolan (AoR), a marginal vessel in the left colon, interconnects the superior and inferior mesenteric arteries. A 65-year-old woman presented with an incidental aneurysmal lesion in the left upper abdomen found on ultrasound. Computed tomography revealed a 27-mm saccular aneurysm in the AoR with occlusion of the celiac artery and severe stenosis of the superior mesenteric artery. Angiography showed that the inferior mesenteric artery provided blood to the perfusion areas of the superior mesenteric artery, celiac artery, and left colon via the AoR. We performed open surgical repair of the aneurysm and reconstruction of the inferior mesenteric artery.

Repeated CT scans on 12,984 Asians to diagnose lung cancer once it is suspected.

In Taiwan, lung cancer remains the leading cause of cancer-related fatalities, resulting in substantial healthcare expenses. This research aims to evaluate both the frequency and the costs of low-dose computed tomography (LDCT) in individuals suspected of having lung cancer until their diagnosis of cancer. LDCT screening was not conducted on a population-wide scale, and asymptomatic participants had to cover the expenses for the screening personally or reimburse from other sources. If the screening results were positive or suspicious, National Health Insurance (NHI) could be utilized for subsequent follow-up examinations. This cohort study utilized the NHI Database and focused on individuals with suspected cases of lung cancer identified between 2010 and 2014. A total of 17,572 suspected new lung cancer cases were initially identified and assigned to the relevant International Classification of Diseases codes. Individuals with suspected lung cancer received a diagnosis following an average follow-up period of 2.24 (95%CI, 2.11-2.37) years, and required the use of 2.36 (95%CI, 2.20-2.51) repeated CT scans. The NHI expenditures incurred by the use of CT scans for monitoring suspected lung cancer cases were relatively modest.