Clinical study of ICG-R15 combined with three-dimensional image reconstruction technology in preoperative evaluation of liver cancer / 重庆医学

Objective To explore the advantages of indocyanine green clearance rate at 15 min(ICG-R15)combined with three-dimensional image reconstruction technology in preoperativ evaluation of liver cancer,as well as its impact on the efficacy of liver resection surgery.Methods The data of the patients with liver cancer undergoing preoperative three-dimensional image reconstruction evaluation(experimental group,n=65)and traditional CT evaluation(control group,n=70)in the Jining Municipal First People's Hospital from January 2018 to January 2021 were retrospectively analyzed.All patients performed the ICG-R15 test be-fore operation.In the experimental group,45 cases adopted laparotomy and 20 cases adopted laparoscopic sur-gery,which in the control group had 50 cases and 20 cases,respectively.The data of preoperative laboratory tests,intraoperative related indicators and postoperative laboratory tests were collected in the two groups.The influences between the two kinds of evaluation modes on the effects of laparotomy and laparoscopic surgery in liver cancer were compared.Results In laparotomy,compared with the control group,the operation time and postoperative drainage tube extraction time in the experimental group were significantly shortened,the intrao-perative bleeding volume was significantly decreased,the incidence rate of postoperative complications,direct bilirubin and AST levers on 7 d after operation were significantly decreased(P＜0.05);there were no statis-tically significant differences in the intraoperative blood transfusion rate,postoperative hospitalization dura-tion,levels of total bilirubin,ALT and albumin and prothrombin time on 7 d after operation between the two groups(P＞0.05).In laparoscopic surgery,compared with the control group,the postoperative hospitalization duration and postoperative drainage tube extraction time in the experimental group were significantly short-ened,the levels of AST and ALT on 7 d after operation were significantly decreased(P＜0.05);there was no statistically significant difference in the other observation indicators between the two groups(P＞0.05);in the control group,3 cases were converted to laparotomy due to inability to excision during laparoscopic explo-ration.Compared with the control group,the accuracy rate of preoperative evaluation of the number of liver tumors and Couinaud segmentation localization(96.9％vs.85.7％)and preoperative evaluation of liver vas-cular variation(100.0％vs.53.8％)were increased in the experimental group,the percentage of the patients with actual resection range greater than preoperative prediction range was lower(7.7％vs.20.0％),and the differences were statistically significant(P＜0.05).There was no statistically significant difference in the accu-racy of preoperative evaluation of portal vein invasion between the two groups(P＞0.05).Conclusion ICG-R15 combined with three dimensional reconstruction technology in preoperatively assessing liver cancer has more advantages compared with combined traditional CT,moreover which is conducive to reduce intraoperative bleeding,shorten operation time and has the positive effect on the patients'prognosis.

Application and diagnostic value of low dose scan technique of chest CT combined with 3D reconstruction for ribs in chest trauma / 中国医学装备

Objective:To explore the application and diagnostic value of low-dose scan technique of chest computed tomography(CT)combined with three dimensional(3D)reconstruction for ribs in chest trauma.Methods:A total of 118 patients with highly suspected rib fracture who admitted to the 904th Hospital of People's Liberation Army Joint Service Support Force were selected,and all cases underwent low-dose scan technique of chest CT combined with 3D reconstruction for ribs.The image qualities of chest CT scans with different low-doses combined with 3D reconstruction for ribs were analyzed,and the diagnostic accuracies among low dose scan technique of chest CT,3D reconstruction for ribs and the combination of them for chest trauma were compared.Results:Both the sharpness and clarity of the edges of the bronchi,blood vessels,lung parenchyma,interlobular septum,mediastinum and ribs were poorer,and the artifacts of soft tissue were more and the noise were more when the tube current of CT scan was 50 Ma.Both the sharpness and clarity of the edges of the bronchi,blood vessels,lung parenchyma,interlobular septum,mediastinum and ribs were general,and a part of soft tissues existed artifacts and the noise amounts were less when the tube current of CT scan was 70 Ma,which did not affect the diagnosis.The radiation dose as 50 mA was significantly higher than that as 70 mA,with a statistically significant difference(t=10.969,P<0.05).In 118 patients with chest trauma,the examination of low-dose scan technique of chest CT combined with 3D reconstruction for ribs indicated that there were 112 cases of rib fractures and 7 cases of costal cartilage fractures.In the examined 388 fractures of rib and costal cartilage,355 fractures(91.49%)were rib fractures and 33 fractures(8.51%)were costal cartilage fractures.In 118 patients with chest trauma,76 cases(64.41%)complicated with pulmonary contusions and lacerations,and 41 cases(35.75%)complicated with pleural effusion,and 10 cases(8.47%)complicated with thoracic vertebral fractures,and 6 cases(5.08%)complicated with splenic contusions and lacerations,and 5 cases(4.24%)complicated with mediastinal and subcutaneous emphysemas.The most direct imaging sign of rib fracture was visible and transparent low-density shadow.Chest CT scan can generally better display dislocation of the fractured end.The 3D reconstruction image showed a visibly line-like shadow on one side of rib if only one side of ribs fractured and the other side was intact.A total of 395 rib and costal cartilage fractures were confirmed by 3D reconstruction,which included 363 rib fractures(91.90%)and 32 costal cartilage fractures(8.10%).A total of 410 rib and costal cartilage fractures were confirmed by low-dose scan technique of chest CT combined with 3D reconstruction for ribs,which included 375 rib fractures(91.46%)and 35 costal cartilage fractures(8.54%).In the comparison of 418 rib injuries that were confirmed during surgery,the accuracy of low-dose scan technique of chest CT was 92.82%(388/418)in diagnosing rib and costal cartilage fractures,and the accuracy of 3D reconstruction for ribs was 94.50%(395/418)in diagnosing that,and the accuracy of low-dose scan technique of chest CT combined with 3D reconstruction for ribs was 95.69%(410/418)in diagnosing that.There was a significant difference in accuracy among the three types of examinations(x2=13.062,P<0.05).Conclusion:Low dose scan technique of chest CT combines with 3D reconstruction for ribs can be used in the diagnosis of chest trauma,which has higher accuracy and can provide reliable imaging information for clinical diagnosis and treatment.

Study on anatomical parameters of adult lumbar intervertebral disc and endplate based on CT / 中国骨伤

OBJECTIVE@#To provide basic data for clinical application and individualized design of lumbar disc prostheses by measuring the anatomical parameters of lumbar intervertebral discs and endplates in healthy adults with CT three-dimensional reconstruction technology.@*METHODS@#A retrospective analysis was performed on 200 males and 200 females with normal lumbar spine who were admitted to the imaging center or outpatient department of the Second Affiliated Hospital of Xinjiang Medical University from September 2019 to December 2020. The age ranged from 20 to 60 years old, with an average of (40.61±11.22) years old. The measurement segment was L1-S1 intervertebral disc, and the measurement indicators included the axial anteroposterior diameter and transverse diameter of the intervertebral disc, sagittal anterior, middle and posterior height, coronal left and right height, intervertebral space angle, and transverse and anteroposterior diameters of the upper and lower endplates of each vertebral body.@*RESULTS@#①In terms of gender, the anatomical parameters of L1-S1 disc axial diameter, transverse diameter, sagittal anterior, middle and posterior height, left and right coronal height and intervertebral space angle were all higher in males than in females(P<0.05), and the anatomical parameters of upper and lower endplates of L1-S1 vertebral body were higher in males than in females(P<0.001). ②In comparison of sagittal height of anterior, middle and posterior intervertebral discs, the sagittal height of L1-L5 intervertebral discs was middle-high > anterior-high > posterior-high(P<0.001), while that of L5S1 intervertebral disc was anterior-high > middle-high > posterior-high (P<0.001). ③In the comparison of left and right coronal height, there was no statistical significance in the left and right coronal height of L1-S1 disc between male and female(P>0.05). ④The L1-S1 intervertebral spaces angle between male and female increased with the increase of vertebral body segments. ⑤The anterior and posterior diameters and transverse diameters of upper and lower of L1-S1 vertebral bodies endplates were height in males than in females(P<0.001).@*CONCLUSION@#The results suggest that gender differences should be considered in the design of adult lumbar disc prostheses. The anatomical parameters of the lumbar intervertebral disc varied with the increase of the vertebral body sequence, suggesting that different anatomical parameters of the intervertebral disc should be considered in the design of the artificial intervertebral disc, and the changes in the height of the sagittal position suggest that the design of the intervertebral disc should be wedge-shaped.

Clinical study of three-dimensional reconstruction combined with intraoperative ultrasound precise hepatectomy in complicated intrahepatic bile duct stones / 中华肝胆外科杂志

Objective:To evaluate the efficacy of preoperative three-dimensional (3D) image reconstruction combined with intraoperative dynamic ultrasonography (IOUS) in laparoscopic precision hepatectomy for intrahepatic bile duct stones.Methods:The clinical data of 66 patients with intrahepatic bile duct stones undergoing laparoscopic hepatectomy in the First People's Hospital of Fuyang District, Hangzhou from January 2018 to January 2023 were retrospectively analyzed, including 32 males and 34 females, aged (49.6±15.2) years old. Patients were divided into the study group ( n=32), who underwent laparoscopic precision hepatectomy using 3D reconstruction combined with IOUS, and the control group ( n=34), who underwent conventional laparoscopic hepatectomy. Perioperative data including the operation time, intraopera-tive blood loss, total volume of drainage on postoperative day (POD) 3, and the rates of complications were compared between the groups. Serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), liver function indices including total bilirubin (TBil) and alanine aminotransferase (ALT) were monitored preoperatively and on POD 1, 3, 5, and 7. Results:The operation time was shorter in the study group [(178±17) min vs. (189±18) min, t=2.55, P=0.010]. The intraoperative blood loss was reduced in the study group [(218±19) ml vs. (395±21) ml, P<0.001]. The incidence of total volume of drainage >300 ml on POD 3 were comparable between the groups [9.4%(3/32) vs. 14.7%(5/34), P=0.507]. There were no significant differences in preoperative serum level of TBil, ALT, CRP and IL-6 between the groups (all P>0.05). Compared to the control group, serum levels of TBil, ALT and CRP in the study group were decreased on POD 1, 3, 5 and 7, and IL-6 was decreased on POD 1 and 3 (all P<0.05). The occurrences of postoperative bile leakage [9.4% (3/32) vs. 29.4% (10/34)] and liver cutting surface fluid accumulation [12.5% (4/32) vs. 35.3% (12/34)] and the rate of stone retention [3.0% (1/32) vs. 20.6% (7/34)] were lower in the study group (all P<0.05). Conclusion:Preoperative 3D image reconstruction combined with IOUS in laparoscopic precision hepatectomy for intrahepatic bile duct stones could reduce intra-operative blood loss, hepatic inflammatory response, and postoperative complications.

Establishment and application of a simulation system for auricular reconstruction with autogenous costal cartilage / 中华医学美学美容杂志

Objective:To design and develop a digital auricle reconstruction simulation training system and to evaluate the application effect of the system.Methods:Based on 3D reconstruction and 3D printing technology, a new auricle reconstruction simulation training system was designed and developed from September 2019 to December 2021. Thirty-six basic volunteers (including 15 males and 21 females, aged from 22 to 27 years, with mean 23.1 years) without auricle reconstruction (surgical clinical standardized training students) were selected and divided into two groups (experimental group and control group) for clinical teaching experiment, and the teaching effect of simulation system was preliminarily evaluated.Results:Theoretical test scores before and after the intervention in the experimental group were 8.00 (4.75, 11.25) compared to 16.50 (13.00, 19.25) , P<0.001; design test scores were 2.00 (0, 4.25) compared to 7.00 (6.00, 10.00), P<0.001. In the control group, theoretical test scores before and after the intervention were 5.50 (3.75, 12.25) compared to 11.00 (9.50, 16.25), P<0.001; design test scores were 1.00 (1.00, 2.25) compared to 5.00 (3.75, 6.00), P<0.001. The improvement in the experimental group compared to the control group was significantly more pronounced with a statistically significant difference ( P<0.001). Conclusions:This system can assist teachers in teaching more systematically in auricle reconstruction training with autologous costal cartilage, and the teaching effect is better.

CT anatomical features of the sustentaculum fragment and their clinical significance / 中华创伤骨科杂志

Objective:To determine the anatomical parameters concerning the length, width and height of the sustentaculum fragment of the calcaneus using CT imaging data and their clinical significance.Methods:A retrospective study was conducted to analyze the CT imaging data of normal calcaneus in 96 patients (100 feet) which had been collected by Department of Orthopedics, Shanghai Tongji Hospital from January 2019 to September 2020. There were 45 males (48 feet) and 51 females (52 feet) with an age of (42.1±13.6) years, and 56 left feet and 44 right feet. After 3D models were reconstructed with the CT data using software Mimics 22.0, the calcaneus was viewed layer by layer at each level of the scan. After the first continuous bone trabecula on the medial side of the calcaneal central triangle was taken as the boundary, the model of the sustentaculum fragment was segmented. The length, width, and height of the sustentaculum fragment were measured. The outer contour of the sustentaculum fragment was projected onto the lateral wall of the calcaneus to draw the contour line using software Materialise 3-Matic 22.0. By overlaying projection line diagrams, a summary of projection line diagrams of 100 sustentaculum fragments was obtained. Seven screw insertion points were selected in the summary region of the projection line diagrams of the lateral wall of the calcaneus, and the distance from each point to the medial side of the calcaneus were measureed. The length, width, and height of the sustentaculum fragment, as well as the distance from the 7 insertion points to the medial side of the calcaneus, were compared between different feet and genders.Results:The length, width, and height of the sustentaculum fragment were (45.19±4.60) mm, (38.57±4.59) mm and (40.76±5.48) mm, respectively. There were no significant differences in the length, width or height of the sustentaculum fragment between different feet or in the height of the sustentaculum fragment between different genders ( P>0.05), but the length and width of the sustentaculum fragment in females were significantly smaller than those in the males ( P<0.05). The projection of the sustentaculum fragment was approximately ellipse on the summary region of the projection line diagrams on the lateral wall of the calcaneus, with the long axis approximately parallel to the midpoint tangent of the lateral edge of the calcaneal posterior articular surface, ranging from 2 to 20 mm from the posterior articular surface. The distances from the 7 insertion points to the medial surface of the calcaneus were (39.91±3.77) mm at point A, (40.89±3.55) mm at point B, (36.42±5.98) mm at point C, (39.12±5.52) mm at point D, (40.04±4.84) mm at point E, (33.00±3.96) mm at point F, and (33.04±3.82) mm at point H. There was no significant difference in the distances from the 7 insertion points to the medial surface of the calcaneus between different feet ( P>0.05), but the distances from the 7 insertion points to the medial surface of the calcaneus in the females were significantly smaller than those in the males ( P<0.05). Conclusions:Anatomical measurements of the sustentaculum fragment can provide a theoretical basis for the range of fixation of the sustentaculum screws. A summary of projection line diagrams of the sustentaculum fragment on the lateral surface of the calcaneus can serve as a reference for placement of sustentaculum screws. Measurement of the distances from 7 insertion points to the medial surface of the calcaneus can facilitate determination of the lengths of sustentaculum screws.

Chinese expert consensus on the application of integrated 3D reconstruction with artificial intelligence in thoracic surgery / 中国胸心血管外科临床杂志

@# In order to further regulate the application of 3D reconstruction in thoracic surgery, the Chinese Expert Consensus Group on the Application of Integrated 3D Reconstruction with Artificial Intelligence in Thoracic Surgery conducted discussions and developed this consensus. This consensus is based on the clinical experience and existing prospective or retrospective studies of 3D reconstruction technology in various scenarios of thoracic surgery and summarizes recommendations, and also appends a list of 3D reconstruction technology application scenarios that are currently controversial, not fully studied, or still in the exploratory stage, to provide direction and evidence for future clinical research and disease diagnosis and treatment, and to reach a consensus.

Clinical Value Evaluation of DR Corneal Suture Ring Localization and CT 3D Reconstruction Localization of Orbital Foreign Body / 中山大学学报(医学科学版)

ObjectiveTo investigate the clinical value of DR corneal suture ring localization and CT 3D reconstruction localization of orbital foreign bodies. MethodsRetrospective analysis was performed on patients （51 cases） suspected of ocular foreign bodies admitted to our hospital from January 2016 to December 2020 At the same time， DR corneal suture ring localization and CT three-dimensional reconstruction localization of orbital foreign bodies were performed， and the detection rate of foreign bodies by the two methods was calculated to analyze the location of ocular foreign bodies. ResultsThere were 38 cases of intraorbital foreign body identified by DR corneal suture ring localization method， and 46 cases of intraorbital foreign body identified by CT three-dimensional reconstruction localization method. The accuracy of CT three-dimensional reconstruction localization method was 90.20%， which was higher than that of DR corneal suture ring localization method 74.51% （P<0.05）. Intraocular foreign bodies in 23 cases could be distinguished by DR corneal suture ring localization， and 25 cases by CT 3D reconstruction localization. The maximum diameter of intraocular foreign bodies that could be distinguished by CT 3D reconstruction localization was （2.65±0.14） mm. The diameter of intraspherical foreign body was （2.94±0.36） mm （P<0.05） lower than that which could be distinguished by DR corneal suture ring localization method. The results of DR corneal suture ring localization of orbital foreign body showed no difference compared with the results of CT 3D reconstruction localization （P>0.05）. Forty cases of high density images inside and outside the eye could be clearly distinguished by CT 3D reconstruction. By using DR corneal suture ring localization method， 23 cases were confirmed to be intraocular high-density shadows， and 15 cases could not be confirmed to be intraocular high-density shadows （P < 0.05）. ConclusionsFor the location of intraorbital foreign bodies， CT three-dimensional reconstruction can be used as a conventional method for locating ocular foreign bodies with high resolution and accuracy， and can detect fine metal particles inside the eyeball. Meanwhile， for a few small foreign bodies in the iris root， ciliary body and lateral suspension ligament， it is necessary to locate orbital foreign bodies with DR corneal suture ring.

Tomografía computarizada con reconstrucción 3D para el diagnóstico de lesiones traumáticas de uretra / Three-dimensional computed tomography reconstruction for the diagnosis of traumatic urethral injuries

RESUMEN La uretrografía retrógrada es la técnica de referencia (gold standard) utilizada clásicamente para hacer diagnóstico de lesiones de uretra. En este contexto se presenta un caso en el que se realizó tomografía computarizada con reconstrucción 3D con contraste intravenoso y endouretral, pudiendo reconstruir la uretra en toda su extensión en forma tridimensional. De esta manera se arribó al diagnóstico de certeza de la lesión de uretra. Como ventaja del método se menciona la posibilidad de diagnosticar ‒ con un solo estudio por imágenes‒ lesiones de todo el tracto urinario, órganos sólidos, huecos y lesión del anillo pélvico asociados al traumatismo, con una alta sensibilidad y especificidad sin necesidad de requerir otros estudios complementarios.

ABSTRACT Retrograde urethrography is the gold standard method for the diagnosis of urethral injuries. In this setting, we report the use of computed tomography with intravenous injection and urethral administration of contrast medium and 3D reconstruction of the entire urethra. The definitive diagnosis of urethral injury was made. The advantage of this method is the possibility of making the diagnosis of traumatic injuries of the entire urinary tract, solid organs, hollow viscera and of the pelvic ring within a single imaging test, with high sensitivity and specificity, with no need to perform other complementary tests.

Bridging the structure gap between pellets in artificial dissolution media and in gastro-intestinal tract in rats

Changes in structure of oral solid dosage forms (OSDF) elementally determine the drug release and its therapeutic effects. In this research, synchrotron radiation X-ray micro-computed tomography was utilized to visualize the 3D structure of enteric coated pellets recovered from the gastrointestinal tract of rats. The structures of pellets in solid state and in vitro compendium media were measured. Pellets in vivo underwent morphological and structural changes which differed significantly from those in vitro compendium media. Thus, optimizations of the dissolution media were performed to mimic the appropriate in vivo conditions by introducing pepsin and glass microspheres in media. The sphericity, pellet volume, pore volume and porosity of the in vivo esomeprazole magnesium pellets in stomach for 2 h were recorded 0.47, 1.55 × 108 μm3, 0.44 × 108 μm3 and 27.6%, respectively. After adding pepsin and glass microspheres, the above parameters in vitro reached to 0.44, 1.64 × 108 μm3, 0.38 × 108 μm3 and 23.0%, respectively. Omeprazole magnesium pellets behaved similarly. The structural features of pellets between in vitro media and in vivo condition were bridged successfully in terms of 3D structures to ensure better design, characterization and quality control of advanced OSDF.

Effects of Fixed-Point Lateral Flexion and Rotation Manipulation on Intervertebral Foramina Morphology of Cervical Spondylotic Radiculopathy / 医用生物力学

Objective To analyze the changes in morphology of intervertebral foramina in patients with cervical spondylotic radiculopathy (CSR) treated with fixedpoint lateral flexion and rotation manipulation based on three-dimensional (3D) reconstruction technology, so as to provide references for the effectiveness of manipulation treatment. MethodsForty patients with CSR were treated with fixed point lateral flexion and rotation manipulation once every other day for a total of 7 times and 2 weeks as a course of treatment. CT data of the patients before and after treatment were analyzed by using multifunctional CT, Mimics 21.0, Geomagic and SolidWorks 2017. The area of the intervertebral foramen, anterior and posterior diameter of the intervertebral foramen, upper and lower diameter of the intervertebral foramen were measured before and after treatment, as well as the infrared thermal imaging temperature differences of the bilateral neck and shoulder, front and back of the upper limb, and the VAS scores of the patients were observed before treatment, 7 d after treatment, 14 d after treatment and 1 month follow-up. Results Foraminal area, anterior and posterior diameters, upper and lower diameters of 40 patients were improved after treatment, and the temperature differences of infrared thermal imaging of patients before and after treatment were statistically significant. The VAS score of the patients decreased progressively. Conclusions Fixed point lateral flexion manipulation can significantly improve the shape of the intervertebral foramen in patients with CSR, so as to achieve the treatment purpose of relieving nerve compression.

Morphological analysis and measurement of spinoglenoid notch of scapula based on 3D reconstruction of CT / 解剖学报

Objective To observe the anatomical structure of spinoglenoid notch of scapula by 3D reconstruction of normal adult scapula by computed tomography (CT), and to provide reference for clinical assessment of suprascapular nerve compression risk, suprascapular nerve compression treatment and shoulder joint operation. Methods Totally 335 cases of normal adult scapula were reconstructed by CT, and classified according to the anatomical shape of spinoglenoid notch; the spinoglenoid notch width (MN), spinoglenoid notch depth (OP), spinoglenoid notch thickness (XY), spinoglenoid notch angle (Z.M0N), distance from 0 point to the inner upper corner of scapula (0A), distance from 0 point to medial lateral edge of scapula (OB), distance from 0 point to inferior angle of scapula (OC) and distance from 0 point to the lowest point of suprascapular notch (OD) were observed and analyzed. Results 1. The morphology of spinoglenoid notch was divided into four types; U type (41. 79%), fin type (42. 99%), L type (8. 36%) and ladder type (6. 86%). U type and fin type were the most common types. Comparison of the four shapes; fin type was the narrowest (11.58 ± 1.74) mm and the deepest (14.58 ± 1.81) mm, the /_ M0N was the smallest (45.62 ± 6.43) ° and the ladder type was the widest (14. 20 ± 2. 67) mm and the shallowest (10. 80 ± 0. 79) mm, the Z.MON was maximum (57. 69 ± 2. 22) ° and the least prone to suprascapular nerve compression. 2. There was no significant difference in MN, OP, XY, zlMON, OA, OB, 0C and OD between left and right sides. 3. The data of MN, OP, XY, OA, OB, OC and OD of men were larger than those of women significantly, but Z. MON was smaller than that of women, indicating that men' s spinoglenoid notch was thicker, wider and deeper, and scapula was wider and longer than that of women. Conclusion The measurement of the morphological and anatomical characteristics of spinoglenoid notch with CT three-dimensional reconstruction is helpful to evaluate the risk of suprascapular nerve compression, the treatment of suprascapular nerve compression, and provide guidance for clinical shoulder surgery.

Anatomic classification of the acromial angle and its clinical significance / 解剖学报

Objective To study the acromial angle morphologic type and measurement analysis based on CT 3D reconstruction. Methods Totally 278 cases of adult CT three-dimensional reconstruction of the shoulder morphological data were collected, and the measurement data of the different types was analyzed, its statistical significance was clarified, and the morphological characteristics to division the type of acromial angle were summarized, its diagnosis and treatment under the acromion impingement of guiding significance were discussed. Results The acromial angle was divided into three types (C shaped acromial angle, L shaped acromial angle, and double angle shaped acromial angle). Among them, L type was the most, accounting for 48. 56%, followed by C type, and double angle type was the least. In comparison of the breadth of the acromion and the length of the acromion, L type was significantly longer than C type (P<0. 05). The thickness of acromion at a point of the double angle shaped acromial angle was greater than that of the other two type (P<0. 05). In the comparison of ∠a, the double-angle type was greater than the C type（P＜0.05）, and the C type was greater than the L type（P＜0.05）. Conclusion There are significant differences in the classification and anatomical parameters of acromial angle, and the differences are statistically significant. It has certain guiding significance to the etiology and clinical diagnosis and treatment of subacromial impingement syndrome.

Effect of iliac crest on L5-S1 transforaminal puncture and catheterization evaluated by CT scan and 3D reconstruction / 西安交通大学学报(医学版)

【Objective】 To analyze the effect of iliac crest on the difficulty of L5-S1 transforaminal puncture and catheterization by using CT images and oblique sagittal reconstruction images. 【Methods】 We made a retrospective analysis of the CT images and oblique sagittal reconstruction images of the adults aged from 30 to 50 years who underwent abdominopelvic CT examination in Affiliated Hospital of Nantong University. Based on the feasibility of puncture and catheterization， all the subjects were divided into two groups： group Ⅰ （suitable for puncture and catheterization） and group Ⅱ （unsuitable for puncture and catheterization）. We compared and analyzed differences in the rostral puncture inclination angle （α）， the abaxial angle of iliac crest （β）， the distance between the highest iliac crests （a）， the distance between sacroiliac joints （b）， the height of the superior articular process of sacral （c）， the height of iliac crest （d）， and the height of the superior articular process of sacral （c’） in the oblique sagittal images between the two groups. We explored the effect of anatomical indexes and iliac crests in oblique sagittal images on puncture and catheterization. 【Results】 The number of high/low iliac crests for group Ⅰ and group Ⅱ was （117/58 vs. 63/0）， and the number of men/women was 64/111 vs. 56/7， respectively. Variables α， b and c were higher in group Ⅰ than in group Ⅱ （34.77±4.86 vs. 31.11±5.16， P<0.001； 137.19±19.24 vs. 128.56±20.73， P = 0.003； 14.34±2.38 vs. 13.02±2.68， P<0.001）， and d was lower than that in group Ⅱ （27.51±6.73 vs. 37.65±6.35， P<0.001）. In addition， no statistically significant difference was found in the height of c of coronal CT scan and c’ of oblique sagittal reconstruction images （13.99±2.53 vs. 13.93±2.40， P = 0.465）. 【Conclusion】 It is more comprehensive and effective to evaluate preoperatively the influence of iliac crest on L5-S1 puncture and catheterization of TF-PELD by using CT scan and CT 3D reconstruction oblique sagittal images. The key factors in the evaluation of iliac crest are the degree of “cohesion” and the height. It is more easily to successfully puncture and catheterize when the shape of iliac crest is wider and lower. Therefore， it has higher probability to successfully puncture and catheterize in women.

Hemodynamic Analysis on Proximal End of the Aortic Dissection with Different Rupture Shapes / 医用生物力学

Objective To explore hemodynamic performance of the aortic dissection after lesions, so as to provide a more scientific basis for patient treatment. Methods Based on computed tomography angiography (CTA) image data from a patient with complex Stanford B-type aortic dissection, the personalized aortic dissection models with different rupture shapes (H-type, O-type, and V-type) at proximal end of the aortic dissection were established. Combined with computational fluid dynamics (CFD) and morphological analysis method, distributions of the velocity at rupture section, the blood flow, the wall pressure and the wall shear stress (WSS) were analyzed. Results The flow velocity, the highest pressure difference and the WSS proportion at entrance of the H-shaped rupture showed larger hemodynamic parameters than those of the other two types. The risk of dissection rupture for type H was the largest, while type V was in the middle, and type O was the smallest. Conclusions This study provides an effective reference for further numerical analysis the cases and formulation of treatment plans.

CT manifestations and application progress of airway complications after lung transplantation / 器官移植

With the continuous improvement of surgical techniques and perioperative management, the success rate of lung transplantation has gradually increased, but airway complications after lung transplantation are still common. Airway complications after lung transplantation may reduce the quality of life, increase medical costs, and even threaten the lives of the recipients. In 2018, the International Society for Heart and Lung Transplantation (ISHLT) consensus proposed that airway complications included ischemic necrosis, anastomotic dehiscence, airway stenosis and tracheobronchomalacia. Bronchoscopy remains the gold standard for the diagnosis of airway complications. However, during the follow-up of lung transplant recipients, use of end-inspiratory CT scan combined with end-expiratory or dynamic expiratory CT scan may contribute to identifying a variety of airway complications, evaluating the location and degree of airway complications and providing beneficial supplement for the selection of clinical treatment.

Application of Three-dimensional Reconstruction in Single Utility-port Thoracoscopic Segmentectomy for Early Stage Non-small Cell Lung Cancer: A Propensity Score-matched Analysis / 肿瘤防治研究

Objective To evaluate the clinical value of 3D reconstruction in the single utility-port thoracoscopic segmentectomy of early stage NSCLC by propensity score matching (PSM). Methods We retrospectively analyzed clinical data of 150 early stage NSCLC patients undergoing single utility-port thoracoscopic segmentectomy. The patients were divided into reconstruction group (n=58) and non-reconstruction group (n=92) according to 3D reconstruction. PSM was performed on two groups to compare perioperative outcomes. Results Procedures were successfully completed on all patients, without perioperative death. In each group, 43 patients were successfully matched after PSM on the basis of 8 confounding factors, age, gender, smoking status, BMI, maximum tumor diameter on CT, tumor location, % FEV1 and type of planned segmentectomy. After PSM, in complex segmentectomy, the patients in the reconstruction group had shorter operation time (155.77±30.17 vs. 212.94±66.49min, P < 0.001) and less blood loss (46.00±25.94 vs. 88.79±68.36ml, P=0.002), compared with the non- reconstruction group. Conclusion Preoperative 3D reconstruction could help improve the efficiency of single utility-port thoracoscopic surgery for complex segmentectomy and reduce intraoperative bleeding.

Medical image software in anatomical measurements and precision craniotomy via suboccipital retrosigmoid sinus approach / 中华神经医学杂志

Objective:To evaluate the application of a medical image software (RadiAnt) in anatomical measurements and precision craniotomy via suboccipital retrosigmoid sinus approach.Methods:A total of 43 inpatients who underwent craniocerebral CT venography (CTV) in our hospital from June 2020 to June 2021 were selected for the study; the CTV data of 35 patients was used to measure the spatial relations between transverse sigmoid sinus junction (TSSJ) and asterion; the preoperative planning in suboccipital retrosigmoid sinus craniotomy with the software was performed in the left 8 patients. Craniotomy time (subjected to exposure of venous sinus margin), venous sinus injury and incidence of complications within 2 weeks of craniotomy in these 8 patients were recorded.Results:(1) Anatomic measurement: for the left side, TSSJ was located at (0.89±0.33) cm lateral and (0.63±0.46) cm inferior to the asterion, and their direct distance was (1.15±0.42) cm; TSSJ was located at (0.76±0.49) cm interior and (1.97±0.52) cm superior to the starting point of the mastoid notch, and their direct distance was (2.18±0.49) cm; about 29% asterion were located superior to the transverse sinus, 37% were located on the surface of the transverse sinus, and 34% were located inferior to the transverse sinus. For the right side, TSSJ was located at (0.88±0.39) cm lateral and (0.64±0.43) cm inferior to the asterion, and their direct distance was (1.12±0.54) cm; TSSJ was located at (0.74±0.40) cm interior and (1.93±0.45) cm superior to the starting point of the mastoid notch, and their direct distance was (2.16±0.43) cm; about 26% asterion were located superior to the transverse sinus, 40% were located on the surface of the transverse sinus, and 34% were located inferior to the transverse sinus. (2) Preoperative planning and surgeries: in these 8 patients, the key-hole was located at (0.96±0.49) cm lateral and (0.53±0.18) cm inferior to the asterion, and (0.46±0.35) cm interior and (1.76±0.47) superior to the starting point of mastoid notch. The interior of sigmoid sinus was located (0.13±0.51) cm interior and (0.21±0.46) cm superior to the starting point of mastoid notch. The inferior of the transverse sinus was located (2.17±0.45) cm interior and (0.53±0.35) cm inferior to the asterion. An accurate localization of the real position of TSSJ, inferior of transverse sinus and interior of sigmoid sinus was performed in all 8 surgical patients. The distance between the margin of the bone window and the interior of sigmoid sinus was (3.5±1.0) mm, and the craniotomy time was (25.7±4.1) min; no sinus injury was noted. Post-operative CT showed good reposition of the bone flaps and less bone defect. There was no cerebrospinal fluid leakage or subcutaneous effusion during the 2 weeks of follow-up.Conclusion:Anatomical measurements and preoperative planning can be quickly finished with low cost with Radiant ?, which provides an efficient and safe method for accurate craniotomy via suboccipital retrosigmoid approach.

Value of preoperative multimodal image fusion 3D reconstruction technology in brain tumor surgery / 中华神经医学杂志

Objective:To explore the application value of preoperative multimodal image fusion 3D reconstruction technology in brain tumor surgery.Methods:The preoperative cranial CT and MR imaging data of 46 patients with brain tumors admitted to our hospital from October 2019 to September 2020 were collected. The image registration and fusion of above imaging data were performed by AW workstation software (GE company), and 3D reconstruction was performed to construct 3D digital anatomic image of brain tumor and its surrounding anatomic structure. Based on this, the surgical approach and surgical plan were designed, and its application value was evaluated by consistency grading.Results:The reconstructed 3D digital anatomical image could clearly show the size, location, shape of the tumors and the anatomical relationships between the tumors and surrounding structures, which was consistent with the original image before and during the surgery. Among the 46 patients, 43 were completely resected and 3 were partially resected. There were no approach-related complications after surgery. The application value of preoperative 3D image fusion was evaluated as 36 with outstanding value, 8 with value, and 2 without value.Conclusion:Preoperative multimodal image fusion 3D reconstruction technology can provide a large amount of visual information during brain tumor surgery, guide the choice of surgical approach and precise resection of tumors.

Clinical related factors for peritumoral brain edema in meningiomas / 中华神经医学杂志

Objective:To investigate the clinical related factors that affecting peritumoral brain edema (PTBE) and its severity in meningiomas.Methods:A total of 139 patients with meningiomas, admitted to and underwent surgery in our hospital from from January 2017 to October 2020 were chosen; their clinical data were analyzed retrospectively. Meningioma volume and edema volume were calculated from drawn regions of interest on preoperative MRI images by 3D-slicer software. Edema index (EI) was used to evaluate the severity of PTBE. The clinical factors affecting PTBE and EI were determined by statistical methods, and the value of meningioma volume in predicting PTBE was further analyzed.Results:(1) The PTBE incidence was 33.8% (47/139), and average EI was 2.47±0.73. (2) Univariate analysis showed that there was significant difference in percentage of patients with benign/malignant meningiomas, meningioma location, meningioma volume, and Ki-67 index between patients from PTBE group ( n=47) and non-PTBE group ( n=92, P<0.05). Multivariate binary Logistic regression analysis showed that benign/malignant meningiomas and meningioma volumes were independent risk factors for PTBE ( P<0.05). (3) There were significant differences in EI values among patients with different gender, WHO grading, KI-67 index and meningioma volumes ( P<0.05). Multivariate linear regression analysis showed meningioma malignant degrees and meningioma volume were independent risk factors for EI ( P<0.05). (4) Receiver operating characteristic curve showed that the area under curve of meningiomas of the cranial base and non-meningiomas of the cranial base in predicting PTBE was 0.824 and 0.825, respectively, with sensitivity of 0.800 and 0.784, and with specificity of 0.818 and 0.729. Conclusions:(1) Malignant degrees and meningioma volumes are the main factors affecting the incidence of PTBE, and are positively correlated with EI. (2) Meningioma volume has high predictive value in PTBE occurrence.