Determinants of perivascular adipose tissue stranding as a novel imaging marker and its relation to inflammatory biomarker high-sensitivity C-reactive protein.

Purpose: This study aimed to examine the relationship of perivascular adipose tissue (PVAT) stranding in coronary computed tomography angiography (CCTA) with high-sensitivity C-reactive protein (hsCRP) and the determinants of PVAT stranding in coronary artery disease (CAD) patients. Material and methods: This retrospective cross-sectional study was done by collecting data from CAD patients who were referred to Rajaie Cardiovascular Centre between January 2018 and September 2020, with CCTA and hsCRP test 72 hours apart from the CCTA. PVAT stranding was defined as irregular obscuration of PVAT adjacent to the coronary arteries. An attempt was made to find a correlation between included variables and PVAT stranding by comparing them between 2 groups: patients with and without PVAT stranding. Results: From 92 patients, 31 participants had PVAT stranding, and statistically significant higher levels of hsCRP were detected in them (p = 0.007). We demonstrated significantly higher prevalence of history of hyperlipidaemia (OR = 3.83, p = 0.029), high-risk plaque features (OR = 11.80, p = 0.015), and obstructive coronary luminal stenosis (OR = 3.25, p = 0.025) in patients with PVAT stranding. Also, significantly higher PVAT attenuation was detected in patients with PVAT stranding (p < 0.001) independently from mean attenuation of epicardial fat. Conclusion: PVAT stranding could be used as a novel non-invasive marker in CCTA of CAD patients. More studies focusing on patient outcomes are required to better evaluate the reliability and prognostic value of this marker.

Coronary artery calcification: Effects on severity and survival in patients with COVID-19.

Background: The aim of this study was to evaluate the effect of coronary artery calcification on disease severity and prognosis in patients with coronavirus disease-2019 (COVID-19). Materials and Methods: One hundred and forty-one patients with COVID-19 were included in this study. The severity of pulmonary involvement and calcification of coronary arteries were assessed by computed tomography scan and calcification was classified by two methods: Weston and segmental. In both the methods, patients were divided into three groups with scores of 0, 1-6, and 7-12, which are called groups 1, 2, and 3, respectively. Results: The mean age of patients was 54.26 ± 14.55. Difference in score of pulmonary involvement was reported to be significant between deceased and discharged patients (11.73 ± 5.26 and 7.28 ± 4.47, P = 0.002, respectively). In Weston score system, the chance of recovery of Group 1 patients was significantly higher than Group 3 (odds ratio [OR] =6.72, P = 0.05, 95% confidence interval [CI] =1.901-50.257). Similar results were observed in the segmental scoring system (OR =6.34, P = 0.049, 95% CI =1.814-49.416). Despite the higher chance of severe disease in patients with coronary artery calcification, this increase was not statistically significant in either Weston or segmental methods (OR =0.47, P = 0.23 and OR =0.85, P = 0.79, respectively). Conclusion: Coronary artery calcification in patients with COVID-19 has a significant association with poor prognosis. However, no significant relationship was observed between this issue and the severity.

Association between pulmonary arterial obstruction index and right lateral ventricular wall thickness with in-hospital mortality in patients with acute pulmonary embolism.

PURPOSE: To retrospectively assess the correlation between pulmonary arterial obstruction index (PAOI) and right lateral ventricular wall thickness with in-hospital mortality in patients with acute pulmonary embolism. METHODS: CT angiography (CTA) of 55 consecutive patients (30 males; 25 females; mean age ± SD, 59 ± 11 years) with proven acute pulmonary embolism was investigated. PAOI was determined according to the Qanadli score on CTA. Right ventricular lateral wall thickness was also measured, and patients' in-hospital mortality was recorded. The correlation between PAOI and mortality, right ventricular lateral wall thickness and mortality, and PAOI and right ventricular lateral wall thickness was evaluated. RESULTS: PAOI was 23.6 and 10.4 in patients with and without in-hospital mortality, respectively (P < 0.001). Right ventricular lateral wall thickness was 8.7 mm and 7.5 mm in patients with and without in-hospital mortality, respectively (P < 0.001). PAOI more than 21.5 and right ventricular lateral wall thickness more than 8.75 were predictive of in-hospital mortality with a high accuracy. Also, PAOI and right ventricular lateral wall thickness had a significant correlation with each other (P < 0.001; r = 0.695). CONCLUSION: PAOI and right ventricular lateral wall thickness on CTA were highly predictive of in-hospital mortality in patients with pulmonary embolism. Right ventricular lateral wall thickness and PAOI had a significant correlation with each other as well.

Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset.

OBJECTIVES: To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. METHODS: The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). RESULTS: 4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models. CONCLUSIONS: Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations. KEY POINTS: • Duke clinical score is not implemented correctly in NICE guideline 95. • Pretest probability assessment in NICE guideline 95 is impossible for most patients. • Improved clinical decision making requires accurate pretest probability calculation. • These refinements are essential for appropriate use of cardiac CT.

Correction to: Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset.

The original version of this article, published on 19 March 2018, unfortunately contained a mistake. The following correction has therefore been made in the original: The names of the authors Philipp A. Kaufmann, Ronny Ralf Buechel and Bernhard A. Herzog were presented incorrectly.

Pulmonary Embolism As a Consequence of Ultrasonographic Examination of Extremities for Suspected Venous Thrombosis: A Systematic Review.

Ultrasonographic examination for deep vein thrombosis (DVT) appears to be a safe diagnostic method, but a theoretical concern has been raised for dislodgment of thrombi during examination. We conducted a systematic review of the literature to identify reports of possible or confirmed pulmonary embolism (PE) as a consequence of ultrasonographic assessment of extremities in patients with suspected DVT. We searched PubMed for studies published in English from January 1, 1960, to April 10, 2015. We included all cohort studies, case series, and case reports that described PE as a consequence of ultrasonographic assessment of extremities. We excluded studies that reported assessment of areas other than extremities. We screened 3,626 articles, 15 of which reported the issue of clot dislodgement and embolization following ultrasonographic examination of the extremities, including 8 original case reports (7 men and 1 woman). DVTs were in the lower extremities in all eight cases: five in right and three in left lower extremity. In six cases, the femoral veins were involved, and a free-floating thrombus was reported in two cases. Compression ultrasonography was used in all cases, with or without adjunct techniques. Overall, there were seven confirmed and one probable PE cases, two of which had fatal outcomes. Clot embolization is a rare but potential complication of ultrasonic examination for DVT that can lead into PE. Radiologists and clinicians should be aware of this potentially serious phenomenon and avoid excessive pressure when performing ultrasonographic studies of the extremities.

Abdominal fat sonographic measurement compared to anthropometric indices for predicting the presence of coronary artery disease.

OBJECTIVES: Sonography for measuring intra-abdominal fat is more accurate than anthropometric measurements. Computed tomographic (CT) angiography has become an accurate noninvasive method for detection of coronary artery disease (CAD). We examined the associations between both sonographic and anthropometric measurements of abdominal adiposity and the presence of CAD on CT angiography. METHODS: We evaluated 83 consecutive patients (70% men; mean age ± SD, 56 ± 10.8 years) who were referred for CT angiography. Clinical and laboratory variables were determined, and CT angiography was performed using a 64-slice scanner. The severity of CAD was defined by visual assessment of any plaque, either calcified or noncalcified. Preperitoneal fat, subcutaneous fat, and visceral fat thicknesses were determined on sonography, and the abdominal fat index was calculated as the preperitoneal fat thickness-to-subcutaneous fat thickness ratio. RESULTS: Coronary artery disease was detected in 56 patients (67%). Patients with CAD had higher visceral fat thickness (9.3 ± 2.0 versus 8.2 ± 2.2 cm; P = .035) and a higher waist-to-hip ratio (0.97 ± 0.07 versus 0.92 ± 0.07; P = .018) than those without CAD. The preperitoneal fat thickness, subcutaneous fat thickness, and abdominal fat index were not correlated with the CAD status. After adjusting for traditional cardiovascular risk factors, however, only a waist-to-hip ratio higher than 0.95 remained significantly associated with the presence of CAD (odds ratio, 4.03; 95% confidence interval, 1.2-13.4). CONCLUSIONS: This study shows that sonographically based obesity measurements are not superior to anthropometric indices in predicting the presence of CAD.

Not-to-tap cystic lesions: spectrum of hydatid disease.

Hydatid disease (HD) may occur almost anywhere in the body. Despite their characteristic radiologic manifestations at times, they may enlarge and produce bizarre imaging features which make diagnosis challenging, particularly for those radiologists working in areas of low incidence. Plain radiography, ultrasonography, computed tomography, and magnetic resonance imaging may demonstrate some of the typical imaging manifestations of HD as well as its exact extension. On the other hand, particular caution is required before any kind of interventions to be done in that biopsy or aspiration of such lesions may cause devastating consequences, in particular anaphylactic shock. Hence, being familiar with various radiologic features of HD is essential in improving diagnostic accuracy and also preventing adverse reactions in these patients. The purpose of this pictorial review is to illustrate the different radiological features of HD in various organs.

Left ventricular ejection fraction impact on contrast opacification of coronary artery bypass grafts in 64-slice multidetector computed tomography angiography.

OBJECTIVE: The objective of the study was to find whether changes in left ventricular ejection fraction (LVEF) have an impact on contrast opacification of coronary artery bypass grafts (CABGs) in coronary computed tomography angiography (CTA). METHODS: One hundred two CABG patients were assessed using 64-slice CTA. Concurrently, their LVEF was measured using computed tomography. Density of grafts were measured, and their correlation with parameters including LVEF determined. RESULTS: A total of 253 grafts including 89 left internal mammary artery (LIMA) grafts, 41 saphenous vein grafts (SVGs) to diagonal artery, 66 SVGs to obtuse marginal (OM) artery, and 57 SVGs to posterior descending artery (PDA) were patent and assessed. Mean measured LVEF was 49% (SD, 7%). Mean attenuation value of the LIMA grafts was 302.39 (SD, 91.16) Hounsfield units (HU), and those of SVGs to diagonal artery, SVGs to OM artery, and SVGs to PDA were 348.73 (SD, 100.38) HU, 326.95 (SD, 101.41) HU, and 339.50 (SD, 111.67) HU, respectively. A significant negative correlation was found between LVEF and mean attenuation values of LIMA graft (P < 0.001; r = -0.80), SVG to diagonal artery (P < 0.001; r = -0.66), SVG to OM artery (P < 0.001; r = -0.75), and SVG to PDA (P < 0.001; r = -0.76). CONCLUSIONS: A negative correlation was found between density of grafts and LVEF of CABG patients, which is usually echocardiographically assessed before CTA.

Comparison of virtual bronchoscopy with fiberoptic bronchoscopy findings in patients exposed to sulfur mustard gas.

BACKGROUND: Fiberoptic bronchoscopy (FB) is the best modality for evaluation of tracheobronchial endoluminal lesions. Virtual bronchoscopy (VB) with the aid of computed tomography (CT) makes it possible to reconstruct endoscopic-like visualization of major airways. Sulfur mustard (SM) used during the Iraq-Iran war affects respiratory tracts and can lead to tracheobronchial stenosis. PURPOSE: To compare VB with FB in SM-exposed patients suspected for airway stenosis. MATERIAL AND METHODS: Thirty-one patients were evaluated with CT and bronchoscopic studies about 15 years after chemical attacks. The median age of patients was 40 years. Spiral CT scans were obtained and data were transferred to a workstation to generate VB images of major airways. Less than one week after CT scan, FB was performed. RESULTS: For the tracheal pathologies seen in FB, the sensitivity, specificity, and accuracy of VB was 90.9%, 95%, and 93.5% for tracheal stenosis, 40%, 96.2%, and 87.1% for vocal cord problems, 100%, 100%, and 100% for postoperative changes, and 100%, 96.7%, and 96.8% for intratracheal nodule. The inflammation of mucosal surface could not be assessed by VB. The bronchial pathologies seen in FB included eight cases of stenosis, and one case of nodule. Sensitivity, specificity, and accuracy of VB for detection of bronchial stenosis was 62.5%, 97.8% and 92.6%, respectively. Overall sensitivity, specificity and accuracy of VB in detecting tracheobronchial stenosis were 78.9%, 97.0%, and 92.9%, respectively. CONCLUSION: Our study indicates that VB is an accurate method for evaluating stenoses, endoluminal nodules, and poststenotic areas within the tracheobronchial tree of SM-exposed victims. This complementary method could be helpful in revealing hidden post-stenotic lesions and also better depict the long tracheal strictures and their actual length.

Correlation Between Low-Dose Chest Computed Tomography and RT-PCR Results for the Diagnosis of COVID-19: A Report of 27,824 Cases in Tehran, Iran.

RATIONALE AND OBJECTIVES: Real-time polymerase chain reaction (RT-PCR) remains the gold standard for confirmation of Coronavirus Disease 2019 (COVID-19) despite having many disadvantages. Here, we investigated the diagnostic performance of chest computed tomography (CT) as an alternative to RT-PCR in patients with clinical suspicion of COVID-19 infection. METHODS: In this descriptive cross-sectional study, 27,824 patients with clinical suspicion of COVID-19 infection who underwent unenhanced low-dose chest CT from 20 February, 2020 to 21 May, 2020 were evaluated. Patients were recruited from seven specifically designated hospitals for patients with COVID-19 infection affiliated to Shahid Beheshti University of Medical Sciences. In each hospital, images were interpreted by two independent radiologists. CT findings were considered as positive/negative for COVID-19 infection based on RSNA diagnostic criteria. Then, the correlation between the number of daily positive chest CT scans and number of daily PCR-confirmed cases and COVID-19-related deaths in Tehran province during this three-month period was assessed. The trends of admission rate and patients with positive CT scans were also evaluated. RESULTS: A strong positive correlation between the numbers of daily positive CT scans and daily PCR-confirmed COVID-19 cases (r = 0.913, p < 0.001) was observed. Furthermore, in hospitals located in regions with a lower socioeconomic status, the admission rate and number of positive cases within this three-month period was higher as compared to other hospitals. CONCLUSION: Low-dose chest CT is a safe, rapid and reliable alternative to RT-PCR for the diagnosis of COVID-19 in high-prevalence regions. In addition, our study provides further evidence for considering patients' socioeconomic status as an important risk factor for COVID-19.

A new approach to cardiac fat volume assessment and the correlation with coronary artery calcification.

BACKGROUND: Coronary artery disease (CAD) is the foremost cause of death in the most developed societies. Plaque formation in epicardial coronary arteries and ensuing inflammation are a known pathophysiologic factor of CAD. OBJECTIVES: We aimed to separately and simultaneously evaluate the correlation between pericardial fat pad volume and overall peri-coronary epicardial adipose tissue (EAT) thickness with coronary calcium score (CCS) to improve risk stratification of CAD. METHODS: We retrospectively reviewed patients who underwent a non-invasive contrast-enhanced coronary multidetector CT (MDCT) angiography. Peri-coronary EAT thickness, pericardial fat pad volume and CCS were obtained by an expert radiologist from the patients coronary multidetector CT (MDCT) angiography. RESULTS: We included 141 symptomatic patients (86 men, 55 women) with an average age of 53.53 ± 12.92. An increment of overall peri-coronary EAT thickness (1/3 × (left anterior descending artery (LAD) + left circumflex artery (LCx) + right coronary artery (RCA)) was associated with a 49% increase in the odds for the presence of coronary artery calcification (CAC) (P = 0.004). Significant predictability of peri-coronary EAT-average was seen in diagnosing calcified plaque. Pericardial fat pad volume was positively correlated with overall peri-coronary EAT thickness in age and body mass index (BMI)-adjusted linear regression models, (P < 0.001). CONCLUSION: Our results amplify previous idea that peri-coronary EAT and pericardial fat pad volume might act as useful markers and better indicators of CCS based on Agatston score in comparison with BMI or body weight in order to reveal subsequent CADs.

Diagnostic performance of 64-channel multislice computed tomography in assessment of significant coronary artery disease in symptomatic subjects.

The recent development of 64-channel multislice computed tomography (MSCT) has resulted in noninvasive coronary artery imaging improvement. This study was conducted to determine the accuracy of 64-slice MSCT in a relatively unselected group of 143 patients with presentations suggestive of coronary artery disease, including those with unstable angina pectoris, who underwent both coronary computed tomographic angiography and invasive coronary angiography. No arrhythmia was considered an exclusion criterion except for atrial fibrillation or frequent extrasystoles. In patients with fast heart rates, a beta blocker was administered orally. Data were obtained using electrocardiography gated 64-slice MSCT. Computed tomographic angiography and invasive coronary angiography findings of each coronary segment were compared to determine the sensitivity, specificity, positive predictive value, and negative predictive value of MSCT in the detection of their normalcy or insignificant (<50% diameter decrease) stenosis versus significant (>or=50% diameter decrease) stenosis or total occlusion. In per-patient assessment, the calculated sensitivity, specificity, positive predictive value, and negative predictive value of MSCT were 96%, 67%, 91%, and 83%, respectively. These values in per-artery evaluation were 94%, 94%, 87%, and 97%, and corresponding values in per-segment analysis were 92%, 97%, 77%, and 99%, respectively. In conclusion, computed tomographic angiography has high diagnostic performance in the assessment of significant coronary artery disease in most patients in a daily routine practice, including those presenting with unstable angina pectoris symptoms.

Idiopathic inferior mesenteric arteriovenous fistula: a rare cause of pulsatile abdominal mass.

Inferior mesenteric arteriovenous fistula (AVF) is an extremely rare vascular abnormality which may be idiopathic or secondary to previous trauma or surgery, and it may result in portal hypertension or ischemic colitis if left untreated. Imaging can help accurately diagnose visceral AVFs and create a vascular map to display the feeding artery and draining vein before the surgery; however, multidetector computed tomography (MDCT) angiography of inferior mesenteric AVF is not well documented in the literature. In this article, the authors report a case of inferior mesenteric AVF in a 48-year-old woman evaluated for left-sided abdominal pain and diagnosed preoperatively by MDCT angiography. Surgical excision of the AVF was successfully performed, and the postoperative course was uneventful.

Individual patient data meta-analysis for the clinical assessment of coronary computed tomography angiography: protocol of the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT).

BACKGROUND: Coronary computed tomography angiography has become the foremost noninvasive imaging modality of the coronary arteries and is used as an alternative to the reference standard, conventional coronary angiography, for direct visualization and detection of coronary artery stenoses in patients with suspected coronary artery disease. Nevertheless, there is considerable debate regarding the optimal target population to maximize clinical performance and patient benefit. The most obvious indication for noninvasive coronary computed tomography angiography in patients with suspected coronary artery disease would be to reliably exclude significant stenosis and, thus, avoid unnecessary invasive conventional coronary angiography. To do this, a test should have, at clinically appropriate pretest likelihoods, minimal false-negative outcomes resulting in a high negative predictive value. However, little is known about the influence of patient characteristics on the clinical predictive values of coronary computed tomography angiography. Previous regular systematic reviews and meta-analyses had to rely on limited summary patient cohort data offered by primary studies. Performing an individual patient data meta-analysis will enable a much more detailed and powerful analysis and thus increase representativeness and generalizability of the results. The individual patient data meta-analysis is registered with the PROSPERO database (CoMe-CCT, CRD42012002780). METHODS/DESIGN: The analysis will include individual patient data from published and unpublished prospective diagnostic accuracy studies comparing coronary computed tomography angiography with conventional coronary angiography. These studies will be identified performing a systematic search in several electronic databases. Corresponding authors will be contacted and asked to provide obligatory and additional data. Risk factors, previous test results and symptoms of individual patients will be used to estimate the pretest likelihood of coronary artery disease. A bivariate random-effects model will be used to calculate pooled mean negative and positive predictive values as well as sensitivity and specificity. The primary outcome of interest will be positive and negative predictive values of coronary computed tomography angiography for the presence of coronary artery disease as a function of pretest likelihood of coronary artery disease, analyzed by meta-regression. As a secondary endpoint, factors that may influence the diagnostic performance and clinical value of computed tomography, such as heart rate and body mass index of patients, number of detector rows, and administration of beta blockade and nitroglycerin, will be investigated by integrating them as further covariates into the bivariate random-effects model. DISCUSSION: This collaborative individual patient data meta-analysis should provide answers to the pivotal question of which patients benefit most from noninvasive coronary computed tomography angiography and thus help to adequately select the right patients for this test.

Prevalence of Congenital Coronary Artery Anomalies and Variants in 2697 Consecutive Patients Using 64-Detector Row Coronary CTAngiography.

BACKGROUND: Coronary artery anomalies are not common, but could be very serious. OBJECTIVES: This study determines the frequency of coronary anomalies and normal variants by multi-detector-row computed tomography (MDCT). PATIENTS AND METHODS: The results of cardiac MDCT study in 2697 consecutive patients were analyzed retrospectively. Acquisition was performed by a 64-detector row CT machine. Imaging results were assessed by experienced radiologists. RESULTS: Myocardial bridging was by far the most frequent coronary variant (n = 576, 21.3%). Eighty-three subjects (3.1%) showed other coronary anomalies and variants. Anomalies of origination and course of the left main coronary artery (LMCA) were detected in 1.09% of the subjects. The frequency of these anomalies in the right coronary artery (RCA), left circumflex artery (LCx), left anterior descending artery (LAD), posterior descending artery (PDA) and obtuse marginal (OM) artery were 1.24%, 0.33%, 0.1%, 0.07% and 0.03%, respectively. The single coronary pattern was seen in 0.18% and coronary fistulas in 0.07%. CONCLUSION: Based on the fact that coronary CT-angiography using MDCT can display different coronary anomalies, this study shows similar results to other reports on the subject. Future advances in the performance of CT machines will further improve the quality of CT-based cardiac imaging.

Diagnostic performance of multislice CT coronary angiography in the assessment of significant coronary artery disease.

The use of noninvasive assessment tools such as multi-slice CT coronary angiography (MSCT-CA-CA) is recently considered mainly because it offers safety, patient convenience, and faster performance. The aim of the present study was to determine the ability of MSCT-CA-CA for the detection of significant stenoses in the coronary arteries, in comparison to conventional invasive coronary angiography (ICA). A total of 58 consecutive patients who were candidate for coronary angiography, with the diagnosis of acute coronary syndrome, from September 2006 to March 2006 were entered into the study. They underwent both coronary MSCT-CA-CA and ICA. The findings of each coronary segment were compared to MSCT-CA-CA in comparison with ICA. Based on artery analysis, sensitivity and specificity of MSCT-CA for the detection of involvement in RCA were 90.0% and 92.8%, in LAD were 71.8% and 92.9% and in LCX were 67.9% and 92.6%, respectively. On a per-segment basis, the sensitivity of MSCT-CA in the detection of injured segments ranged between 33.3% (for segment 11) and 100% (for segments 1, 2 and 12). Also, specificity ranged from 63.6% (for segment 15) and 98.1% (for segment 6). The presence of hypertension, hyperlipidemia, and smoking led to the reduction of the specificity and accuracy of MSCT-CA, whereas history of diabetes mellitus could increase the specificity and accuracy of this tool. MSCT-CA has high diagnostic performance in the assessment of significant coronary artery disease. Risk factors for coronary artery disease may influence this performance.

Three-dimensional anatomy of the pelvic bone in bladder exstrophy: comparison between patients managed with osteotomy and pubic symphysis internal fixation using metal plates.

OBJECTIVES: To compare intrapelvic osseous dimensions in classic bladder exstrophy patients who underwent pelvic osteotomy and pubic symphysis internal fixation, using metal plates without osteotomy by defining intrapelvic angles and distances using three-dimensional computed tomography scan (3D-CT). METHODS: Fourteen exstrophy patients who were operated with osteotomy (OST) and 19 patients who had undergone pubic approximation using metal plates (PLT) were enrolled in this study. 3D-CT was performed to measure 8 intrapelvic angles and 9 distances. In addition, a 3D-CT image of control group of 14 age- and sex-matched patients and the preoperative data of 12 cases (6 patients in each group) were considered to compare the bony aspects of exstrophy patients before and 6 months after surgery. RESULTS: Sacroiliac joint angle, pubococcygeal angle, ischiopubic angle, pubic diastasis, and inter-triradiate distance were different from controls in both techniques. Iliac wing angle, however, was at near normal values in PLT group. The result of before-after comparison revealed significant changes in iliac wing angle, sacroiliac joint angle, and pubic diastasis in both groups. CONCLUSIONS: Our study suggests that internal fixation of pubic arch using metal plates in bladder exstrophy may be as effective as the currently accepted osteotomy-containing techniques from the standpoint of intrapelvic osseous dimensions and angles. Modification of our new pubic approximation technique is essential to better recapitulate the anatomy of the normal bony pelvis.