Value of three-dimensional computed tomography reconstruction in the treatment of posterior tibial plateau fractures.
- 作者列表："Van den Berg J","Struelens B","Nijs S","Hoekstra H
BACKGROUND:Indication for surgical treatment of posterior tibial plateau fractures (TPFs) remains up for debate. Three-dimensional computed tomography (3D-CT) reconstruction can provide insight into fracture morphology and could improve treatment strategy and surgical planning. In this study, we investigated the value of 3D-CT reconstruction in the treatment of posterior TPF and evaluated the influence on surgical decision-making. METHODS:CT images of 34 cases with a TPF involving the posterior column were included and digitally presented to a panel of five international observers at two intervals. At the first evaluation, only coronal, axial and sagittal images were shown. After an interval of at least three weeks, 3D-CT reconstruction images were added. During both surveys, observers were asked to classify the TPF according to the revised three-column classification (rTCC), as well as to define operative strategy. RESULTS:When using 2D images, overall multirated kappa value was 0.48, with an average pairwise agreement of 68%. After adding 3D images, overall multirated kappa value was 0.43, with average pairwise agreement of 67%. Hierarchical logistic regression of decision to operate on image condition (3D vs. 2D) shows an odds ratio of 2.01 (95% confidence interval, 1.11-3.67), P = .022. Increase in operative indication was seen mainly in posterolateral fractures. CONCLUSION:This study investigated the value of 3D classification in the treatment of posterior column TPF. Contrary to expectations, the addition of 3D images to the assessment did not reduce but rather appeared to increase operative indications, especially in fractures involving the posterolateral region.
背景: 胫骨平台后侧骨折 (TPFs) 手术治疗的适应证仍有待商榷。三维计算机断层扫描 (3D-CT) 重建可以提供对骨折形态的洞察，并且可以改进治疗策略和手术计划。本研究探讨三维ct重建技术在后路TPF治疗中的应用价值，并评价其对手术决策的影响。 方法: 包括34例累及后柱的TPF患者的CT图像，并以两次间隔向五名国际观察员小组数字化呈现。在第一次评估时，仅显示冠状、轴向和矢状图像。间隔至少三周后，添加3D-CT重建图像。在这两次调查期间，观察员被要求根据修订的三栏分类 (rTCC) 对TPF进行分类，并确定运作战略。 结果: 当使用2D图像时，总体多分kappa值为0.48，平均成对一致性为68%。添加3D图像后，总体多分kappa值为0.43，平均成对一致性为67%。决定在图像条件下操作的分层逻辑回归 (3D vs. 2D) 显示2.01的比值比 (95% 置信区间，1.11-3.67)，p = .022。手术指征增加主要见于后外侧骨折。 结论: 本研究探讨三维分类在后柱TPF治疗中的价值。与预期相反，在评估中增加3D图像并没有减少，而是似乎增加了手术适应症，特别是在涉及后外侧区域的骨折中。
METHODS:OBJECTIVES:The aim was to evaluate the image quality and sensitivity to artifacts of compressed sensing (CS) acceleration technique, applied to 3D or breath-hold sequences in different clinical applications from brain to knee. METHODS:CS with an acceleration from 30 to 60% and conventional MRI sequences were performed in 10 different applications in 107 patients, leading to 120 comparisons. Readers were blinded to the technique for quantitative (contrast-to-noise ratio or functional measurements for cardiac cine) and qualitative (image quality, artifacts, diagnostic findings, and preference) image analyses. RESULTS:No statistically significant difference in image quality or artifacts was found for each sequence except for the cardiac cine CS for one of both readers and for the wrist 3D proton density (PD)-weighted CS sequence which showed less motion artifacts due to the reduced acquisition time. The contrast-to-noise ratio was lower for the elbow CS sequence but not statistically different in all other applications. Diagnostic findings were similar between conventional and CS sequence for all the comparisons except for four cases where motion artifacts corrupted either the conventional or the CS sequence. CONCLUSIONS:The evaluated CS sequences are ready to be used in clinical daily practice except for the elbow application which requires a lower acceleration. The CS factor should be tuned for each organ and sequence to obtain good image quality. It leads to 30% to 60% acceleration in the applications evaluated in this study which has a significant impact on clinical workflow. KEY POINTS:• Clinical implementation of compressed sensing (CS) reduced scan times of at least 30% with only minor penalty in image quality and no change in diagnostic findings. • The CS acceleration factor has to be tuned separately for each organ and sequence to guarantee similar image quality than conventional acquisition. • At least 30% and up to 60% acceleration is feasible in specific sequences in clinical routine.
METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.
METHODS:OBJECTIVE:The primary purpose of this study was to evaluate the effectiveness of a three-dimensional (3D) software tool (smart planes) for displaying fetal brain planes, and the secondary purpose was to evaluate its accuracy in performing automatic measurements. MATERIAL AND METHODS:This prospective study included singleton fetuses with a gestational age (GA) greater than 18 weeks. Transabdominal two-dimensional ultrasound (2DUS) and 3D smart planes images were respectively used to obtain the basic planes of the fetal brain, with five parameters measured. The images, by either two-dimensional (2D) manual or 3D automatic operation, were reviewed by two experienced sonographers. The agreements between two measurements were analyzed. RESULTS:A total of 226 cases were included. The rates of successful detection by automatic display were as high as 80%. There was substantial agreement between the measurements of the biparietal diameter, head circumference and transcerebellar diameter, but poor agreement between the measurements of cisterna magna and lateral ventricle width. CONCLUSIONS:Smart Planes might be valuable for the rapid evaluation of fetal brain, because it simplifies the evaluation process. However, the technology requires improvement. In addition, this technology cannot replace the conventional manual US scans; it can only be used as an additional approach.