3D Knee Trochlear Morphology Assessment by Magnetic Resonance Imaging in Patients With Normal and Dysplastic Trochleae.
- 作者列表："Pennock AT","Chang A","Doan J","Bomar JD","Edmonds EW
BACKGROUND:Trochlear dysplasia is recognized as a significant risk factor for patellar instability, but current imaging modalities fail to allow full visualization and classification of the complex 3-dimensional (3D) anatomy of the trochlea. The purpose of this study was to elucidate primary differences in trochlear morphology between patients with and without patellar instability by utilizing 3D magnetic resonance imaging (MRI) reconstructions of the trochlea. METHODS:An institutional review board-approved retrospective review included 24 patients with a diagnosis of patellar instability and an age-matched and sex-matched control population of 12 patients. 3D models of the femoral trochlea were created from MRI images and measurements were performed. 3D measurements were trochlear groove volume and surface area that were normalized to the femoral width. 2D measurements were performed throughout the length of the trochlea including the bony and cartilaginous sulcus angles as well as the bony and cartilaginous trochlear depths. Differences were also assessed between sex, skeletal maturity, and trochlear dysplasia severity. RESULTS:Surface topography of the trochlea varied significantly based on location with the trochlea becoming progressively more flat proximally away from the notch (P<0.05). Patients with patella instability had reduced trochlear volumes and trochlear depths compared with control patients (P<0.05). These differences were more pronounced with the cartilaginous measurements as well as more proximally within the trochlea. Patients with high-grade dysplasia had greater reductions in trochlear volumes and depth especially proximally in the trochlea (P<0.05). Once femoral size was standardized, minimal differences were observed based on sex or skeletal maturity (P>0.05). CONCLUSIONS:Novel 3D MRI reconstructions demonstrated that measurements of trochlear morphology varied significantly between patients with and without patellar instability. When trochlear dysplasia is present, it appears to affect the majority of the trochlear surface, but preferentially the proximal extent. Future trochlear dysplasia classification systems may benefit from assessment of articular cartilage surface measures rather than primarily osseous structure measurements. LEVEL OF EVIDENCE:Level III-case-control prognostic study.
背景: 滑车发育不良被认为是髌骨不稳定的重要危险因素，但目前的成像模式无法对滑车的复杂三维 (3D) 解剖进行全面可视化和分类。本研究的目的是通过使用滑车的3D磁共振成像 (MRI) 重建来阐明伴有和不伴有髌骨不稳定的患者之间滑车形态的主要差异。 方法: 机构审查委员会批准的回顾性审查包括24例诊断为髌骨不稳定的患者和12例年龄匹配和性别匹配的对照人群。从MRI图像创建股骨滑车的3D模型并进行测量。3D测量为滑车槽体积和表面积，其标准化为股骨宽度。在滑车的整个长度上进行2D测量，包括骨和软骨沟角以及骨和软骨滑车深度。还评估了性别、骨骼成熟度和滑车发育不良严重程度之间的差异。 结果: 滑车的表面形貌因位置而显著变化，滑车从凹口近端逐渐变得更平坦 (P<0.05)。与对照组患者相比，髌骨不稳定患者的滑车体积和滑车深度减小 (P<0.05)。这些差异在软骨测量中更明显，以及在滑车内更接近。高度发育不良的患者滑车体积和深度减少更多，尤其是在滑车近端 (P<0.05)。一旦股骨尺寸标准化，基于性别或骨骼成熟度观察到最小差异 (P>0.05)。 结论: 新的3D MRI重建表明，滑车形态测量在髌骨不稳定和非髌骨不稳定患者之间有显著差异。当存在滑车发育不良时，它似乎影响滑车表面的大部分，但优先影响近端范围。未来的滑车发育不良分类系统可能受益于关节软骨表面测量的评估，而不是主要的骨结构测量。 证据级别: III级-病例对照预后研究。
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.