Gender-Associated Differences in Sacral Morphology Do Not Affect Feasibility Rates of Transsacral Screw Insertion. Radioanatomic Investigation Based on Pelvic Cross-sectional Imaging of 200 Individuals.
- 作者列表："Balling H
STUDY DESIGN:Retrospective radioanatomic single-center cohort study. OBJECTIVE:To investigate sex-specific differences in transsacral corridor dimensions, determine feasibility rates of transsacral screw placement without extended safety zones around planned screw positions, and develop an index defining sacral dysmorphism (SD) irrespective of transsacral corridor diameters. SUMMARY OF BACKGROUND DATA:Previously reported SD definitions used radiologically identifiable pelvic characteristics or predefined minimum diameter thresholds of transsacral corridors in the upper sacral segment including safety zones for screw placement. Technical progress of surgical 3D image guidance improved sacral screw insertion accuracy questioning established minimum diameter threshold-based SD definitions. METHODS:Datasets from cross-sectional pelvic imaging of 100 women and 100 men presenting to a general hospital from July 2018 through August 2018 were included in a database to evaluate transsacral trajectory rates, and dimensions of transsacral corridor lengths, widths (TSCWs), and heights (TSCHs) in sacral segments I to III (S1-3). SD was assumed, if no transsacral trajectory was found in S1 with a corridor diameter of at least 7.5 mm. RESULTS:Women presented significantly higher rates of transsacral trajectories in the inferior sector of S1 (P = 0.03), and larger transsacral corridor lengths in S2 (superior sector, P = 0.045), and S3 (central position, P = 0.02). In men, significantly higher feasibility rates were found for the placement of two transsacral screws in S2 (P = 0.0002), and singular screws in S3 (P = 0.006), with larger S1- (P = 0.0002), and central S2-TSCWs (P = 0.006). SD was prevalent in 17% of women, and 16% of men (P = 0.85). Calculating TSCW ratios of S1 and S2 was significantly indicative for SD at values below a threshold of 0.8 in women (P < 0.00001), and men (P = 0.0004). CONCLUSION:SD is independent of sex despite significant differences in sacral morphology. An index defining SD irrespective of absolute transsacral corridor dimensions is presented to reliably differentiate dysmorphic from nondysmorphic sacra in women and men. LEVEL OF EVIDENCE:2.
研究设计: 回顾性放射解剖学单中心队列研究。 目的: 研究经骶骨通道尺寸的性别差异，确定经骶骨螺钉放置的可行性率，在计划的螺钉位置周围没有延伸的安全区，并制定一个定义骶骨畸形 (SD) 的指标，而不考虑经骶骨通道直径。 背景数据摘要: 先前报告的SD定义使用放射学可识别的骨盆特征或骶上段经骶骨通道的预定最小直径阈值，包括用于螺钉放置的安全区。手术3D图像引导的技术进展提高了骶骨螺钉插入精度，质疑建立了基于最小直径阈值的SD定义。 方法: 从2018年7月至2018年8月在综合医院就诊的100名女性和100名男性的横断面骨盆成像数据集被纳入数据库，以评估经骶骨轨迹率以及经骶骨通道长度、宽度 (TSCWs) 和高度 (TSCHs) 的尺寸在骶段I至III (S1-3)。假设在通道直径至少为7.5 mm的S1中未发现经骶骨轨迹，则为SD。 结果: 女性在S1的下段表现出显著较高的经骶骨轨迹率 (p = 0.03)，在S2 (上段，p = 0.045) 和S3 (中心位置，p = 0.02) 表现出较大的经骶骨通道长度。在男性中，在S2 (p = 0.0002) 和S3 (p = 0.006) 中放置两个经骶骨螺钉的可行性率显著较高，S1-较大 (p = 0.0002) 和中S2-TSCWs (p = 0.006)。SD在17% 的女性和16% 的男性中流行 (p = 0.85)。在女性 (p <0.8) 和男性 (p = 0.00001) 中，计算S1和S2的TSCW比率显著指示了低于0.0004阈值的SD值。 结论: 尽管骶骨形态存在显著差异，但SD与性别无关。给出了定义SD的指数，而不考虑绝对经骶骨通道尺寸，以可靠地区分女性和非畸形骶骨。 证据级别: 2.
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.