3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement.
- 作者列表："Lintz F","Mast J","Bernasconi A","Mehdi N","de Cesar Netto C","Fernando C","International Weight-Bearing CT Society.","Buedts K
BACKGROUND:We investigated the association between hindfoot residual malalignment assessed on weightbearing computed tomography (WBCT) images and the development of periprosthetic cysts (PPCs) after total ankle replacement (TAR). We hypothesized that PPCs would be found predominantly medially in the varus configuration and laterally in the valgus configuration. METHODS:Cases of primary TAR with available WBCT imaging of the ankle were included in this retrospective study. The location of the PPC was marked and the following volumes were calculated: total (TCV), medial (MCV), central (CCV), and lateral (LCV) cyst volumes. Hindfoot alignment was measured as Foot and Ankle Offset (FAO), with 95% confidence intervals (95% CIs) calculated to define varus (<95% CI) and valgus (>95% CI) groups. Cyst volumes were compared between these 2 groups. The American Orthopaedic Foot & Ankle Society (AOFAS) score at the time of the WBCT was also retrieved. Receiver operating characteristic (ROC) curves were used to determine FAO thresholds for predicting an increased risk of PPC. RESULTS:Forty-eight TARs (mean follow-up, 44.6 months) were included, 81% of which had at least 1 PPC. The mean FAO was 0.12% (95% CI, -1.12 to 1.36). Patients with greater residual malalignment (P < .001) and those with longer follow-up (P < .001) presented with increased TCV. In varus cases, the MCV was greater than the LCV (P = .042), with a threshold FAO value of -2.75% or less predicting an increased MCV. In valgus cases, the LCV was greater than the MCV (P = .049), with a FAO threshold value of 4.5% or more predicting an increased LCV. CONCLUSION:In this series, the PPC volume after primary TAR significantly correlated with postoperative hindfoot malalignment and longer follow-up. LEVEL OF EVIDENCE:Level III, retrospective comparative series.
背景: 我们研究了在负重计算机断层扫描 (WBCT) 图像上评估的后足残余对准不良与全踝关节置换 (TAR) 后假体周围囊肿 (PPCs) 发展之间的关联。我们假设PPCs主要见于内翻构型的内侧和外翻构型的外侧. 方法: 本回顾性研究纳入了可获得踝关节WBCT成像的原发性TAR病例。标记PPC的位置并计算以下体积: 总 (TCV) 、内侧 (MCV) 、中央 (CCV) 和外侧 (LCV) 囊肿体积。后足对准测量为足和踝偏移 (FAO)，计算95% 置信区间 (95% CI) 以定义内翻 (<95% CI) 和外翻 (>95% CI) 组。比较两组间的囊肿体积。还检索了WBCT时的美国矫形足踝协会 (AOFAS) 评分。受试者工作特征 (ROC) 曲线用于确定用于预测PPC风险增加的FAO阈值。 结果: 包括48个TARs (平均随访，44.6个月)，其中81% 具有至少1个PPC。平均FAO值为0.12% (95% CI，-1.12 ~ 1.36)。残留排列不良较大 (P < .001) 和随访时间较长 (P < .001) 的患者TCV增加。在内翻病例中，MCV大于LCV (P = .042)，FAO阈值为-2.75% 或更低预测MCV增加。在外翻病例中，LCV大于MCV (P = .049)，FAO阈值为4.5% 或更高预测LCV增加。 结论: 在这个系列中，原发性TAR术后PPC体积与术后后足排列不良和更长的随访显著相关。 证据级别: III级，回顾性比较系列。
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.