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Linkugel AD, Wang T, Boroojeni PE, Eldeniz C, Chen Y, Skolnick GB, Commean PK, Merrill CM, Strahle JM, Goyal MS, An H, Patel KB. MR Cranial Bone Imaging: Evaluation of Both Motion-Corrected and Automated Deep Learning Pseudo-CT Estimated MR Images. AJNR Am J Neuroradiol 2024:ajnr.A8335. [PMID: 38991771 DOI: 10.3174/ajnr.a8335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/19/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND AND PURPOSE CT imaging exposes patients to ionizing radiation. MR imaging is radiation free but previously has not been able to produce diagnostic-quality images of bone on a timeline suitable for clinical use. We developed automated motion correction and use deep learning to generate pseudo-CT images from MR images. We aim to evaluate whether motion-corrected pseudo-CT produces cranial images that have potential to be acceptable for clinical use. MATERIALS AND METHODS Patients younger than age 18 who underwent CT imaging of the head for either trauma or evaluation of cranial suture patency were recruited. Subjects underwent a 5-minute golden-angle stack-of-stars radial volumetric interpolated breath-hold MR image. Motion correction was applied to the MR imaging followed by a deep learning-based method to generate pseudo-CT images. CT and pseudo-CT images were evaluated and, based on indication for imaging, either presence of skull fracture or cranial suture patency was first recorded while viewing the MR imaging-based pseudo-CT and then recorded while viewing the clinical CT. RESULTS A total of 12 patients underwent CT and MR imaging to evaluate suture patency, and 60 patients underwent CT and MR imaging for evaluation of head trauma. For cranial suture patency, pseudo-CT had 100% specificity and 100% sensitivity for the identification of suture closure. For identification of skull fractures, pseudo-CT had 100% specificity and 90% sensitivity. CONCLUSIONS Our early results show that automated motion-corrected and deep learning-generated pseudo-CT images of the pediatric skull have potential for clinical use and offer a high level of diagnostic accuracy when compared with standard CT scans.
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Affiliation(s)
- Andrew D Linkugel
- From the Division of Plastic and Reconstructive Surgery (A.D.L., G.B.S., C.M.M., K.B.P.), Washington University in St. Louis, St. Louis, Missouri
| | - Tongyao Wang
- Mallinckrodt Institute of Radiology (T.W., P.E.B., C.E., P.K.C., M.S.G., H.A.), Washington University in St. Louis, St. Louis, Missouri
| | - Parna Eshraghi Boroojeni
- Mallinckrodt Institute of Radiology (T.W., P.E.B., C.E., P.K.C., M.S.G., H.A.), Washington University in St. Louis, St. Louis, Missouri
| | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology (T.W., P.E.B., C.E., P.K.C., M.S.G., H.A.), Washington University in St. Louis, St. Louis, Missouri
| | - Yasheng Chen
- Department of Neurology (Y.C., H.A.), Washington University in St. Louis, St. Louis, Missouri
| | - Gary B Skolnick
- From the Division of Plastic and Reconstructive Surgery (A.D.L., G.B.S., C.M.M., K.B.P.), Washington University in St. Louis, St. Louis, Missouri
| | - Paul K Commean
- Mallinckrodt Institute of Radiology (T.W., P.E.B., C.E., P.K.C., M.S.G., H.A.), Washington University in St. Louis, St. Louis, Missouri
| | - Corinne M Merrill
- From the Division of Plastic and Reconstructive Surgery (A.D.L., G.B.S., C.M.M., K.B.P.), Washington University in St. Louis, St. Louis, Missouri
| | - Jennifer M Strahle
- Department of Neurosurgery (J.M.S.), Washington University in St. Louis, St. Louis, Missouri
| | - Manu S Goyal
- Mallinckrodt Institute of Radiology (T.W., P.E.B., C.E., P.K.C., M.S.G., H.A.), Washington University in St. Louis, St. Louis, Missouri
| | - Hongyu An
- Mallinckrodt Institute of Radiology (T.W., P.E.B., C.E., P.K.C., M.S.G., H.A.), Washington University in St. Louis, St. Louis, Missouri
- Department of Neurology (Y.C., H.A.), Washington University in St. Louis, St. Louis, Missouri
| | - Kamlesh B Patel
- From the Division of Plastic and Reconstructive Surgery (A.D.L., G.B.S., C.M.M., K.B.P.), Washington University in St. Louis, St. Louis, Missouri
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Kamona N, Jones BC, Lee H, Song HK, Rajapakse CS, Wagner CS, Bartlett SP, Wehrli FW. Cranial bone imaging using ultrashort echo-time bone-selective MRI as an alternative to gradient-echo based "black-bone" techniques. MAGMA (NEW YORK, N.Y.) 2024; 37:83-92. [PMID: 37934295 PMCID: PMC10923077 DOI: 10.1007/s10334-023-01125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES CT is the clinical standard for surgical planning of craniofacial abnormalities in pediatric patients. This study evaluated three MRI cranial bone imaging techniques for their strengths and limitations as a radiation-free alternative to CT. METHODS Ten healthy adults were scanned at 3 T with three MRI sequences: dual-radiofrequency and dual-echo ultrashort echo time sequence (DURANDE), zero echo time (ZTE), and gradient-echo (GRE). DURANDE bright-bone images were generated by exploiting bone signal intensity dependence on RF pulse duration and echo time, while ZTE bright-bone images were obtained via logarithmic inversion. Three skull segmentations were derived, and the overlap of the binary masks was quantified using dice similarity coefficient. Craniometric distances were measured, and their agreement was quantified. RESULTS There was good overlap of the three masks and excellent agreement among craniometric distances. DURANDE and ZTE showed superior air-bone contrast (i.e., sinuses) and soft-tissue suppression compared to GRE. DISCUSSIONS ZTE has low levels of acoustic noise, however, ZTE images had lower contrast near facial bones (e.g., zygomatic) and require effective bias-field correction to separate bone from air and soft-tissue. DURANDE utilizes a dual-echo subtraction post-processing approach to yield bone-specific images, but the sequence is not currently manufacturer-supported and requires scanner-specific gradient-delay corrections.
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Affiliation(s)
- Nada Kamona
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Brandon C Jones
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Hyunyeol Lee
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Electronics Engineering, Kyungpook National University, Daegu, South Korea
| | - Hee Kwon Song
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chamith S Rajapakse
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Connor S Wagner
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott P Bartlett
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Felix W Wehrli
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Zavala CA, Zima LA, Greives MR, Fletcher SA, Shah MN, Miller BA, Sandberg DI, Nguyen PD. Can Craniosynostosis be Diagnosed on Physical Examination? A Retrospective Review. J Craniofac Surg 2023; 34:2046-2050. [PMID: 37646354 PMCID: PMC10592286 DOI: 10.1097/scs.0000000000009686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/26/2023] [Indexed: 09/01/2023] Open
Abstract
Craniosynostosis is a developmental craniofacial defect in which one or more sutures of the skull fuse together prematurely. Uncorrected craniosynostosis may have serious complications including elevated intracranial pressure, developmental delay, and blindness. Proper diagnosis of craniosynostosis requires a physical examination of the head with assessment for symmetry and palpation of sutures for prominence. Often, if craniosynostosis is suspected, computed tomography (CT) imaging will be obtained. Recent literature has posited that this is unnecessary. This study aims to address whether physical examination alone is sufficient for the diagnosis and treatment planning of single suture craniosynostosis. Between 2015 and 2022, the Divisions of Pediatric Neurosurgery and Pediatric Plastic Surgery at UTHealth Houston evaluated 140 children under 36 months of age with suspected craniosynostosis by physical examination and subsequently ordered CT imaging for preoperative planning. Twenty-three patients received a clinical diagnosis of multi-sutural or syndromic craniosynostosis that was confirmed by CT. One hundred seventeen patients were diagnosed with single suture craniosynostosis on clinical examination and follow-up CT confirmed suture fusion in 109 (93.2%) patients and identified intracranial anomalies in 7 (6.0%) patients. These patients underwent surgical correction. Eight (6.8%) patients showed no evidence of craniosynostosis on CT imaging. Treatment for patients without fused sutures included molding helmets and observation alone. This evidence suggests that physical examination alone may be inadequate to accurately diagnose single suture synostosis, and surgery without preoperative CT evaluation could lead to unindicated procedures.
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Affiliation(s)
| | - Laura A Zima
- Departments of Neurological Surgery and Pediatric Surgery, McGovern Medical School/UT Health and Children's Memorial Hermann Hospital
| | - Matthew R Greives
- Division of Pediatric Plastic Surgery, McGovern Medical School/UT Health and Children's Memorial Hermann Hospital, Houston, TX
| | - Stephen A Fletcher
- Departments of Neurological Surgery and Pediatric Surgery, McGovern Medical School/UT Health and Children's Memorial Hermann Hospital
| | - Manish N Shah
- Departments of Neurological Surgery and Pediatric Surgery, McGovern Medical School/UT Health and Children's Memorial Hermann Hospital
| | - Brandon A Miller
- Departments of Neurological Surgery and Pediatric Surgery, McGovern Medical School/UT Health and Children's Memorial Hermann Hospital
| | - David I Sandberg
- Departments of Neurological Surgery and Pediatric Surgery, McGovern Medical School/UT Health and Children's Memorial Hermann Hospital
| | - Phuong D Nguyen
- Division of Pediatric Plastic Surgery, McGovern Medical School/UT Health and Children's Memorial Hermann Hospital, Houston, TX
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CT-like MR-derived Images for the Assessment of Craniosynostosis and other Pathologies of the Pediatric Skull. Clin Neuroradiol 2023; 33:57-64. [PMID: 35763060 PMCID: PMC10014729 DOI: 10.1007/s00062-022-01182-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the diagnostic value of CT-like images based on a 3D T1-weighted spoiled gradient echo-based sequence (T1SGRE) for the visualization of the pediatric skull and the identification of pathologies, such as craniosynostosis or fractures. METHODS In this prospective study, 20 patients with suspected craniosynostosis (mean age 1.26 ± 1.38 years, 10 females) underwent MR imaging including the T1SGRE sequence and 2 more patients were included who presented with skull fractures (0.5 and 6.3 years, both male). Additionally, the skull of all patients was assessed using radiography or CT in combination with ultrasound. Two radiologists, blinded to the clinical information, evaluated the CT-like images. The results were compared to the diagnosis derived from the other imaging modalities and intraoperative findings. Intrarater and interrater agreement was calculated using Cohen's κ. RESULTS Of the 22 patients 8 had a metopic, 4 a coronal and 2 a sagittal craniosynostosis and 2 patients showed a complex combination of craniosynostoses. The agreement between the diagnosis based on the T1SGRE and the final diagnosis was substantial (Cohen's κ = 0.92, 95% confidence interval (CI) 0.77-1.00 for radiologist 1 and κ = 0.76, CI 0.51-1.00 for radiologist 2). Of the patients with fractures, one presented with a ping pong fracture and one with a fracture of the temporal bone. Both radiologists could identify the fractures using the T1SGRE. CONCLUSION The visualization of the pediatric skull and the assessment of sutures using a CT-like T1SGRE MR-sequence is feasible and comparable to other imaging modalities, and thus may help to reduce radiation exposure in pediatric patients. The technique may also be a promising imaging tool for other pathologies, such as fractures.
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Boroojeni PE, Chen Y, Commean PK, Eldeniz C, Skolnick GB, Merrill C, Patel KB, An H. Deep-learning synthesized pseudo-CT for MR high-resolution pediatric cranial bone imaging (MR-HiPCB). Magn Reson Med 2022; 88:2285-2297. [PMID: 35713359 PMCID: PMC9420780 DOI: 10.1002/mrm.29356] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 05/23/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE CT is routinely used to detect cranial abnormalities in pediatric patients with head trauma or craniosynostosis. This study aimed to develop a deep learning method to synthesize pseudo-CT (pCT) images for MR high-resolution pediatric cranial bone imaging to eliminating ionizing radiation from CT. METHODS 3D golden-angle stack-of-stars MRI were obtained from 44 pediatric participants. Two patch-based residual UNets were trained using paired MR and CT patches randomly selected from the whole head (NetWH) or in the vicinity of bone, fractures/sutures, or air (NetBA) to synthesize pCT. A third residual UNet was trained to generate a binary brain mask using only MRI. The pCT images from NetWH (pCTNetWH ) in the brain area and NetBA (pCTNetBA ) in the nonbrain area were combined to generate pCTCom . A manual processing method using inverted MR images was also employed for comparison. RESULTS pCTCom (68.01 ± 14.83 HU) had significantly smaller mean absolute errors (MAEs) than pCTNetWH (82.58 ± 16.98 HU, P < 0.0001) and pCTNetBA (91.32 ± 17.2 HU, P < 0.0001) in the whole head. Within cranial bone, the MAE of pCTCom (227.92 ± 46.88 HU) was significantly lower than pCTNetWH (287.85 ± 59.46 HU, P < 0.0001) but similar to pCTNetBA (230.20 ± 46.17 HU). Dice similarity coefficient of the segmented bone was significantly higher in pCTCom (0.90 ± 0.02) than in pCTNetWH (0.86 ± 0.04, P < 0.0001), pCTNetBA (0.88 ± 0.03, P < 0.0001), and inverted MR (0.71 ± 0.09, P < 0.0001). Dice similarity coefficient from pCTCom demonstrated significantly reduced age dependence than inverted MRI. Furthermore, pCTCom provided excellent suture and fracture visibility comparable to CT. CONCLUSION MR high-resolution pediatric cranial bone imaging may facilitate the clinical translation of a radiation-free MR cranial bone imaging method for pediatric patients.
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Affiliation(s)
- Parna Eshraghi Boroojeni
- Dept. of Biomedical Engineering, Washington University in
St. Louis, St. Louis, Missouri 63110, USA
| | - Yasheng Chen
- Dept. of Neurology, Washington University in St. Louis, St.
Louis, Missouri 63110, USA
| | - Paul K. Commean
- Mallinckrodt Institute of Radiology, Washington University
in St. Louis, St. Louis, Missouri 63110, USA
| | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology, Washington University
in St. Louis, St. Louis, Missouri 63110, USA
| | - Gary B. Skolnick
- Division of Plastic and Reconstructive Surgery, Washington
University in St. Louis, St. Louis, Missouri 63110, USA
| | - Corinne Merrill
- Division of Plastic and Reconstructive Surgery, Washington
University in St. Louis, St. Louis, Missouri 63110, USA
| | - Kamlesh B. Patel
- Division of Plastic and Reconstructive Surgery, Washington
University in St. Louis, St. Louis, Missouri 63110, USA
| | - Hongyu An
- Dept. of Biomedical Engineering, Washington University in
St. Louis, St. Louis, Missouri 63110, USA
- Dept. of Neurology, Washington University in St. Louis, St.
Louis, Missouri 63110, USA
- Mallinckrodt Institute of Radiology, Washington University
in St. Louis, St. Louis, Missouri 63110, USA
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Bharadwaj UU, Coy A, Motamedi D, Sun D, Joseph GB, Krug R, Link TM. CT-like MRI: a qualitative assessment of ZTE sequences for knee osseous abnormalities. Skeletal Radiol 2022; 51:1585-1594. [PMID: 35088162 PMCID: PMC9198000 DOI: 10.1007/s00256-021-03987-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To qualitatively evaluate the utility of zero echo-time (ZTE) MRI sequences in identifying osseous findings and to compare ZTE with optimized spoiled gradient echo (SPGR) sequences in detecting knee osseous abnormalities. MATERIALS AND METHODS ZTE and standard knee MRI sequences were acquired at 3T in 100 consecutive patients. Three radiologists rated confidence in evaluating osseous abnormalities and image quality on a 5-grade Likert scale in ZTE compared to standard sequences. In a subset of knees (n = 57) SPGR sequences were also obtained, and diagnostic confidence in identifying osseous structures was assessed, comparing ZTE and SPGR sequences. Statistical significance of using ZTE over SPGR was characterized with a paired t-test. RESULTS Image quality of the ZTE sequences was rated high by all reviewers with 278 out of 299 (100 studies, 3 radiologists) scores ≥ 4 on the Likert scale. Diagnostic confidence in using ZTE sequences was rated "very high confidence" in 97%, 85%, 71%, and 73% of the cases for osteophytosis, subchondral cysts, fractures, and soft tissue calcifications/ossifications, respectively. In 74% of cases with osseous findings, reviewer scores indicated confidence levels (score ≥ 3) that ZTE sequences improved diagnostic certainty over standard sequences. The diagnostic confidence in using ZTE over SPGR sequences for osseous structures as well as abnormalities was favorable and statistically significant (p < 0.01). CONCLUSION Incorporating ZTE sequences in the standard knee MRI protocol was technically feasible and improved diagnostic confidence for osseous findings in relation to standard MR sequences. In comparison to SPGR sequences, ZTE improved assessment of osseous abnormalities.
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Affiliation(s)
- Upasana Upadhyay Bharadwaj
- Musculoskeletal Imaging, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA.
| | - Adam Coy
- Musculoskeletal Imaging, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
- Musculoskeletal Radiology, Vision Radiology, Dallas, TX, USA
| | - Daria Motamedi
- Musculoskeletal Imaging, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Dong Sun
- Musculoskeletal Imaging, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gabby B Joseph
- Musculoskeletal Imaging, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Roland Krug
- Musculoskeletal Imaging, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
| | - Thomas M Link
- Musculoskeletal Imaging, Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry Street, Suite 350, San Francisco, CA, 94107, USA
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Patel KB, Eldeniz C, Skolnick GB, Commean PK, Eshraghi Boroojeni P, Jammalamadaka U, Merrill C, Smyth MD, Goyal MS, An H. Cranial vault imaging for pediatric head trauma using a radial VIBE MRI sequence. J Neurosurg Pediatr 2022; 30:113-118. [PMID: 35453112 PMCID: PMC9587135 DOI: 10.3171/2022.2.peds2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Head trauma is the most common indication for a CT scan. In this pilot study, the authors assess the feasibility of a 5-minute high-resolution 3D golden-angle (GA) stack-of-stars radial volumetric interpolated breath-hold examination (VIBE) MRI sequence (GA-VIBE) to obtain clinically acceptable cranial bone images and identify cranial vault fractures compared to CT. METHODS Patients younger than 18 years of age presenting after head trauma were eligible for the study. Three clinicians reviewed and assessed 1) slice-by-slice volumetric CT and inverted MR images, and 2) 3D reconstructions obtained from inverted MR images and the gold standard (CT). For each image set, reviewers noted on 5-point Likert scales whether they recommended that a repeat scan be performed and the presence or absence of cranial vault fractures. RESULTS Thirty-one patients completed MRI after a clinical head CT scan was performed. Based on CT imaging, 8 of 31 patients had cranial fractures. Two of 31 patients were sedated as part of their clinical MRI scan. In 30 (97%) of 31 MRI reviews, clinicians agreed (or strongly agreed) that the image quality was acceptable for clinical diagnosis. Overall, comparing MRI to acceptable gold-standard CT, sensitivity and specificity of fracture detection were 100%. Furthermore, there were no discrepancies between CT and MRI in classification of fracture type or location. CONCLUSIONS When compared with the gold standard (CT), the volumetric and 3D reconstructed images using the GA-VIBE sequence were able to produce clinically acceptable cranial images with excellent ability to detect cranial vault fractures.
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Affiliation(s)
| | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, Missouri; and
| | | | - Paul K. Commean
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, Missouri; and
| | | | | | | | - Matthew D. Smyth
- Department of Neurosurgery, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
| | - Manu S. Goyal
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, Missouri; and
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, Missouri; and
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Eley KA, Delso G. Imaging of Bone in the Head and Neck Region, is There More Than CT? CURRENT RADIOLOGY REPORTS 2022; 10:69-82. [PMID: 35463479 PMCID: PMC9013214 DOI: 10.1007/s40134-022-00396-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 01/22/2023]
Abstract
Purpose of Review The objective of this review is to document the advances in non-ionising imaging alternatives to CT for the head and neck. Recent Findings The main alternative to CT for imaging bone of the head and neck region is MRI, particularly techniques which incorporate gradient echo imaging (Black Bone technique) and ultra-short or zero-echo time imaging. Since these techniques can provide high resolution isometric voxels, they can be used to provide multi-planar reformats and, following post processing, 3D reconstructed images of the craniofacial skeleton. As expected, the greatest advancements in recent years have been focused on enhanced image processing techniques and attempts to address the difficulties encountered at air-bone interfaces. Summary This article will review the imaging techniques and recent advancements which are bringing non-ionising alternatives to CT imaging of the bone of the head and neck region into the realm of routine clinical application.
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Affiliation(s)
- Karen A. Eley
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 218, Cambridge, CB2 0QQ UK
| | - Gaspar Delso
- MR Applications & Workflow, GE Healthcare, Barcelona, Spain
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Xiong R, Zhang S, Gan Z, Qi Z, Liu M, Xu X, Wang Q, Zhang J, Li F, Chen X. A novel 3D-vision-based collaborative robot as a scope holding system for port surgery: a technical feasibility study. Neurosurg Focus 2022; 52:E13. [PMID: 34973666 DOI: 10.3171/2021.10.focus21484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A clear, stable, suitably located vision field is essential for port surgery. A scope is usually held by hand or a fixing device. The former yields fatigue and requires lengthy training, while the latter increases inconvenience because of needing to adjust the scope. Thus, the authors innovated a novel robotic system that can recognize the port and automatically place the scope in an optimized position. In this study, the authors executed a preliminary experiment to test this system's technical feasibility and accuracy in vitro. METHODS A collaborative robotic (CoBot) system consisting of a mechatronic arm and a 3D camera was developed. With the 3D camera and programmed machine vision, CoBot can search a marker attached to the opening of the surgical port, followed by automatic alignment of the scope's axis with the port's longitudinal axis so that optimal illumination and visual observation can be achieved. Three tests were conducted. In test 1, the robot positioned a laser range finder attached to the robot's arm to align the sheath's center axis. The laser successfully passing through two holes in the port sheath's central axis defined successful positioning. Researchers recorded the finder's readings, demonstrating the actual distance between the finder and the sheath. In test 2, the robot held a high-definition exoscope and relocated it to the setting position. Test 3 was similar to test 2, but a metal holder substituted the robot. Trained neurosurgeons manually adjusted the holder. The manipulation time was recorded. Additionally, a grading system was designed to score each image captured by the exoscope at the setting position, and the scores in the two tests were compared using the rank-sum test. RESULTS The CoBot system positioned the finder successfully in all rounds in test 1; the mean height errors ± SD were 1.14 mm ± 0.38 mm (downward) and 1.60 mm ± 0.89 mm (upward). The grading scores of images in tests 2 and 3 were significantly different. Regarding the total score and four subgroups, test 2 showed a more precise, better-positioned, and more stable vision field. The total manipulation time in test 2 was 20 minutes, and for test 3 it was 52 minutes. CONCLUSIONS The CoBot system successfully acted as a robust scope holding system to provide a stable and optimized surgical view during simulated port surgery, providing further evidence for the substitution of human hands, and leading to a more efficient, user-friendly, and precise operation.
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Affiliation(s)
- Ruochu Xiong
- 1Medical School of Chinese PLA, Beijing.,2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
| | - Shiyu Zhang
- 1Medical School of Chinese PLA, Beijing.,2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
| | - Zhichao Gan
- 2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and.,3Medical School, Nankai University, Tianjin, China
| | - Ziyu Qi
- 2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and.,3Medical School, Nankai University, Tianjin, China
| | - Minghang Liu
- 1Medical School of Chinese PLA, Beijing.,2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
| | - Xinghua Xu
- 2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
| | - Qun Wang
- 2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
| | - Jiashu Zhang
- 2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
| | - Fangye Li
- 2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
| | - Xiaolei Chen
- 2Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing; and
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Ravindra VM, Awad AW, Baker CM, Lee A, Anderson RCE, Gociman B, Patel KB, Smyth MD, Birgfeld C, Pollack IF, Goldstein JA, Imahiyerobo T, Siddiqi FA, Kestle JRW. Preoperative imaging patterns and intracranial findings in single-suture craniosynostosis: a study from the Synostosis Research Group. J Neurosurg Pediatr 2021; 28:344-350. [PMID: 34171835 DOI: 10.3171/2021.2.peds2113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/08/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The diagnosis of single-suture craniosynostosis can be made by physical examination, but the use of confirmatory imaging is common practice. The authors sought to investigate preoperative imaging use and to describe intracranial findings in children with single-suture synostosis from a large, prospective multicenter cohort. METHODS In this study from the Synostosis Research Group, the study population included children with clinically diagnosed single-suture synostosis between March 1, 2017, and October 31, 2020, at 5 institutions. The primary analysis correlated the clinical diagnosis and imaging diagnosis; secondary outcomes included intracranial findings by pathological suture type. RESULTS A total of 403 children (67% male) were identified with single-suture synostosis. Sagittal (n = 267), metopic (n = 77), coronal (n = 52), and lambdoid (n = 7) synostoses were reported; the most common presentation was abnormal head shape (97%), followed by a palpable or visible ridge (37%). Preoperative cranial imaging was performed in 90% of children; findings on 97% of these imaging studies matched the initial clinical diagnosis. Thirty-one additional fused sutures were identified in 18 children (5%) that differed from the clinical diagnosis. The most commonly used imaging modality by far was CT (n = 360), followed by radiography (n = 9) and MRI (n = 7). Most preoperative imaging was ordered as part of a protocolized pathway (67%); some images were obtained as a result of a nondiagnostic clinical examination (5.2%). Of the 360 patients who had CT imaging, 150 underwent total cranial vault surgery and 210 underwent strip craniectomy. The imaging findings influenced the surgical treatment 0.95% of the time. Among the 24% of children with additional (nonsynostosis) abnormal findings on CT, only 3.5% required further monitoring. CONCLUSIONS The authors found that a clinical diagnosis of single-suture craniosynostosis and the findings on CT were the same with rare exceptions. CT imaging very rarely altered the surgical treatment of children with single-suture synostosis.
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Affiliation(s)
- Vijay M Ravindra
- 1Department of Neurosurgery, and
- 2Division of Neurosurgery, University of California, San Diego
- 3Department of Neurosurgery, Naval Medical Center San Diego, California
| | | | | | - Amy Lee
- 4Department of Neurosurgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Richard C E Anderson
- 5Department of Neurosurgery, Columbia University, Morgan Stanley Children's Hospital, and
| | - Barbu Gociman
- 6Division of Plastic and Reconstructive Surgery, University of Utah, Salt Lake City, Utah
| | - Kamlesh B Patel
- 7Division of Plastic and Reconstructive Surgery, Department of Surgery, and
| | - Matthew D Smyth
- 8Department of Neurosurgery, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, Missouri
| | | | | | - Jesse A Goldstein
- 10Plastic Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Thomas Imahiyerobo
- 11Division of Plastic Surgery, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Faizi A Siddiqi
- 6Division of Plastic and Reconstructive Surgery, University of Utah, Salt Lake City, Utah
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