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Belouaer A, Cossu G, Papadakis GE, Gaudet JG, Perez MH, Chanez V, Boegli Y, Mury C, Peters D, Addor V, Levivier M, Daniel RT, Demartines N, Messerer M. Implementation of the Enhanced Recovery After Surgery (ERAS®) program in neurosurgery. Acta Neurochir (Wien) 2023; 165:3137-3145. [PMID: 37688648 PMCID: PMC10624709 DOI: 10.1007/s00701-023-05789-y] [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: 06/23/2023] [Accepted: 08/22/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Over the past decade, Enhanced Recovery After Surgery (ERAS®) guidelines have been proven to simplify postoperative care and improve recovery in several surgical disciplines. The authors set out to create and launch an ERAS® program for cranial neurosurgery that meets official ERAS® Society standards. The authors summarize the successive steps taken to achieve this goal in two specific neurosurgical conditions and describe the challenges they faced. METHODS Pituitary neuroendocrine tumors (Pit-NET) resected by a transsphenoidal approach and craniosynostosis (Cs) repair were selected as appropriate targets for the implementation of ERAS® program in the Department of Neurosurgery. A multidisciplinary team with experience in managing these pathologies was created. A specialized ERAS® nurse coordinator was hired. An ERAS® certification process was performed involving 4 seminars separated by 3 active phases under the supervision of an ERAS® coach. RESULTS The ERAS® Pit-NET team included 8 active members. The ERAS® Cs team included 12 active members. Through the ERAS® certification process, areas for improvement were identified, local protocols were written, and the ERAS® program was implemented. Patient-centered strategies were developed to increase compliance with the ERAS® protocols. A prospective database was designed for ongoing program evaluation. Certification was achieved in 18 months. Direct costs and time requirements are reported. CONCLUSION Successful ERAS® certification requires a committed multidisciplinary team, an ERAS® coach, and a dedicated nurse coordinator.
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Affiliation(s)
- Amani Belouaer
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Giulia Cossu
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Georgios E Papadakis
- Service of Endocrinology, Diabetology, and Metabolism, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - John G Gaudet
- Department of Anesthesiology, Neurospinal Unit, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Maria-Helena Perez
- Pediatric Intensive and Intermediate Care Units, Department of Pediatrics, Women-Mother-Child Department, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Vivianne Chanez
- Pediatric Intensive and Intermediate Care Units, Department of Pediatrics, Women-Mother-Child Department, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Yann Boegli
- Department of Anesthesiology, Pediatric Unit, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Caroline Mury
- Department of Anesthesiology, Pediatric Unit, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - David Peters
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Valérie Addor
- Department of Visceral Surgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Marc Levivier
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Roy Thomas Daniel
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Mahmoud Messerer
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
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Lyoo Y, Choi YH, Lee SB, Lee S, Cho YJ, Shin SM, Phi JH, Kim SK, Cheon JE. Ultra-low-dose computed tomography with deep learning reconstruction for craniosynostosis at radiation doses comparable to skull radiographs: a pilot study. Pediatr Radiol 2023; 53:2260-2268. [PMID: 37488451 DOI: 10.1007/s00247-023-05717-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Craniofacial computed tomography (CT) is the diagnostic investigation of choice for craniosynostosis, but high radiation dose remains a concern. OBJECTIVE To evaluate the image quality and diagnostic performance of an ultra-low-dose craniofacial CT protocol with deep learning reconstruction for diagnosis of craniosynostosis. MATERIALS AND METHODS All children who underwent initial craniofacial CT for suspected craniosynostosis between September 2021 and September 2022 were included in the study. The ultra-low-dose craniofacial CT protocol using 70 kVp, model-based iterative reconstruction and deep learning reconstruction techniques was compared with a routine-dose craniofacial CT protocol. Quantitative analysis of the signal-to-noise ratio and noise was performed. The 3-dimensional (D) volume-rendered images were independently evaluated by two radiologists with regard to surface coarseness, step-off artifacts and overall image quality on a 5-point scale. Sutural patency was assessed for each of six sutures. Radiation dose was compared between the two protocols. RESULTS Among 29 patients (15 routine-dose CT and 14 ultra-low-dose CT), 23 patients had craniosynostosis. The 3-D volume-rendered images of ultra-low-dose CT without deep learning showed decreased image quality compared to routine-dose CT. The 3-D volume-rendered images of ultra-low-dose CT with deep learning reconstruction showed higher noise level, higher surface coarseness but decreased step-off artifacts, comparable signal-to-noise ratio and overall similar image quality compared to the routine-dose CT images. Diagnostic performance for detecting craniosynostosis at the suture level showed no significant difference between ultra-low-dose CT without deep learning reconstruction, ultra-low-dose CT with deep learning reconstruction and routine-dose CT. The estimated effective radiation dose for the ultra-low-dose CT was 0.05 mSv (range, 0.03-0.06 mSv), a 95% reduction in dose over the routine-dose CT at 1.15 mSv (range, 0.54-1.74 mSv). This radiation dose is comparable to 4-view skull radiography (0.05-0.1 mSv) and lower than previously reported effective dose for craniosynostosis protocols (0.08-3.36 mSv). CONCLUSION In this pilot study, an ultra-low-dose CT protocol using radiation doses at a level similar to skull radiographs showed preserved diagnostic performance for craniosynostosis, but decreased image quality compared to the routine-dose CT protocol. However, by combining the ultra-low-dose CT protocol with deep learning reconstruction, image quality was improved to a level comparable to the routine-dose CT protocol, without sacrificing diagnostic performance for craniosynostosis.
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Affiliation(s)
- Youngwook Lyoo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Seul Bi Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Su-Mi Shin
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Ji Hoon Phi
- Department of Pediatric Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Ki Kim
- Department of Pediatric Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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3
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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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Nielsen A, Moor R, Neal D, Governale LS, Ching JA. Impact of Low-Dose Computed Tomography and Physician Education on Referral for Head Shape. J Craniofac Surg 2023; 34:1989-1993. [PMID: 37431936 DOI: 10.1097/scs.0000000000009530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 05/19/2023] [Indexed: 07/12/2023] Open
Abstract
Imaging before specialist evaluation of abnormal head shape is associated with a delay in evaluation and an increase in radiation exposure. A retrospective cohort study was performed to identify referral patterns before and after the implementation of a low-dose computed tomography (LDCT) protocol and physician education to examine the intervention's impact on time to evaluation and radiation exposure. Six hundred sixty-nine patients with an abnormal head shape diagnosis at a single academic medical center between July 1, 2014 and December 1, 2019 were reviewed. Demographics, referral information, diagnostic testing, diagnoses, and timeline of clinical evaluation were recorded. Before and after the LDCT and physician education intervention, the average ages at initial specialist appointments were 8.82 and 7.75 months, respectively ( P = 0.125). Children referred after our intervention were less likely to have prereferral imaging than children referred prior (odds ratio: 0.59, CI: 0.39-0.91, P = 0.015). Average radiation exposure per patient before referral decreased from 14.66 mGy to 8.17 mGy ( P = 0.021). Prereferral imaging, referral by a non-pediatrician, and non-Caucasian race were associated with older age at the initial specialist appointment. Widespread craniofacial center adoption of an LDCT protocol and improved clinician knowledge may lead to a reduction in late referrals and radiation exposure in pediatric patients with an abnormal head shape diagnosis.
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Affiliation(s)
| | - Rachel Moor
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Florida
| | | | - Lance S Governale
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Florida
- Craniofacial Center, UF Health Shands Children's Hospital, Gainesville, FL
| | - Jessica A Ching
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Florida
- Craniofacial Center, UF Health Shands Children's Hospital, Gainesville, FL
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5
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Watt A, Lee J, Toews M, Gilardino MS. Smartphone Integration of Artificial Intelligence for Automated Plagiocephaly Diagnosis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4985. [PMID: 37197011 PMCID: PMC10184988 DOI: 10.1097/gox.0000000000004985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/17/2023] [Indexed: 05/19/2023]
Abstract
Positional plagiocephaly is a pediatric condition with important cosmetic implications affecting ∼40% of infants under 12 months of age. Early diagnosis and treatment initiation is imperative in achieving satisfactory outcomes; improved diagnostic modalities are needed to support this goal. This study aimed to determine whether a smartphone-based artificial intelligence tool could diagnose positional plagiocephaly. Methods A prospective validation study was conducted at a large tertiary care center with two recruitment sites: (1) newborn nursery, (2) pediatric craniofacial surgery clinic. Eligible children were aged 0-12 months with no history of hydrocephalus, intracranial tumors, intracranial hemorrhage, intracranial hardware, or prior craniofacial surgery. Successful artificial intelligence diagnosis required identification of the presence and severity of positional plagiocephaly. Results A total of 89 infants were prospectively enrolled from the craniofacial surgery clinic (n = 25, 17 male infants [68%], eight female infants [32%], mean age 8.44 months) and newborn nursery (n = 64, 29 male infants [45%], 25 female infants [39%], mean age 0 months). The model obtained a diagnostic accuracy of 85.39% compared with a standard clinical examination with a disease prevalence of 48%. Sensitivity was 87.50% [95% CI, 75.94-98.42] with a specificity of 83.67% [95% CI, 72.35-94.99]. Precision was 81.40%, while likelihood ratios (positive and negative) were 5.36 and 0.15, respectively. The F1-score was 84.34%. Conclusions The smartphone-based artificial intelligence algorithm accurately diagnosed positional plagiocephaly in a clinical environment. This technology may provide value by helping guide specialist consultation and enabling longitudinal quantitative monitoring of cranial shape.
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Affiliation(s)
- Ayden Watt
- From the Department of Experimental Surgery, McGill University, Montreal, Canada
| | - James Lee
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada
| | - Matthew Toews
- École de Technologie Supérieure, Department of Systems Engineering, Montréal, Canada
| | - Mirko S. Gilardino
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada
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Moderne Behandlung von Kraniosynostosen. Monatsschr Kinderheilkd 2023. [DOI: 10.1007/s00112-022-01683-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Zusammenfassung
Hintergrund
Bei 13–48 % aller Lebendgeborenen treten Auffälligkeiten der Schädelform auf. Meistens ist ein lagerungsbedingter Plagiozephalus ursächlich. Bei vorzeitigem Verschluss von Schädelnähten resultieren pathognomische Deformitäten durch das kompensatorische Wachstum der umgebenden Schädelknochen. Es muss zwischen Einzelnahtsynostosen und Kraniosynostosen im Rahmen syndromaler Erkrankungen unterschieden werden.
Ziel
Diese Arbeit soll einen Überblick über Diagnostik, konservative und chirurgische Therapie von Kraniosynostosen geben.
Methoden
Narratives Review.
Ergebnis
Bei Verdacht auf eine Kraniosynostose erfolgt zunächst die klinische Beurteilung und Einschätzung durch erfahrene Untersucher. Die pathognomische Schädelform ergibt die Arbeitsdiagnose. Bestätigt wird diese durch Verfahren wie 3D-Stereofotografie und Sonographie. In komplexen Fällen können CT oder MRT notwendig sein.
Die Indikation für eine Therapie ergibt sich aus ästhetischen Gesichtspunkten und der Vorbeugung psychosozialer Folgen. Bei syndromalen Formen besteht diese insbesondere zur Vermeidung möglicher Folgen eines erhöhten Hirndrucks.
Besteht die Indikation zur Operation muss zwischen endoskopischer und offener Technik unterschieden werden. Unterschiede bestehen hier hinsichtlich Invasivität und möglichem Korrekturausmaß. Im Anschluss an die operative Behandlung schließt sich häufig eine Helmtherapie an, um das bestmögliche Ergebnis zu erreichen. Die anschließende Follow-up-Periode erstreckt sich mindestens bis zum 12. Lebensjahr. Insgesamt sollte die Behandlung im Team mit Neurochirurgen, Mund‑, Kiefer‑, Gesichtschirurgen, Kinderärzten, Augenärzten und Humangenetikern stattfinden.
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European recommendations on practices in pediatric neuroradiology: consensus document from the European Society of Neuroradiology (ESNR), European Society of Paediatric Radiology (ESPR) and European Union of Medical Specialists Division of Neuroradiology (UEMS). Pediatr Radiol 2023; 53:159-168. [PMID: 36063184 PMCID: PMC9816178 DOI: 10.1007/s00247-022-05479-4] [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: 04/13/2022] [Revised: 06/27/2022] [Accepted: 08/01/2022] [Indexed: 01/24/2023]
Abstract
Pediatric neuroradiology is a subspecialty within radiology, with possible pathways to train within the discipline from neuroradiology or pediatric radiology. Formalized pediatric neuroradiology training programs are not available in most European countries. We aimed to construct a European consensus document providing recommendations for the safe practice of pediatric neuroradiology. We particularly emphasize imaging techniques that should be available, optimal site conditions and facilities, recommended team requirements and specific indications and protocol modifications for each imaging modality employed for pediatric neuroradiology studies. The present document serves as guidance to the optimal setup and organization for carrying out pediatric neuroradiology diagnostic and interventional procedures. Clinical activities should always be carried out in full agreement with national provisions and regulations. Continued education of all parties involved is a requisite for preserving pediatric neuroradiology practice at a high level.
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8
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Bruce MK, Tao W, Beiriger J, Christensen C, Pfaff MJ, Whitaker R, Goldstein JA. 3D Photography to Quantify the Severity of Metopic Craniosynostosis. Cleft Palate Craniofac J 2022:10556656221087071. [PMID: 35306870 PMCID: PMC9489814 DOI: 10.1177/10556656221087071] [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] [Indexed: 11/17/2022] Open
Abstract
This study aims to determine the utility of 3D photography for evaluating the severity of metopic craniosynostosis (MCS) using a validated, supervised machine learning (ML) algorithm. This single-center retrospective cohort study included patients who were evaluated at our tertiary care center for MCS from 2016 to 2020 and underwent both head CT and 3D photography within a 2-month period. The analysis method builds on our previously established ML algorithm for evaluating MCS severity using skull shape from CT scans. In this study, we regress the model to analyze 3D photographs and correlate the severity scores from both imaging modalities. 14 patients met inclusion criteria, 64.3% male (n = 9). The mean age in years at 3D photography and CT imaging was 0.97 and 0.94, respectively. Ten patient images were obtained preoperatively, and 4 patients did not require surgery. The severity prediction of the ML algorithm correlates closely when comparing the 3D photographs to CT bone data (Spearman correlation coefficient [SCC] r = 0.75; Pearson correlation coefficient [PCC] r = 0.82). The results of this study show that 3D photography is a valid alternative to CT for evaluation of head shape in MCS. Its use will provide an objective, quantifiable means of assessing outcomes in a rigorous manner while decreasing radiation exposure in this patient population.
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Affiliation(s)
- Madeleine K Bruce
- Department of Plastic Surgery, 6619UPMC Children's Hospital, Pittsburgh, PA, United States
| | - Wenzheng Tao
- School of Computing, University of Utah, Salt Lake City, UT, United States
| | - Justin Beiriger
- Department of Plastic Surgery, 6619UPMC Children's Hospital, Pittsburgh, PA, United States
| | | | - Miles J Pfaff
- Department of Plastic Surgery, 6619UPMC Children's Hospital, Pittsburgh, PA, United States
| | - Ross Whitaker
- School of Computing, University of Utah, Salt Lake City, UT, United States
| | - Jesse A Goldstein
- Department of Plastic Surgery, 6619UPMC Children's Hospital, Pittsburgh, PA, United States
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Khandelwal P, Zimmerman CE, Xie L, Lee H, Song HK, Yushkevich PA, Vossough A, Bartlett SP, Wehrli FW. Automatic Segmentation of Bone Selective MR Images for Visualization and Craniometry of the Cranial Vault. Acad Radiol 2022; 29 Suppl 3:S98-S106. [PMID: 33903011 PMCID: PMC8536795 DOI: 10.1016/j.acra.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 11/24/2022]
Abstract
RATIONALE AND OBJECTIVES Solid-state MRI has been shown to provide a radiation-free alternative imaging strategy to CT. However, manual image segmentation to produce bone-selective MR-based 3D renderings is time and labor intensive, thereby acting as a bottleneck in clinical practice. The objective of this study was to evaluate an automatic multi-atlas segmentation pipeline for use on cranial vault images entirely circumventing prior manual intervention, and to assess concordance of craniometric measurements between pipeline produced MRI and CT-based 3D skull renderings. MATERIALS AND METHODS Dual-RF, dual-echo, 3D UTE pulse sequence MR data were obtained at 3T on 30 healthy subjects along with low-dose CT images between December 2018 to January 2020 for this prospective study. The four-point MRI datasets (two RF pulse widths and two echo times) were combined to produce bone-specific images. CT images were thresholded and manually corrected to segment the cranial vault. CT images were then rigidly registered to MRI using mutual information. The corresponding cranial vault segmentations were then transformed to MRI. The "ground truth" segmentations served as reference for the MR images. Subsequently, an automated multi-atlas pipeline was used to segment the bone-selective images. To compare manually and automatically segmented MR images, the Dice similarity coefficient (DSC) and Hausdorff distance (HD) were computed, and craniometric measurements between CT and automated-pipeline MRI-based segmentations were examined via Lin's concordance coefficient (LCC). RESULTS Automated segmentation reduced the need for an expert to obtain segmentation. Average DSC was 90.86 ± 1.94%, and average 95th percentile HD was 1.65 ± 0.44 mm between ground truth and automated segmentations. MR-based measurements differed from CT-based measurements by 0.73-1.2 mm on key craniometric measurements. LCC for distances between CT and MR-based landmarks were vertex-basion: 0.906, left-right frontozygomatic suture: 0.780, and glabella-opisthocranium: 0.956 for the three measurements. CONCLUSION Good agreement between CT and automated MR-based 3D cranial vault renderings has been achieved, thereby eliminating the laborious manual segmentation process. Target applications comprise craniofacial surgery as well as imaging of traumatic injuries and masses involving both bone and soft tissue.
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Affiliation(s)
- Pulkit Khandelwal
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA,Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Carrie E. Zimmerman
- Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Long Xie
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA,Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Hyunyeol Lee
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA,Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Hee Kwon Song
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA,Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul A. Yushkevich
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA,Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Arastoo Vossough
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA,Children’s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA, USA
| | - Scott P. Bartlett
- Division of Plastic and Reconstructive Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA,Department of Surgery, University of Pennsylvania, Philadelphia, PA USA
| | - Felix W. Wehrli
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA,Laboratory for Structural, Physiologic and Functional Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA,Corresponding Author: University of Pennsylvania, Department of Radiology, MRI Education Center, 1 Founders Building, 3400 Spruce Street, Philadelphia, PA 19104-4283,
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10
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Chow I, Brisbin AK, Anstadt EE, Goldstein JA, Losee JE. Delayed Presentation of Unicoronal Craniosynostosis-Masked by Ipsilateral Posterior Deformational Plagiocephaly. Cleft Palate Craniofac J 2022; 60:768-772. [PMID: 35195470 DOI: 10.1177/10556656221080996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite a greater awareness of the differential diagnosis of head shape abnormalities among pediatricians, the effect of deformational forces on calvarial morphology can complicate the diagnosis of craniosynostosis. In this report, we describe 2 patients diagnosed with unicoronal craniosynostosis (UCS) in a delayed fashion due to the presence of concomitant posterior deformational plagiocephaly (PDP). In both cases, the severity of each patients' PDP obscured changes typically associated with UCS. This unique presentation underscores the importance of having a high index of suspicion for possible premature suture fusion despite the presence of concomitant PDP.
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Affiliation(s)
- Ian Chow
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alyssa K Brisbin
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Erin E Anstadt
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jesse A Goldstein
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph E Losee
- Department of Plastic Surgery, University of Pittsburgh, 6595University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Examining the Role of Early Diagnostic Imaging for Craniosynostosis in the Era of Endoscopic Suturectomy: A Single Institution Experience. J Craniofac Surg 2022; 33:1363-1368. [PMID: 35132031 DOI: 10.1097/scs.0000000000008534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/15/2022] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Endoscopic suturectomy is a minimally invasive surgical treatment for single-suture craniosynostosis in children between 1 and 4 months of age. This study sought to characterize the role played by diagnostic imaging in facilitating early surgical management with endoscopic suturectomy. The authors also characterized the overall diagnostic utility of imaging in patients assessed for abnormal head shape at their institution, regardless of surgical status. A retrospective cohort of children diagnosed with single-suture synostosis undergoing either primary endoscopic suturectomy or open calvarial reconstruction at the authors' institution from 1998 to 2018 was first reviewed. Of 132 surgical patients, 53 underwent endoscopic suturectomy and 79 underwent open repair. There was no difference in the proportion of endoscopic and open surgery patients imaged preoperatively before (24.5% versus 35.4%; P = 0.24) or after (28.3% versus 25.3%; P = 0.84) craniofacial assessment. Stratifying by historical epoch (1998-2010 versus 2011-2018), there was also no difference found between preoperative imaging rates (63.6% versus 56.4%; P = 0.35). In another cohort of 175 patients assessed for abnormal head shape, 26.9% were imaged to rule out craniosynostosis. Positive diagnostic imaging rates were recorded for suspected unicoronal (100%), metopic (87.5%), lambdoidal (75.0%), sagittal (63.5%), multi-suture (50%), and bicoronal (0%) synostosis. The authors conclude that the use of diagnostic imaging at their institution has not increased despite higher utilization of endoscopic suturectomy and need for expedient identification of surgical candidates. However, their results suggest that imaging may play a greater diagnostic role for suspected bicoronal, sagittal, and multi-sutural synostosis among sutural subtypes of synostosis.
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Watt A, Zammit D, Lee J, Gilardino M. Novel Screening and Monitoring Techniques for Deformational Plagiocephaly: A Systematic Review. Pediatrics 2022; 149:184526. [PMID: 35059723 DOI: 10.1542/peds.2021-051736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
This article summarizes the current state of diagnostic modalities for infant craniofacial deformities and highlights capable diagnostic tools available currently to pediatricians.
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Affiliation(s)
- Ayden Watt
- Department of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Dino Zammit
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - James Lee
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Mirko Gilardino
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
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13
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Wang Y, Ma LY, Yin XP, Gao BL. Radiomics and Radiogenomics in Evaluation of Colorectal Cancer Liver Metastasis. Front Oncol 2022; 11:689509. [PMID: 35070948 PMCID: PMC8776634 DOI: 10.3389/fonc.2021.689509] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer is one common digestive malignancy, and the most common approach of blood metastasis of colorectal cancer is through the portal vein system to the liver. Early detection and treatment of liver metastasis is the key to improving the prognosis of the patients. Radiomics and radiogenomics use non-invasive methods to evaluate the biological properties of tumors by deeply mining the texture features of images and quantifying the heterogeneity of metastatic tumors. Radiomics and radiogenomics have been applied widely in the detection, treatment, and prognostic evaluation of colorectal cancer liver metastases. Based on the imaging features of the liver, this paper reviews the current application of radiomics and radiogenomics in the diagnosis, treatment, monitor of disease progression, and prognosis of patients with colorectal cancer liver metastases.
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Affiliation(s)
| | | | - Xiao-Ping Yin
- CT-MRI Room, Affiliated Hospital of Hebei University, Baoding, China
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14
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Barreto IL, Tuna IS, Rajderkar DA, Ching JA, Governale LS. Pediatric craniosynostosis computed tomography: an institutional experience in reducing radiation dose while maintaining diagnostic image quality. Pediatr Radiol 2022; 52:85-96. [PMID: 34731286 DOI: 10.1007/s00247-021-05205-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/15/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children with craniosynostosis may undergo multiple computed tomography (CT) examinations for diagnosis and post-treatment follow-up, resulting in cumulative radiation exposure. OBJECTIVE To reduce the risks associated with radiation exposure, we evaluated the compliance, radiation dose reduction and clinical image quality of a lower-dose CT protocol for pediatric craniosynostosis implemented at our institution. MATERIALS AND METHODS The standard of care at our institution was modified to replace pediatric head CT protocols with a lower-dose CT protocol utilizing 100 kV, 5 mAs and iterative reconstruction. Study-ordered, protocol-utilized and radiation-dose indices were collected for studies performed with routine pediatric brain protocols (n=22) and with the lower-dose CT protocol (n=135). Two pediatric neuroradiologists evaluated image quality in a subset (n=50) of the lower-dose CT studies by scoring visualization of cranial structures, confidence of diagnosis and the need for more radiation dose. RESULTS During the 30-month period, the lower-dose CT protocol had high compliance, with 2/137 studies performed with routine brain protocols. With the lower-dose CT protocol, volume CT dose index (CTDIvol) was 1.1 mGy for all patients (0-9 years old) and effective dose ranged from 0.06 to 0.22 mSv, comparable to a 4-view skull radiography examination. CTDIvol was reduced by 98% and effective dose was reduced up to 67-fold. Confidence in diagnosing craniosynostosis was high and more radiation dose was considered unnecessary in all studies (n=50) by both radiologists. CONCLUSION Replacing the routine pediatric brain CT protocol with a lower-dose CT craniosynostosis protocol substantially reduced radiation exposure without compromising image quality or diagnostic confidence.
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Affiliation(s)
- Izabella L Barreto
- Division of Medical Physics, Department of Radiology, University of Florida, P.O. Box 100374, Gainesville, FL, 32610, USA.
| | - Ibrahim S Tuna
- Department of Radiology, University of Florida, Gainesville, FL, USA
| | | | - Jessica A Ching
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA.,Craniofacial Center, UF Health Shands Children's Hospital, Gainesville, FL, USA
| | - Lance S Governale
- Craniofacial Center, UF Health Shands Children's Hospital, Gainesville, FL, USA.,Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Florida, Gainesville, FL, USA
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15
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Evaluating the Utility of Routine Computed Tomography Scans after Cranial Vault Reconstruction for Children with Craniosynostosis. Plast Reconstr Surg 2021; 148:63e-70e. [PMID: 34181612 DOI: 10.1097/prs.0000000000008056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Postoperative computed tomography scans allow for evaluation of the structural results of cranial vault reconstruction and potential surgical concerns. The authors evaluated the clinical utility of routine postoperative scans to identify relevant surgical findings in children treated for craniosynostosis. METHODS The authors conducted a retrospective study of postoperative computed tomography reports for patients with craniosynostosis following cranial vault reconstruction during a 9-year period at their tertiary care pediatric hospital. They categorized postoperative computed tomography findings as typical, atypical, or indeterminate. Images with reported indeterminate or atypical findings were reviewed and verified by a pediatric neuroradiologist and a pediatric neurological surgeon. Clinical outcomes of patients with abnormal postoperative images were assessed with chart review for clinical relevance. RESULTS Postoperative computed tomography radiology reports for 548 operations in 506 participants were included. Most participants had single-suture craniosynostosis (89 percent), were male (64 percent), and under 1 year of age (78 percent). Surgically concerning scans were described in 52 reports (<9.5 percent), and the research team's pediatric neuroradiologist confirmed abnormal findings in 36 (6.5 percent). Potentially relevant abnormal findings included subdural blood (n = 18), subarachnoid blood (n = 4), intraparenchymal findings (n = 6), bone abnormalities (n = 5), vascular injury (n = 3), and increased ventricular size (n = 2). Most cases with abnormal findings did not require additional observation nor intervention. Only three cases (of 548; 0.55 percent) required further intervention, which included additional medical management (n = 2) and return to the operating room (n = 1). CONCLUSION Abnormal findings on routine computed tomography scans after cranial vault reconstruction are uncommon and rarely result in an urgent surgical or medical intervention. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, IV.
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Weighing In on the Controversy: Preoperative Imaging in Unicoronal Craniosynostosis Leads to Strategic Changes in Surgical Care. Plast Reconstr Surg 2021; 147:1133-1139. [PMID: 33890895 DOI: 10.1097/prs.0000000000007830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical findings in children with unilateral coronal craniosynostosis are characteristic, and therefore clinicians have questioned the need for confirmatory imaging. Preoperative computed tomographic imaging is a powerful tool for diagnosing associated anomalies that can alter treatment management and surgical planning. The authors' aim was to determine whether and how routine preoperative imaging affected treatment management in unilateral coronal craniosynostosis patients within their institution. METHODS A retrospective, single-center review of all patients who underwent cranial vault remodeling for unilateral coronal craniosynostosis between 2006 and 2014 was performed. Patient data included demographics, age at computed tomographic scan, age at surgery, results of the radiographic evaluation, and modification of treatment following radiologic examination. RESULTS Of 194 patients diagnosed with single-suture craniosynostosis, 29 were diagnosed with unilateral coronal craniosynostosis. Additional radiographic anomalies were found in 19 unilateral coronal craniosynostosis patients (65.5 percent). These included severe deviation of the anterior superior sagittal sinus [n = 12 (41.4 percent)], Chiari I malformation [n = 1 (3.4 percent)], and benign external hydrocephalus [n = 2 (6.9 percent)]. The radiographic anomalies resulted in a change in management for 48.3 percent of patients. Specifically, alteration in frontal craniotomy design occurred in 12 patients (41.4 percent), and two patients (6.9 percent) required further radiographic studies. CONCLUSIONS Although clinical findings in children with unilateral coronal craniosynostosis are prototypical, preoperative computed tomographic imaging is still of great consequence and continues to play an important role in surgical management. Preoperative imaging enabled surgeons to alter surgical management and avoid inadvertent complications such as damage to a deviated superior sagittal sinus. Imaging findings of Chiari malformation and hydrocephalus also permitted judicious follow-up. CLINICAL QUESTIONS/LEVEL OF EVIDENCE Therapeutic, IV.
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17
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Fletcher JG, Levin DL, Sykes AMG, Lindell RM, White DB, Kuzo RS, Suresh V, Yu L, Leng S, Holmes DR, Inoue A, Johnson MP, Carter RE, McCollough CH. Observer Performance for Detection of Pulmonary Nodules at Chest CT over a Large Range of Radiation Dose Levels. Radiology 2020; 297:699-707. [PMID: 32990514 DOI: 10.1148/radiol.2020200969] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background There is a wide variation in radiation dose levels that can be used with chest CT in order to detect indeterminate pulmonary nodules. Purpose To compare the performance of lower-radiation-dose chest CT with that of routine dose in the detection of indeterminate pulmonary nodules 5 mm or greater. Materials and Methods In this retrospective study, CT projection data from 83 routine-dose chest CT examinations performed in 83 patients (120 kV, 70 quality reference mAs [QRM]) were collected between November 2013 and April 2014. Reference indeterminate pulmonary nodules were identified by two nonreader thoracic radiologists. By using validated noise insertion, five lower-dose data sets were reconstructed with filtered back projection (FBP) or iterative reconstruction (IR; 30 QRM with FBP, 10 QRM with IR, 5 QRM with FBP, 5 QRM with IR, and 2.5 QRM with IR). Three thoracic radiologists circled pulmonary nodules, rating confidence that the nodule was a 5-mm-or-greater indeterminate pulmonary nodule, and graded image quality. Analysis was performed on a per-nodule basis by using jackknife alternative free-response receiver operating characteristic figure of merit (FOM) and noninferiority limit of -0.10. Results There were 66 indeterminate pulmonary nodules (mean size, 8.6 mm ± 3.4 [standard deviation]; 21 part-solid nodules) in 42 patients (mean age, 51 years ± 17; 21 men and 21 women). Compared with the FOM for routine-dose CT (size-specific dose estimate, 6.5 mGy ± 1.8; FOM, 0.86 [95% confidence interval: 0.80, 0.91]), FOM was noninferior for all lower-dose configurations except for 2.5 QRM with IR. The sensitivity for subsolid nodules at 70 QRM was 60% (range, 48%-72%) and was significantly worse at a dose of 5 QRM and lower, whether or not IR was used (P < .05). Diagnostic image quality decreased with decreasing dose (P < .001) and was better with IR at 5 QRM (P < .05). Conclusion CT images reconstructed at dose levels down to 10 quality reference mAs (size-specific dose estimate, 0.9 mGy) had noninferior performance compared with routine dose in depicting pulmonary nodules. Iterative reconstruction improved subjective image quality but not performance at low dose levels. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by White and Kazerooni in this issue.
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Affiliation(s)
- Joel G Fletcher
- From the Department of Radiology (J.G.F., D.L.L., A.M.G.S., R.M.L., D.B.W., R.S.K., V.S., L.Y., S.L., A.I., C.H.M.), Department of Physiology and Biomedical Engineering (D.R.H.), and Department of Health Science Research (M.P.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - David L Levin
- From the Department of Radiology (J.G.F., D.L.L., A.M.G.S., R.M.L., D.B.W., R.S.K., V.S., L.Y., S.L., A.I., C.H.M.), Department of Physiology and Biomedical Engineering (D.R.H.), and Department of Health Science Research (M.P.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Anne-Marie G Sykes
- From the Department of Radiology (J.G.F., D.L.L., A.M.G.S., R.M.L., D.B.W., R.S.K., V.S., L.Y., S.L., A.I., C.H.M.), Department of Physiology and Biomedical Engineering (D.R.H.), and Department of Health Science Research (M.P.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Rebecca M Lindell
- From the Department of Radiology (J.G.F., D.L.L., A.M.G.S., R.M.L., D.B.W., R.S.K., V.S., L.Y., S.L., A.I., C.H.M.), Department of Physiology and Biomedical Engineering (D.R.H.), and Department of Health Science Research (M.P.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Darin B White
- From the Department of Radiology (J.G.F., D.L.L., A.M.G.S., R.M.L., D.B.W., R.S.K., V.S., L.Y., S.L., A.I., C.H.M.), Department of Physiology and Biomedical Engineering (D.R.H.), and Department of Health Science Research (M.P.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Ronald S Kuzo
- From the Department of Radiology (J.G.F., D.L.L., A.M.G.S., R.M.L., D.B.W., R.S.K., V.S., L.Y., S.L., A.I., C.H.M.), Department of Physiology and Biomedical Engineering (D.R.H.), and Department of Health Science Research (M.P.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Vighnesh Suresh
- From the Department of Radiology (J.G.F., D.L.L., A.M.G.S., R.M.L., D.B.W., R.S.K., V.S., L.Y., S.L., A.I., C.H.M.), Department of Physiology and Biomedical Engineering (D.R.H.), and Department of Health Science Research (M.P.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Lifeng Yu
- From the Department of Radiology (J.G.F., D.L.L., A.M.G.S., R.M.L., D.B.W., R.S.K., V.S., L.Y., S.L., A.I., C.H.M.), Department of Physiology and Biomedical Engineering (D.R.H.), and Department of Health Science Research (M.P.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Shuai Leng
- From the Department of Radiology (J.G.F., D.L.L., A.M.G.S., R.M.L., D.B.W., R.S.K., V.S., L.Y., S.L., A.I., C.H.M.), Department of Physiology and Biomedical Engineering (D.R.H.), and Department of Health Science Research (M.P.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - David R Holmes
- From the Department of Radiology (J.G.F., D.L.L., A.M.G.S., R.M.L., D.B.W., R.S.K., V.S., L.Y., S.L., A.I., C.H.M.), Department of Physiology and Biomedical Engineering (D.R.H.), and Department of Health Science Research (M.P.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Akitoshi Inoue
- From the Department of Radiology (J.G.F., D.L.L., A.M.G.S., R.M.L., D.B.W., R.S.K., V.S., L.Y., S.L., A.I., C.H.M.), Department of Physiology and Biomedical Engineering (D.R.H.), and Department of Health Science Research (M.P.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Matthew P Johnson
- From the Department of Radiology (J.G.F., D.L.L., A.M.G.S., R.M.L., D.B.W., R.S.K., V.S., L.Y., S.L., A.I., C.H.M.), Department of Physiology and Biomedical Engineering (D.R.H.), and Department of Health Science Research (M.P.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Rickey E Carter
- From the Department of Radiology (J.G.F., D.L.L., A.M.G.S., R.M.L., D.B.W., R.S.K., V.S., L.Y., S.L., A.I., C.H.M.), Department of Physiology and Biomedical Engineering (D.R.H.), and Department of Health Science Research (M.P.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
| | - Cynthia H McCollough
- From the Department of Radiology (J.G.F., D.L.L., A.M.G.S., R.M.L., D.B.W., R.S.K., V.S., L.Y., S.L., A.I., C.H.M.), Department of Physiology and Biomedical Engineering (D.R.H.), and Department of Health Science Research (M.P.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Health Science Research, Mayo Clinic, Jacksonville, Fla (R.E.C.)
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Persad A, Aronyk K, Beaudoin W, Mehta V. Long-term 3D CT follow-up after endoscopic sagittal craniosynostosis repair. J Neurosurg Pediatr 2019; 25:291-297. [PMID: 31860808 DOI: 10.3171/2019.10.peds19297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical treatment of sagittal synostosis involves various surgical modalities. Long-term follow-up issues include increased intracranial pressure, secondary sutural fusion, incomplete reossification, and suboptimal cosmetic appearance. The authors' objective in this study was to review their long-term endoscopic surgical results in children with sagittal synostosis using 3D CT. METHODS The authors reviewed the long-term results of their first 38 patients who underwent endoscopic sagittal synostosis repair at age 16 weeks or younger. A standard vertex craniectomy with biparietal wedges was done in each case. After surgery, the children were fitted with a helmet, which they wore until 8 months of age. Patients were followed up for 5 years or longer, at which point a 3D CT scan was obtained. The authors examined data on the cranial index, area of bony defect, presence or absence of secondary sutural fusion, neosuture formation, and scalloping of the inner table of the skull. RESULTS Thirty-two of 38 children met inclusion criteria. There was a small but significant recession of the cranial index after the completion of helmeting (from 0.772 after completion of helmeting to 0.755 at 5 years). Of 32 children, 14 had a bony defect area > 4 cm2. Three children had secondary sutural fusion (two unilateral coronal, one bicoronal). Ten of 32 patients had partial neosuture formation. CONCLUSIONS The authors report their experience with 32 of their first 38 children who underwent endoscopic sagittal synostosis repair at 16 weeks of age or younger. With a minimum duration of 5 years, this is the longest clinicoradiological follow-up utilizing 3D CT to date in children with sagittal synostosis treated with endoscopic surgery. The authors report detailed measurements of bony loss, adjacent sutural fusion, and neosuture formation.
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Affiliation(s)
- Amit Persad
- 1Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan; and
| | - Keith Aronyk
- 2Division of Neurosurgery, Department of Surgery, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Wendy Beaudoin
- 2Division of Neurosurgery, Department of Surgery, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Vivek Mehta
- 2Division of Neurosurgery, Department of Surgery, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada
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MRI Protocol for Craniosynostosis: Replacing Ionizing Radiation–Based CT. AJR Am J Roentgenol 2019; 213:1374-1380. [DOI: 10.2214/ajr.19.21746] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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20
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Makar KG, Gunaseelan V, Waljee J, Vercler CJ, Buchman SR. Variation in the Utilization of Postoperative Computed Tomography for Patients With Nonsyndromic Craniosynostosis: A National Claims Analysis. Cleft Palate Craniofac J 2019; 57:288-295. [PMID: 31648534 DOI: 10.1177/1055665619882568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Routine postoperative computed tomography (CT) imaging in nonsyndromic craniosynostosis remains controversial due to the hazards of radiation exposure. The extent to which postoperative head CTs are performed remains unknown. Therefore, we sought to measure the use of postoperative CTs in this population. DESIGN The authors reviewed insurance claims from OptumInsight, using Current Procedural Terminology codes to identify procedures and postoperative imaging. Multilevel logistic regression was used to describe the odds of undergoing postoperative CTs, adjusting for patient and provider covariates. PARTICIPANTS Craniosynostosis patients who underwent reconstruction between 2001 and 2017 were reviewed. Patients older than 5 years at surgery, postoperative lengths of stay >15 days, syndromic diagnoses, operative complications within 30 days of surgery, and cranial bone grafting merited exclusion. MAIN OUTCOME MEASURE Odds of postoperative head CTs after cranial vault reconstruction. RESULTS In this cohort (n = 1150), 326 (28.4%) patients underwent postoperative head CTs. The number of CTs ranged from 0 to 14. Older age at surgery (odds ratio [OR]: 1.32, P = .002), increasing years of follow-up (OR: 1.12, P < .001), and increasing comorbidities (OR: 1.21, P = .017) were associated with postoperative CTs. After adjusting for patient factors, provider factors accounted for 31.3% of variation in imaging. CONCLUSIONS Over a quarter of patients underwent head CTs following reconstruction, and provider factors accounted for a large percentage of the variation. Given the risks of radiation, neurosurgeons and craniofacial surgeons face a critical need to establish postoperative imaging protocols to reduce unnecessary imaging in these vulnerable patients.
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Affiliation(s)
- Katelyn G Makar
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Vidhya Gunaseelan
- Michigan Opioid Prescribing Engagement Network, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer Waljee
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Christian J Vercler
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven R Buchman
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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21
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Fletcher JG, DeLone DR, Kotsenas AL, Campeau NG, Lehman VT, Yu L, Leng S, Holmes DR, Edwards PK, Johnson MP, Michalak GJ, Carter RE, McCollough CH. Evaluation of Lower-Dose Spiral Head CT for Detection of Intracranial Findings Causing Neurologic Deficits. AJNR Am J Neuroradiol 2019; 40:1855-1863. [PMID: 31649155 DOI: 10.3174/ajnr.a6251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/21/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Despite the frequent use of unenhanced head CT for the detection of acute neurologic deficit, the radiation dose for this exam varies widely. Our aim was to evaluate the performance of lower-dose head CT for detection of intracranial findings resulting in acute neurologic deficit. MATERIALS AND METHODS Projection data from 83 patients undergoing unenhanced spiral head CT for suspected neurologic deficits were collected. Cases positive for infarction, intra-axial hemorrhage, mass, or extra-axial hemorrhage required confirmation by histopathology, surgery, progression of findings, or corresponding neurologic deficit; cases negative for these target diagnoses required negative assessments by two neuroradiologists and a clinical neurologist. A routine dose head CT was obtained using 250 effective mAs and iterative reconstruction. Lower-dose configurations were reconstructed (25-effective mAs iterative reconstruction, 50-effective mAs filtered back-projection and iterative reconstruction, 100-effective mAs filtered back-projection and iterative reconstruction, 200-effective mAs filtered back-projection). Three neuroradiologists circled findings, indicating diagnosis, confidence (0-100), and image quality. The difference between the jackknife alternative free-response receiver operating characteristic figure of merit at routine and lower-dose configurations was estimated. A lower 95% CI estimate of the difference greater than -0.10 indicated noninferiority. RESULTS Forty-two of 83 patients had 70 intracranial findings (29 infarcts, 25 masses, 10 extra- and 6 intra-axial hemorrhages) at routine head CT (CT dose index = 38.3 mGy). The routine-dose jackknife alternative free-response receiver operating characteristic figure of merit was 0.87 (95% CI, 0.81-0.93). Noninferiority was shown for 100-effective mAs iterative reconstruction (figure of merit difference, -0.04; 95% CI, -0.08 to 0.004) and 200-effective mAs filtered back-projection (-0.02; 95% CI, -0.06 to 0.02) but not for 100-effective mAs filtered back-projection (-0.06; 95% CI, -0.10 to -0.02) or lower-dose levels. Image quality was better at higher-dose levels and with iterative reconstruction (P < .05). CONCLUSIONS Observer performance for dose levels using 100-200 eff mAs was noninferior to that observed at 250 effective mAs with iterative reconstruction, with iterative reconstruction preserving noninferiority at a mean CT dose index of 15.2 mGy.
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Affiliation(s)
- J G Fletcher
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - D R DeLone
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - A L Kotsenas
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - N G Campeau
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - V T Lehman
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - L Yu
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - S Leng
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - D R Holmes
- Biomedical Imaging Resource (D.R.H., P.E.)
| | | | - M P Johnson
- Biomedical Statistics and Informatics (M.P.J.), Mayo Clinic, Rochester, Minnesota
| | - G J Michalak
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
| | - R E Carter
- Health Sciences Research (R.E.C.), Mayo Clinic, Jacksonville, Florida
| | - C H McCollough
- From the Departments of Radiology (J.G.F., D.R.D., A.L.K., N.G.C., V.T.L., L.Y., S.L., G.J.M., C.H.M.)
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Evolution of Bandeau Shape, Orbital Morphology, and Craniofacial Twist after Fronto-Orbital Advancement for Isolated Unilateral Coronal Synostosis. Plast Reconstr Surg 2019; 143:1703-1711. [DOI: 10.1097/prs.0000000000005639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Craniofacial Flash: Minimizing Radiation Dose in Pediatric Craniofacial Computed Tomography. J Craniofac Surg 2018; 29:1751-1754. [DOI: 10.1097/scs.0000000000004755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Fletcher JG, Fidler JL, Venkatesh SK, Hough DM, Takahashi N, Yu L, Johnson M, Leng S, Holmes DR, Carter R, McCollough CH. Observer Performance with Varying Radiation Dose and Reconstruction Methods for Detection of Hepatic Metastases. Radiology 2018; 289:455-464. [PMID: 30204077 DOI: 10.1148/radiol.2018180125] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To estimate the ability of lower dose levels and iterative reconstruction (IR) to display hepatic metastases that can be detected by radiologists. Materials and Methods Projection data from 83 contrast agent-enhanced CT examinations were collected. Metastases were defined by histopathologic analysis or progression and regression. Lower radiation dose configurations were reconstructed at five dose levels with filtered back projection (FBP) and IR (automatic exposure control settings: 80, 100, 120, 160, and 200 quality reference mAs [QRM]). Three abdominal radiologists circumscribed metastases, indicating confidence (confidence range, 0-100) and image quality. Noninferiority was assessed by using jackknife alternative free-response receiver operating characteristic (JAFROC) analysis (noninferiority limit, -0.10) and reader agreement rules, which required identification of metastases identified at routine dose, and no nonlesion localizations in patients negative for metastases, in 71 or more patient CT examinations (of 83), for each configuration. Results There were 123 hepatic metastases (mean size, 1.4 cm; median volume CT dose index and size-specific dose estimate, 11.0 and 13.4 mGy, respectively). By using JAFROC figure of merit, 100 QRM FBP did not meet noninferiority criteria and had estimated performance difference from routine dose of -0.08 (95% confidence interval: -0.11, -0.04). Preset reader agreement rules were not met for 100 QRM IR or 80 QRM IR, but were met for doses 120 QRM or higher (ie, size-specific dose estimate ≥ 8.0 mGy). IR improved image quality (P < .05) but not reader performance. Other than 160 QRM IR, lower dose levels were associated with reduced confidence in metastasis detection (P < .001). Conclusion For detection of hepatic metastases by using contrast-enhanced CT, dose levels that corresponded to 120 quality reference mAs (size-specific dose estimate, 8.0 mGy) and higher performed similarly to 200 quality reference mAs with filtered back projection. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Joel G Fletcher
- From the Departments of Radiology (J.G.F., J.L.F., S.K.V., D.M.H., N.T., L.Y., S.L., C.H.M.), Health Sciences Research (M.J., R.C.), and Physiology and Biomedical Research (D.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Jeff L Fidler
- From the Departments of Radiology (J.G.F., J.L.F., S.K.V., D.M.H., N.T., L.Y., S.L., C.H.M.), Health Sciences Research (M.J., R.C.), and Physiology and Biomedical Research (D.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Sudhakar K Venkatesh
- From the Departments of Radiology (J.G.F., J.L.F., S.K.V., D.M.H., N.T., L.Y., S.L., C.H.M.), Health Sciences Research (M.J., R.C.), and Physiology and Biomedical Research (D.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - David M Hough
- From the Departments of Radiology (J.G.F., J.L.F., S.K.V., D.M.H., N.T., L.Y., S.L., C.H.M.), Health Sciences Research (M.J., R.C.), and Physiology and Biomedical Research (D.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Naoki Takahashi
- From the Departments of Radiology (J.G.F., J.L.F., S.K.V., D.M.H., N.T., L.Y., S.L., C.H.M.), Health Sciences Research (M.J., R.C.), and Physiology and Biomedical Research (D.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Lifeng Yu
- From the Departments of Radiology (J.G.F., J.L.F., S.K.V., D.M.H., N.T., L.Y., S.L., C.H.M.), Health Sciences Research (M.J., R.C.), and Physiology and Biomedical Research (D.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Matthew Johnson
- From the Departments of Radiology (J.G.F., J.L.F., S.K.V., D.M.H., N.T., L.Y., S.L., C.H.M.), Health Sciences Research (M.J., R.C.), and Physiology and Biomedical Research (D.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Shuai Leng
- From the Departments of Radiology (J.G.F., J.L.F., S.K.V., D.M.H., N.T., L.Y., S.L., C.H.M.), Health Sciences Research (M.J., R.C.), and Physiology and Biomedical Research (D.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - David R Holmes
- From the Departments of Radiology (J.G.F., J.L.F., S.K.V., D.M.H., N.T., L.Y., S.L., C.H.M.), Health Sciences Research (M.J., R.C.), and Physiology and Biomedical Research (D.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Rickey Carter
- From the Departments of Radiology (J.G.F., J.L.F., S.K.V., D.M.H., N.T., L.Y., S.L., C.H.M.), Health Sciences Research (M.J., R.C.), and Physiology and Biomedical Research (D.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Cynthia H McCollough
- From the Departments of Radiology (J.G.F., J.L.F., S.K.V., D.M.H., N.T., L.Y., S.L., C.H.M.), Health Sciences Research (M.J., R.C.), and Physiology and Biomedical Research (D.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Image based simulation of the low dose computed tomography images suggests 13 mAs 120 kV suitability for non-syndromic craniosynostosis diagnosis without iterative reconstruction algorithms. Eur J Radiol 2018; 105:168-174. [DOI: 10.1016/j.ejrad.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 05/03/2018] [Accepted: 06/10/2018] [Indexed: 11/18/2022]
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Thenier-Villa JL, Sanromán-Álvarez P, Miranda-Lloret P, Plaza Ramírez ME. Incomplete reossification after craniosynostosis surgery-incidence and analysis of risk factors: a clinical-radiological assessment study. J Neurosurg Pediatr 2018; 22:120-127. [PMID: 29799353 DOI: 10.3171/2018.2.peds17717] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE One of the principles of the surgical treatment of craniosynostosis includes the release of fused bone plates to prevent recurrence. Such bone defects require a reossification process after surgery to prevent a cosmetic problem or brain vulnerability to damage. The objective of this study is to describe and analyze the radiological and clinical evolution of bone defects after craniosynostosis. METHODS From January 2005 to May 2016, 248 infants underwent surgical correction of craniosynostosis at HUiP La Fe Valencia; the authors analyzed data from 216 of these cases that met the inclusion criteria for this study. Various surgical techniques were used according to the age of the patient and severity of the case, including endoscopic-assisted suturectomy, open suturectomy, fronto-orbital advancement, and cranial vault remodeling. Clinical follow-up and radiological quantitative measurements in 2 periods-12-24 months and 2 years after surgery-were analyzed; 94 patients had a postoperative CT scan and were included in the radiological analysis. RESULTS At the end of the follow-up period, 92 of 216 patients (42.59%) showed complete closure of the bone defect, 112 patients (51.85%) had minor bone defects, and 12 patients (5.56%) had significant bone defects that required surgical intervention. In the multivariate analysis, age at first surgery was not significantly associated with incomplete reossification (p = 0.15), nor was surgical site infection (p = 0.75). Multivariate analysis identified area of cranial defect greater than 5 cm2 in the first CT scan as predictive of incomplete reossification (p = 0.04). The mean area of cranial defect in the first CT scan (12-24 months after surgery) was 3.69 cm2 in patients treated with open surgery and 7.13 cm2 in those treated with endoscopic-assisted procedures; in the multivariate analysis, type of procedure was not related to incomplete reossification (p = 0.46). The positive predictive value of palpation as evaluation of bone cranial defects was 50% for significant defects and 71% for minor defects. CONCLUSIONS The incidence of cranial defects due to incomplete reossification requiring cranioplasty was 5.56% in our series. Defects greater than 5 cm2 in the first postoperative CT scan showed a positive association with incomplete reossification. Patients treated with endoscope-assisted procedures had larger defects in the initial follow-up, but the final incidence of cranial defects was not significantly different in the endoscope-assisted surgery group from that in the open surgery group.
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Affiliation(s)
- José Luis Thenier-Villa
- 1Department of Neurological Surgery, HUiP La Fe, Valencia; and.,2Department of Neurosurgery, University Hospital Complex of Vigo, Vigo, Spain
| | - Pablo Sanromán-Álvarez
- 1Department of Neurological Surgery, HUiP La Fe, Valencia; and.,2Department of Neurosurgery, University Hospital Complex of Vigo, Vigo, Spain
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Kuusela L, Hukki A, Brandstack N, Autti T, Leikola J, Saarikko A. Use of black-bone MRI in the diagnosis of the patients with posterior plagiocephaly. Childs Nerv Syst 2018; 34:1383-1389. [PMID: 29594536 DOI: 10.1007/s00381-018-3783-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 03/16/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Ionising radiation exposure is especially harmful to brain development. The purpose of this study was to evaluate whether black-bone (BB) magnetic resonance imaging (MRI), a non-ionising imaging method, offers an alternative to ionising imaging methods such as computed tomography (CT) in the examination of cranial deformities. METHODS From 2012 to 2014, a total of 408 children were referred to the Craniofacial Centre at the Helsinki University Hospital for further examination due to flatness of the posterior skull. Fifteen of these patients required further diagnostic imaging. To avoid ionising radiation, we used an MRI protocol that included sequences for evaluation of both brain anatomy and skull bone and sutures by BB-MRI. A semi-automatic skull segmentation algorithm was developed to facilitate the visualisation. Two patients with scaphocephaly were included in the study to confirm the ability to differentiate synostosis with BB-MRI. RESULTS We obtained informative 3D images using BB-MRI. Seven patients (7/15, 46.7%) had plagiocephaly on the right side and seven on the left side (7/15, 46.7%). One patient (1/15, 6.7%) had symmetric posterior flatness affecting both sides. Neither structural nor signal-intensity alterations of the brain were detected in visual analysis. CONCLUSION BB-MRI provides an alternative to CT when imaging craniofacial deformities. BB-MRI provides not only high-quality 3D-reconstructed imaging of the bony structures and sutures but also information on brain structure in one imaging session. With further development, this method could replace ionising radiation-based methods in analysing deformities of the skull.
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Affiliation(s)
- Linda Kuusela
- Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland.,Department of Physics, University of Helsinki, Helsinki, Finland
| | - Ada Hukki
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Central Hospital, Topeliuksenkatu 3-5, PO Box 266, 00029, Helsinki, Finland
| | - Nina Brandstack
- Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Taina Autti
- Helsinki Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Junnu Leikola
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Central Hospital, Topeliuksenkatu 3-5, PO Box 266, 00029, Helsinki, Finland
| | - Anne Saarikko
- Cleft Palate and Craniofacial Centre, Department of Plastic Surgery, Helsinki University Central Hospital, Topeliuksenkatu 3-5, PO Box 266, 00029, Helsinki, Finland.
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