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van Doesburg JR, Luttikhold J, Lindblad M, van Berge Henegouwen MI, Eshuis WJ, Derks S, Geijsen ED, Pouw RE, Gisbertz SS, Nilsson M, Daams F. Diagnostic workup for esophageal cancer patients can be improved with checklists and clearer protocols; a comparative study between two tertiary centers in Europe. Eur J Surg Oncol 2024; 50:107318. [PMID: 38145609 DOI: 10.1016/j.ejso.2023.107318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/26/2023] [Accepted: 12/07/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Rapid and complete workup of newly diagnosed esophageal cancer is vital for a timely, individual and high-quality treatment strategy. The aim of this study was to uncover potential delay, inefficiencies and non-contributing investigations in the diagnostic process in two tertiary referral centers. METHODS This retrospective cohort study included all newly diagnosed esophageal cancer patients referred to or diagnosed in the Amsterdam UMC and Karolinska University Hospital between July 2020 and July 2021. Radiology, pathological assessment and multidisciplinary team meeting reports were reviewed. To assess time interval from diagnosis to treatment, dates of diagnosis, admittance to referral hospital, MDT meeting and start of treatment were collected. RESULTS In total, 252 esophageal cancer patients were included, 187 were treated with curative intent. Curatively treated patients had a mean age of 66 years, were predominantly male (74.9 %) with an adenocarcinoma (71.1 %). Curatively treated patients had a median time from diagnosis to referral of seven days (IQR:0-11) and of 35 days (IQR:28-45) between diagnosis and start of treatment. Main reasons for the significant (P < 0.001) differences in time between diagnosis and treatment between centers, Amsterdam UMC (39 days) vs Karolinska (27 days), were need for additional diagnostics (47.8 %) and differences in referral routine. Gastroscopy was repeated in 32.2 % of patients, mainly for further anatomical mapping. CONCLUSION Significant time differences between centers in the path from diagnosis to start treatment can be explained by differences in workup approach, referral routines and MDT meeting regulations. Repeat of gastroscopy can be prevented with clearer endoscopy guidelines.
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Affiliation(s)
- J R van Doesburg
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit, de Boelelaan 1117, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, the Netherlands.
| | - J Luttikhold
- Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, And Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - M Lindblad
- Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, And Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - M I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, the Netherlands
| | - W J Eshuis
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, the Netherlands
| | - S Derks
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit, de Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - E D Geijsen
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit, de Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - R E Pouw
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Amsterdam UMC Location Vrije Universiteit, de Boelelaan 1117, Amsterdam, the Netherlands
| | - S S Gisbertz
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - M Nilsson
- Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, And Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - F Daams
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit, de Boelelaan 1117, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
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Xing F, Zhang X, Ji S, Zeng Y, Zhou H, Xu J, Wang C, Liu H. Computer Tomography (CT)-Based Study to Investigate Feasibility and Efficacy of Thoracoscopic Surgery in the Treatment of Penetrating Chest Wall Tuberculosis. Curr Med Imaging 2024; 20:1-10. [PMID: 38389354 DOI: 10.2174/0115734056256971231025051729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Chest wall tuberculosis may develop if tuberculous (TB) lesions spread through the chest wall and invade the thoracic cavity. The presence of a mass on the patient's chest wall may be the first indication of TB, and a chest CT scan can help diagnose external penetrating chest wall TB, the incursion of tuberculosis from the lungs into the chest wall. OBJECTIVE This study examines the safety and efficacy of thoracoscopic-assisted surgery for the treatment of penetrating chest wall tuberculosis as a means of exploring novel concepts of minimally invasive surgery. METHODS Our hospital conducted a retrospective study of 25 patients with penetrating chest wall TB who underwent thoracoscopic surgery between January 2020 and June 2021. General demographics, CT scan data linked to surgery, and postoperative patient outcomes were compared between the two groups. The data was also evaluated to determine the range of operation time and the volume of bleeding from different foci in the thoracic cavity. RESULTS All procedures went well after patients took conventional antituberculosis medication for at least two weeks prior to surgery. CT scans showed that thoracoscopic surgery needed a smaller incision than traditional chest wall TB surgery, with no discernible increase in surgical time. Postoperative tube use, length of hospital stay, and blood loss were all significantly lower than they would have been with conventional surgery. In addition, thoracoscopy was associated with a significantly reduced rate of subsequent treatment. Fibrous plate development and calcification caused the longest operation times in the thoracoscopic surgery group, whereas multiple pleural tuberculomas generated the most hemorrhage. Thoracoscopic surgery usually reveals tuberculous foci hiding in the thoracic cavity. CONCLUSION Thethoracic surgery can eliminate the TB focus in the chest wall and intrathoracic while treating penetrating chest wall tuberculosis. The CT scan is a crucial part of the diagnostic process for these patients. Minor surgical trauma, low complication and recurrence rates, and good results. There is a greater distinction between the two surgical approaches for patients with penetrating chest wall TB as opposed to those with basic chest wall tuberculosis.
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Affiliation(s)
- Fuchen Xing
- Department of Thoracic Surgery, The Second Hospital of Nanjing, Nanjing, 210003, China
| | - Xia Zhang
- Department of Tuberculosis, The Second Hospital of Nanjing, Nanjing, 210003, China
| | - Saiguang Ji
- Department of Thoracic Surgery, The Second Hospital of Nanjing, Nanjing, 210003, China
| | - Yi Zeng
- Department of Tuberculosis, The Second Hospital of Nanjing, Nanjing, 210003, China
| | - Hai Zhou
- Department of Thoracic Surgery, The Second Hospital of Nanjing, Nanjing, 210003, China
| | - Jian Xu
- Department of Thoracic Surgery, The Second Hospital of Nanjing, Nanjing, 210003, China
| | - Chenyan Wang
- Department of Thoracic Surgery, The Second Hospital of Nanjing, Nanjing, 210003, China
| | - Hong Liu
- Department of Thoracic Surgery, The Second Hospital of Nanjing, Nanjing, 210003, China
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Fojtová M, Křístek J, Kučera L. A pathological lesion or a postmortem artefact? An interdisciplinary approach to deal with an interesting early medieval case. Int J Paleopathol 2023; 43:93-98. [PMID: 37913591 DOI: 10.1016/j.ijpp.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/27/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE This study evaluates a case of pseudopathology and the effects that postmortem taphonomic changes and environmental influences can have on bone. MATERIAL A skeleton of a young male from the early medieval site Staré Město, dated to the 9th-10th century CE. METHODS The skeletal remains were subjected to detailed macroscopic and X-ray examination, and then a CT scan and XRF analysis were performed. RESULTS X-ray examination of the mandible revealed unusually dense structures, whose appearance was not consistent with any known pathology. Based on the results of CT scanning, it was hypothesized that these were cavities filled with alluvial sediment. X-ray fluorescence spectrometry (XRF), focusing on the determination of the silica content, revealed a high intensity of silica in the samples of the affected area of the bone. CONCLUSION The hypothesis that the inclusions were composed of waterborne sediment was supported. SIGNIFICANCE Although it is well known that soil can infiltrate bones buried in the ground, its appearance on plain radiographs is not that commonly known. The case illustrates the usefulness of differentiating true pathologies from postmortem alterations to avoid inappropriate interpretations. LIMITATIONS No similar cases have been described. SUGGESTION FOR FURTHER RESEARCH In palaeopathological evaluation, the use of multiple imaging and evaluative techniques should be implemented to differentiate pathological lesions from pseudopathology.
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Affiliation(s)
| | - Jan Křístek
- Department of Radiology, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Medical Imaging, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lukáš Kučera
- Department of Analytical Chemistry, Faculty of Science, Palacký University, Olomouc, Czech Republic
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Ospino R, Brookmeyer C. Development of unilateral renal peripelvic lymphangiectasia after renal vein thrombosis. Radiol Case Rep 2023; 18:3690-3694. [PMID: 37601119 PMCID: PMC10432910 DOI: 10.1016/j.radcr.2023.07.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/22/2023] Open
Abstract
Renal peripelvic lymphangiectasia is a rare entity that can mimic hydronephrosis on routine contrast-enhanced computer tomography (CT). While it may remain asymptomatic, symptomatic cases can exhibit refractory hypertension (HTN) and recurrent abdominal pain. Diagnostic challenges stem from its nonspecific symptoms and imaging characteristics, which can overlap with other renal disorders. Thereby, adequate protocolling of CT or magnetic resonance (MR) imaging is important for accurate diagnosis. In this report, we present a case of renal lymphangiectasia that developed in a medically complex patient following renal vein thrombosis.
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Affiliation(s)
- Rafael Ospino
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claire Brookmeyer
- Russell H. Morgan Department of Radiology, Johns Hopkins School of Medicine, 601 N Caroline St, Baltimore, MD, 21287, USA
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Kowalski F, Adamowicz J, Jozwicki J, Grzanka D, Drewa T. The role of early diagnosis of emphysematous cystitis: A case report and literature review. Urol Case Rep 2021; 36:101581. [PMID: 33643846 PMCID: PMC7889795 DOI: 10.1016/j.eucr.2021.101581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/20/2021] [Indexed: 10/26/2022] Open
Abstract
Emphysematous cystitis (EC) is a rare entity caused by bacteria, which produce gas filled cysts in the bladder wall. We present a case of EC in a 72-year-old woman admitted to Vascular Surgery Department because of diabetic foot syndrome. During the hospital stay, the patient's general condition deteriorated. CT established EC diagnosis. Surgical treatment was inevitable. Salvage cystectomy was performed. Despite macroscopic removal of necrotic tissues, the condition of the patient didn't improve, 75 days past diagnosis of EC she died due to the multi-organ failure. Prompt diagnosis provided by imaging plays a key role in the treatment of EC.
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Affiliation(s)
- F Kowalski
- Department of Urology, Antoni Jurasz Memorial University Hospital, Bydgoszcz, 85094, Kujavian-Pomeranian Voivodship, Poland.,Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 85037, Kujavian-Pomeranian Voivodship, Poland
| | - J Adamowicz
- Department of Urology, Antoni Jurasz Memorial University Hospital, Bydgoszcz, 85094, Kujavian-Pomeranian Voivodship, Poland.,Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 85037, Kujavian-Pomeranian Voivodship, Poland
| | - J Jozwicki
- Department of Pathomorphology, Antoni Jurasz Memorial University Hospital, Bydgoszcz, 85094, Kujavian-Pomeranian Voivodship, Poland.,Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 85037, Kujavian-Pomeranian Voivodship, Poland
| | - D Grzanka
- Department of Pathomorphology, Antoni Jurasz Memorial University Hospital, Bydgoszcz, 85094, Kujavian-Pomeranian Voivodship, Poland.,Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 85037, Kujavian-Pomeranian Voivodship, Poland
| | - T Drewa
- Department of Urology, Antoni Jurasz Memorial University Hospital, Bydgoszcz, 85094, Kujavian-Pomeranian Voivodship, Poland.,Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 85037, Kujavian-Pomeranian Voivodship, Poland
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Lu Z, Wu S, Yan C, Chen J, Li Y. Clinical value of energy spectrum curves of dual-energy computer tomography may help to predict pathological grading of gastric adenocarcinoma. Transl Cancer Res 2021; 10:1-9. [PMID: 35116234 PMCID: PMC8797754 DOI: 10.21037/tcr-20-1269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 11/27/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND To explore the clinical value of energy spectrum curves of dual-energy computer tomography (CT) in quantitative evaluation of different pathological grades of gastric adenocarcinoma. METHODS A total of 62 patients with 36 poorly, 25 moderately and 1 well differentiated gastric adenocarcinomas confirmed pathologically were collected. Dual-energy CT plain and enhanced scanning were undergone before operation. Dual-Energy software was used to measure the slope of the energy spectrum curves (λ) in arterial and venous phases (VPs) after image reconstruction. Patients were divided into two groups according to the pathological results, including well and moderately differentiated gastric adenocarcinoma group and poorly differentiated gastric adenocarcinoma group. Data of each group were analyzed by independent sample t-test. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic efficiency of the corresponding parameters. RESULTS There were significant differences in λ values of 40-50, 40-60, 40-80, 40-90, 40-100, 40-120, 40-130, 40-140 and 40-150 keV energy ranges in VP between the well and moderately differentiated group and poorly differentiated group (P<0.05), but no significant differences in λ values of different energy ranges in arterial phase (AP) between the two groups (P>0.05). And the area under curve in 40-120 keV energy range was the largest in VP. λ40-120keV=2.69 was selected as the diagnostic threshold with the maximum Youden index, the sensitivity and specificity were 61.1% and 76%, respectively. CONCLUSIONS The energy spectrum curve of dual-energy CT had certain diagnostic value in the quantitative evaluation of pathological grading of gastric adenocarcinoma.
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Affiliation(s)
- Zhihua Lu
- Department of Radiology, Putian First Hospital of Fujian Province, Putian, China
| | - Suying Wu
- Department of Radiology, Putian First Hospital of Fujian Province, Putian, China
| | - Chuan Yan
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jianwei Chen
- Department of Radiology, Fujian Cancer Hospital, Fuzhou, China
| | - Yueming Li
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Lomoro P, Simonetti I, Vinci G, Fichera V, Prevedoni Gorone MS. Pancake kidney, a rare and often misdiagnosed malformation: a case report and radiological differential diagnosis. J Ultrasound 2019; 22:207-213. [PMID: 30361920 PMCID: PMC6531527 DOI: 10.1007/s40477-018-0331-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/09/2018] [Indexed: 12/13/2022] Open
Abstract
Renal ectopia and fusion anomalies are Congenital Anomalies of the Kidney and the Urinary Tract (CAKUT) that are usually incidentally detected and asymptomatic. Patients affected present a higher risk of complications like recurrent urinary tract infections or obstruction. Pancake kidney (PK) is one of the rarest types of renal anomaly with complete fusion of the superior, mild and inferior poles of both kidneys in the pelvic cavity. Each kidney has its own excretory system with two ureters that do not cross the midline. In the asymptomatic cases, a conservative approach should be performed. Surgical management may be needed when urological problems occur. PK is often associated with congenital anomalies of other organs. Ultrasound is the first line radiological examination for the diagnosis and the follow-up of kidney malformations. The main sonographic findings suggesting PK diagnosis are a large and lobulated renal mass consisting of two fused lateral lobes without an intervening septum located in the pelvic cavity. Each lobe usually has a separate pelvicalyceal system, the renal pelvis is anteriorly placed and the ureters are usually short and enter the bladder normally without crosses the midline. Ultrasonography gives useful information on the morphology and volume of the organ, and on its vascularization through the use of the Color- and Power-Doppler. Computer Tomography and Magnetic Resonance Urography are second level techniques used to confirm the diagnosis and to evaluate the presence of other abnormalities. The knowledge of the imaging findings and the anatomy of congenital renal malformations is important to avoid diagnostic pitfalls and misinterpretations. We report the case of a 14-years old female with PK who was misdiagnosed with a horseshoe kidney (HSK) during an abdominal ultrasound.
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Affiliation(s)
- P. Lomoro
- Department of Diagnostic Medicine, Institute of Radiology IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - I. Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - G. Vinci
- Department of Nephrology, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - V. Fichera
- Department of Pediatrics, Anna Meyer Children’s University Hospital, Florence, Italy
| | - M. S. Prevedoni Gorone
- Department of Diagnostic and Interventional Radiology and Neuroradiology of IRCCS, San Matteo University Hospital Foundation, Pavia, Italy
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Simonetti I, Puglia M, Tarotto L, Palumbo F, Esposito F, Sciuto A, Palumbo L, Ragozzino A. When traditions become dangerous: Intestinal perforation from unusual foreign body-Case report and short literature review. Eur J Radiol Open 2019; 6:152-5. [PMID: 31024984 DOI: 10.1016/j.ejro.2019.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 11/25/2022] Open
Abstract
Gastrointestinal perforation (GI) is a common cause of acute abdomen in the emergency department that needs a prompt surgery intervention. Nowadays, CT examinations represent the method of choice to image patients with acute abdominal pain in emergency. GI perforations by foreign bodies ingested is rare and only <1% of ingested foreign bodies are believed to cause perforation of GI. MDCT is to be considered the best imaging method for identifying foreign bodies, the perforation site and the surgical treatment to be planned reliably. We presente a case of 70-year-old lady presented to our Emergency Department with acute abdominal pain.
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Kano T, Koseki M. A new metal artifact reduction algorithm based on a deteriorated CT image. J Xray Sci Technol 2016; 24:901-912. [PMID: 27612053 DOI: 10.3233/xst-160600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Computed tomography (CT) is an established imaging technology primarily used as a non-invasive diagnostic tool that reconstructs axial images. However, significant problems with metal artifacts remain. A metal artifact is a strong radial noise in an image, which makes it difficult to diagnose patients and inspect products containing metal implants. Historically, studies related to metal artifact reduction used projection data, though the data is not typically saved after processing. OBJECTIVE This study proposes a new metal artifact reduction algorithm that does not require projection data, for new applications and for accurate diagnostic techniques. METHODS The algorithm utilizes reconstructed images and is based on iterative reconstruction. By reproducing an accurate forward projection on simulation and combining it with an iterative calculation, discrepancies causing metal artifacts are eliminated. RESULTS Validation was completed with numerical phantom models. Our results indicate that the proposed algorithm effectively reduces metal artifacts, even if numerous complex-shaped metal pieces were embedded in the cross-section. CONCLUSIONS We developed a novel reconstruction algorithm for metal artifact reduction in CT imaging that only requires reconstructed images and projection conditions. Any historical CT data containing metal artifacts could be improved with this method.
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Affiliation(s)
- Toru Kano
- School of Media Science, Tokyo University of Technology, 1404-1, Katakura, Hachioji, Tokyo, Japan
| | - Michihiko Koseki
- Faculty of Textile Science and Technology, Shinshu University, Tokida, Ueda, Nagano, Japan
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Fitzgerald O'Connor E, Rozen WM, Chowdhry M, Band B, Ramakrishnan VV, Griffiths M. Preoperative computed tomography angiography for planning DIEP flap breast reconstruction reduces operative time and overall complications. Gland Surg 2016; 5:93-8. [PMID: 27047777 DOI: 10.3978/j.issn.2227-684x.2015.05.17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The approach and operative techniques associated with breast reconstruction have steadily been refined since its inception, with abdominal perforator-based flaps becoming the gold standard reconstructive option for women undergoing breast cancer surgery. The current study comprises a cohort of 632 patients, in whom specific operative times are recorded by a blinded observer, and aims to address the potential benefits seen with the use of computer tomography (CT) scanning preoperatively on operative outcomes, complications and surgical times. METHODS A prospectively recorded, retrospective review was undertaken of patients undergoing autologous breast reconstruction with a DIEP flap at the St Andrews Centre over a 4-year period from 2010 to 2014. Computed tomography angiography (CTA) scanning of patients began in September 2012 and thus 2 time periods were compared: 2 years prior to the use of CTA scans and 2 years afterwards. For all patients, key variables were collected including patient demographics, operative times, flap harvest time, pedicle length, surgeon experience and complications. RESULTS In group 1, comprising patients within the period prior to CTA scans, 265 patients underwent 312 flaps; whilst in group 2, the immediately following 2 years, 275 patients had 320 flaps. The use of preoperative CTA scans demonstrated a significant reduction in flap harvest time of 13 minutes (P<0.013). This significant time saving was seen in all flap modifications: unilateral, bilateral and bipedicled DIEP flaps. The greatest time saving was seen in bipedicle flaps, with a 35-minute time saving. The return to theatre rate significantly dropped from 11.2% to 6.9% following the use of CTA scans, but there was no difference in the total failure rate. CONCLUSIONS The study has demonstrated both a benefit to flap harvest time as well as overall operative times when using preoperative CTA. The use of CTA was associated with a significant reduction in complications requiring a return to theatre in the immediate postoperative period. Modern scanners and techniques can reduce the level of ionising radiation, facilitating patients being able to benefit from the advantages that this preoperative planning can convey.
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Affiliation(s)
- Edmund Fitzgerald O'Connor
- 1 STAAR St Andrews Anglia Ruskin Research Group, Anglia Ruskin University, Essex, UK ; 2 St Andrew's Centre for Plastic Surgery and Burns, Room E322, Mayflower Ward, Level 3, Zone E, West Wing, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex CM1 7ET, UK
| | - Warren Matthew Rozen
- 1 STAAR St Andrews Anglia Ruskin Research Group, Anglia Ruskin University, Essex, UK ; 2 St Andrew's Centre for Plastic Surgery and Burns, Room E322, Mayflower Ward, Level 3, Zone E, West Wing, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex CM1 7ET, UK
| | - Muhammad Chowdhry
- 1 STAAR St Andrews Anglia Ruskin Research Group, Anglia Ruskin University, Essex, UK ; 2 St Andrew's Centre for Plastic Surgery and Burns, Room E322, Mayflower Ward, Level 3, Zone E, West Wing, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex CM1 7ET, UK
| | - Bassam Band
- 1 STAAR St Andrews Anglia Ruskin Research Group, Anglia Ruskin University, Essex, UK ; 2 St Andrew's Centre for Plastic Surgery and Burns, Room E322, Mayflower Ward, Level 3, Zone E, West Wing, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex CM1 7ET, UK
| | - Venkat V Ramakrishnan
- 1 STAAR St Andrews Anglia Ruskin Research Group, Anglia Ruskin University, Essex, UK ; 2 St Andrew's Centre for Plastic Surgery and Burns, Room E322, Mayflower Ward, Level 3, Zone E, West Wing, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex CM1 7ET, UK
| | - Matthew Griffiths
- 1 STAAR St Andrews Anglia Ruskin Research Group, Anglia Ruskin University, Essex, UK ; 2 St Andrew's Centre for Plastic Surgery and Burns, Room E322, Mayflower Ward, Level 3, Zone E, West Wing, Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Chelmsford, Essex CM1 7ET, UK
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Richter M, Seidl B, Zech S, Hahn S. PedCAT for 3D-imaging in standing position allows for more accurate bone position (angle) measurement than radiographs or CT. Foot Ankle Surg 2014; 20:201-7. [PMID: 25103709 DOI: 10.1016/j.fas.2014.04.004] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/08/2014] [Accepted: 04/16/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND PedCAT (Curvebeam, Warrington, USA) is a new technology that allows 3D-imaging with full weight bearing which is not influenced by projection and/or foot orientation (as radiographs). The aim of this study was to compare time spent of the image acquisition, and comparison of specific bone position (angle) measurements between three imaging methods (radiographs, CT, pedCAT), and to analyze and compare measurement differences and inter- and intraobserver reliability. METHODS In a prospective consecutive controlled study, 30 patients in which standard digital radiographs with full weight bearing in standing position (feet bilateral dorsoplantar and lateral views and Saltzman hindfoot view), CT without weight bearing, and pedCAT scan with full weight bearing in standing position were included, starting July 1, 2013. The following angles were measured for the right foot by three different investigators three times: 1st - 2nd intermetatarsal angle, talo-metatarsal 1-angle (TMT) both dorsoplantar and lateral projection, hindfoot angle, calcaneal pitch. The angles were digitally measured and compared (ANOVA with Post Hoc Scheffe test). RESULTS The angles differed between radiographs, CT and pedCAT (ANOVA, all p≤.01). The angles differed between pedCAT and both radiographs and CT (Post Hoc Scheffe test, each p≤.05 except for TMT dorsoplantar and calcaneal pitch angels versus radiographs). CONCLUSIONS The angles differed between radiographs, CT and pedCAT, indicating that only pedCAT is able to detect the correct angles. PedCAT includes weight bearing in contrast to CT. PedCAT prevents inaccuracies of projection and foot orientation in contrast to radiographs due to the 3D dataset which is principally independent from projection and foot orientation.
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Affiliation(s)
- Martinus Richter
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany.
| | - Bernd Seidl
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
| | - Stefan Zech
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
| | - Sarah Hahn
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
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