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Diagnostic and Interventional Radiology... Mar 2020When compared with chest radiographs, medical devices of the abdomen and pelvis are less frequently seen. However, with recent advances in technology the interpreting... (Review)
Review
When compared with chest radiographs, medical devices of the abdomen and pelvis are less frequently seen. However, with recent advances in technology the interpreting radiologists are seeing more medical objects on these radiographs. The identification of these devices and materials are crucial for not only enabling the radiologist to understand the underlying background pathology but also for evaluating any related complications. An online survey of literature showed our review article to be the most detailed. In this first part of our two-part series, we discuss about the various gastrointestinal and vascular devices and materials seen on abdominal and pelvic radiographs.
Topics: Abdomen; Equipment and Supplies; Gastrointestinal Tract; Humans; Pelvis; Prostheses and Implants; Radiography, Abdominal
PubMed: 32071024
DOI: 10.5152/dir.2019.19390 -
Radiographics : a Review Publication of... 2019Pelvic masses can present a diagnostic challenge owing to the difficulty in assessing their origin and the overlap in imaging features. The majority of pelvic tumors... (Review)
Review
Pelvic masses can present a diagnostic challenge owing to the difficulty in assessing their origin and the overlap in imaging features. The majority of pelvic tumors arise from gastrointestinal or genitourinary organs, with less common sites of origin including the connective tissues, nerves, and lymphovascular structures. Lesion evaluation usually starts with clinical assessment followed by imaging, or the lesion may be an incidental finding at imaging performed for other clinical indications. Since accurate diagnosis is essential for optimal management, imaging is useful for suggesting the correct diagnosis or narrowing the differential possibilities and distinguishing tumors from their mimics. Some masses may require histologic confirmation of the diagnosis with biopsy and/or up-front surgical resection. In this case, imaging is essential for presurgical planning to assess mass size and location, evaluate the relationship to adjacent pelvic structures, and narrow differential possibilities. Pelvic US is often the first imaging modality performed in women with pelvic symptoms. While US is often useful to detect a pelvic mass, it has significant limitations in assessing masses located deep in the pelvis or near gas-filled organs. CT also has limited value in the pelvis owing to its inferior soft-tissue contrast. MRI is frequently the optimal imaging modality, as it offers both multiplanar capability and excellent soft-tissue contrast. This article highlights the normal anatomy of the pelvic spaces in the female pelvis and focuses on MRI features of common tumors and tumor mimics that arise in these spaces. It provides an interpretative algorithm for approaching an unknown pelvic lesion at MRI. It also discusses surgical management, emphasizing the value of MRI as a road map to surgery and highlighting anatomic locations where surgical resection may present a challenge. RSNA, 2019.
Topics: Female; Genital Neoplasms, Female; Humans; Magnetic Resonance Imaging; Ovarian Neoplasms; Pelvic Neoplasms; Pelvis; Peritoneal Neoplasms; Rectal Neoplasms; Sigmoid Neoplasms; Urinary Bladder Neoplasms
PubMed: 31283453
DOI: 10.1148/rg.2019180173 -
Abdominal Radiology (New York) Jul 2021To assess the spectrum of computed tomography angiogram (CTA) abdominal and pelvic findings in critically ill COVID-19 patients and investigate correlation with CT chest...
PURPOSE
To assess the spectrum of computed tomography angiogram (CTA) abdominal and pelvic findings in critically ill COVID-19 patients and investigate correlation with CT chest scores.
METHODS
An IRB approved retrospective study of CTA of the chest, abdomen and pelvis between dates March 1st to September 15th, 2020 was performed in the hospitalized COVID-19 positive patients. CTA studies of solely the chest were excluded. Medical record review was performed to note patient demographics, CTA scan details and coagulation profile. CTA findings were reviewed to record vascular and non-vascular findings. CT chest was reviewed to calculate CT chest score. Logistic regression analyses were performed to correlate CT chest scores with odds of vascular and other abdomen-pelvis findings. A p < 0.05 was considered statistically significant.
RESULTS
A total of 45 consecutive hospitalized COVID-19 positive patients with 61 years mean age and M:F (2:1) gender ratio were evaluated, out of which majority 68.9% (n = 31) had CTA chest, abdomen and pelvis. The most common vascular findings were hematoma 46.7% (n = 21), active extravasation 24.4% (n = 11) and vascular occlusion 17.8% (n = 8). Higher CT chest scores were significantly associated with hematoma/extravasation (OR 1.19, 95% CI 1.07-1.34, p < 0.01). The most common non-vascular abdomen-pelvis findings were seen in organs gallbladder 20% (n = 9), liver 20% (n = 9) followed by kidney 15.6% (n = 7). Higher CT chest scores were significantly associated with bowel findings (OR 1.28, 95% CI 1.01-1.63, p < 0.05) and cholestasis (OR 13.3, 95% CI 1.28-138.9, p < 0.05).
CONCLUSION
Patients with moderate to severe COVID-19 pneumonia have significantly higher rate of vascular complications in the abdomen and pelvis.
Topics: Abdomen; COVID-19; Computed Tomography Angiography; Critical Illness; Humans; Pelvis; Retrospective Studies; SARS-CoV-2; Tomography, X-Ray Computed
PubMed: 34115186
DOI: 10.1007/s00261-021-03164-y -
Diagnostic and Interventional Imaging 2021The purpose of this study was to test a new post-processing and denoising engine for patient dose reduction while maintaining diagnostic image quality (IQ) in pediatric...
PURPOSE
The purpose of this study was to test a new post-processing and denoising engine for patient dose reduction while maintaining diagnostic image quality (IQ) in pediatric digital radiography (DR).
MATERIALS AND METHODS
Pediatric DR images of the thorax, pelvis, abdomen and spine obtained in 174 patients (102 males, 72 females; mean age, 2±1.8 [SD] years; age range: 6 months-9 years) were retrieved. Artificial noise was added to the images to simulate acquisitions at 50%, 32% and 12.5% of the routine dose levels. A total of 696 images corresponding to four dose levels were post-processed using S-Vue™ and further blindly scored by three pediatric radiologists using a scoring grid of 4-6 criteria specifically defined per anatomical area. The mean score was assessed for each area and weight class (5-15 and 15-30kg) and compared across the simulated low dose images. Paired Wilcoxon test was used with a threshold difference of 0.5 (half a criterion) between scores to highlight a significant reduction in image quality. Inter-rater reliability was assessed using intraclass correlation coefficient (ICC).
RESULTS
Only the 50% reduced dose images showed non-inferiority when compared to routine images for all of areas and weight classes (P<0.01). Very good inter-rater reliability of the overall scores was observed for the pelvis in the 5-15kg weight class (ICC=0.85) for images at full dose, 50% and 32% reduced dose. For the remaining areas (thorax, abdomen and spine) and weight classes, inter-rater reliability was moderate (ICC: 0.3-0.6).
CONCLUSION
S-Vue™ post-processing software allows a two-fold radiation dose reduction while maintaining satisfactory IQ in pediatric DR.
Topics: Child; Child, Preschool; Drug Tapering; Female; Humans; Infant; Male; Pelvis; Radiation Dosage; Radiographic Image Enhancement; Reproducibility of Results
PubMed: 33547025
DOI: 10.1016/j.diii.2021.01.009 -
European Radiology Oct 2022To evaluate ultra-high-resolution (UHR) imaging of large joints using an investigational photon-counting detector (PCD) CT.
OBJECTIVE
To evaluate ultra-high-resolution (UHR) imaging of large joints using an investigational photon-counting detector (PCD) CT.
MATERIALS AND METHODS
Patients undergoing clinical shoulder or pelvis energy-integrating-detector (EID) CT exam were scanned using the UHR mode of the PCD-CT system. Axial EID-CT images (1-mm sections) and PCD-CT images (0.6-mm sections) were reconstructed using Br62/Br64 and Br76 kernels, respectively. Two musculoskeletal radiologists rated visualization of anatomic structures using a 5-point Likert scale. Wilcoxon rank-sum test was used for statistical analysis of reader scores, and paired t-test was used for comparing bone CT numbers and image noise from PCD-CT and EID-CT.
RESULTS
Thirty-two patients (17 shoulders and 15 pelvis) were prospectively recruited for this feasibility study. Mean age for shoulder exams was 67.3 ± 15.5 years (11 females) and 47.2 ± 15.8 years (11 females) for pelvis exams. The mean volume CT dose index was lower on PCD-CT compared to that on EID-CT (shoulders: 18 mGy vs. 34 mGy, pelvis: 11.6 mGy vs. 16.7 mGy). PCD-CT was rated significantly better than EID-CT (p < 0.001) for anatomic-structure visualization. Trabecular delineation in shoulders (mean score = 4.24 ± 0.73) and femoroacetabular joint visualization in the pelvis (mean score = 3.67 ± 1.03) received the highest scores. PCD-CT demonstrated significant increase in bone CT number (p < 0.001) relative to EID-CT; no significant difference in image noise was found between PCD-CT and EID-CT.
CONCLUSION
The evaluated PCD-CT system provided improved visualization of osseous structures in the shoulders and pelvises at a 31-47% lower radiation dose compared to EID-CT.
KEY POINTS
• A full field-of-view PCD-CT with 0.151 mm × 0.176 mm detector pixel size (isocenter) facilitates bilateral, high-resolution imaging of shoulders and pelvis. • The evaluated investigational PCD-CT system was rated superior by two musculoskeletal radiologists for anatomic structure visualization in shoulders and pelvises despite a 31-47% lower radiation dose compared to EID-CT. • PCD-CT demonstrated significantly higher bone CT number compared to EID-CT, while no significant difference in image noise was observed between PCD-CT and EID-CT despite a 31-47% dose reduction on PCD-CT.
Topics: Aged; Aged, 80 and over; Feasibility Studies; Female; Humans; Middle Aged; Pelvis; Phantoms, Imaging; Photons; Shoulder; Tomography, X-Ray Computed
PubMed: 35689699
DOI: 10.1007/s00330-022-08925-x -
Computerized Medical Imaging and... Sep 2022Contrast agents are commonly used to highlight blood vessels, organs, and other structures in magnetic resonance imaging (MRI) and computed tomography (CT) scans....
Contrast agents are commonly used to highlight blood vessels, organs, and other structures in magnetic resonance imaging (MRI) and computed tomography (CT) scans. However, these agents may cause allergic reactions or nephrotoxicity, limiting their use in patients with kidney dysfunctions. In this paper, we propose a generative adversarial network (GAN) based framework to automatically synthesize contrast-enhanced CTs directly from the non-contrast CTs in the abdomen and pelvis region. The respiratory and peristaltic motion can affect the pixel-level mapping of contrast-enhanced learning, which makes this task more challenging than other body parts. A perceptual loss is introduced to compare high-level semantic differences of the enhancement areas between the virtual contrast-enhanced and actual contrast-enhanced CT images. Furthermore, to accurately synthesize the intensity details as well as remain texture structures of CT images, a dual-path training schema is proposed to learn the texture and structure features simultaneously. Experiment results on three contrast phases (i.e. arterial, portal, and delayed phase) show the potential to synthesize virtual contrast-enhanced CTs directly from non-contrast CTs of the abdomen and pelvis for clinical evaluation.
Topics: Abdomen; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Pelvis; Tomography, X-Ray Computed
PubMed: 35914340
DOI: 10.1016/j.compmedimag.2022.102094 -
Folia Morphologica 2023Anatomical variations are defined as atypical morphologic and positional presentations of anatomical entities. Pelvic anatomical variations encountered during abdominal... (Review)
Review
BACKGROUND
Anatomical variations are defined as atypical morphologic and positional presentations of anatomical entities. Pelvic anatomical variations encountered during abdominal hysterectomy can be of clinical interest, given that misidentification of certain structures can lead to iatrogenic injuries and postoperative sequelae. The aim of the present study was to detect and highlight the anatomical structures of interest and their variations to the surgeon performing abdominal hysterectomy for benign conditions.
MATERIALS AND METHODS
A narrative review of the literature was performed including reports of anatomical variations encountered in cadavers, by surgeons during abdominal hysterectomy and radiologists on computed tomography angiography, searching within a 10-year span on PubMed database. Studies regarding the treatment of malignant conditions requiring lymphadenectomy and different modes of surgical approach were reviewed with regards to the aspects relevant to benign conditions. The search was extended to the reference lists of all retrieved articles.
RESULTS
Ureters and the uterine arteries, due to anatomical variations, are the anatomical structures most vulnerable during abdominal hysterectomy. Specifically, the ureters can present multiplications, retroiliac positionings and ureteric diverticula, whereas, the uterine arteries can present notable variability in their origins. Such variations can be detected preoperatively or intraoperatively.
CONCLUSIONS
Although rare, the presence of anatomical variations of the uterine arteries and ureters can increase the possibility of complications should they escape detection. Intraoperative misidentification could lead to improper dissection or ligation of the affected structures. Knowledge of these variations, coupled with extensive preoperative investigation and intraoperative vigilance can minimise the risk of complications.
Topics: Female; Humans; Hysterectomy; Pelvis; Ureter
PubMed: 36254107
DOI: 10.5603/FM.a2022.0089 -
Journal of Sports Science & Medicine Sep 2020The aim of this study was to analyze the relationship of range of motion (ROM) in the sagittal plane and timing parameters during a bodyweight squat to the depth of the...
The aim of this study was to analyze the relationship of range of motion (ROM) in the sagittal plane and timing parameters during a bodyweight squat to the depth of the squat. Sixty participants (20 females and 40 males) took part in this study. They were instructed to perform a bodyweight squat to the maximal depth position. Kinematic data were obtained using the optical motion capture system. The time for the descent phase of squatting was normalized from 0% (initial position, start of movement) to 100% (squat position-stop of movement). The ROM of ankle, knee, hip, pelvis and spine in the sagittal plane and the normalized time when the maximum joint angles occurred during the descent were analyzed to investigate the relationship between them and the squat depth in males and females. The knee ROM contributed most significantly, from all joints to squatting depth in both females and males (r = 0.92, p < 0.001). The squat depth was related to lumbar, hip and knee motion in females and to all kinematics parameters in males. Maximal ankle dorsiflexion and pelvis anterior tilt were reached earlier than the maximal angles of knee, hip and spine during squatting. Pelvis and ankle timing was negatively correlated with the squat depth (r = -0.64, p < 0.001 and r = -0.29, p = 0.02, respectively). This suggests that pelvis and ankle timing can be important to keeping balance during squatting and can lead to achieving the desired depth
Topics: Ankle; Biomechanical Phenomena; Exercise; Female; Hip; Humans; Knee; Lower Extremity; Lumbar Vertebrae; Male; Pelvis; Postural Balance; Range of Motion, Articular; Time and Motion Studies; Young Adult
PubMed: 32874102
DOI: No ID Found -
International Journal of Colorectal... May 2021Male sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This...
PURPOSE
Male sex, high BMI, narrow pelvis, and bulky mesorectum were acknowledged as clinical variables correlated with a difficult pelvic dissection in colorectal surgery. This paper aimed at comparing pelvic biometric measurements in female and male patients and at providing a perspective on how pelvimetry segmentation may help in visualizing mesorectal distribution.
METHODS
A 3D software was used for segmentation of DICOM data of consecutive patients aged 60 years, who underwent elective abdominal CT scan. The following measurements were estimated: pelvic inlet, outlet, and depth; pubic tubercle height; distances from the promontory to the coccyx and to S3/S4; distance from S3/S4 to coccyx's tip; ischial spines distance; pelvic tilt; offset angle; pelvic inlet angle; angle between the inlet/sacral promontory/coccyx; angle between the promontory/coccyx/pelvic outlet; S3 angle; and pelvic inlet to pelvic depth ratio. The measurements were compared in males and females using statistical analyses.
RESULTS
Two-hundred patients (M/F 1:1) were analyzed. Out of 21 pelvimetry measurements, 19 of them documented a significant mean difference between groups. Specifically, female patients had a significantly wider pelvic inlet and outlet but a shorter pelvic depth, and promontory/sacral/coccyx distances, resulting in an augmented inlet/depth ratio when comparing with males (p < 0.0001). The sole exceptions were the straight conjugate (p = 0.06) and S3 angle (p = 0.17). 3D segmentation provided a perspective of the mesorectum distribution according to the pelvic shape.
CONCLUSION
Significant differences in the structure of pelvis exist in males and females. Surgeons must be aware of the pelvic shape when approaching the rectum.
Topics: Colorectal Neoplasms; Digestive System Surgical Procedures; Female; Humans; Male; Pelvimetry; Pelvis; Rectum
PubMed: 33230658
DOI: 10.1007/s00384-020-03802-9 -
Science Advances Aug 2022Evolutionary responses to selection for bipedalism and childbirth have shaped the human pelvis, a structure that differs substantially from that in apes. Morphology...
Evolutionary responses to selection for bipedalism and childbirth have shaped the human pelvis, a structure that differs substantially from that in apes. Morphology related to these factors is present by birth, yet the developmental-genetic mechanisms governing pelvic shape remain largely unknown. Here, we pinpoint and characterize a key gestational window when human-specific pelvic morphology becomes recognizable, as the ilium and the entire pelvis acquire traits essential for human walking and birth. We next use functional genomics to molecularly characterize chondrocytes from different pelvic subelements during this window to reveal their developmental-genetic architectures. We then find notable evidence of ancient selection and genetic constraint on regulatory sequences involved in ilium expansion and growth, findings complemented by our phenotypic analyses showing that variation in iliac traits is reduced in humans compared to African apes. Our datasets provide important resources for musculoskeletal biology and begin to elucidate developmental mechanisms that shape human-specific morphology.
Topics: Animals; Biological Evolution; Female; Hominidae; Humans; Parturition; Pelvis; Pregnancy; Selection, Genetic
PubMed: 35977020
DOI: 10.1126/sciadv.abq4884