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Medicine Jan 2021Tomoscintigraphic reconstruction in nuclear medicine assumes that the distribution of the tracer is unchanged in the volume of interest throughout the duration of the...
Tomoscintigraphic reconstruction in nuclear medicine assumes that the distribution of the tracer is unchanged in the volume of interest throughout the duration of the acquisition. This condition is however not met in early-phase bone scintigraphy and early-phase pelvic SPECT may display helical artifacts due to the filling of the bladder. Those artifacts may hamper proper interpretation of surrounding bone areas. The aim of this study was to construct a 4D digital pelvic phantom to simulate different acquisition protocols and optimize the acquisition.A 4D digital pelvic phantom was generated with a dynamic component consisting in an expanding bladder with 2 ureters and a static part consisting in the 2 kidneys, bone structures, and soft tissues. Projection data were obtained using an attenuated Radon transform function. Four acquisitions protocols were tested: 32 projections of 16 seconds (32-16-1), 32 projections of 8 seconds (32-8-1), 2 consecutive SPECT of 32 projections of 4 seconds (32-4-2) and 2 consecutive SPECT of 16 projections of 8 seconds (16-8-2). The optimal protocol was then tested on one patient.The amplitude of the artifacts was reduced with the 32-8-1, 32-4-2, and 16-8-2 protocols. The 16-8-2 protocol had the highest signal to noise ratio among those 3 protocols. The bladder artifact was visually markedly reduced on the patient acquisition with a 16-8-2 protocol.Two successive early-phase bone SPECT, with a lower number of projection than the usual protocol reduce the impact of the helical artifacts around the bladder.
Topics: Artifacts; Humans; Image Processing, Computer-Assisted; Pelvic Bones; Phantoms, Imaging; Quality Improvement; Tomography, Emission-Computed; Urinary Bladder
PubMed: 33530260
DOI: 10.1097/MD.0000000000024473 -
The Journal of International Medical... Jun 2021The number of patients with metastatic bone tumors of the pelvis (MBTP) has increased, and the risk of metastasis and recurrence in the pelvic bones is difficult to...
OBJECTIVE
The number of patients with metastatic bone tumors of the pelvis (MBTP) has increased, and the risk of metastasis and recurrence in the pelvic bones is difficult to assess. Therefore, we investigated the clinical features and oncological outcomes of patients with MBTP.
METHODS
We analyzed the clinical features and oncological outcomes of MBTP in 72 patients (42 men, 30 women; mean age, 50.5 years) from 2008 to 2017. Recurrence in the pelvic bones and survival rates were analyzed with regard to patients' potential contributing factors.
RESULTS
Enneking region I was the area most commonly containing MBTP (47.3%). Low- and high-grade tumors were identified in 40 and 32 patients, respectively. The most common pathological type was adenomatous carcinoma (34.7%), and the most common primary lesion was lung cancer (20.8%). The 3-year overall recurrence rate within the pelvic bones was 34.7%, and the 5-year overall survival rate was 29.2%.
CONCLUSION
Patients with MBTP have a high risk of recurrence in the pelvic bones and poor survival after multimodal treatment. Pelvic recurrence might be affected by the metastatic involvement, tumor grade, surgical margins, and type of surgery, whereas the survival rate tends to be associated with the tumor grade.
Topics: Bone Neoplasms; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvic Bones; Pelvic Neoplasms; Pelvis; Retrospective Studies
PubMed: 34154434
DOI: 10.1177/03000605211013152 -
The Journal of Bone and Joint Surgery.... Nov 2010High energy fractures of the pelvis are a challenging problem both in the immediate post-injury phase and later when definitive fixation is undertaken. No single... (Review)
Review
High energy fractures of the pelvis are a challenging problem both in the immediate post-injury phase and later when definitive fixation is undertaken. No single management algorithm can be applied because of associated injuries and the wide variety of trauma systems that have evolved around the world. Initial management is aimed at saving life and this is most likely to be achieved with an approach that seeks to identify and treat life-threatening injuries in order of priority. Early mortality after a pelvic fracture is most commonly due to major haemorrhage or catastrophic brain injury. In this article we review the role of pelvic binders, angiographic embolisation, pelvic packing, early internal fixation and blood transfusion with regard to controlling haemorrhage. Definitive fixation seeks to prevent deformity and reduce complications. We believe this should be undertaken by specialist surgeons in a hospital resourced, equipped and staffed to manage the whole spectrum of major trauma. We describe the most common modes of internal fixation by injury type and review the factors that influence delayed mortality, adverse functional outcome, sexual dysfunction and venous thromboembolism.
Topics: External Fixators; Fracture Fixation, Internal; Fractures, Bone; Humans; Pelvic Bones; Treatment Outcome
PubMed: 21037339
DOI: 10.1302/0301-620X.92B11.25911 -
Acta Bio-medica : Atenei Parmensis Dec 2019Pelvic ring fractures represent a challenge for orthopaedic surgeon. Their management depends on patient's condition, pattern of fracture and associated injuries....
BACKGROUND AND AIM
Pelvic ring fractures represent a challenge for orthopaedic surgeon. Their management depends on patient's condition, pattern of fracture and associated injuries. Optimal timing for synthesis is not yet clear. The aim of this study was to define if surgical timing influenced clinic and radiographic outcomes following open reduction and internal fixation for Tile B and C fractures.
MATERIALS AND METHODS
38 patients were included. Patients underwent a clinical examination with the Majeed Score, Iowa Pelvic Score and Orlando Pelvic Score. The radiographic assessment was performed according to Matta Pelvic Score. A statistical analysis of the data compared patients who were operated within 3 weeks (group 1) and those operated later (group 2).
RESULTS
Both clinical and radiological outcomes were influenced by timing of surgery.
CONCLUSION
Pelvic ring fractures interest many polytrauma patients and, therefore, their surgical orthopedic approach is frequently delayed as consequence of the severity of the associated clinical conditions. An early surgery of pelvic rong fractures allows a better quality of reduction and osteosynthesis.
Topics: Adult; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Male; Middle Aged; Open Fracture Reduction; Pelvic Bones; Radiography; Time Factors; Treatment Outcome
PubMed: 31821288
DOI: 10.23750/abm.v90i12-S.8949 -
Korean Journal of Radiology May 2023To investigate the association between pelvic bone computed tomography (CT)-derived body composition and patient outcomes in older adult patients who underwent surgery...
OBJECTIVE
To investigate the association between pelvic bone computed tomography (CT)-derived body composition and patient outcomes in older adult patients who underwent surgery for proximal femur fractures.
MATERIALS AND METHODS
We retrospectively identified consecutive patients aged ≥ 65 years who underwent pelvic bone CT and subsequent surgery for proximal femur fractures between July 2018 and September 2021. Eight CT metrics were calculated from the cross-sectional area and attenuation of the subcutaneous fat and muscle, including the thigh subcutaneous fat (TSF) index, TSF attenuation, thigh muscle (TM) index, TM attenuation, gluteus maximus (GM) index, GM attenuation, gluteus medius and minimus (Gmm) index, and Gmm attenuation. The patients were dichotomized using the median value of each metric. Multivariable Cox regression and logistic regression models were used to determine the association between CT metrics with overall survival (OS) and postsurgical intensive care unit (ICU) admission, respectively.
RESULTS
A total of 372 patients (median age, 80.5 years; interquartile range, 76.0-85.0 years; 285 females) were included. TSF attenuation above the median (adjusted hazard ratio [HR], 2.39; 95% confidence interval [CI], 1.41-4.05), GM index below the median (adjusted HR, 2.63; 95% CI, 1.33-5.26), and Gmm index below the median (adjusted HR, 2.33; 95% CI, 1.12-4.55) were independently associated with shorter OS. TSF index (adjusted odds ratio [OR], 6.67; 95% CI, 3.13-14.29), GM index (adjusted OR, 3.45; 95% CI, 1.49-7.69), GM attenuation (adjusted OR, 2.33; 95% CI, 1.02-5.56), Gmm index (adjusted OR, 2.70; 95% CI, 1.22-5.88), and Gmm attenuation (adjusted OR, 2.22; 95% CI, 1.01-5.00) below the median were independently associated with ICU admission.
CONCLUSION
In older adult patients who underwent surgery for proximal femur fracture, low muscle indices of the GM and gluteus medius/minimus obtained from their cross-sectional areas on preoperative pelvic bone CT were significant prognostic markers for predicting high mortality and postsurgical ICU admission.
Topics: Female; Humans; Aged; Aged, 80 and over; Proximal Femoral Fractures; Retrospective Studies; Pelvic Bones; Body Composition; Tomography
PubMed: 37133212
DOI: 10.3348/kjr.2022.0835 -
Journal of Orthopaedic Research :... Mar 2022Limb-salvaging hemipelvectomy surgeries involving allograft or custom prosthesis reconstruction require high quality remaining pelvic bone for adequate device fixation....
Limb-salvaging hemipelvectomy surgeries involving allograft or custom prosthesis reconstruction require high quality remaining pelvic bone for adequate device fixation. Modeling studies of custom pelvis prosthesis designs typically mirror contralateral pelvic bone material properties to the ipsilateral pelvis. However, the extent of bone material property and geometric symmetry, and thus the appropriateness of mirroring, remains unknown and should be considered when designing or analyzing the performance of pelvic prostheses. This study investigates preoperative differences between ipsilateral and contralateral pelvic bone for patients with a pelvic sarcoma. Computed tomography (CT) data were obtained retrospectively from eight patients with a pelvic sarcoma. Subject-specific computational models of the pelvic bones were constructed from the CT data. Bilateral asymmetry of bone material properties and cross-sectional areas between the ipsilateral and contralateral hemipelvis were quantified at points adjacent to the pelvic sarcoma. Large bilateral asymmetry (>20%) in trabecular but not cortical bone density was observed within 20 mm of the tumor location. Differences in trabecular bone density typically declined with increased distance from the tumor. The greatest bilateral difference in cross-sectional area occurred within 10 mm of the tumor boundary for three patients and within 40 mm from the tumor site for four patients. Our results suggest that pelvic sarcomas can cause significant bilateral asymmetries in trabecular bone density for patients with a pelvic sarcoma. These differences should be taken into account when designing custom implants for this patient population.
Topics: Bone Density; Bone Neoplasms; Humans; Pelvic Bones; Retrospective Studies; Sarcoma; Tomography, X-Ray Computed
PubMed: 33914952
DOI: 10.1002/jor.25067 -
The Bone & Joint Journal Nov 2014Acetabular bone loss is a challenging problem facing the revision total hip replacement surgeon. Reconstruction of the acetabulum depends on the presence of... (Review)
Review
Acetabular bone loss is a challenging problem facing the revision total hip replacement surgeon. Reconstruction of the acetabulum depends on the presence of anterosuperior and posteroinferior pelvic column support for component fixation and stability. The Paprosky classification is most commonly used when determining the location and degree of acetabular bone loss. Augments serve the function of either providing primary construct stability or supplementary fixation. When a pelvic discontinuity is encountered we advocate the use of an acetabular distraction technique with a jumbo cup and modular porous metal acetabular augments for the treatment of severe acetabular bone loss and associated chronic pelvic discontinuity.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Bone Diseases, Metabolic; Hip Prosthesis; Humans; Pelvic Bones; Prosthesis Design; Prosthesis Failure; Radiography; Reoperation
PubMed: 25381406
DOI: 10.1302/0301-620X.96B11.34455 -
European Journal of Trauma and... Dec 2021
Topics: Fractures, Bone; Humans; Pelvic Bones; Retrospective Studies; Trauma Centers
PubMed: 34845506
DOI: 10.1007/s00068-021-01823-9 -
Orthopaedic Surgery Jun 2020To preliminarily study the efficacy and safety of stop-flow pelvic chemoperfusion, a novel therapeutic strategy for treating pelvic malignancies.
OBJECTIVE
To preliminarily study the efficacy and safety of stop-flow pelvic chemoperfusion, a novel therapeutic strategy for treating pelvic malignancies.
METHODS
Stop-flow chemoperfusion was performed six times in 5 patients with primary pelvic malignancies. Aortic and vena cave balloons and tourniquets were used to isolate pelvic blood flow from systemic circulation. Cisplatin was then perfused through a transarterial catheter to achieve exposure to a higher drug concentration. Pelvic and peripheral blood samples were collected to determine drug concentration during perfusion. The efficacy of stop-flow pelvic perfusion was assessed by measuring the change in tumor size, the visual analogue scale, and the tumor necrosis rate after perfusion. Safety was assessed by classifying adverse events according to CTCAE v4.03.
RESULTS
The mean area under the curve (AUC) and maximum drug concentration in the pelvis during perfusion were 246.23 min μg/mL and 17.29 μg/mL, respectively. These measures were significantly higher than the peripheral mean AUC and maximum drug concentration of 52.08 min μg/mL and 5.14 μg/mL, respectively. All 5 patients showed stable disease in response, with changes in tumor size of -4.7%, -5.4%, +4.7%, -8.4%, and 0.0%. Among the 5 patients, 3 (60%) experienced significant pain relief after perfusion. Three patients underwent surgery, with tumor necrosis of 63%, <60%, and 93%. No severe complications were observed in this study.
CONCLUSIONS
Stop-flow pelvic chemoperfusion resulted in exposure to drug higher concentration with fewer serious complications. These preliminary results suggest that further studies are required to comprehensively assess the therapeutic potential of stop-flow pelvic chemoperfusion in pelvic malignancies.
Topics: Adult; Antineoplastic Agents; Bone Neoplasms; Chemotherapy, Cancer, Regional Perfusion; Cisplatin; Female; Humans; Male; Neoplasm Metastasis; Pain Measurement; Pelvic Bones
PubMed: 32243077
DOI: 10.1111/os.12666 -
Scientific Reports Mar 2022Haemostatic procedures such as preperitoneal pelvic packing (PPP), pelvic angiography (PA), and internal iliac artery ligation are used for haemorrhage control in pelvic...
Haemostatic procedures such as preperitoneal pelvic packing (PPP), pelvic angiography (PA), and internal iliac artery ligation are used for haemorrhage control in pelvic fracture patients with haemodynamic instability. Pelvic external fixation (PEF) and pelvic binder (PB) are usually applied with haemostatic procedures to reduce the pelvic volume. This study aimed to compare the clinical outcomes between patients who underwent PEF and PB. Among 173 patients with pelvic fracture admitted to the emergency room of three regional trauma centres between January 2015 and December 2018, the electronic charts of haemodynamically unstable patients were retrospectively analysed. Among the 84 patients included in the analysis, 20 underwent PEF with or without PB, and 64 underwent only PB. There were significant differences in tile classification and laparotomy between the PEF and PB groups (p = 0.023 and p = 0.032). PPP tended to be more frequently preformed in the PEF group (p = 0.054), whereas PA tended to be more commonly performed in the PB group than in the PEF group (p = 0.054). After propensity score matching to adjust for differences in patient characteristics and adjunct haemostatic procedure, there was no significant difference in 7-day, 30-day, and overall mortality rates between the PEF and PB groups (10.5% vs 21.1%, p = 0.660, 21.1% vs 26.3%, p = 1.000, and 26.3% vs 26.3%, p = 1.000). Cox proportional hazard regression analysis and multivariate analysis for correction of covariates (age, lactate, and abdominal injury) showed that PEF was not an independent factor for 30-day mortality compared with PB (adjusted hazard ratio, 0.526; 95% confidence interval, 0.092-3.002; p = 0.469). Among the volume reduction procedures performed with other haemostatic procedures in patients with pelvic fracture and haemodynamic instability, PEF did not significantly reduce the 30-day mortality rate compared to PB.
Topics: External Fixators; Fracture Fixation; Fractures, Bone; Hemodynamics; Hemostatics; Humans; Pelvic Bones; Retrospective Studies; Treatment Outcome; Vascular Diseases
PubMed: 35256684
DOI: 10.1038/s41598-022-07694-3