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Magma (New York, N.Y.) Jun 2022In this study we address the automatic segmentation of selected muscles of the thigh and leg through a supervised deep learning approach.
OBJECTIVE
In this study we address the automatic segmentation of selected muscles of the thigh and leg through a supervised deep learning approach.
MATERIAL AND METHODS
The application of quantitative imaging in neuromuscular diseases requires the availability of regions of interest (ROI) drawn on muscles to extract quantitative parameters. Up to now, manual drawing of ROIs has been considered the gold standard in clinical studies, with no clear and universally accepted standardized procedure for segmentation. Several automatic methods, based mainly on machine learning and deep learning algorithms, have recently been proposed to discriminate between skeletal muscle, bone, subcutaneous and intermuscular adipose tissue. We develop a supervised deep learning approach based on a unified framework for ROI segmentation.
RESULTS
The proposed network generates segmentation maps with high accuracy, consisting in Dice Scores ranging from 0.89 to 0.95, with respect to "ground truth" manually segmented labelled images, also showing high average performance in both mild and severe cases of disease involvement (i.e. entity of fatty replacement).
DISCUSSION
The presented results are promising and potentially translatable to different skeletal muscle groups and other MRI sequences with different contrast and resolution.
Topics: Deep Learning; Image Processing, Computer-Assisted; Leg; Magnetic Resonance Imaging; Muscle, Skeletal; Thigh
PubMed: 34665370
DOI: 10.1007/s10334-021-00967-4 -
BMC Musculoskeletal Disorders Dec 2022In soft tissue reconstructive surgery, perforator localization and flap harvesting have always been critical challenges, but augmented reality (AR) has become a dominant...
PURPOSE
In soft tissue reconstructive surgery, perforator localization and flap harvesting have always been critical challenges, but augmented reality (AR) has become a dominant technology to help map perforators.
METHODS
The lateral circumflex femoral artery (LCFA) and its perforators were reconstructed by CTA in consecutive patients (N = 14). Then, the anterolateral thigh perforators and the points from which the perforators emerged from the deep fascia were marked and projected onto the skin surface. As the virtual images were projected onto patients according to bony markers, the courses of the LCFA and its perforators were depicted on the skin surface for intraoperative guidance. Finally, the locations of the emergence points were verified by intraoperative findings and compared to those determined by handheld Doppler ultrasound.
RESULTS
The sources, locations, and numbers of perforators were determined by CTA. The perforators and their emergence points were accurately mapped on the skin surface by a portable projector to harvest the anterolateral thigh perforator flap. During the operation, the accuracy of the CTA & AR method was 90.2% (37/41), and the sensitivity reached 97.4% (37/38), which were much higher than the corresponding values of Doppler ultrasound. Additionally, the differences between the AR-marked points and the intraoperative findings were much smaller than those seen with Doppler ultrasound (P < 0.001). Consequently, all of the flaps were well designed and survived, and only one complication occurred.
CONCLUSION
Augmented reality, namely, CTA combined with projection in this study, plays a vital and reliable role in locating the perforator emergence points and guiding the procedure to harvest flaps and has fewer potential risks.
Topics: Humans; Augmented Reality; Thigh; Veins; Surgical Flaps; Angiography
PubMed: 36457082
DOI: 10.1186/s12891-022-06013-1 -
Medicina (Kaunas, Lithuania) Mar 2022: The anterolateral thigh (ALT) flap is widely used in head and neck reconstruction, but the postoperative thigh sensory function lacks sufficient evaluation. The...
: The anterolateral thigh (ALT) flap is widely used in head and neck reconstruction, but the postoperative thigh sensory function lacks sufficient evaluation. The present study reports the postsurgical pain and cancer-related quality of life (QoL) in different stages of oral cancer patients receiving anterolateral thigh (ALT) flap reconstruction. : Patients were subgrouped into postoperative early-, mid-, and late-recovery stages (postoperative 0.5-1 years, 1-2 years, and above 2 years) according to the time point of assessment. The QoL was examined using the EORTC C-30. Postsurgical donor and receipt site pain was evaluated through subjective reports and sensory tests. : Ninety-four patients were included in the final analysis. The functional and global health-related QoL significantly improved with time after surgery. However, spontaneous pain was reported in 57.7%, 72.3%, and 42% of patients in early-, mid-, and late-recovery stages, mainly in donor sites rather than in receipt sites. The highest incidence of donor site pain after ALT flap reconstruction in oral cancer surgery was in the mid-recovery stage but remained high in the late-recovery stage (56.8% and 36.7%, respectively). : The postsurgical pain in the donor site might persist to or exhibit delayed onset one to two years postoperatively but is much improved after postoperatively two years later. A longer postsurgical follow-up for over two years for pain and sensory dysfunction is indicated.
Topics: Free Tissue Flaps; Humans; Mouth Neoplasms; Pain, Postoperative; Quality of Life; Thigh
PubMed: 35334567
DOI: 10.3390/medicina58030391 -
Ugeskrift For Laeger Jan 2014
Topics: Adult; Female; Humans; Panniculitis; Thigh
PubMed: 24629686
DOI: No ID Found -
The Journal of the American Academy of... Jun 2007Hamstring strain is common in athletes, and both diagnosis and surgical treatment of this injury are becoming more common. Nonsurgical treatment of complete ruptures has... (Review)
Review
Hamstring strain is common in athletes, and both diagnosis and surgical treatment of this injury are becoming more common. Nonsurgical treatment of complete ruptures has resulted in complications such as muscle weakness and sciatic neuralgia. Surgical treatment recently has been advocated to repair the complete rupture of the hamstring tendons from the ischial tuberosity. Surgical repair involves a transverse incision in the gluteal crease, protection of the sciatic nerve, mobilization of the ruptured tendons, and repair to the ischial tuberosity with the use of suture anchors. Reports in the literature of surgical treatment of proximal hamstring rupture are few, and most series have had a relatively small number of patients. Surgical repair results project 58% to 85% rate of return to function and sports activity, near normal strength, and decreased pain.
Topics: Adult; Algorithms; Braces; Humans; Magnetic Resonance Imaging; Middle Aged; Muscle, Skeletal; Physical Examination; Rupture; Thigh
PubMed: 17548884
DOI: 10.5435/00124635-200706000-00004 -
Journal of Physiological Anthropology Sep 2021The primary aim of this study was to investigate whether using the extracellular water/intracellular water (ECW/ICW) index and phase angle combined with...
BACKGROUND
The primary aim of this study was to investigate whether using the extracellular water/intracellular water (ECW/ICW) index and phase angle combined with segmental-bioimpedance analysis (BIA) improved the model fitting of skeletal muscle volume (SMV) estimation. The secondary aim was to compare the accuracy of segmental-BIA with that of ultrasound for estimating the quadriceps SMV measured with MRI.
METHODS
Seventeen young men (mean age, 23.8 ± 3.3 years) participated in the study. The T-1 weighted images of thigh muscles were obtained using a 1.5 T magnetic resonance imaging (MRI) scanner. Thigh and quadriceps SMVs were calculated as the sum of the products of anatomical cross-sectional area and slice thickness of 6 mm across all slices. Segmental-BIA was applied to the thigh region, and data on the 50-kHz bioelectrical impedance (BI) index, ICW index, ECW/ICW index, and phase angle were obtained. The muscle thickness index was calculated as the product of the mid-thigh muscle thickness, determined using ultrasound, and thigh length. The standard error of estimate (SEE) of the regression equation was calculated to determine the model fitting of SMV estimation and converted to %SEE by dividing the SEE values by the mean SMV.
RESULTS
Multiple regression analysis indicated that the combination of 50-kHz BI and the ECW/ICW index or phase angle was a significant predictor when estimating thigh SMV (SEE = 7.9 and 8.1%, respectively), but were lower than the simple linear regression (SEE = 9.4%). The ICW index alone improved the model fitting for the estimation equation (SEE = 7.6%). The model fitting of the quadriceps SMV with the 50-kHz BI or ICW index was similar to that with the skeletal muscle thickness index measured using ultrasound (SEE = 10.8, 9.6 and 9.7%, respectively).
CONCLUSIONS
Combining the traditionally used 50-kHz BI index with the ECW/ICW index and phase angle can improve the model fitting of estimated SMV measured with MRI. We also showed that the model suitability of SMV estimation using segmental-BIA was equivalent to that on using ultrasound. These data indicate that segmental-BIA may be a useful and cost-effective alternative to the gold standard MRI for estimating SMV.
Topics: Adult; Anthropology, Physical; Body Composition; Electric Impedance; Humans; Magnetic Resonance Imaging; Male; Muscle, Skeletal; Thigh; Young Adult
PubMed: 34593041
DOI: 10.1186/s40101-021-00263-z -
BMC Musculoskeletal Disorders Jan 2022We aimed to evaluate the feasibility of the upper thigh level as a landmark to measure muscle area for sarcopenia assessment on computed tomography (CT).
BACKGROUND
We aimed to evaluate the feasibility of the upper thigh level as a landmark to measure muscle area for sarcopenia assessment on computed tomography (CT).
METHODS
In the 116 healthy subjects who performed CT scans covering from mid-abdomen to feet, the skeletal muscle area in the upper thigh level at the inferior tip of ischial tuberosity (SMA), the mid-thigh level (SMA), and L3 inferior endplate level (SMA) were measured by two independent readers. Pearson correlation coefficients between SMA, SMA, and SMA were calculated. Inter-reader agreement between the two readers were evaluated using intraclass correlation coefficient (ICC) and Bland-Altman plots with 95% limit of agreement (LOA).
RESULTS
In readers 1 and 2, very high positive correlations were observed between SMA and SMA (r = 0.91 and 0.92, respectively) and between SMA and SMA (r = 0.90 and 0.91, respectively), while high positive correlation were observed between SMA and SMA (r = 0.87 and 0.87, respectively). Based on ICC values, the inter-reader agreement was the best in the SMA (0.999), followed by the SMA (0.990) and SMA (0.956). The 95% LOAs in the Bland-Altman plots indicated that the inter-reader agreement of the SMA (- 0.462 to 1.513) was the best, followed by the SMA (- 9.949 to 7.636) and SMA (- 12.105 to 14.605).
CONCLUSION
Muscle area measurement at the upper thigh level correlates well with those with the mid-thigh and L3 inferior endpoint level and shows the highest inter-reader agreement. Thus, the upper thigh level might be an excellent landmark enabling SMA as a reliable and robust biomarker for muscle area measurement for sarcopenia assessment.
Topics: Biomarkers; Humans; Magnetic Resonance Imaging; Muscle, Skeletal; Sarcopenia; Thigh; Tomography, X-Ray Computed
PubMed: 35086521
DOI: 10.1186/s12891-022-05032-2 -
The British Journal of Radiology May 2022We examined the longitudinal and cross-sectional relationship between automated MRI-analysis and single-slice axial CT imaging for determining muscle size and muscle fat...
OBJECTIVES
We examined the longitudinal and cross-sectional relationship between automated MRI-analysis and single-slice axial CT imaging for determining muscle size and muscle fat infiltration (MFI) of the anterior thigh.
METHODS
Twenty-two patients completing sex-hormone treatment expected to result in muscle hypertrophy ( = 12) and atrophy ( = 10) underwent MRI scans using 2-point Dixon fat/water-separated sequences and CT scans using a system operating at 120 kV and a fixed flux of 100 mA. At baseline and 12 months after, automated volumetric MRI analysis of the anterior thigh was performed bilaterally, and fat-free muscle volume and MFI were computed. In addition, cross-sectional area (CSA) and radiological attenuation (RA) (as a marker of fat infiltration) were calculated from single slice axial CT-images using threshold-assisted planimetry. Linear regression models were used to convert units.
RESULTS
There was a strong correlation between MRI-derived fat-free muscle volume and CT-derived CSA ( = 0.91), and between MRI-derived MFI and CT-derived RA ( = -0.81). The 95% limits of agreement were ±0.32 L for muscle volume and ±1.3% units for %MFI. The longitudinal change in muscle size and MFI was comparable across imaging modalities.
CONCLUSIONS
Both automated MRI and single-slice CT-imaging can be used to reliably quantify anterior thigh muscle size and MFI.
ADVANCES IN KNOWLEDGE
This is the first study examining the intermodal agreement between automated MRI analysis and CT-image assessment of muscle size and MFI in the anterior thigh muscles. Our results support that both CT- and MRI-derived measures of muscle size and MFI can be used in clinical settings.
Topics: Adipose Tissue; Adult; Humans; Lower Extremity; Magnetic Resonance Imaging; Muscle, Skeletal; Thigh; Tomography, X-Ray Computed
PubMed: 35195445
DOI: 10.1259/bjr.20211094 -
Annals of Plastic Surgery May 2020This study aimed to present the use of flow-through free anterolateral thigh (ALT) flap for the reconstruction of severe limb injury.
OBJECTIVE
This study aimed to present the use of flow-through free anterolateral thigh (ALT) flap for the reconstruction of severe limb injury.
PATIENTS AND METHODS
Four patients (2 male and 2 female subjects), with an average age of 26 (9-39) years, were included. These injuries referred to upper and lower limbs, including bone, soft tissue, nerve, and arterial segments. Two patients experienced large soft tissue defects in the lower limb and were repaired by double flow-through ALT flaps. The sizes of damaged soft tissues in the remaining 2 patients were 14 × 10 cm and 21 × 13 cm, respectively. Three patients had bone fractures, in which one of them experienced bone shortening during operation. The arterial injury was observed in 2 patients and the lengths of defects were 5 and 12 cm, respectively. Flow-through free ALT flap was applied for all 4 patients.
RESULTS
Patients were followed up for 18 months. All the flaps have survived successfully without any vascular crisis or infection. All incision wounds were under primary healing stage, without any severe complications. The flaps showed better appearance, color, texture, and satisfactory sensation. All patients had satisfactory functional recovery of their injured limbs.
CONCLUSIONS
The flow-through free ALT flap assists in overcoming complex traumatic injuries with severe soft tissue and arterial defects in the limbs. This flow-through ALT flap can be an effective alternative for reconstruction of severe limb injury.
Topics: Adult; Female; Free Tissue Flaps; Humans; Male; Plastic Surgery Procedures; Skin Transplantation; Soft Tissue Injuries; Thigh; Treatment Outcome
PubMed: 32282414
DOI: 10.1097/SAP.0000000000002372 -
Antimicrobial Agents and Chemotherapy Feb 2023Temocillin is used for the treatment of various infections caused by . The pharmacokinetic (PK)/pharmacodynamic (PD) index that is best correlated with the activity of...
Temocillin is used for the treatment of various infections caused by . The pharmacokinetic (PK)/pharmacodynamic (PD) index that is best correlated with the activity of beta-lactams is the percentage of time that the unbound concentration exceeds the MIC (%T>MIC). However, the %T>MIC needed for a bacteriostatic or killing effect of temocillin is unknown in thigh and lung infection models. In the present study, we studied the temocillin PK in plasma and epithelial lining fluid (ELF) of infected neutropenic mice and determined the plasma exposure-response relationships for Escherichia coli and Klebsiella pneumoniae. Neutropenic murine thigh and lung infection models were used. The bacterial loads in the thighs or lungs were determined. A sigmoid maximum-effect model was used to fit the plasma exposure-response relationship. A one-compartment model with first-order absorption best described temocillin PK (clearance [CL], 1.03 L/h/kg; volume of distribution [], 0.457 L/kg). Protein binding was 78.2% ± 1.3% across different plasma concentrations. A static effect was achieved for all strains in both the thigh and lung infection models. However, the median %T>MIC needed for a static effect was much lower in the lung infection model (27.8% for E. coli and 38.2% for K. pneumoniae) than in the thigh infection model (65.2% for E. coli and 64.9% for K. pneumoniae). A 1-log kill was reached for all strains in the lung infection model (median %T>MIC values of 42.1% for E. coli and 44.1% for K. pneumoniae) and 7 out of 8 strains in the thigh infection model (median %T>MIC values of 85.4% for E. coli and 74.5% for K. pneumoniae). These data support the use of temocillin in patients with pneumonia.
Topics: Mice; Animals; Anti-Bacterial Agents; Escherichia coli; Penicillins; Lung; Communicable Diseases; Klebsiella pneumoniae; Neutropenia; Microbial Sensitivity Tests; Thigh
PubMed: 36692307
DOI: 10.1128/aac.01433-22