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4D-computerized visualisation of human craniofacial skeletal growth and of the development of the dentition.

The understanding of growth and developmental changes can be improved when shapes and changes in size, proportion, and relationships are visualized in 3 dimensions and at different stages. This applies particularly to craniofacial skeletal growth and the development of the dentition. For that purpose 3D-data were collected from prenatal human heads ranging from 18 up to 275 mm CRL and from a collection of macerated fetal and postnatal skulls. Computer-aided graphical reconstructions were obtained from histological serial sections of embryonic and early fetal specimens. Proportional changes in the growing skull were recorded by means of radiological and cephalometric evaluation. In addition, computed tomography was applied to fetal and postnatal skulls. Furthermore, the prenatal and postnatal development of the dentition was digitized. To that end 3D-polygone sets of these data were read into a workstation computer and animated by means of the software Soft Image (Microsoft). This comprehensive 4D insight into growth facilitates the understanding and teaching of normal and abnormal development.

Abortion, Legal↗

Nasal polyps herniating through lacrimal-nasal bony ostium mimicking dacryocystocele: a rare cause of DCR failure.

PURPOSE: To describe a rare cause of dacryocystorhinostomy (DCR) failure resulting from polyps herniating through the lacrimal-nasal ostium in a patient with severe, recurrent nasal polyposis. DESIGN/METHODS: Observational case report. Clinical practice setting. RESULTS: Five years after DCR surgery, a 65-year-old male patient presented with epiphora and a soft cystic enlargement in the lacrimal sac area mimicking a dacryocystocele. The Jones 1 test was negative but the Jones 2 test positive. Computer tomography (CT) showed bilateral obstruction of the nasal space by soft tissue, herniating through the lacrimal-nasal ostium, suggestive of recurrent nasal polyposis. Transnasal polypectomy was performed, which re-established tear-drainage to the nose. CONCLUSIONS: Recurrent nasal polyposis may lead to DCR failure and may give rise to a soft tissue swelling at the site of previous DCR surgery.

Aged↗

D2 dopamine receptor up-regulation, treatment response, neurological soft signs, and extrapyramidal side effects in schizophrenia: a follow-up study with 123I-iodobenzamide single photon emission computed tomography in the drug-naive state and after neuroleptic treatment.

BACKGROUND: Animal and postmortem studies indicate that neuroleptic therapy may induce D2 dopamine receptor up-regulation in the basal ganglia. METHODS: To address this phenomenon in a clinical study, we investigated the D2 dopamine receptor binding in 15 DSM-III-R schizophrenics in the drug-naive state and 3 days after completion of a standardized neuroleptic therapy (benperidol 12-16 mg/day, for 25 days) using single photon emission computed tomography (SPECT). SPECT scans were obtained 2 hours after intravenous injection of 185 MBq 123I-iodobenzamide. For analysis, basal ganglia to frontal cortex (BG/FC) ratios were calculated and the patient sample was subgrouped into patients with a favorable versus a poor treatment response. RESULTS: Neuroleptic treatment led to decreased BG/FC ratios in patients with a favorable response, but increased ratios in the poor responders (df = 1, F = 4.1, p = .06). Changes of BG/FC ratios were significantly correlated with extrapyramidal side effects but not with neurological soft signs. CONCLUSIONS: Our findings suggest that neuroleptic therapy may induce D2 dopamine receptor up-regulation in a subgroup of patients characterized by poor treatment response and pronounced extrapyramidal side effects.

Adult↗

Spread of carcinoma of the base of the tongue as detected by computer tomography.

21 patients with histologically proven carcinoma involving the base of the tongue were studied with computer tomography utilizing a high dose of intravenous infusion of contrast material. Computer tomography demonstrated not only excellent visualization of the primary carcinoma at the base of the tongue, but also its traditional means of spread to contiguous soft tissues of the pharyngeal walls and lymph node metastasis. Computer tomography also demonstrated the unusual spread to the retropharyngeal lymph nodes and nasopharynx. Computer tomography with high-dose intravenous contrast is the best radiographic modality for the evaluation of carcinoma of the base of the tongue.

Adult↗

A comparative study of the quantitative accuracy of three-dimensional reconstructions of spinal cord from serial histological sections.

We evaluated the accuracy of estimating the volume of biological soft tissues from their three-dimensional (3D) computer wireframe models, reconstructed from histological data sets obtained from guinea-pig spinal cords. We compared quantification from two methods of three-dimensional surface reconstruction to standard quantitative techniques, Cavalieri method employing planimetry and point counting and Geometric Best-Fitting. This involved measuring a group of spinal cord segments and test objects to evaluate the accuracy of our novel quantification approaches. Once a quantitative methodology was standardized there was no statistical difference in volume measurement of spinal segments between quantification methods. We found that our 3D surface reconstructions' ability to model precisely actual soft tissues provided an accurate volume quantification of complex anatomical structures as standard approaches of Cavalieri estimation and Geometric Best-Fitting. Additionally, 3D reconstruction quantitatively interrogates and three-dimensionally images spinal cord segments and obscured internal pathological features with approximately the same effort required for standard quantification alone.

Animals↗

Three-dimensional computed tomography of the foot: optimizing the image.

The complex anatomy of the foot can be imaged using high resolution computed tomography. High resolution serial nonoverlapping CT scans of foot anatomy have a high degree of soft tissue contrast, and excellent geometrical accuracy (no magnification error). Three-dimensional surface reconstruction from CT scans of the foot were performed using specially developed computer software. These surface reconstructions display the osseous and soft tissue anatomy of the foot in a form similar to anatomic preparations. The removal of overlying skin, disarticulation of the ankle, tarsals and metatarsals was accomplished using computer methods. Major factors necessary to optimize three-dimensional images are presented and illustrated. The technique has been applied in living subjects with arthritis, carpal coalitions, osteochondritis dissecans, and fractures. These images have been useful in communicating the findings on high resolution CT scans to referring clinicians, correlating CT findings in areas of complex anatomy, and eliminating overlying or obscuring structures by mathematically disarticulating the foot and individual tarsal bones.

Cadaver↗

Computed tomography of benign ovarian masses.

Although ultrasound is the primary imaging modality for evaluating benign gynecologic pelvic masses, CT may provide diagnostic information regarding ovarian masses that are discovered fortuitously. The relatively infrequent use of CT in evaluating the adnexa has resulted in a paucity of literature regarding the CT characteristics of benign ovarian masses. The CT appearances of 24 benign ovarian masses are presented. Pathologic diagnoses were ovarian cyst (nine), endometrioma (five), teratoma (three), serous cystadenoma (two), mucinous cystadenoma (two), thecoma (one), cystadenofibroma (one), and Brenner tumor (one). Benign ovarian cysts have characteristic homogeneous water density and smooth walls on CT. Single internal septations and slight wall irregularity are also common features, but soft-tissue mural or septal nodules are uncommon. Computed tomography can be diagnostic in evaluating cystic teratomas. Other benign ovarian masses exhibit a spectrum of CT appearances that is often nonspecific, and surgical or biopsy proof may be necessary to exclude malignancy.

Cystadenoma↗

Expansile subchondral degenerative bone cyst secondary to osteoarthritis.

A 53-year-old man known to have osteoarthritis of the left knee was examined because of a soft-tissue swelling overlying the pes anserinus tendon. Plain radiography and computed tomography revealed an expansile subchondral cyst of the proximal tibia. The cyst was multiloculated, had a sclerotic margin and an extraosseous soft-tissue component, and interrupted the cortex. Proof of a degenerative cyst was obtained by open biopsy. Such presentation in the knee is rare. Awareness of the possible aggressive behaviour of such degenerative cysts should help avoid confusion with neoplasm.

Bone Cysts↗

[Radiologic diagnosis of malignant peripheral soft tissue tumors].

In malignant soft-tissue tumors of the extremities the radiologist is asked to define size and extent of the lesion and it's relationship to adjacent structures. The assessment of the nature of the lesion is of utmost importance, however, the contribution of the different imaging modalities varies considerably. In a review article the current roles of conventional radiography, xeroradiography, real-time ultrasonography, computed tomography and arteriography in the diagnostic workup of malignant soft-tissue tumors of the extremities are discussed. The statements made are based upon own comparative studies as well as on a review of the literature. In the assessment of the nature of a soft-tissue mass the contribution of all radiologic imaging methods is rather limited, although arteriography may add valuable information if performed complementary to CT. Real-time ultrasonography is well suited to define size, location and extent of peripheral soft-tissue masses. It is therefore recommended as the first imaging method and for follow-up studies. Equivocal findings by real-time sonography and new cases for treatment planning must be confirmed by computed tomography which proved to be the most reliable and the best reproducible imaging method for soft-tissue tumors of the extremities.

Adult↗

An evaluation of two VTO methods.

A sample of 34 growing Class II patients was used to assess the reliability of manual and computer-generated visual treatment objectives (VTOs) when compared with the actual treatment results. Skeletal, dental, and soft tissue measurements were performed on the VTO and on the posttreatment tracings. Using paired t-tests and Pearson correlation coefficients, comparisons were made between the VTO and posttreatment tracings. Both the manual and computer VTO methods were accurate when predicting skeletal changes that occurred during treatment. However, both methods were only moderately successful in forecasting dental and soft tissue alterations during treatment. Only slight differences were seen between the manual and computer VTO methods, with the computer being slightly more accurate with the soft tissue prediction. However, the differences between the two methods were not judged to be clinically significant. Overall, the prediction tracings were accurate to only a moderate degree, with marked individual variation evident throughout the sample.

Adolescent↗

[Sport injuries of the extensor mechanism of the knee].

Injuries of the extensor mechanism of the knee occur frequently during sport activity. For a successful treatment they must be diagnosed early. Besides osseous structures the patellar tendon, the patella, the quadriceps muscle and tendon, retinacula and bursae can be affected. After initial clinical examination there are different noninvasive imaging modalities available for assessment of bone, cartilage, ligaments, tendons and soft tissue. Conventional radiographs are still the basic imaging tool for the clinician. Additional information about the osseous status is provided by computed tomography, whereas sonography plays an important role concerning diagnosis of soft tissue injuries. For the detection of cartilagenous, ligamentous or tendon lesions MRI is the superior non-invasive imaging modality.

Athletic Injuries↗

Computed tomography of musculoskeletal tumors.

Modern chemotherapy has resulted in increased survival and even cure in many patients with malignant bone and soft tissue tumors. As a results, whereas amputation was commonly practiced in the past, many centers now use limb preservation surgery in selected patients. This technique requires accurate preoperative assessment of tumor location, extent and relationships, and the role of different imaging techniques, including conventional radiography, CT, radionuclide scanning, sonography and angiography in evaluating these parameters is discussed. CT provides the most accurate technique currently available for assessing the local extent of musculoskeletal tumors and has thus had a significant effect on their management. An algorithmic approach to the evaluation of musculoskeletal tumors is proposed.

Angiography↗

Bladder leiomyoma with right hydronephrosis.

The authors describe one female patient with leiomyoma of the bladder who presented with female pseudoprostate and right hydronephrosis. A computed tomography (CT) of the pelvis revealed a soft tissue mass, circumferential and heterogenous in appearance with some calcification inside the mass. Bladder leiomyoma might be one of the differential diagnoses with CT imaging findings of female pseudoprostate.

Diagnosis, Differential↗

The role of power Doppler sonography in the evaluation of superficial soft tissue abscesses.

OBJECTIVE: To evaluate the efficacy of power doppler ultrasonography in depicting increased vasculature and hyperemia around the superficial soft tissue abscess. MATERIALS AND METHODS: 21 patients with soft tissue abscess were evaluated with gray scale imaging, color doppler sonography, power doppler sonography and computed tomography. In each case attempts were made using power doppler sonography to demonstrate any areas of increased vascularity around the lesion. The results were compared with computed tomographic findings. RESULTS: Peripheral hyperemia and increased vasculature were demonstrated with power doppler sonography in 19 of 21 patients with soft tissue abscess. The hyperemic area demonstrated around the wall of the abscess by power doppler sonography was similar to the enhanced area shown by computed tomography performed after contrast administration. CONCLUSION: Power doppler sonography shows increased vasculature and hyperemia in the wall of abscesses. Therefore, power doppler sonography can be used to assist with the diagnosis of superficial soft tissue abscess.

Abscess↗

Fat-containing soft-tissue masses of the extremities.

The authors review the radiologic spectrum of fat-containing soft-tissue masses of the extremities, with emphasis on computed tomography, magnetic resonance imaging, and pathologic correlation. These masses include both common and uncommon, benign and malignant lesions, such as lipoma, intramuscular and intermuscular lipoma, neural fibrolipoma, lipoblastoma, lipomatosis, hibernoma, hemangioma, elastofibroma, and liposarcoma, as well as lesions that may mimic fat-containing soft-tissue masses. Imaging studies of fat-containing lesions will often allow a specific presumptive diagnosis. When a specific diagnosis is not possible, however, knowledge of the spectrum of fat-containing lesions will allow a suitably ordered differential diagnosis.

Adolescent↗

Evaluation of soft tissue profile following intraoral ramus osteotomy in Chinese adults with mandibular prognathism.

Twenty-five Chinese adults with mandibular prognathism were treated with either the intraoral vertical subcondylar osteotomy or the bilateral sagittal split ramus osteotomy. The patients were kept in maxillomandibular fixation for 6 to 8 weeks while osteosynthesis was achieved with the use of intraosseous wiring. Serial lateral cephalograms were taken presurgery and between 12 and 26 months postsurgery, and specific soft and hard tissue points were digitized on a computer. The mean mandibular setback postsurgically was 8.4 +/- 3.2 mm, with a 5.2-degree reduction in point A-nasion-point B angle. Posterior movement of pogonion, point B and the mandibular incisal edge was accompanied by posterior movement of 95% at soft tissue pogonion (r = .96), 89% at soft tissue point B (r = .83), and 67% at labrale inferius (r = .81), respectively. The correlation between changes in the labrale superius and mandibular setback appeared to be dependent on both the amount of mandibular setback and the degree of mandibular rotation during the setback surgery. The presently reported ratios of the soft tissue response to hard tissue movement vary from those reported in white patients by other researchers, which confirms the need for different ratios for different racial types.

Adult↗

[Experience in using computed tomography in the diagnosis of diseases of the maxillofacial area].

Thirty patients aged 19 to 70 suffering from various diseases and injuries of maxillofacial organs and tissues (chronic odontogenic osteomyelitis, sinusitis, malignant and benign neoformations of the jaws and perimaxillary soft tissues, injuries to facial skull) were examined using computer-aided tomography. The method is described in detail, its potentialities in the diagnosis of the said diseases and injuries are demonstrated.

Adult↗