Acute appendagitis: emergency presentation and computed tomographic appearances

Acute epiploic appendagitis is an uncommon cause of abdominal pain. It is caused by torsion of an epiploic appendage or spontaneous venous thrombosis of a draining appendageal vein.1 The diagnosis of this condition primarily relies on cross-sectional imaging and is made most often after computed tomography (CT). Clinically, it is most often mistaken for acute diverticulitis. Approximately 7.1% of patients investigated to exclude sigmoid diverticulitis have imaging findings of primary epiploic appendagitis.

Three-dimensional tomographic reconstruction of an exceptionally well preserved ichnological assemblage from the Stainmore Foundation, Carboniferous, UK

This Ph.D. thesis addresses current issues with ichnotaxonomic practice, and characterizes an exceptionally well preserved ichnological assemblage from the Carboniferous Stainmore Formation, Northumberland, United Kingdom. Samples were collected from closely localized float representative of various units throughout the succession, which was deposited in a storm-dominated marine shoreface. Three dominant ichnotaxa were selected for three-dimensional morphological analysis due to their complicated morphology and/or unclear taxonomic status: 1) Dactyloidites jordii isp. nov.; 2) Beaconites capronus, and; 3) Neoeione moniliformis comb. nov. Using serial grinding and photography, these ichnotaxa were ground and modelled in true colour. High-resolution models of three taxa produced in this study are the basis of the first complete three-dimensional consideration of the traces, and forms the basis for refined palaeobiological and ethological analysis of these taxa. Dactyloidites jordii isp. nov. is a stellate to palmate burrow composed of numerous long, narrow rays that exhibit three orders of branching arranged into tiered galleries radiating from a central shaft. It is considered to be the feeding structure produced by a vermiform organism. Beaconites capronus is a winding trace with distinctly chevron-shaped, meniscate backfill demonstrated herein to backfill the vertical shafts associated with its burrows in a comparable fashion to the horizontal portion of the burrow. This lack of a surface connection would result in the trace making organism being exposed to low-oxygen porewater. Coping with this porewater dysoxia could be approached by burrowing organisms in a number of ways: 1) revisiting the sediment-water interface; 2) creating periodic shafts; or 3) employing anaerobic metabolism. Neoeione moniliformis was originally introduced as Eione moniliformis, however, the genus Eione Tate, 1859 is a junior homonym of Eione Rafinesque, 1814. This led to the transfer of Eione moniliformis to Parataenidium. Through careful examination and three-dimensional characterization of topotypes, the transfer to Parataenidium moniliformis is demonstrated herein to be problematic, as Parataenidium refers to primarily horizontal burrows with two distinct layers and Eione moniliformis is composed of one distinct level. As such, the new ichnogenus Neoeione is created to accommodate Neoeione moniliformis.

Measurement limitations in knife-edge tomographic phase retrieval of focused IR laser beams

An experimental setup to measure the three-dimensional phase-intensity distribution of an infrared laser beam in the focal region has been presented. It is based on the knife-edge method to perform a tomographic reconstruction and on a transport of intensity equation-based numerical method to obtain the propagating wavefront. This experimental approach allows us to characterize a focalized laser beam when the use of image or interferometer arrangements is not possible. Thus, we have recovered intensity and phase of an aberrated beam dominated by astigmatism. The phase evolution is fully consistent with that of the beam intensity along the optical axis. Moreover, this method is based on an expansion on both the irradiance and the phase information in a series of Zernike polynomials. We have described guidelines to choose a proper set of these polynomials depending on the experimental conditions and showed that, by abiding these criteria, numerical errors can be reduced.

Statistical methods for polyhedral shape classification with incomplete data - application to cryo-electron tomographic images

A certain type of bacterial inclusion, known as a bacterial microcompartment, was recently identified and imaged through cryo-electron tomography. A reconstructed 3D object from single-axis limited angle tilt-series cryo-electron tomography contains missing regions and this problem is known as the missing wedge problem. Due to missing regions on the reconstructed images, analyzing their 3D structures is a challenging problem. The existing methods overcome this problem by aligning and averaging several similar shaped objects. These schemes work well if the objects are symmetric and several objects with almost similar shapes and sizes are available. Since the bacterial inclusions studied here are not symmetric, are deformed, and show a wide range of shapes and sizes, the existing approaches are not appropriate. This research develops new statistical methods for analyzing geometric properties, such as volume, symmetry, aspect ratio, polyhedral structures etc., of these bacterial inclusions in presence of missing data. These methods work with deformed and non-symmetric varied shaped objects and do not necessitate multiple objects for handling the missing wedge problem. The developed methods and contributions include: (a) an improved method for manual image segmentation, (b) a new approach to 'complete' the segmented and reconstructed incomplete 3D images, (c) a polyhedral structural distance model to predict the polyhedral shapes of these microstructures, (d) a new shape descriptor for polyhedral shapes, named as polyhedron profile statistic, and (e) the Bayes classifier, linear discriminant analysis and support vector machine based classifiers for supervised incomplete polyhedral shape classification. Finally, the predicted 3D shapes for these bacterial microstructures belong to the Johnson solids family, and these shapes along with their other geometric properties are important for better understanding of their chemical and biological characteristics.

Tomographic readout of an opto-mechanical interferometer

The quantum state of light changes its nature when being reflected off a mechanical oscillator due to the latter's susceptibility to radiation pressure. As a result, a coherent state can transform into a squeezed state and can get entangled with the motion of the oscillator. Full information of the state of light can only be gathered by a tomographic measurement. Here we demonstrate a tomographic interferometer readout by measuring arbitrary quadratures of the light field exiting a Michelson-Sagnac interferometer that contains a thermally excited high-quality silicon nitride membrane. A readout noise of 1.9 x 10(-16) mHz(-1/2) around the membrane's fundamental oscillation mode at 133 kHz has been achieved, going below the peak value of the standard quantum limit by a factor of 8.2 (9 dB). The readout noise was entirely dominated by shot noise in a rather broad frequency range around the mechanical resonance.

Air-coupled ultrasonic tomographic imaging of concrete elements

Ultrasonic tomography is a powerful tool for identifying defects within an object or structure. This method can be applied on structures where x-ray tomography is impractical due to size, low contrast, or safety concerns. By taking many ultrasonic pulse velocity (UPV) readings through the object, an image of the internal velocity variations can be constructed. Air-coupled UPV can allow for more automated and rapid collection of data for tomography of concrete. This research aims to integrate recent developments in air-coupled ultrasonic measurements with advanced tomography technology and apply them to concrete structures. First, non-contact and semi-contact sensor systems are developed for making rapid and accurate UPV measurements through PVC and concrete test samples. A customized tomographic reconstruction program is developed to provide full control over the imaging process including full and reduced spectrum tomographs with percent error and ray density calculations. Finite element models are also used to determine optimal measurement configurations and analysis procedures for efficient data collection and processing. Non-contact UPV is then implemented to image various inclusions within 6 inch (152 mm) PVC and concrete cylinders. Although there is some difficulty in identifying high velocity inclusions, reconstruction error values were in the range of 1.1-1.7% for PVC and 3.6% for concrete. Based upon the success of those tests, further data are collected using non-contact, semi-contact, and full contact measurements to image 12 inch (305 mm) square concrete cross-sections with 1 inch (25 mm) reinforcing bars and 2 inch (51 mm) square embedded damage regions. Due to higher noise levels in collected signals, tomographs of these larger specimens show reconstruction error values in the range of 10-18%. Finally, issues related to the application of these techniques to full-scale concrete structures are discussed.

Unwrapping microcomputed tomographic images for measuring cortical osteolytic lesions in the 5T2 murine model of myeloma treated by bisphosphonate

International audience

Assessment of the performance of an enhanced planar processing algorithm for whole-body bone scintigraphy : a phantom study

A cintigrafia óssea de corpo inteiro representa um dos exames imagiológicos mais frequentes realizados em medicina nuclear. Para além de outras aplicações, este procedimento é capaz de fornecer o diagnóstico de metástases ósseas. Em doentes oncológicos, a presença de metástases ósseas representa um forte indicador prognóstico da longevidade do doente. Para além disso, a presença ou ausência de metástases ósseas irá influenciar o planeamento do tratamento, requerendo para isso uma interpretação precisa dos resultados imagiológicos. Problema: Tendo em conta que a metastização óssea é considerada uma complicação severa relacionada com aumento da morbilidade e diminuição de sobrevivência dos doentes, o conceito de patient care torna-se ainda mais imperativo nestas situações. Assim, devem ser implementadas as melhores práticas imagiológicas de forma a obter o melhor resultado possível do procedimento efetuado, associado ao desconforto mínimo do doente. Uma técnica provável para atingir este objetivo no caso específico da cintigrafia óssea de corpo inteiro é a redução do tempo de aquisição, contudo, as imagens obtidas por si só teriam qualidade de tal forma reduzida que os resultados poderiam ser enviesados. Atualmente, surgiram novas técnicas, nomeadamente relativas a processamento de imagem, através das quais é possível gerar imagens cintigráficas com contagem reduzida de qualidade comparável àquela obtida com o protocolo considerado como standard. Ainda assim, alguns desses métodos continuam associados a algumas incertezas, particularmente no que respeita a sustentação da confiança diagnóstica após a modificação dos protocolos de rotina. Objetivos: O presente trabalho pretende avaliar a performance do algoritmo Pixon para processamento de imagem por meio de um estudo com fantoma. O objetivo será comparar a qualidade de imagem e a detetabilidade fornecidas por imagens não processadas com aquelas submetidas à referida técnica de processamento. Para além disso, pretende-se também avaliar o efeito deste algoritmo na redução do tempo de aquisição. De forma a atingir este objetivo, irá ser feita uma comparação entre as imagens obtidas com o protocolo standard e aquelas adquiridas usando protocolos mais rápidos, posteriormente submetidas ao método de processamento referido. Material e Métodos: Esta investigação for realizada no departamento de Radiologia e Medicina Nuclear do Radboud University Nijmegen Medical Centre, situado na Holanda. Foi utilizado um fantoma cilíndrico contendo um conjunto de seis esferas de diferentes tamanhos, adequado à técnica de imagem planar. O fantoma foi preparado com diferentes rácios de atividade entre as esferas e o background (4:1, 8:1, 17:1, 22:1, 32:1 e 71:1). Posteriormente, para cada teste experimental, o fantoma foi submetido a vários protocolos de aquisição de imagem, nomeadamente com diferentes velocidades de aquisição: 8 cm/min, 12 cm/min, 16 cm/min e 20 cm/min. Todas as imagens foram adquiridas na mesma câmara gama - e.cam Signature Dual Detector System (Siemens Medical Solutions USA, Inc.) - utilizando os mesmos parâmetros técnicos de aquisição, à exceção da velocidade. Foram adquiridas 24 imagens, todas elas submetidas a pós-processamento com recurso a um software da Siemens (Siemens Medical Solutions USA, Inc.) que inclui a ferramenta necessária ao processamento de imagens cintigráficas de corpo inteiro. Os parâmetros de reconstrução utilizados foram os mesmos para cada série de imagens, estando estabelecidos em modo automático. A análise da informação recolhida foi realizada com recurso a uma avaliação objetiva (utilizando parâmetros físicos de qualidade de imagem) e outra subjetiva (através de dois observadores). A análise estatística foi efetuada recorrendo ao software SPSS versão 22 para Windows. Resultados: Através da análise subjetiva de cada rácio de atividade foi demonstrado que, no geral, a detetabilidade das esferas aumentou após as imagens serem processadas. A concordância entre observadores para a distribuição desta análise foi substancial, tanto para imagens não processadas como imagens processadas. Foi igualmente demonstrado que os parâmetros físicos de qualidade de imagem progrediram depois de o algoritmo de processamento ter sido aplicado. Para além disso, observou-se ao comparar as imagens standard (adquiridas com 8 cm/min) e aquelas processadas e adquiridas com protocolos mais rápidos que: imagens adquiridas com uma velocidade de aquisição de 12 cm/min podem fornecer resultados melhorados, com parâmetros de qualidade de imagem e detetabilidade superiores; imagens adquiridas com uma velocidade de 16 cm/min fornecem resultados comparáveis aos standard, com valores aproximados de qualidade de imagem e detetabilidade; e imagens adquiridas com uma velocidade de 20 cm/min resultam em valores diminuídos de qualidade de imagem, bem como redução a nível da detetabilidade. Discussão: Os resultados obtidos foram igualmente estabelecidos por meio de um estudo clínico numa investigação independente, no mesmo departamento. Foram incluídos cinquenta e um doentes referidos com carcinomas da mama e da próstata, com o objetivo de estudar o impacto desta técnica na prática clínica. Os doentes foram, assim, submetidos ao protocolo standard e posteriormente a uma aquisição adicional com uma velocidade de aquisição de 16 cm/min. Depois de as imagens terem sido cegamente avaliadas por três médicos especialistas, concluiu-se que a qualidade de imagem bem como a detetabilidade entre imagens era comparável, corroborando os resultados desta investigação. Conclusão: Com o objetivo de reduzir o tempo de aquisição aplicando um algoritmo de processamento de imagem, foi demonstrado que o protocolo com 16 cm/min de velocidade de aquisição será o limite para o aumento dessa mesma velocidade. Após processar a informação, este protocolo fornece os resultados mais equivalentes àqueles obtidos com o protocolo standard. Tendo em conta que esta técnica foi estabelecida com sucesso na prática clínica, pode-se concluir que, pelo menos em doentes referidos com carcinomas da mama e da próstata, o tempo de aquisição pode ser reduzido para metade, duplicando a velocidade de aquisição de 8 para 16 cm/min.

Is Thyroid Stunning Clinically Relevant? A Retrospective Analysis Of 208 Patients.

Current guidelines have advised against the performance of (131)I-iodide diagnostic whole body scintigraphy (dxWBS) to minimize the occurrence of stunning, and to guarantee the efficiency of radioiodine therapy (RIT). The aim of the study was to evaluate the impact of stunning on the efficacy of RIT and disease outcome. This retrospective analysis included 208 patients with differentiated thyroid cancer managed according to a same protocol and followed up for 12-159 months (mean 30 ± 69 months). Patients received RIT in doses ranging from 3,700 to 11,100 MBq (100 mCi to 300 mCi). Post-RIT-whole body scintigraphy images were performed 10 days after RIT in all patients. In addition, images were also performed 24-48 hours after therapy in 22 patients. Outcome was classified as no evidence of disease (NED), stable disease (SD) and progressive disease (PD). Thyroid stunning occurred in 40 patients (19.2%), including 26 patients with NED and 14 patients with SD. A multivariate analysis showed no association between disease outcome and the occurrence of stunning (p = 0.3476). The efficacy of RIT and disease outcome do not seem to be related to thyroid stunning.

Finite-element Analysis Of 3 Situations Of Trauma In The Human Edentulous Mandible.

Maxillofacial trauma resulting from falls in elderly patients is a major social and health care concern. Most of these traumatic events involve mandibular fractures. The aim of this study was to analyze stress distributions from traumatic loads applied on the symphyseal, parasymphyseal, and mandibular body regions in the elderly edentulous mandible using finite-element analysis (FEA). Computerized tomographic analysis of an edentulous macerated human mandible of a patient approximately 65 years old was performed. The bone structure was converted into a 3-dimensional stereolithographic model, which was used to construct the computer-aided design (CAD) geometry for FEA. The mechanical properties of cortical and cancellous bone were characterized as isotropic and elastic structures, respectively, in the CAD model. The condyles were constrained to prevent free movement in the x-, y-, and z-axes during simulation. This enabled the simulation to include the presence of masticatory muscles during trauma. Three different simulations were performed. Loads of 700 N were applied perpendicular to the surface of the cortical bone in the symphyseal, parasymphyseal, and mandibular body regions. The simulation results were evaluated according to equivalent von Mises stress distributions. Traumatic load at the symphyseal region generated low stress levels in the mental region and high stress levels in the mandibular neck. Traumatic load at the parasymphyseal region concentrated the resulting stress close to the mental foramen. Traumatic load in the mandibular body generated extensive stress in the mandibular body, angle, and ramus. FEA enabled precise mapping of the stress distribution in a human elderly edentulous mandible (neck and mandibular angle) in response to 3 different traumatic load conditions. This knowledge can help guide emergency responders as they evaluate patients after a traumatic event.

Predictors Of Silent Myocardial Ischemia In Resistant Hypertensive Patients.

Hypertension is the most prevalent and significant modifiable risk factor for coronary heart disease. A portion of patients with uncontrolled hypertension are considered to have resistant hypertension (RHTN). Myocardial ischemia incidence increases along with blood pressure (BP) levels. However, the prevalence of myocardial ischemia in patients with RHTN, as well as the factors associated with it, is unknown. We enrolled 129 patients with true RHTN regularly followed in our specialty hypertension clinic and evaluated then by resting and dipyridamole pharmacological stress myocardial perfusion scintigraphy. Patients were then divided into 2 groups: those with (I-RHTN; n = 36) and those without (NI-RHTN; n = 93) myocardial ischemia. Echocardiography, 24-hour ambulatory BP monitoring (ABPM), and flow mediated dilation (FMD) were also evaluated. Thirty six (28%) patients had myocardial ischemia. There was no difference between groups regarding age, sex, biochemical parameters, office, and 24-hour ABPM levels. Patients in the I-RHTN group were more likely diabetic (31% vs. 11%; P < 0.05) and obese (75% vs. 40%; P < 0.001). Adjusting for age and body mass index, multiple logistic regression showed that diabetes (odds ratio (OR) = 6.5; 95% confidence interval (CI) = 1.06-40.14; P = 0.04), FMD (OR = 0.18; 95% CI = 0.07-0.41; P < 0.001), heart rate (OR = 1.23; 95% CI = 1.11-1.36; P < 0.001), left ventricular mass index (OR = 1.02; 95% CI = 1.01-1.04; P = 0.04), and microalbuminuria (OR = 1.02; 95% CI = 1.01-1.04; P = 0.002) were independent predictors of ischemia. In conclusion, there is a high prevalence of myocardial ischemia in patients with RHTN. Increased microalbuminuria, heart rate, endothelial dysfunction, and left ventricular mass can be useful to guide the investigation for myocardial ischemia in these high risk patients.

Conservative Management For Lingual Thyroid Ectopic.

Lingual thyroid gland is a rare clinical entity. The presence of an ectopic thyroid gland located at the base of the tongue may be presented with symptoms like dysphagia, dysphonia, and upper airway obstruction. We are introducing a case of an 8-year-old girl who had lingual thyroid that presented dysphagia and foreign body sensation in the throat. The diagnostic was reached with clinical examination, thyroid scintigraphy with Tc(99m) and ultrasound. A laryngoscopy was performed which confirmed a spherical mass at base of tongue. Investigation should include thyroid function tests. In this case we observed subclinical hypothyroidism. There are different types of surgical approaches for the treatment of this condition; however, the treatment with Levothyroxine Sodium allowed the stabilization of TSH levels and clinical improvement of symptoms in a follow-up of 2 years.

Estudo do esvaziamento gástrico e da distribuição intragástrica de uma dieta sólida através da cintilografia: diferenças entre os sexos

Gender-related differences in gastric emptying are still controversial. The aims of this study were: to confirm the sex-related difference in gastric emptying of a solid meal and to investigate its association with different patterns of meal distribution between the proximal and distal gastric compartments. Eighteen healthy volunteers (nine males, mean age 35 ± 9 years; nine females, mean age: 41 ± 11 years) were studied in the morning, after ingestion of the solid test-meal (an omelette labeled with 185MBq of 99mTc-sulfur colloid). Simultaneous anterior and posterior images of the stomach were acquired immediately after ingestion of the meal and every 10 minutes for 120 minutes. Time versus activity curves were obtained for the whole, proximal and distal stomach. Gastric T½ was longer in women (96.1 ± 17.2 min) than in men (79.9 ± 17.8 min; P = 0.02). The analysis of the meal distribution inside the stomach showed no differences between males and females in proximal gastric emptying, but the meal retention in the distal compartment was significantly increased among women (P = 0.04). In conclusion, gastric emptying of a solid meal is slower in pre-menopausal women than in age-matched men, probably due to an increased retention of the meal in the distal compartment. This should be taken into consideration to avoid misleading diagnosis of gastroparesis for female patients.

Hidrocefalia multiloculada: relato de dois casos

Multiloculated hydrocephalus is a clinicopathological entity consisting of enlarged, loculated ventricles and paraventricular poroencephalic cavities. We present two cases of multiloculated hydrocephalus: one due to infectious process of central nervous system and the other consequent to a congenital malformation. Tomographic aspects of this condition that permit the diagnosis are stressed. The pathophysiology, the management and the prognosis are discussed according to the available literature.

Tratamento clínico da epilepsia resistente

The authors analysed 34 cases of resistant epilepsy (20 males and 14 females, mean age 23 years), treated clinically between February/1984 and May/1986. The patients underwent neurological, neuropsychological, psychological, psychiatric, cerebrospinal fluid, electroencephalographic, tomographic and/or angiographic examination. Most of the patients had complex partial seizures. The etiology was unknown in 19 patients (55.8%), probable neurocysticercosis in 6, perinatal hypoxia in 5, delivery trauma in 3 and probable sequelae of encephalitis in 2 patients. There was a clear past history of infantile febrile convulsion in 2 patients. Most patients received carbamazepine (mean dose 24.5 mg/kg/day), phenytoin (5 mg/kg and valproic acid (28 mg/kg) as monotherapy or in association. Twenty-two patients (64.7%) had more than 80% decrease of the seizure frequency. Nine resistant epilepsy-cases (24.5%) were evaluated as candidates for surgical therapy. The authors concluded that the resistant epilepsy is best managed by a specialised, multidisciplinary team, and pointed out the need of a correct diagnosis of the seizure type, an adequate drug therapy and a good engagement of the patient and his family in the treatment.