Objective To study the clinical significance of multi-slice spiral CT in portal vein imaging. Methods One hundred and thirty seven cases underwent enhanced scan with GE Light SpeedQX/i4 CT scanner were collected, including 41 cases of liver cancer, 20 cases of hepatic cirrhosis, 21 cases of cavernous hemangioma of liver, 9 cases of hepatic abscess, 6 cases of carcinoma of gallbladder, 14 cases of cholangiocarcinoma, 16 cases of pancreatic carcinoma, and 5 cases in normal. The results of portal vein images were reconstructed with three-dimensional software and analyzed. Results In 109 cases, portal vein, cranial mesenteric vein, and splenic vein were demonstrated successfully in the stage of portal vein: volume rendering images were clear in 84 cases, and maximum intensity projection images and multiplanar reconstruction images were clear in 109 cases. Forty-five cases of portal hypertension, 18 cases of opened collateral circulation, 15 cases of portal vein tumor thrombus, 1 case of splenic vein tumor thrombus, and 6 cases of large cavernous hemangioma were demonstrated successfully. Conclusion The portal vein imaging with multi-slice spiral CT can show the dissection and lesions of portal vein and its branches clearly, and can provide the clinical evidence for clinicians to formulate a treatment plan correctly.
Objective To investigate the feasibility of establishing the visualization models of intraneural microvessels of sciatic nerves in Sprague Dawley (SD) rats by systemic infusion of Evan’s blue (EB) or lead oxide and to compare the advantages and disadvantages. Methods Fifteen healthy adult SD rats of either gender, weighing 200-250 g, were randomly divided into traditional group (group A, n=5), fluorescence group (group B, n=5), and radiography group (group C, n=5). Ink, EB, and lead oxide, all mixed with gelatin solution, were injected in groups A, B, and C, respectively. After 2 hours of cryopreservation under 4°C, all sciatic nerves were harvested and observed through stereomicroscope to make sure the filling condition. The two-dimentional (2D) images were then collected via reflexion fluorescent microscope in group B and via micro-CT scan in group C. All images were imported into computer to establish three-dimentional (3D) reconstruction models by Mimics 15.0. Results All groups could show the outline of intraneural microvessels of sciatic nerves under stereomicroscope. Diameters of them were measured under fluorescent microscope, ranging from 10 µm to 30 µm. Both groups B and C could establish 3D reconstruction models from 2D images. These models could clearly reproduce the structure of microvessels. Conclusion Both EB and lead oxide can be used to establish 3D reconstruction models to observe structure of the intraneural vessels. However, EB has some disadvantages, such as predisposition to infiltration, grainy 2D images and time-consuming procedure; it is not suitable for researches of large specimen. Though 2D pictures from lead oxide have lower resolution than EB, it is easier to be manipulated and appropriate for experiments of large specimen.
【Abstract】 Objective To observe the distribution feature of nerve bundles in C7 nerve anterior and posterior division end. Methods The brachial plexus specimen was harvested from 1 fresh adult cadaver. After C7 nerve was confirmed, the distal end of anterior and posterior division was dissected and embedded by OCT. Then the samples were serially horizontally sliced with each 10 μm deep. After acetylcholinesterase (AChE) histochemical staining, the stain characteristics of different nerve fiber bundles were observed and amount of the nerve fiber bundles were counted under optic-microscope. At last, the imaging which were collected were three-dimensional (3-D) reconstructed by using Amira 4.1 software. Results There was no obvious difference in the stain between the anterior and posterior divisions. The running of the nerve fiber bundles were dispersive from proximal end of nerve to distal end of nerve. Nerve fiber bundles of anterior division were mainly sensor nerve fiber bundles, which located in medial side. Nerve fiber bundles of posterior division were mainly moter nerve fiber bundles, having no regularity in the distribution of nerve fiber bundles. The total number of nerve fiber bundles in distal end of anterior division was 7.85 ± 1.04, the number of motor nerve fiber bundles was 2.85 ± 0.36, and the number of sensor nerve fiber bundles was 5.13 ± 1.01. The total number of nerve fiber bundles in distal end of posterior division was 9.79 ± 1.53, the number of motor nerve fiber bundles was 6.00 ± 0.69, and the number of sensor nerve fiber bundles was 3.78 ± 0.94. There were significant differences in the numbers of motor and sensor nerve fiber bundles between anterior and posterior divisions (P lt; 0.05). The microstructure 3-D model was reconstructed based on serial slice through Amira 4.1. The intercross and recombination process of nerves bundles could be observed obviously. The nerve bundle distribution showed cross and combination. Conclusion Nerve fiber bundles of anterior division are mainly sensor nerve fiber bundles and locate in medial side. Nerve fiber bundles of posterior division are mainly motor nerve fiber bundles, which has no regularity in the distribution of nerve fiber bundles. The 3-D reconstruction can display the internal structure feature of the C7 division end.
Objective To study the feasibility of virtual intercondylar notchplasty by applying MRI two-dimensional (2D) images to reconstruct three-dimensional (3D) images and measure the size of intercondylar notch. Methods Thirty healthy volunteers who had no knee joint disease and surgery history were selected. There were 15 females and 15 males with an age range of 20-30 years, weight range of 45-74 kg, and height range of 150-185 cm. They were divided into male group and female group, and the knees of each group were divided into 2 subgroups (the left group and right group). MRI scan of the left and right knees was performed, and the 2D images of MRI were imported into Mimics10.01 medical image control system for 3D reconstruction. The related anatomical data as follows were measured from the 3D digital model and analyzed by statistical software: notch width (NW), condylar width (CW), and notch width index (NWI). Then the 3D knee images of patients with anterior cruciate ligament (ACL) injury were collected between January and March 2010, and 4 patients with narrow intercondylar notch (NWI≤0.2) were selected for reconstructing the 3D model of the knee and simulating the intercondylar notch plasty. Then, the volume of osteotomy in 3D model was calculated and applied in the ACL reconstruction surgery, and whether the graft had impingement with intercondylar notch or not was evaluated. Results There were significant differences in NW and CW between male group and female group (P≤lt;≤0.05), but no significant difference was found in the NWI (P≤gt;≤0.05). And there was no significant difference in NW, CW, and NWI between the left and right knees both in male group and female group (P≤gt;≤0.05). After ACL reconstruction and intercondylar notchplasty, the shape of intercondylar notch became normal (NWI≤gt;≤0.22), no impingement occurred between the graft and intercondylar notch under arthroscopy within 3-month follow-up. Conclusion The shape of intercondylar notch of 3D model based on MRI 2D images is similar to the real intercondylar notch. NWI is one of important indexes which can reflect the narrow level of intercondylar notch. The virtual intercondylar notchplasty may provide preoperative plan and guidence for ACL reconstruction operation to avoid the impingement between graft and intercondylar notch after surgery.
Objective To study digitize design of custom-made radial head prosthesis and to verify its matching precision by the surgery of preoperative three-dimensional (3-D) virtual replacement. Methods Six healthy adult volunteers (3 males and 3 females, aged 25-55 years with an average of 33 years) received slice scan of bilateral elbow by Speed Light 16-slice spiral CT. The CT Dicom data were imported into Mimics 10.0 software individually for 3-D reconstruction image, and the left proximal radial 3-D image was extracted, the mirror of the image was generated and it was split into 2 pieces: the head and the neck. The internal diameter and the length of the radial neck were obtained by Mimics 10.0 software measurement tools. In Geomagic Studio 12 software, the radial head was simulated to cover the cartilage surface (1 mm thickness) and generated to an entity. In UG NX 8.0 software, the stem of prosthesis was designed according to the parameters above and assembled head entity. Each custom-made prosthesis was performed and verified its matching precision by the surgery of preoperative 3-D virtual replacement. Results Comparing the morphology of 6 digitize custom-made prostheses with ipsilateral radial heads by the 3-D virtual surgery, the error was less than 1 mm. The radial head prosthesis design on basis of the contralateral anatomy was verified excellent matching. Conclusion The 3-D virtual surgery test and the digitized custom-made radial head prosthesis will be available for clinical accurate replacement.
Objective To explore the histochemical staining for distinguishing and local izing nerve fibers and fascicles at histological level in three-dimensional reconstruction of peri pheral nerves. Methods The right median nerve was harvested from one fresh cadaver and embedded in OCT compound. The sample was serially horizontally sl iced with 6 μm thickness. All sections were stained with Karnovsky-Roots method (group A, n=30) firstly and then stained with toluidine blue (group B, =28) and Ponceau 2R (group C, n=21) in proper sequence. The results of each step were taken photos (× 100). After successfully stitching, the two-dimensional panorama images were compared, including texture feature, the number and aver gray level of area showing acetylchol inesterase (AchE) activity, and result of auto microscopic medical image segmentation. Results In groups A, B, and C, the number of AchE-positive area was (21.63 ± 4.06)× 102, (20.64 ± 3.51)× 102, and (20.54 ± 5.71)× 102, respectively, showing no significant difference among 3 groups (F=0.64, P=0.54); the mean gray level was (1.41 ± 0.06)× 102, (1.10 ± 0.05)× 102, and (1.14 ± 0.07)× 102, respectively, showing significant differences between group A and groups B and C (P lt; 0.001). In the image of group A, only AchE-positive area was stained; in the image of group B, myelin sheath was obscure; and in the image of group C, axons and myelin sheath could be indentified, the character of nerve fibers could be distinguished clearly and accurately, and the image segmentation of fascicles could be achieved easier than other 2 images. Conclusion The image of Karnovsky-Roots-toluidine blue-Ponceau 2R staining has no effect on the AchE-positive area in the image of Karnovsky-Roots staining and shows better texture feature. This improved histochemical process may provide ideal image for the three-dimensional reconstruction of peri pheral nerves.
Objective To discuss the authenticity of reconstructing the anterior cruciate l igament (ACL) threedimensional digital model of normal adult knee joint by use of MRI. Methods The double knee joint specimens were selected from 20 fresh normal adult corpses and double knee joint of 20 normal adult volunteers, and were scanned with MRI; continuous image data of level thick 1.0 mm were acquired, and then these data were imported into Mimics 10.01 software for three-dimensional reconstruction; and full three-dimensional digital models were built, including the corpse specimens (corpsemodel group) and normal adult (normal model group). The relevance anatomy index of ACL were measured with easuring tool of Mimics 10.01 software, and double knee joint specimens of 20 fresh normal adult corpses were dissected, and the relevance data were measured (corpse specimens group). Results There was no significant difference in all indexes between corpse model group and corpse specimen group (P gt; 0.05), and between corpse model group and normal model group (P gt; 0.05). Conclusion The image data gathered by MRI could reconstruct the ACL three-dimensional digital model of normal adult knee joint, which has authenticity.
Objective To investigate the cl inical directive significance of three-dimensional reconstruction of CT in treating mandibular angle hypertrophy. Methods Between March 2009 and January 2011, 18 patients with mandibular angle hypertrophy were treated using the three-dimensional reconstruction technology of CT. All patients were female, aged20-36 years with an average of 25 years. Eighteen patients included: 14 single mandibular angle hypertrophy, 3 mandibular angle hypertrophy with masseter hypertrophy, and 1 mandibular angle hypertrophy with bilateral asymmetry; 6 cases of ptosis of mandibular angle, 9 cases of prominent mandibular angle, and 3 cases of introversive mandibular angle. According to the types of mandibular angle hypertrophy, the surgical methods could be correctly chosen. The procedure was planned and simulated; the osteotomy l ine was marked and the osteotomy was measured on the workstations of three-dimensional reconstruction. Results No fracture of mandible occurred in the operation. Facial nerve temporary attack occurred in 1 case and recovered at 3 months after operation. All patients were followed up 6-12 months (mean, 7.6 months). After 6 months of operation, the effectiveness was satisfactory in 15 cases, basically satisfactory in 2 cases, and unsatisfactory in 1 case (bilateral asymmetry). Conclusion Based on three-dimensional reconstruction technology of CT, surgical design performed on the model will promote the accuracy of operation. Basically symmetrical appearances can be achieved with satisfactory results.
Objective To investigate the cl inical results of the flap pedicled with collateral branch of descendingrarus of lateral circumflex femoral artery with digital three-dimensional reconstruction technique for lower l imb soft tissue defects. Methods Between March 2009 and January 2010, 7 patients with lower l imb soft tissue defects were treated with free flap pedicled with collateral branch of descending rarus of lateral circumflex femoral artery. There were 6 males and 1 female with an age range from 6 to 51 years. They were injured by traffic accident (4 cases), or by object hit from height (3 cases). The locations were foot in 2 cases, ankle in 2 cases, and anterior tibia in 3 cases. The disease duration was 8 hours to 40 days (mean, 20 days). All the cases compl icated by exposure of tendons or bones. The areas of soft tissue defect ranged from 12 cm × 7 cm to 20 cm × 14 cm. Free flaps were transplanted at 4 to 16 days after symptomatic treatment. Before operation, all the flaps were designed with digital three-dimensional reconstruction technique. The size of flaps ranged from 15 cm × 9 cm to 22 cm × 16 cm The donor sites were closed directly in all cases. Results All the flaps survived. The wounds and incisions at donor sites healed by first intention. All the patients were followed up 6 to 12 months. The texture, appearance, and function of the flaps were satisfactory, and no compl ication occurred. All the flaps had protective sensation, which could meet the requirement of the daily l ife. The function of ankle was satisfactory with normal walk; the extension was 19-22° and the flexion was 30-36°. No obvious scar formed at donor sites. Conclusion The flap pedicled with collateral branch of descending rarus of lateral circumflex femoral artery has rel iable blood supply, easy operation, l ittle influence on the donor site, and high success rate with digital three-dimensional reconstruction technique. It is an excellent option for repairing lower l imb soft tissue defects.
Objective To evaluate the accuracy of the related parameters measured by spinal virtual surgery system (SVSS) three-dimensional (3D) techniques by comparing with the parameters measured by multi-spiral CT (MSCT) workstation. Methods Seven vertebrae specimens of adult men were scanned with MSCT, and the messages were sent toMSCT workstation and SVSS. The 3D image of spine was reconstructed by using volume rendering and multi-planar reformation; based on the parameter requirement of lower cervical pedicle fixation, 10 related parameters were measured. Then SPSS11.0 analyzer software was used to analyze the parameters measured by 2 systems. Between June 2009 and March 2010, 6 patients who received screw insertion in lower cervical spines were given MSCT scanning, then the messages were sent to SVSS 3D reconstruction to evaluate the situation and to collect the parameters of pedicle screw insertion. Results SVSS measurement showed that 1 pedicle was clausura (C3) and the diameters of 4 pedicles in coronal view were lee than 3 mm (C4 in 1, C5 in 2, C6 in 1), which did not fit for screw insertion; the results were similar to those by MSCT measurement. A total of 66 lower cervical pedicle were measured successfully. Significant differences were found in 14 parameters as follows between 2 systems (P lt; 0.05): the left pedicle height of C3, the both sides pedicle width of C4, the right pedicle spongy width of C4, the left X-direction entrance of C6, the both sides Y-direction entrance of C3, total pedicle length of sagittal view in both sides pedicle of C3 and the left pedicle of C5, total pedicle length of axial view in C3 pedicles, the left pedicle of C5, and the right pedicle of C6. There was no significantdifference in the other parameters (P gt; 0.05). In 6 cl inical cases, 34 screws were inserted, the postoperative MSCT scanning showed that 30 screws were placed successfully. The rate of accuracy was 88.24%. According to the Richter’s perforation classification, perforation at grade I and at grade II occurred in 2 cases (5.88%), respectively. Conclusion The accuracy of the parameters measured by SVSS is similar to that by MSCT.