Iterative reconstruction for helical CT: a simulation study

BACKGROUND: The purpose of this study was to evaluate prospectively the efficacy of subtalar distractional realignment arthrodesis in the treatment of calcaneal malunion associated with subtalar arthritis, collapse of height, talonavicular subluxation, malalignment of the heel axis, and widening heel with calcaneofibular abutment. METHODS: Thirty-four patients with severe calcaneal malunion were treated with a lateral approach, lateral decompression, medial subtalar capsulotomy, and distraction and realignment of the subtalar joint with an anteriorly and laterally tapered wedge bone graft. The patients were evaluated with a functional rating scale and radiographs, both before and after surgery. RESULTS: Thirty-two of the 34 patients were evaluated at a mean of 71 months (range, 60-92 months) after the arthrodesis. Solid subtalar fusion was achieved in 31 of the 32 patients. The average gain of subtalar distraction was 12 mm. Neutral or mild valgus alignment was achieved in 26 of the 32 patients. The mean postoperative score (83) showed significant improvement over the mean preoperative score (47). Overall, the functional rating scale revealed excellent or good results in 26 patients and fair results in 6 patients. CONCLUSION: Coupled with wedge bone grafting, the subtalar distractional realignment arthrodesis achieved restoration of hindfoot height and axial alignment with a good union rate and significant improvement in the majority of patients with calcaneal malunion.     

New classes of helical weighting algorithms with applications to fast CT reconstruction

The focus of this paper is on CT helical weighting algorithms using one source rotation, or 2 pi, worth of projection data. Currently known 2 pi helical weighting algorithms include a fan-angle dependency, and do not lend themselves to fast reconstruction, for two reasons. First, it can be shown that the weight distributions present a line of discontinuity across the sinogram (projection space), which defines two separate sinogram regions. Second, the expressions for the weighting functions differ for those two regions. Accordingly, reconstruction of P different image planes (all using a given projection) requires P weightings and filterings of that projection. In this paper, it is shown that, by first generalizing the concept of the interpolation/extrapolation function used in the weighting, to the concept of distance function, and second by selecting particular classes of such distance functions, the discontinuity across the sinogram can be eliminated. By imposing specific sufficient conditions on such distance functions, single analytical expressions across the entire 2 pi sinogram are obtained. Decomposition of these particular "single" distance functions leads to two-filtering reconstruction algorithms, for which a given projection needs to be filtered only two times for an arbitrary number P of reconstruction planes. Finally, another generalization of the concept of helical weighting leads to one-filtering weight functions that depend only on the sum of the projection--and fan angles. Accordingly, after rebinning the fan-beam projections to parallel projections, the corresponding 2 pi helical weighting algorithms do not include a dependency over the ray parameter. Equivalently, for these algorithms, weighting commutes with filtering, and reconstruction of an arbitrary number P of image planes requires only one filtering per projection. These algorithms are shown to be consistent with the hypothesis of a linear z variation of the projections.     

The evaluation of three dimensional image distortion of helical scanning CT

We developed a computer algorithm to simulate distortion in the three-dimensional (3D) displays obtained by helical scanning. The algorithm constitutes calculation of the image profile in the longitudinal direction, which is assumed to be a convolution of the object function with the slice sensitivity profile (SSP) of helical scanning. Experiments were performed to examine the algorithm for its validity with the use of a K2HPO4 phantom. Simulated results and measurements was in a good agreement. The distortion was investigated by the computer simulation. The model simulated was a high density object (Ol) surrounded by low density tissue (Os). The helical interpolation used was 360-degree linear interpolation. Two parameters were defined: delta Lz, which is the difference in length between the 3D image and the actual object Ol in the longitudinal direction, and the cut level index (CLI), which is defined as CLI = (Cut Level CT Number-CT Number of Os)/(CT Number of OI-CT Number of Os). We found that magnitude of delta Lz increased depending on the table feed distance per 360-degree scan (Dt). When Ol was twice as long as Dt, delta Lz directly depended on CLI, but was independent of Ol length. When Ol length was longer than Dt, delta Lz was shown to be 0 at CLI not equal to 0.5 at every Dt. When Ol was shorter than Dt, delta Lz decreased remarkably depending on the length of Ol in higher CLI. The simulations, with the use of a newly developed algorithm, were demonstrated to be useful for evaluating the amount of distortion and for better understanding the characteristics of 3D displays of helical scanning.     

Clinical usefulness of helical scanning CT (HES-CT) for orbital lesion

As part of an investigation of the structural requirements for the induction, by phenobarbital-type inducers, of a coordinate pleiotropic response consisting of increases in hepatic cytochrome P450 2B (P450 2B) activity, increases in other phase I and II enzyme activities, and liver hypertrophy, we have examined a series of analogues of phenobarbital in which the ethyl/phenyl substitution at the sp3 carbon of the parent molecule was kept constant while the heterocyclic portion of the molecule was modified. The induction of hepatic P450 2B protein and ethoxy-, pentoxy-, and (benzyloxy)resorufin O-dealkylation activities, and epoxide hydration activity and liver/body weight ratio increase were examined in male F344/NCr rats fed the various congeners for 14 days at doses equimolar to 500 ppm phenobarbital. Increases in the measured parameters were maximal in rats fed phenobarbital or 5-ethyl-5-phenylhydantoin. The responses to primidone or 2-ethyl-2-phenylsuccinimide were approximately 65% of maximal, while glutethimide yielded a response approximately 50% of maximal. Induction of this response in rats fed the ring-opened and decarboxylated analogues, (ethylphenylacetyl)urea and 2-ethyl-2-phenylmalonamide, were < 25% of maximal. 5-Ethyl-5-phenyloxazolidinedione caused minimal increases in the measured end points when administered at a dose equimolar to 500 ppm phenobarbital. The profound differences among the congeners in ability to induce P450 2B protein and associated catalytic activities were not due to differences in food consumption by the various groups of rats.(ABSTRACT TRUNCATED AT 250 WORDS)     

Optimal CT scanning plan for long-bone 3-D reconstruction

OBJECTIVES: This study examined whether pregnancy intention was associated with cigarette smoking, alcohol drinking, use of vitamins, and consumption of caffeinated drinks prior to pregnancy and in early pregnancy. METHODS: Data from a telephone survey of 7174 pregnant women were analyzed. RESULTS: In comparison with women whose pregnancies were intended, women with unintended pregnancies were more likely to report cigarette smoking and less likely to report daily vitamin use. Women with unintended pregnancies were also less likely to decrease consumption of caffeinated beverages or increase daily vitamin use. CONCLUSIONS: Pregnancy intention was associated with health behaviors, prior to pregnancy and in early pregnancy, that may influence pregnancy course and birth outcomes.     

A case of extrahepatic portal vein aneurysm with massive thrombosis: diagnosis with reconstruction images from helical CT scans

Acute promyelocytic leukemia (APL) originate from chromosomal translocations generating two types of fusion proteins both involving the retinoic acid receptor alpha (RAR alpha) and either the gene PML (t(15;17)) or PLZF (t(11;17)). Recent publications cast a new light on the detailed molecular mechanism underlying the oncogenic activity of these fusion proteins which block myeloid terminal differentiation by recruiting histone deacetylases to the promoters of target genes through co-repressor proteins. They also explain the different responses to treatment by all-trans retinoic acid (ATRA) of these two variants which are otherwise clinically indistinguishable.     

Electron-beam CT scanning for detection of coronary calcification and prediction of coronary heart disease

Electron-beam or ultrafast computerized tomographic (CT) scanning provides a convenient and sensitive means of detecting coronary calcification, which is an early index of atherosclerosis. The procedure has strong negative predictive power for the presence of coronary artery disease, but a limited ability to predict disease severity. However, preliminary indications are that it is as good or better than conventional risk factors in this respect. Although further validation is needed before electron-beam CT can be regarded as an established method of detecting presymptomatic coronary atherosclerosis, the procedure has potential in this context.     

A quantitative evaluation of the three dimensional reconstruction of patients' coronary arteries

BACKGROUND: Through extensive training and experience angiographers learn to mentally reconstruct the three dimensional (3D) relationships of the coronary arterial branches. Graphic computer technology can assist angiographers to more quickly visualize the coronary 3D structure from limited initial views and then help to determine additional helpful views by predicting subsequent angiograms before they are obtained. METHODS: A new computer method for facilitating 3D reconstruction and visualization of human coronary arteries was evaluated by reconstructing biplane left coronary angiograms from 30 patients. The accuracy of the reconstruction was assessed in two ways: 1) by comparing the vessel's centerlines of the actual angiograms with the centerlines of a 2D projection of the 3D model projected into the exact angle of the actual angiogram; and 2) by comparing two 3D models generated by different simultaneous pairs on angiograms. The inter- and intraobserver variability of reconstruction were evaluated by mathematically comparing the 3D model centerlines of repeated reconstructions. RESULTS: The average absolute corrected displacement of 14,662 vessel centerline points in 2D from 30 patients was 1.64 +/- 2.26 mm. The average corrected absolute displacement of 3D models generated from different biplane pairs was 7.08 +/- 3.21 mm. The intraobserver variability of absolute 3D corrected displacement was 5.22 +/- 3.39 mm. The interobserver variability was 6.6 +/- 3.1 mm. CONCLUSIONS: The centerline analyses show that the reconstruction algorithm is mathematically accurate and reproducible. The figures presented in this report put these measurement errors into clinical perspective showing that they yield an accurate representation of the clinically relevant information seen on the actual angiograms. These data show that this technique can be clinically useful by accurately displaying in three dimensions the complex relationships of the branches of the coronary arterial tree.     

Three-dimensional respiratory-gated MR angiography of coronary arteries: comparison with conventional coronary angiography

OBJECTIVE: MR coronary angiography is most often performed using two-dimensional techniques. Although three-dimensional (3D) acquisitions do have important advantages, they take too long for a single breath-hold and are thus susceptible to respiratory motion artifacts. The purpose of this study was to investigate the accuracy of a unique respiratory-gated 3D MR angiographic technique in identifying the proximal coronary arteries in patients suspected of having coronary artery disease. In addition, we investigated the capability of this technique to detect proximal stenoses. SUBJECTS AND METHODS: We performed a prospective blinded study in 20 patients who were referred for conventional coronary angiography. A cardiac-gated 3D gradient-echo sequence with fat suppression was used. Retrospective respiratory gating was performed using navigator echoes of the diaphragm position. Using multiplanar reformatting, two independent readers blindly analyzed the data sets for visualization of major coronary arteries, lengths of imaged segments, and detection of significant stenoses (> 50% occlusion of the luminal diameter by conventional angiography). RESULTS: Seventy-seven of 80 (96%) coronary arteries were positively identified. In one patient, an anomalous coronary anatomy was readily identified and confirmed by conventional angiography. The average lengths of the imaged segments of the right, left main, left anterior descending, and left circumflex coronary arteries were 58 +/- 13 mm, 9 +/- 5 mm, 59 +/- 16 mm, and 24 +/- 10 mm, respectively. Overall sensitivity for the detection of stenoses was low (38%), with a specificity of 95%. Interobserver agreement was 0.92, with a kappa value of 0.65. CONCLUSION: Respiratory-gated 3D MR angiography allows accurate identification of proximal coronary arteries and may be valuable for 3D imaging of coronary anomalies. Further technical improvements are required to enhance the value of the technique in detecting stenoses.     

Pleural invasion by peripheral bronchogenic carcinoma: assessment with three-dimensional helical CT

Cystic endometrial hyperplasia resembling that of normal early pregnancy was induced by the insertion of a silk suture into diestrous bitches. Intraluminal trauma (wire scratching) induced a similar but moderate change. Intraluminal olive oil and saline had little or no effect. Maternal decidual response in rodentia produced by mechanical means in progesterone-stimulated uteri in the absence little or no effect. Maternal decidual response in rodentia produced by mechanical means in progesterone-stimulated uteri in the absence of fertilized ova is termed Loeb's deciduoma. A similar response was created in progesterone-stimulated canine uteri by various physical means when compared to the pregnant contralateral horn.     

Dynamic helical CT of breast tumors

Expression of liver-enriched trans-acting hepatocyte nuclear factors 1alpha (HNF1alpha) and 4 (HNF4) is correlated with the hepatic phenotype in cultured rat hepatoma cells. We have used a hepatoma variant cell line, H11, that specifically lacks the HNF4 --> HNF1alpha pathway as a model to understand mechanisms controlling hepatic gene expression. We have introduced randomly marked human chromosomes into H11 cells and have isolated a number of microcell hybrids that have rescued hepatic gene expression, including HNF4, HNF1alpha, and alpha1-antitrypsin. Chromosomal analysis of cell hybrids showed that the rescued hepatic phenotype correlated closely with the presence of human chromosome 12p sequences. Although the gene encoding HNF1alpha is located on chromosome 12q24, its retention was not required to rescue the hepatic phenotype. Thus, we suggest that a locus on human chromosome 12p plays an important role in maintenance of hepatic gene expression through activation of the HNF4 --> HNF1alpha pathway.     

Helical CT reconstruction with longitudinal filtration

Each of the currently used helical reconstruction algorithms represents one tradeoff selection of the image noise or mA requirement and resultant artifacts versus the width of the section profile. For many applications, the performance tradeoffs different from those existed are desired. In this paper, we present a general framework of incorporating the longitudinal (z) filtration in helical CT reconstruction, which leads to a new class of helical reconstruction algorithms with tunable performance characteristics to suit various applications. The z-filtering algorithm enables us to derive the performance curve of image noise or mA requirement versus the width of the section profile, whereas the existing helical reconstruction algorithms only represent limited discrete samples of the curve. We demonstrate that using a new helical reconstruction algorithm derived from this general framework, a substantial reduction in image noise or mA requirement can be achieved with a slight increase of FWHM of the section profile. Thus for many applications requiring both compact section profile and low image noise or mA requirement, the new algorithm represents a better tradeoff than both the 180 degrees and 360 degrees interpolation algorithms. The new algorithm also offers the following potential clinical benefits: (1) longer x-ray tube life; (2) longer scan duration with less x-ray tube cooling delays--longer volume coverage and/or longer thin-slice scan; (3) less radiation to patient; (4) less image noise; and (5) less helical artifacts. Initial clinical results are also presented.     

Scaffolding the coronary arteries: intracoronary stenting

Stenting is a new method for treating coronary artery stenosis. This article presents an overview of the rationale for the implantation of stents, the various types of stents available, and roles the home care nurse assumes in caring for these patients.     

Acute pulmonary embolism: assessment of helical CT for diagnosis

Male pigeons, Columba livia, employ intense mate guarding and frequent copulation apparently as strategies to ensure their paternity. The aim of this study was to investigate the benefits to females of mate guarding by males and frequent copulation. Field observations showed that females initiated the majority of copulations and females that solicited copulations more frequently were guarded more closely by their partner. Experimental removal of guarding male partners showed that: (1) unguarded, fertile females suffered increased harassment from extrapair males which reduced their foraging efficiency; and (2) unguarded, fertile females did not seek copulations with extrapair males. Various explanations for frequent pair copulation initiated by females are discussed and we conclude that female pigeons trade pair copulations for protection (mate guarding) against sexual harassment from other males. Copyright 1998 The Association for the Study of Animal Behaviour.     

Curved multiplanar reconstructions for the evaluation of contrast-enhanced electron beam CT of the coronary arteries

OBJECTIVE: We investigated the applicability of curved multiplanar reconstructions for the evaluation of contrast-enhanced electron beam CT scans of the coronary arteries. SUBJECTS AND METHODS: Thirty-two patients (43-72 years old; mean age, 58 years old) underwent electron beam CT. After injection of i.v. contrast medium, 40 axial cross sections of the heart were acquired, triggered to the ECG during breath-hold (3-mm slice thickness, 1-mm overlap). Curved multiplanar reconstructions were obtained separately for each coronary artery. The reconstructions were independently evaluated by two investigators for the presence of high-grade stenoses and occlusions. The results were then compared with coronary angiography results, of which the two investigators had been unaware. RESULTS: Because of degraded image quality, 15 (12%) of the 128 vessels (left main, left anterior descending, left circumflex, and right coronary arteries in 32 patients) were excluded from evaluation. In the remaining 113 vessels, 16 (89%) of 18 high-grade stenoses and occlusions were correctly detected (89% sensitivity). Absence of significant stenosis was correctly detected in 87 (92%) of 95 vessels (92% specificity). The negative and positive predictive values were 98% and 67%, respectively. CONCLUSION: Curved multiplanar reconstructions are useful in the evaluation of contrast-enhanced electron beam CT scans of coronary arteries.     

Stair-step artifacts in three-dimensional helical CT: an experimental study

We describe 3 sibs, their father, and paternal grandfather with amelogenesis imperfecta. In 2 sibs and the father the defect is associated with a neurological syndrome which has a wide range of phenotypic variability. The proposita has ataxia, EEG abnormalities, moderate dementia, and enamel hypoplasia. This case and the affected relatives are discussed in relation to Kohlschütter-T?nz syndrome and neuroectodermal diseases. The syndrome described here, characterized by the association of a genetic enamel defect and neurological impairment, may be of considerable interest in advancing genetic and clinical knowledge on ectodermal tissues and their development.