[show abstract][hide abstract] ABSTRACT: To assess changes in different tissues during the process of artificial mummification by natron using computed tomography (CT) and magnetic resonance imaging (MRI), and to translate the results to image interpretation in paleoradiological studies of ancient mummies.
A human lower limb (LL) was amputated from a female donor 24 h post-mortem and mummified by artificial natron (54 % NaCl, 16 % Na2SO4, 18 % Na2CO3 12 % NaHCO3) in ancient Egyptian style. The LL was kept in a fume hood at 16-25 °C and 30-75 % relative humidity. CT and MRI were performed at specific intervals with quantitative evaluation of Hounsfield units (HU) and signal intensities (SI).
Evaluated tissues showed different HU and SI changes during the experimental mummification. All tissues revealed an overall but varying increase of HU in CT examinations. All tissues except for the compact bone revealed an overall but varying decrease of SI in the IR and T2-weighted sequences of the MRI. Typical findings included a distinct increase of HU in the cutis at the end of the study and a temporary increase of SI in the IR and T2-weighted sequences in all muscle groups.
Radiological findings showed a regular, controlled and effective dehydration by the applied natron without detectable putrefaction. Evaluated tissues revealed different radiological changes during the experiment, which altogether led to preservation of the tissues without radiologically identifiable destruction. The cutis revealed radiological signs of direct interaction with the natron in the form of covering and possibly permeation.
[show abstract][hide abstract] ABSTRACT: Whole-body multidetector computed tomography (CT) was performed on the mummified corpse of two-year-old Rosalia Lombardo, an anthropogenic mummy displayed in the Capuchin Catacombs of Palermo, Sicily, Italy. Rosalia Lombardo reportedly died of bronchopneumonia in 1920 and was preserved by the embalmer and taxidermist Alfredo Salafia by a formaldehyde-based fluid. Rosalia Lombardo's body is still exhibited in the Capuchin Catacombs inside the original glass-topped coffin in which she was placed. Only her head is visible: the rest of her body is covered by a sheet. CT images of Rosalia's body within her coffin were of reduced quality because of distinct metal artifacts caused by the coffin itself. Nevertheless, a detailed radiological analysis was possible for most of the body. Analysis of the data from the CT examination revealed indicators for the historically-reported endovasal and intracavity treatment. Rosalia's entire body was preserved in a remarkable state. The exceptional preservation of her internal organs made it possible to consider a radiological diagnosis of pneumonia. For this study, CT was determined to be the ultimate method for investigation, since Rosalia's body had to be kept untouched in her sealed coffin for conservation purposes. The CT examination offered new insights into the current preservation status of the body, and the superior contrast of CT allowed detailed assessment of different tissues. Post-processing methods provided reconstructions on any desired plane, as well as three-dimensional reconstruction, for the best possible visualization and interpretation of the body.
Annals of anatomy = Anatomischer Anzeiger: official organ of the Anatomische Gesellschaft 05/2013; · 1.96 Impact Factor
[show abstract][hide abstract] ABSTRACT: Patients with calcaneus fractures experience considerable interferences with daily living activities. The quality of anatomical reconstruction is important because of its influence on functional outcome. The aim of this study was to develop an automatic algorithm based on computer tomographic (CT) images to quantify the integrity of calcaneal joint surfaces. Validation of this algorithm was done by assessing intra-individual variations of characteristic joint parameters. Bilateral hind foot CT data of 12 subjects were manually segmented, and 3D models from the calcaneus, talus and cuboid were generated. These models were implemented in a custom-made software to analyse the area, 3D orientations and bone distance of the joint surfaces of the calcaneus. Three joints were detected, and the calculated parameters were compared between right and left hind foot by the evaluation of the directional asymmetry (%DA). The results were statistically analysed with a paired t-test. The median of area (5-7 %DA) of the joint surfaces and the distance between two articulating surfaces (8-9 %DA) showed the greatest intra-individual differences. Median differences in 3D orientation were comparatively low (1-2 %DA). None of these differences was statistically significant. Inter-individual variations among subjects were several magnitudes larger than intra-individual differences. The presented computational tool provides 3D joint-specific parameters of the calcaneus, which enable to describe their respective joint integrity. The results show that only small intra-individual differences within the anatomy exist. Surgical treatment should take place with the aid of CT data from the contralateral side. Thus, a good restoration of the anatomy may be reached. The computational tool assesses the quality of reduction, and may be helpful to evaluate the outcome and quality of operative treatment based on the calculated joint-specific parameters of joint reconstructions in the hind foot.
Computer Methods in Biomechanics and Biomedical Engineering 02/2013; · 1.39 Impact Factor
[show abstract][hide abstract] ABSTRACT: To define the number and distribution of osteophytes (OPs) in bilateral knee MRI (magnetic resonance imaging) of patients with unilateral anterior cruciate ligament (ACL) rupture.
Bilateral knee MRIs of 20 patients with unilateral ACL rupture and reconstruction were retrospectively analyzed for OPs. OPs were graded following the KOSS (knee OA scoring system) classification and their compartmental distribution was assessed following the WORMS (Whole-Organ Magnetic Resonance Imaging Score) classification.
All examined knees revealed OPs. Knees with ACL rupture showed significant (p < 0.001) higher total numbers of OPs (mean 11.6; SD ± 4.4) than knees with intact ACL (mean 5.1; SD ± 2.3). Knees with ACL rupture showed increased OP formation in all knee compartments with predominance of marginal OPs in the lateral femorotibial compartment especially on the tibia.
Our results show that after knee injury with ACL rupture and reconstruction, all knee compartments were involved in post-traumatic increase of OP formation. The most affected compartment was the lateral femorotibial compartment on the tibial side.
[show abstract][hide abstract] ABSTRACT: False-negative results are obtained in approx. 20 % of prostate cancer (PCa) patients (pts) at initial systematic transrectal biopsy (Bx), in particular when digital rectal examination (DRE) or transrectal ultrasound (TRUS) is negative. The aim of this study was to assess whether MR endorectal imaging of the prostate in a multi-reader ambulatory care setting may assist in patient selection for re-biopsy.
115 consecutive pts with persistent PSA elevation, negative Bx, DRE and TRUS were examined using T2w axial and coronal and T1w axial sequences for tumor diagnosis. MR images were prospectively read as tumor-suspicious or tumor-negative by the MR radiologist on duty. Additionally, a retrospective readout of a prostate MR expert and an abdominal imaging fellowship-trained radiologist was performed to evaluate the effect of the reader's experience on tumor detection. Imaging findings were compared to the results of the repeat Bx (61 pts) or the clinical course of at least two years.
For the prospective reading, the sensitivity of MRI was 83 %, the specificity was 69 %, the PPV was 33 % and the NPV was 96 %. ROC analysis revealed a significantly better performance of the prostate MR imaging expert compared to the abdominal imaging radiologist (area under ROC 0.88 vs. 0.66, p < 0.001). Based on the prospective reading, a pre-test probability for PCa of 17.4 % as in our study can be reduced to 5 % when obtaining a tumor-negative result in MRI.
MR imaging in a multi-reader ambulatory care setting assists in patient selection for re-biopsy. Reducing the post-test probability for PCa to 5 % allows for further follow-up instead of re-biopsy in MR tumor-negative patients. Specific training and experience improve tumor detection in prostate MR imaging.
RöFo - Fortschritte auf dem Gebiet der R 02/2012; 184(2):130-5. · 2.76 Impact Factor
[show abstract][hide abstract] ABSTRACT: Herniation pits (HPs) of the femoral neck were first described in a radiological publication in 1982 as round to oval radiolucencies in the proximal superior quadrant of the femoral neck on anteroposterior radiographs of adults. In following early clinical publications, HPs were generally recognized as an incidental finding. In contrast, in current clinical literature they are mentioned in the context of femoroacetabular impingement (FAI) of the hip joint, which is known to cause osteoarthritis (OA). The significance of HPs in chronic skeletal disorders such as OA is still unclear, but they are discussed as a possible radiological indicator for FAI in a large part of clinical studies.In this paleoradiological study we examined a sample of mummies from the Capuchin Catacombs of Palermo, Sicily, by a mobile computed tomography (CT) scanner. Evaluation of the CT examinations revealed HPs in six out of 16 (37.5%) adult male mummies.The first aim of this study was to compare the characteristics of HPs shown in our mummy collection to the findings described in clinical literature. Thereby CT evaluation revealed that their osseous imaging characteristics are in accordance, consisting of round to oval subcortical lesions at the anterior femoral neck, clearly demarcated by a sclerotic margin.The second aim was to introduce HPs to the paleoradiological and paleopathological methodology as an entity that underwent a renaissance from an incidental finding to a possible radiological indicator of FAI in the clinical situation. As FAI plays an important role in the development of OA of the hip, which is a very common finding in human skeletal remains, HPs should always be considered in paleoradiological evaluation of hip joint diseases.
PLoS ONE 01/2012; 7(5):e36537. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: BACKGROUND: Distal radius fractures continue to show significant complication rates after operative treatment with locked plating. Failure occurs by screw loosening or screw penetration in the distal fragment. Placement of additional screws may enhance the stiffness of fracture fixation. The aim of this study was to determine the fatigue properties of different screw configurations in distal radius plate osteosynthesis with biomechanical tests and finite element analysis (FEA). MATERIAL AND METHODS: Unstable distal radius fractures were created in 12 human cadaveric bone specimens and were fixed with volar locking plates. Group 4SC was fixed with four screws in the distal row and group 6SC with two additional screws the row below. Dynamic loading was applied physiologically. The radial shortening, the angulation of the distal fragment and the failure mechanism were determined by experimental tests and were further elucidated by FEA. RESULTS: Group 6SC showed a significantly lower radial shortening and inclination. Breakage of the screws within the plate was noted in group 4SC, while moderate screw penetration was observed in group 6SC. FEA confirmed the biomechanical tests. In group 4SC elevated von Mises strain in the locking mechanism explained the inclination of the screws and the distal fragment. The elastic strain in group 6SC was increased at the screw-bone interface which explained the resulting screw penetration. CONCLUSION: The failure mechanism in volar plating of distal radius fractures depended on the number of screws and their configuration. Using two more screws increases construct stiffness and angular stability under dynamic loading. However, increased stiffness also promoted screw penetration mainly in osteoporotic bone. Compared to screw penetration, loss of reposition and inclination of the distal fragment observed in the 4SC configuration is more likely to result in clinical complications.
[show abstract][hide abstract] ABSTRACT: To determine whether a new femoral neck plate has a higher risk for secondary fracture after implant removal than the current standard treatment for intracapsular hip fractures.
Six pairs of human cadaver femora (age, 56 ± 5.6 years; range, 48-64 years; two female and four male donors) were instrumented with the femoral neck plate (FNP) or the compression hip screw combined with an antirotation screw (CHS) in a paired study design. After removal of the implants, axial compression tests to failure of the bones were conducted. Maximum force to failure of the bones after implant removal was determined. Axial stiffness of the bones before surgery and after implant removal was determined.
The FNP resulted in a mean failure load of 4687 ± 1743 N (mean ± standard deviation) and the CHS resulted in a mean failure load of 4892 ± 1608 N with no significant difference between the two implant groups (P = 0.405). There was no significant difference in stiffness (P = 0.214) between the FNP (1240 ± 362 N/mm) and the CHS (1293 ± 304 N/mm). The cavities left by the surgery had no effect on the bone stiffness (P > 0.05). The mean failure load of all specimens correlated with the bone mineral density in the proximal part of the femurs by R² = 0.715 (P = 0.001).
The FNP demonstrated a similar failure load after implant removal compared with the CHS, although the FNP left a 39% larger cavity in the bone.
Journal of orthopaedic trauma 08/2011; 25(12):721-5. · 1.78 Impact Factor
[show abstract][hide abstract] ABSTRACT: Eight anatomical preparations from the collection of Giovan Battista Rini (1795-1856) at the Desenzano Hospital Pathology Division (Brescia, Italy) were examined by computed tomography (CT). The aim of the study was to obtain detailed information on the state of preservation of these "anatomical mummies" and the techniques used to prepare them. Relying on the existing literature, the examined specimens (five heads with necks, two busts and one heart) could be divided into three types of anatomical specimens: "dry preparations," "corrosion preparations," and "organ preparations." CT examination enabled the assessment of the exact features of each specimen, some of the preparation techniques applied, the presence of foreign bodies, and the use of substances to fill the blood vessels. All of the cases demonstrated an extremely good state of preservation. The study sheds new light on important-yet scarcely known-preparation techniques created for different anatomical demonstrations. Results of the CT investigation were consistent with the anatomical preservation methods described in 18th to 20th century literature, particularly those of Italy.
[show abstract][hide abstract] ABSTRACT: Hernitation pits (HPs) of the femoral neck were first described in 1982. The purpose of this paper is to summarize the information concerning HPs published since then and to show their association with the diagnosis of femoroacetabular impingement (FAI) which has occurred within the last years. HPs are predominantly located at the anterior-superior femoral neck with a typical radiological appearance, which makes it possible to differentiate them from the numerous differential diagnoses mentioned. In the early publications HPs were described as a separate entity, while recent studies increasingly assign them to intra-osseous ganglia. In contrast to the early publications depicting HPs as an incidental finding, they are currently mainly mentioned in association with FAI and at the same time are partly considered to be a radiological indicator of FAI. In summary, HPs should always be recognized and documented because they may contribute to the diagnosis of FAI which is essential for preventing or delaying osteoarthritis of the hip joint in the early stage.
RöFo - Fortschritte auf dem Gebiet der R 07/2010; 182(7):565-72. · 2.76 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to use paleoradiologic analyses to investigate a sample of the mummies in the Capuchin Catacombs in Palermo, Sicily, in order to assess skeletal abnormalities and the state of preservation, especially the condition of the internal organs, and to determine radiologic evidence of anthropogenic mummification. Ten 19th and early 20th century mummies with good external preservation were investigated by using a portable direct radiography unit inside the Capuchin Catacombs. The radiographs clearly demonstrated signs of anthropogenic mummification in nine of the 10 mummies investigated. The embalming methods that had been used included (a) evisceration and arterial injection; (b) the placement of foreign materials into the orbits and the nasal and oral cavities; and (c) filling of the thoracic, abdominal, and rectal cavities with foreign materials. Organ preservation varied greatly among the mummies, although brain tissue was found in all of the mummies. Analyses of the skeletal material of the mummies showed evidence of healed vertebral fractures, age-related degenerative changes, and, in one of the child mummies, a remarkable skeletal pathologic condition. The radiographs clearly illustrated different methods of anthropogenic mummification in the catacomb mummies of Palermo, allowed assessment of the preservation of the mummies, and demonstrated skeletal abnormalities.
[show abstract][hide abstract] ABSTRACT: To determine distinguishing features between herniation pits (HPs) and other cystic-appearing lesions at the anterior femoral neck in multi-slice computed tomography (MSCT) and micro-computed tomography (microCT) examinations.
Institutional review board approval was obtained to examine 37 proximal femora of 23 cadaveric specimens (mean age available in 19 cadavers, 83 years; range 68-100 years; 9 female, 8 male, 6 unknown). All 37 femora were investigated by MSCT. 23 femora, which revealed cystic-appearing lesions at the anterior femoral neck in MSCT examinations, were additionally examined by microCT. Cystic-appearing lesions were categorized by their location, sclerotic margin, demarcation and shape in MSCT with assessment of inter-observer agreement. Detailed cortical and trabecular properties were evaluated in microCT examinations.
There were seven HPs in three femora. There were a number of abnormalities potentially imitating HPs, including focal osteoporosis (13 in 13 femora), degenerative changes (5 in 4 femora) and trabecular restructuring (5 in 4 femora) at the anterior femoral neck. HPs were differentiated on the basis of their subchondral/subcortical location, completely surrounding sclerosis, clear demarcation and round-to-oval shape in MSCT. Because of their location and their microscopic appearance, HPs seem to resemble intra-osseous ganglia at the anterior femoral neck.
HPs have to be differentiated from other cystic appearing lesions at the anterior femoral neck to avoid overestimation of their incidence in the context of diagnosis of femoroacetabular impingement.
[show abstract][hide abstract] ABSTRACT: We investigated the skull of a juvenile living in Southern Germany between 1400 and 1800 A.D. A remarkable hemifacial microsomia led to further detailed computed tomographic examination especially of the petrous bone revealing a total bony atresia of the external auditory canal as well as distinct anomalies of the middle ear on the same side. The combination of these findings strongly suggests the diagnosis of Goldenhar syndrome. This very heterogeneous syndrome affects primarily aural, ocular, oral and mandibular development, whereby the constellation of anomalies indicate their origin at approximately 30-45 days of gestation, caused by genetic or intrauterine factors. Despite the lack of clinical information and the absence of soft tissue it was possible to perform a differential diagnosis in this palaeopathological case. Thereby, the use of modern modalities of image reconstructions in this computed tomographic clearly enhanced the supposed diagnosis.
HOMO - Journal of Comparative Human Biology 12/2008; 59(6):453-61. · 0.54 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to evaluate whether there is a correlation between the presence of herniation pits (HPs) and morphological indicators of cam and pincer femoroacetabular impingement (FAI) based on computed tomography (CT) examinations. CT studies of the pelvis obtained from 200 patients were retrospectively analysed for the presence of HPs and morphological abnormalities of the femoral head and acetabulum. As an indicator for cam FAI, we used the angle alpha, describing the anterior femoral head-neck junction. As an indicator for pincer FAI, we measured the acetabular coverage and the acetabular orientation. Student's t-test was used for statistical analysis. HPs were identified in 85 of the 200 patients. HPs were predominantly found in the superior portion of the proximal anterior femoral neck; some were located in the inferior portion. The angle alpha was significantly larger by 10% in the group with HPs. A correlation between the presence of HPs and morphological indicators of pincer FAI was not found. In conclusion HPs are not only located in the superior portion of the proximal anterior femoral neck, but also in the inferior portion. There is an association between the presence of HPs and a high value of angle alpha.
European Radiology 05/2008; 18(9):1869-75. · 3.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: Kyphoplasty (KP) is a minimally invasive technique for the percutaneous stabilisation of vertebral fractures. As such, this technique is highly dependent upon intraoperative fluoroscopic visualisation. In order to assess the range of radiation doses that patients are typically subjected to, 60 consecutive procedures using simultaneous bilateral fluoroscopy were analysed with respect to exposure time (ET). In a subset of 16 of these patients, a theoretical entrance skin dose (ESD) and effective dose was additionally calculated from intraoperatively measured dose area product. Average fluoroscopy time for single level cases reached 2.2 min (range 0.6-4.3) in the lateral plane and 1.6 min (range 0.5-3.0) in the anterior-posterior plane. For multiple level cases the corresponding ET per level was 1.7 min (range 0.6-2.9) per level in the lateral and 1.1 min (range 0.5-2.0) in the anterior-posterior plane. ESD was estimated as an average 0.32 Gy (range 0.05-0.86) in the anterior-posterior and 0.68 Gy (range 0.10-1.43) in the lateral plane. Effective dose (cumulative from both planes) averaged 4.28 mSv (range 0.47-10.14). Safety margins for the development of early transient erythema are respected within the presented fluoroscopy times. Longer ET in the lateral plane may however breach the 2 Gy threshold. Use of large c-arms and judiciously operating the exposure is recommended. With regard to effective dose, a single fluoroscopy guided KP performed for osteoporotic or traumatic vertebral fractures is a safe procedure.
European Spine Journal 04/2006; 15(3):347-55. · 2.13 Impact Factor