Ezio Fanucci

Immediate and post-retention effects of rapid maxillary expansion investigated by computed tomography in growing patients

OBJECTIVE To determine by low-dose computed tomography (CT) protocol the dental and periodontal effects of rapid maxillary expansion (RME). MATERIALS AND METHODS The sample comprised 17 subjects (7 males and 10 females), with a mean age at first observation of 11.2 years. Each patient underwent expansion of 7 mm. Multislice CT scans were taken before rapid palatal expansion (T0), at the end of the active expansion phase (T1), and after a retention period of 6 months (T2). On scanned images, measurements were performed at the dental and periodontal levels. Mean differences between measurements at T0, T1, and T2 were examined through analysis of variance (ANOVA) for repeated measures with post-hoc tests. RESULTS All interdental transverse measurements were significantly increased at both T1 and T2 with respect to T0. In the evaluation of T0-T1 changes, periodontal measurements were significant on the buccal aspect of banded teeth with a reduction in alveolar bone thickness corresponding to the mesial (-0.5 mm; P < .05) and distal (-0.4 mm; P < .05) roots of the right first molar and to the mesial root of the left first molar (-0.3 mm; P < .05). In the evaluation of overall T0-T2 changes, the lingual bone plate thickness of both first molars was found to be significantly increased (+0.6 mm; P < .05). CONCLUSIONS RME therapy induces a significant increase in the transverse dimension of the maxillary arch in growing subjects without causing permanent injury to the periodontal bony support of anchoring teeth discernible on CT imaging.

Modifications of midpalatal sutural density induced by rapid maxillary expansion: A low-dose computed-tomography evaluation.

INTRODUCTION The aim of this study was to evaluate the density of the midpalatal suture as assessed by low-dose computed tomography (CT) before rapid maxillary expansion (RME) (T0), at the end of active expansion (T1), and after a retention period of 6 months (T2). METHODS The study sample comprised 17 prepubertal subjects (mean age, 11.2 years) with constricted maxillary arches and unilateral or bilateral posterior crossbite. The total amount of expansion was 7 mm in all subjects. Multi-slice low-dose CT scans were taken at T0, T1, and T2. On axial CT scanned images, 4 regions of interest (ROIs) were placed along the midpalatal suture (anterior [AS ROI] and posterior [PS ROI]) and in 2 regions of palatal bone (anterior and posterior). Density was measured in Hounsfield units. The Mann-Whitney U test and Friedman analysis of variance (ANOVA) with post-hoc test were used (P <0.05). RESULTS The densities in the AS and PS ROIs were significantly smaller than the reference bone densities before RME therapy. Both AS and PS ROIs showed significant decreases in density from T0 to T1, significant increases from T1 to T2, and no significant differences from T0 to T2. CONCLUSIONS The effective opening of the midpalatal suture by RME in prepubertal subjects was associated with a significant decrease in sutural density. The sutural density after 6 months of retention post-RME indicated reorganization of the midpalatal suture, since it showed values similar to the pretreatment ones.

Role of interventional radiology in pudendal neuralgia: a description of techniques and review of the literature

PurposeThe authors sought to evaluate indications, technical feasibility and clinical efficacy of computed tomography (CT)-guided pudendal nerve infiltration in patients with chronic anoperineal pain by reviewing the role of the CT technique in their personal experience and in the recent interventional literature.Materials and methodsTwenty-eight women, mean age 50 years, and with a diagnosis of pudendal neuralgia on the basis of clinical and electromyographic criteria were enrolled in the study. CT-guided pudendal nerve injections were performed during three consecutive sessions held 2 weeks apart. In each session, patients received two percutaneous injections: one in the ischial spine, and the other in the pudendal (Alcock’s) canal.ResultsOne patient dropped out of the study after the first session. At clinical assessment, 24h h after treatment, 21/27 patients reported significant pain relief. At follow-up at 3, 6, 9 and 12 months, 24/27 patients reported a≥20% improvement in the Quality of Life (QOL) index. Conclusions. In pudendal nerve entrapment, CT-guided perineural injection in the anatomical sites of nerve impingement is a safe and reproducible treatment with a clinical efficacy of 92% at 12 months.RiassuntoObiettivoValutare le indicazioni, la fattibilità tecnica e l’efficacia clinica della infiltrazione TC guidata del nervo pudendo in pazienti con sindrome ano-perineale nevralgica effettuando una revisione del ruolo della tecnica TC nella letteratura recente in ambito interventistico.Materiali e metodiVentotto donne con età media 50 anni e diagnosi di nevralgia del pudendo effettuata sulla base di criteri clinici ed elettromiografici, sono state incluse nel nostro studio. Le iniezioni del nervo pudendo sono state eseguite sotto guida TC, in 3 sedute intervallate da 2 settimane. In ogni seduta, sono state effettuate due sessioni di trattamento iniettivo percutaneo, la prima iniezione è stata effettuata a livello della spina ischiatica e la seconda a livello del canale di Alcock.RisultatiIn un caso la procedura è stata interrotta dopo la prima sessione, è pertanto tale paziente e stata esclusa dalla successiva valutazione. Nella valutazione a ventiquattrore post-trattamento è stato riferito un miglioramento qualitativo significativo della sintomatologia dolorosa in 21 casi su 27; in 24 su 27 casi è stato riportato un miglioramento ≥20% dell’indice di qualità della vita (QOL index) nel follow-up clinico a 3, 6, 9 e 12 mesi.ConclusioniNella sindrome da intrappolamento del nervo pudendo, l’iniezione perineurale TC guidata delle sedi anatomiche di conflitto nervoso risulta una procedura sicura e ripetibile con una efficacia clinica nel 92% dei pazienti trattati nel follow-up a 12 mesi.

Multiparameter characterisation of vertebral osteoporosis with 3-T MR.

Purpose.This study was undertaken to evaluate the diagnostic capabilities of 3-Tesla (T) magnetic resonance (MR) in vertebral osteoporosis.Materials and methods.Thirty subjects (ten healthy controls, ten with osteoporosis but no fracture, ten with osteoporotic vertebral fractures) underwent MR of the lumbar spine. Turbo spin echo (TSE) T1-, T2- and T2- spectral selection attenuated inversion recovery (SPAIR) weighted imaging and spectroscopy for the selective evaluation of water and fat content were performed. The apparent diffusion coefficient (ADC) was calculated, and diffusion tensor imaging (DTI) was performed to create a map of the spatial arrangement of the tissue structures.Results.Morphological imaging detected recent vertebral fractures. In osteoporotic patients, spectroscopic imaging demonstrated an increase in the saturated fats and a decrease in the ADC, whereas the data provided by DTI demonstrated a bone structure with medium-degree anisotropy.Discussion.Osteoporosis is characterised by trabecular thinning, with an increase in the intertrabecular spaces, which are filled with fats. The anisotropic study and the subsequent assessment of colour and vector maps can provide a noninvasive tool for assessing the risk of fracture due to osteoporosis.

The vascular geometry of human arterial bifurcations

We used angiography to evaluate the branching characteristics of 69 morphologically normal human arterial bifurcations. Each angiographic picture was enlarged photographically and traced on paper. The diameter of the parent vessel (d0), the diameters of the two daughter vessels (d1 and d2-d1 denote the larger vessel), and the angles at which the two branches arise from the parent vessel (teta 1 and teta 2) were measured on each bifurcation. Because theoretically there are optimal values for angles and diameters that render an arterial bifurcation more efficient physiologically, the measured data were compared with predicted values. Branch diameters correlated better with predicted values than did branching angles. Twenty-six per cent of teta 1 and only 7.2% of teta 2 angles were within the optimal range; 68.2% of teta 1 and 79.7% of teta 2 were within 2% of optimal values in terms of physiologic efficiency. On the average, teta 1 angles were smaller than teta 2 angles (17.0 degrees vs. 29.5 degrees). Morphologic and hemodynamic pecularities of vessels and errors in the measuring technique must be considered in analyzing the data obtained. Moreover, branching angle measurements changed slightly with age: teta 1 became larger and teta 2 narrower. In the cardiovascular system branching angles and branch diameters follow, to some degree, the principles predicted by theory. Branching angles diverging considerably from those principles may indicate the presence of vascular disease although a direct connection has not been established.

Multidetector CT and Dentascan software: dosimetric evaluation and technique improvement

Purpose.The development of new operative techniques in oral and maxillofacial surgery within the last few years has led to an increasing demand for Dentascan examination, also in paediatric patients. It is necessary to modify acquisition parameters to reduce the absorbed dose. The aim of this study was to define a Dentascan protocol in which a reduced X-ray dose could be used.Materials and methods.Dosimeters were applied to the eyes, mouth, parotid glands, thyroid and back of the neck of an anthropomorphic Plexiglas phantom that underwent multidetector computed tomography (MDCT) Dentascan examinations. Both 120kV and 80 kV were used to study the mandibular and maxillary arches.Results.Examinations obtained with the 80 kV protocol showed a ten-fold reduction in the absorbed dose, without affecting image quality.Conclusions.We suggest a Dentascan protocol that reduces the X-ray dose administered to the patient while ensuring the same high diagnostic accuracy.

Three-Dimensional Evaluation of Masseter Muscle in Different Vertical Facial Patterns A Cross-Sectional Study in Growing Children

The aim of the present study was to analyze the anatomical three-dimensional (3D) characteristics of masseter muscle in growing subjects with different vertical patterns by using an ultrasound (US) method. The sample comprised 60 prepuberal subjects (33 males, 27 females) with a mean age of 11.5 ± 1.6 years with late mixed or permanent dentition and Class I molar and skeletal relationship. For each subject, a lateral cephalogram was required, and according to the mandibular plane angle (Frankfort horizontal plane/mandibular plane angle [FMA]), the subjects were divided into three groups of different underlying vertical facial patterns: brachyfacial: FMA < 22°, mesofacial: 22° ≤ FMA ≤ 28°, and dolichofacial: FMA > 28°. For each subject, an US scan was carried out to analyze the width, the thickness, the cross-sectional area, and the volume of the masseter muscle. Mean differences in measurements between vertical facial subgroups were contrasted by means of analysis of variance (ANOVA) with Tukey’s post hoc tests (p < 0.05). Measurements of the whole masseter in dolichofacial patients were significantly smaller when compared with brachyfacial and mesofacial individuals during relaxation and contraction. The volume of the masseter decreased significantly by 10% going from the brachyfacial group to the mesofacial group and from the mesofacial group to the dolichofacial group with no difference between the left and the right sides. A significant negative correlation was found between the US measurements and the divergency (FMA°). Ultrasound is a technique indicated in children for evaluating muscles of mastication in vivo. Growing patients with a dolichofacial vertical pattern present with a reduced dimension of the masseter when compared with brachyfacial and mesofacial subjects.

Three-dimensional densitometric analysis of maxillary sutural changes induced by rapid maxillary expansion

OBJECTIVE This prospective study evaluated the density of the midpalatal and transverse sutures as assessed by low-dose CT before rapid maxillary expansion (T0), at the end of active expansion (T1) and after a retention period of 6 months (T2). METHODS The study sample comprised 17 pre-pubertal subjects (mean age 11.2 years) with constricted maxillary arches. Total amount of expansion was 7 mm in all subjects. Multislice low-dose CT scans were taken at T0, T1 and T2. On the axial CT scanned images six regions of interest (ROIs) were placed along the midpalatal and transverse sutures and two in maxillary and palatal bony areas. Density was measured in Hounsfield units. Mann-Whitney U test and Friedman analysis of variance with post hoc tests were used (p < 0.05). RESULTS The three ROIs in the midpalatal suture showed a significant decrease in density from T0 to T1, a significant increase from T1 to T2 and a lack of statistically significant differences from T0 to T2. Both ROIs located in the transverse suture showed a significant decrease in density from T0 to T1, followed by a non-significant increase in density from T1 to T2. CONCLUSIONS At the end of the active phase of expansion a significant reduction in density along the midpalatal and transverse sutures was observed in all subjects. The sutural density of the midpalatal suture at T2 indicated reorganization of the midpalatal suture while the density along the transverse suture increased without reaching the pre-treatment values, possibly due to different morphology between midpalatal and transverse sutures.

Dynamic MR defecography with an open-configuration, low-field, tilting MR system in patients with pelvic floor disorders.

PurposeThis study was undertaken to explore the capabilities of an open-configuration, low-field, tilting, magnetic resonance (MR) system for investigating pelvic floor disorders and to compare the results obtained with the patient in the semiorthostatic and supine positions.Materials and methodsEighteen female patients with a diagnosis of pelvic floor disorder (physical examination and conventional defecography) underwent dynamic MR defecography (MRD) with a 0.25-T tilting MR system (G-scan, Esaote). Images were obtained after administration of contrast agent into the rectum, bladder and vagina in both the orthostatic and supine positions. Three-dimensional T2-weighted hybrid contrast-enhanced (HYCE) sequences and dynamic T1-weighted gradient echo (GE) sequences were acquired at rest, during maximal contraction of the anal sphincter, straining and defecation.ResultsGood image quality was obtained in 15/18 patients; three presented severe artefacts due to motion, and three had incontinence, which hampered the functional studies. Better anatomical detail was obtained with MRD compared with conventional defecography. Three prolapses were observed in the semiorthostatic position only, and seven were found to be more severe in the orthostatic than in the supine position.ConclusionsDynamic MRD with an open-configuration, low-field, tilting MR system is a feasible and promising tool for studying the pelvic floor. Larger series are necessary to assess its real diagnostic value.RiassuntoObiettivoAbbiamo voluto valutare la capacità di un sistema di risonanza magnetica (RM) aperto a basso campo a decubito variabile di esaminare i disordini del pavimento pelvico e di confrontare i risultati ottenuti con paziente in posizione supina e in ortostatismo.Materiali e metodiDiciotto pazienti donne con diagnosi di patologia del pavimento pelvico (esame clinico e defecografia convenzionale) hanno eseguito una defecografia con risonanza magnetica dinamica (MRD), utilizzando un sistema di RM da 0,25 T ribaltabile (G-scan, Esaote). Le immagini sono state acquisite dopo sommministrazione di mezzo di contrasto nel retto, nella vescica e nella vagina, sia nella posizione supina che in ortostatismo. Sequenze 3D T2 hybrid contrast enhanced (HYCE) e sequenze dinamiche gradient echo (GE) T1-pesate sono state acquisite rispettivamente a riposo, durante la massima contrazine dello sfintere anale, ponzamento ed evacuazione.RisultatiUna buona qualità delle immagini è stata ottenuta in 15/18 pazienti; 3 pazienti hanno presentato gravi artefatti dovuti al movimento, 3 pazienti presentavano incontinenza che ha impedito gli studi funzionali. Migliori dettagli anatomici sono stati ottenuti dalla MRD in confronto alla defecografia convenzionale. Tre prolassi sono stati osservati soltanto nella posizione semi-ortostatica, 7 prolassi sono risultati più grandi nella posizione ortostatica rispetto a quella supina.ConclusioniLa MRD dinamica con un sistema di RM aperto a basso campo ribaltabile è uno strumento attuabile e promettente per lo studio del pavimento pelvico. Casistiche più ampie sono necessarie per stabilire il reale valore diagnostico.

Vascular involvement in pancreatic neoplasm: a comparison between spiral CT and DSA

The principal criterion for resectability of pancreatic carcinoma is the assessment of vascular involvement. In a prospective evaluation the ability of Spiral CT Angiography (CTA) to detect vascular involvement in 50 patients with pancreatic carcinoma, was proved; DSA was performed later in all patients. In 20 patients, without vascular involvement, a complete concordance was obtained. Of 30 patients with vascular involvement, there was complete concordance between CTA and angiography in 22 patients and discordance in 8 patients. CTA was superior in 2 cases with periadventitial infiltration and in 5 patients with splenoportal confluence thrombosis. DSA was superior in 1 case with infiltration of the superior mesenteric vein. After surgical evaluation, sensitivity of CTA and DSA was 97% and 77%, respectively, and the negative predictive values were 95% and 74%. As compared to DSA, CTA is more rapid and less invasive and can be considered the modality of choice for preoperative work-up of pancreatic neoplasm.