Kuniaki Hayashi

Analysis of trabecular microarchitecture of human iliac bone using microcomputed tomography in patients with hip arthrosis with or without vertebral fracture

Iliac bone samples were obtained from 50 women with osteoarthrosis of the hip (50-80 years of age) during hip surgery for total hip joint replacement. After determining the resolution and threshold for the binary image, the two-dimensional (2D) and three-dimensional (3D) data of the trabecular structure were obtained in these iliac bone samples using microcomputed tomography (micro-CT). Conventional histomorphometry was then performed. Both 2D and 3D parameters of the trabecular structure were significantly correlated with the parameters of conventional histomorphometry (r = 0.63-0.86 in 2D analysis, and r = 0.60-0.77 in 3D analysis). The patients were classified into the non-spinal-fracture group (n = 36) and the spinal fracture group (n = 14). There was no significant difference in patient age between the two groups. The parameter values of bone mass, such as 2D fractional trabecular bone area and 3D fractional bone volume, and the values of trabecular number (Tb.N) in terms of both 2D and 3D analyses were significantly smaller, and those of trabecular separation (Tb.Sp) were significantly higher in the spinal fracture group than in the non-spinal-fracture group. Trabecular thickness (Tb.Th) values did not significantly differ between the two groups. There was no significant difference between 2D and 3D parameters in discriminating the spinal fracture group from the non-spinal-fracture group. However, 3D analysis demonstrated that the value of the bone surface to bone volume (BS/BV) ratio could discriminate between these two groups. These data demonstrated that micro-CT can evaluate the 3D structure of the human iliac bone, and that decreases in the parameters of the 3D-structure-related bone surface density as well as decreases in trabecular bone volume are related to osteoporotic fracture.

RELATION OF EARLY MENARCHE TO HIGH BONE MINERAL DENSITY

The study of background factors in individuals with high bone mineral density (BMD) may provide useful information in the prevention of osteoporosis. We investigated the relationship of reproductive factors to BMD. In 519 female volunteers (327 postmenopausal and 192 premenopausal women) ranging in age from 21 to 74 (mean 52.3 ±11.8) years, spinal BMD values were obtained using both quantitative computed tomography and dual x-ray absorptiometry. The z score was calculated from the mean BMD in each 5-year age group, and high BMD and low BMD was defined as BMD with z score >+1.5 and <-1.5, respectively. Normal BMD was defined as BMD within the range-1.0 <z score <+1.0. Long reproductive period, early menarche, and late menopause were associated with high BMD. Among these, the reproductive period showed the strongest association with BMD. In postmenopausal women, early menopause had a significant relationship with low BMD, and early menarche also had some relation to high BMD. In premenopausal women, there was a significant relationship between early menarche and high BMD. The age at menarche may have a strong association with peak bone mass, as suggested by the positive correlation of early menarche with high BMD observed in this study. It is considered important to prevent risk factors that disturb the beginning of menstruation in adolescent girls.

Contribution of trabecular and cortical components to the mechanical properties of bone and their regulating parameters

To evaluate the mechanical contributions of the spongiosa and cortex to the whole rat vertebra, we developed a finite element analysis (FEA) system linked to three-dimensional data from microcomputed tomography (micro-CT). Twenty-eight fifth lumbar vertebrae (L-5) were obtained from 10-month-old female rats, comprised of ovariectomized (ovx, n = 6), sham operated (n = 7), and alfacalcidol-treated after ovx (0.1 microg/kg [n = 8] and 0.2 microg/kg [n = 7]) groups. The trabecular microstructure of L-5 was measured by micro-CT. Yield strength at the tissue level (YS), defined as the value at which 0.034% of all elements reached yield stress, was calculated by the FEA. Then, the ultimate compressive load of each specimen was measured by mechanical testing. The YS of the whole bone (YSw) showed a significant correlation with ultimate load (r = 0.91, p < 0.0001). The YS values of the isolated spongiosa (YSs) and cortex (YSc) were calculated in models with varying amounts of trabecular or cortical bone mass. The mechanical contribution of the spongiosa showed a nonlinear relationship with bone mass, and ovx reduced the mean mechanical contribution of the spongiosa to the whole bone by 13% in comparison to the sham group. YSs had a strong relationship with trabecular microstructure, especially with trabecular bone pattern factor (TBPf) and structure model index (SMI), and YSc had a strong relationship with cortical bone volume. The structural parameters most strongly related to YSw were BV/TV and TBPf. Our micro-FEA system was validated to assess the mechanical properties of bone, including the individual properties of the spongiosa and cortex, in the osteoporotic rat model. We found that the mechanical property of each component had a significant relationship with the respective bone mass, volume, or structure. Although trabecular microstructure has a significant relationship with bone strength, in ovx bone with deteriorated trabecular microstructure, the strength depended mainly on the cortical component.

Fate of intramural hematoma of the aorta : CT evaluation

PURPOSE Our goal was to investigate the fate of intramural hematoma of the aorta. METHOD In 32 patients with intramural hematoma of the aorta, we reviewed CT (n = 32) and MR (n = 22) findings. The diagnosis was established by CT, and regular follow-up studies were performed. RESULTS All intramural hematomas decreased in size. Ulcer-like projections (ULPs) were identified at the initial study in 6 patients and during the follow-up period in 14 patients. The ULPs progressed to saccular aneurysm in 12 patients (mean 47.0 days), while fusiform aneurysm developed in 6 patients (mean 347.7 days) without ULP. In two patients, the affected aorta progressed to overt aortic dissection. CONCLUSION Intramural hematoma itself usually decreases in size. However, the affected aorta can progress to aneurysm or overt aortic dissection. Development of saccular aneurysm from ULPs can be considered an early complication. In cases without ULP, fusiform aneurysm may develop as a late complication. All intramural hematomas need to be followed since it seems to be difficult to predict the exact fate of intramural hematoma from the initial imaging findings.

Differences of three-dimensional trabecular microstructure in osteopenic rat models caused by ovariectomy and neurectomy

We investigated the differences in three-dimensional microstructure of bone in cases of osteopenia caused by two different procedures: ovariectomy (ovx) and sciatic neurectomy (nx). Thirty-nine 8-week-old female Lewis rats were divided into two groups: (1) ovx and sham operation; and (2) nx and sham operation. At 12 weeks of age these rats were killed to sample the right tibiae. The samples were scanned using microcomputed tomography to obtain metric parameters such as bone volume fraction (BV/TV), trabecular thickness (Tb.Th), and trabecular separation (Tb.Sp), and nonmetric parameters such as structure model index (SMI), trabecular bone pattern factor (TBPf), and degree of anisotropy (DA). The changes in all microstructural parameters were significant in both the ovx and nx groups, with those of BV/TV, Tb.Th, Tb.Sp, and SMI more significant in the ovx group than in the nx group, in comparison to their respective controls. The significantly higher coefficient of variance for Tb.Th across the entire analyzed area of the individual samples indicated that the trabecular thinning occurred heterogenously and that the microstructural deterioration induced by ovx and nx appeared to be locally accelerated, so as to induce perforation and disappearance of trabeculae. The DA increased significantly in the ovx rats, whereas it decreased in the nx rats. The appearance of microstructural deterioration differed between the two osteopenic models. The three-dimensional (3D) images from the nx rats showed flake-like trabeculae, whereas the ovx rats exhibited a diffuse disappearance of trabeculae, especially in the central part of the tibia, but with a preservation of shape for those trabeculae that were retained. The reduction in cortical area was more significant in the nx group. nx and ovx resulted in significant changes in bone microstructure, showing perforation and removal of trabeculae due to locally accelerated bone resorption. The 3D microcomputed tomography images demonstrated the different microstructural changes that occurred in the ovx and nx groups. Loading during bone resorption increased the anisotropy, whereas immobilization increased the isotropy. In addition, immobilization had a more significant effect on the cortical area.

Fast spin-echo MR of the articular cartilage in the osteoarthrotic knee : Correlation of MR and arthroscopic findings

Purpose: the objective was to assess the efficacy of fast spin-echo (FSE) imaging in the detection of articular cartilage abnormality in osteoarthrosis of the knee Material and Methods: We studied 356 articular surfaces in 73 knees that had been examined by both MR imaging and arthroscopy. the MR images were obtained with FSE imaging (TR/TE 4200/100) on a 0.5 T unit. the surface abnormalities of the articular cartilage that were detected by MR imaging were compared with the arthroscopic findings Results: the overall sensitivity and specificity of MR in detecting chondral abnormalities were 60.5% (158/261) and 93.7% (89/95) respectively. MR imaging was more sensitive to the higher grade lesions: 31.8% (34/107) in grade 1; 72.4% (71/98) in grade 2; 93.5% (43/46) in grade 3; and 100% (10/10) in grade 4. the MR and arthroscopic grades were the same in 46.9% (167/356), and differed by no more than 1 grade in 90.2% (321/356) and 2 grades in 99.2% (353/356). the correlation between arthroscopic and MR grading scores was highly significant with a correlation coefficient of 0.705 (p<0.0001) Conclusion: FSE sequence was less sensitive to mild cartilage abnormality but useful in detecting moderate to severe abnormality and in evaluating the degree of articular cartilage abnormality

Gastric cancer: evaluation of triphasic spiral CT and radiologic-pathologic correlation.

PURPOSE The purpose of this study was to evaluate the utility of triphasic spiral CT with water-filling method in the preoperative T staging of gastric cancer. METHOD We performed triphasic spiral CT in 108 patients with gastric cancer (53 with early and 55 with advanced gastric cancer). The CT findings were prospectively analyzed and correlated with the histopathologic findings. Spiral CT scans were assessed for the layered pattern of the normal gastric wall, the detectability of tumor, the enhancing pattern of the tumor, and the depth of tumor invasion. RESULTS The layered pattern of the normal gastric wall was clearly demonstrated in the arterial-dominant or parenchymal phase. All 12 early cancers detected with spiral CT were most clearly depicted in the arterial-dominant or parenchymal phase. On the other hand, 15 (28%) of 54 advanced cancers were most clearly depicted in the equilibrium phase due to the gradual enhancement from the inner mucosal side of the tumor. Most of these tumors were scirrhous type tumor containing abundant fibrous tissue stroma. The accuracy of spiral CT for tumor detection and T staging was 98 and 82%, respectively, in advanced gastric cancer and 23 and 15%, respectively, in early gastric cancer. CONCLUSION Spiral CT with triphasic scan technique improved the accuracy of estimating the depth of tumor invasion in advanced gastric cancer.

High resolution CT anatomy of the pulmonary fissures.

Rationale and Objectives: Pulmonary interlobar fissures are important landmarks for proper identification of normal pulmonary anatomy and evaluation of disease. The purpose of this study was to define the radiologic anatomy of the pulmonary fissures using high resolution computed tomography (HRCT) in a large population. Methods: HRCT of the lungs from aortic arch to diaphragm was performed in 622 patients, with a slice thickness of 1 mm and slice interval of 10 mm. Major, minor, and accessory fissures were studied for their orientation and completeness. Results: Both major fissures were mostly facing laterally in their upper parts (100% and 89% right and left, respectively). The left major fissure faced medially (69%) while the right major fissure faced lateral (60%) in their lower parts. The right major fissure was more often incomplete (48% as compared with 43% on the left, P < 0.05). Minor fissures were convex superiorly with the apex in the anterolateral part of the base of the upper lobe, and were incomplete in 63% of cases. Azygos, inferior accessory, superior accessory, and left minor fissures were also seen in 1.2%, 8.6%, 4.6%, and 6.1% of the cases, respectively. Conclusion: The pulmonary fissures are highly variable and the right major fissure differs considerably from the left. The fissures are often incomplete.

Spontaneous rectus sheath hematomas: clinical and radiological features

Abstract. We reviewed the clinical and radiological features in eight patients with spontaneous rectus sheath hematoma (RSH). The diagnosis was confirmed at surgery in four patients, and spontaneous resolution occurred in the other four. All patients were elderly adults. Acute abdominal pain and a palpable mass after muscular strain, such as coughing or twisting, were features highly suggestive of RSH. Sonographically, these hematomas may be confused with abdominal wall tumors. On CT scans, a hyperdense mass posterior to the rectus abdominis muscle with ipsilateral anterolateral muscular enlargement is considered characteristic of acute RSH, although chronic RSH may be isodense or hypodense relative to the surrounding muscle. MRI is very useful in the diagnosis of RSH, which is demonstrated as a high signal intensity area on both T1- and T2-weighted images, especially when the CT findings are not specific for RSH.

Takayasu's arteritis: decrease in aortic wall thickening following steroid therapy, documented by CT

Takayasus arteritis is a well-known disease entity which most frequently affects the thoracic aorta and its branches. The wall of the aorta is thickened, and the degree of thickening may change during the course of the disease. Steroids are effective in treating the inflammatory process of the arteritis. The effect is usually manifested by improvements in laboratory data and symptoms. This is a report of an acute case of Takayasus arteritis in which considerable decrease in aortic wall thickening followed steroid therapy is documented by computed tomography (CT).