Larry T. Cook

The transverse plane evolution of the most common adolescent idiopathic scoliosis deformities : a cross-sectional study of 181 patients

Study Design. The transverse plane evolution of the most common idiopathic scoliosis deformities was studied using a cross-sectional database of 181 patients whose deformities were visualized by precise three-dimensional techniques. Objective. The objective was to test the hypothesis that for all common idiopathic scoliosis deformities evolution occurs as a torsion, the apex vertebra translating away from the upper end vertebra and at the same time angulating in a clockwise arc for right apex deformities and a counterclockwise arc for left apex deformities. Summary of Background Data. Perdriolle and Vidal proposed this hypothesis in 1987, which explained observations we had made in 1983 and which was partially supported in thoracic curves in our 1992 study. Methods. Deformities were characterized as single thoracic major, thoracic major and thoracolumbar or lumbar minor, double thoracic and thoracolumbar or lumbar major, and single thoracolumbar or lumbar major curves. The dependent variable studied was the coronal plane regional angular (Cobb) deformity. The independent variables studied were the lateral and anteroposterior translation of the apex vertebra in relation to the upper end vertebra, and the transverse plane translation and angulation of the apex vertebra in relation to the upper end vertebra. For the model or hypothesis to be true, the apex vertebra to upper end vertebra transverse plane translational distance and angular relationship should increase as the Cobb angle increases. Results. In relation to the upper end vertebra, the apex vertebra always translated laterally, almost always was accompanied by transverse plane translation increase, and usually was accompanied by transverse plane angulation increase. Anteroposterior translation was minimal, but for thoracolumbar and lumbar curves it tended to be posterior. Conclusion. The theory that these deformities evolve as torsions, with the apex vertebra translating away from the upper end vertebra and at the same time following a clockwise angular pathway to the upper end vertebra of right apex curves and a counterclockwise angular pathway for left apex curves is supported. Compensatory thoracolumbar and lumbar curves evolve in the same manner as major curves

A Three-Dimensional Display System for Diagnostic Imaging Applications

Digitally formatted 3-D imaging will become increasingly important in medical diagnosis. What is the best trade-off of speed, picture quality, and storage requirements?

An Algorithm for Volume Estimation Based on Polyhedral Approxi mation

A volume algorithm is established which uses the data generated by computed tomography (CT) or ultrasound scans. The algorithm is based on a polyhedral reconstruction of an object of interest. Phantom studies indicate that the algorithm calculated volume is accurate within 3 percent. In a controlled clinical experiment on a laboratory animal, the algorithm calculated volume showed a maximum error of about 5 percent. In less controllable applications to human clinical data, volume calculations showed variations ranging up to 16 percent.

Evidence of Extraordinary Growth in the Progressive Enlargement of Renal Cysts

BACKGROUND AND OBJECTIVES In autosomal dominant polycystic kidney disease, cysts derived from tubules are detected at birth by ultrasound (threshold for detection >7.0 mm); thus, fetal cyst growth rates must exceed 2300%/yr. In adults, the combined renal cyst component enlarges at approximately 12%/yr by growth of individual cysts. To explore this discrepancy, the growth rates of individual cysts were determined in adult polycystic kidneys. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Diameter, volume, and growth rates of individual cysts were measured by magnetic resonance in 30 individual cysts in three adult patients over a span of 3 years. Results were confirmed in 22 cysts measured in five patients by computed tomography over a span of 11 years. RESULTS Mean cyst diameters were 20.4 +/- 9.9 mm (range 7.1 to 40.5 mm) at baseline and 25.8 +/- 15.6 mm (range 7.8 to 49.6 mm) after 3 years. Mean cyst volumes, determined by manual segmentation and summation of magnetic resonance cross sections, were 8.7 +/- 12.9 cm(3) (0.3 to 43.3 cm(3)) and 24.2 +/- 66.3 cm(3) (0.3 to 364.8 cm(3)) after 3 years. Mean cyst growth rates ranged from 6.9 to 23.9%/yr; the maximum growth rate was 71.1%/yr, far less than required to develop a 7-mm diameter cyst in utero. Results were similar in 22 cysts examined by computed tomography. CONCLUSIONS It was concluded that renal cysts detected by ultrasound in newborns must have grown at exuberant rates in utero; thereafter, expansion appears to proceed at much slower rates.

Maximum-likelihood approach to strain imaging using ultrasound

A maximum-likelihood (ML) strategy for strain estimation is presented as a framework for designing and evaluating bioelasticity imaging systems. Concepts from continuum mechanics, signal analysis, and acoustic scattering are combined to develop a mathematical model of the ultrasonic waveforms used to form strain images. The model includes three-dimensional (3-D) object motion described by affine transformations, Rayleigh scattering from random media, and 3-D system response functions. The likelihood function for these waveforms is derived to express the Fisher information matrix and variance bounds for displacement and strain estimation. The ML estimator is a generalized cross correlator for pre- and post-compression echo waveforms that is realized by waveform warping and filtering prior to cross correlation and peak detection. Experiments involving soft tissuelike media show the ML estimator approaches the Cramer-Rao error bound for small scaling deformations: at 5 MHz and 1.2% compression, the predicted lower bound for displacement errors is 4.4 microns and the measured standard deviation is 5.7 microns.

Three-dimensional computer reconstruction from surface contours for head CT examinations.

Abstract: A three-dimensional surface reconstruction algorithm based on contour information from anatomic sites as identified on computed tomography examinations is presented. This algorithm efficiently reconstructs the surfaces between the contours using a triangular “tiling” method. A three-dimensional perspective view of the reconstructed surfaces is provided by a gray scale cathode-ray tube computer graphics system. Volume and surface area estimations are provided as a direct result of the surface reconstruction algorithm. Three cases are presented to illustrate the three-dimensional surface reconstruction algorithm.

Backscatter coefficient estimation using array transducers

This paper describes an extension of our broadband method for estimating backscatter coefficients from random media to include data from array transducers. Four different transducer designs have now been considered: oneand two-dimensional linear arrays, annular arrays, and single-element focused pistons commonly used in mechanical sector scanners. The analysis shows that if the backscatter echo spectrum is properly normalized, the shape of the piezoelectric elements affects only the magnitude and not the frequency dependence of the backscatter coefficient estimates. Experimental data were acquired using laboratory and clinical imaging instrumentation to verify the analysis. We compared backscatter coefficients measured as a function of frequency from well-defined scattering media that were obtained using a 1-D linear array and focused piston transducers. Instrument-independent results were found that matched theoretical predictions within the measurement error between 2 and 12 MHz. We conclude from this study that accurate backscatter coefficient estimates may be easily obtained using current clinical imaging instrumentation.<<ETX>>

Three-Dimensional Reconstruction From Serial Sections For Medical Applications

Three-dimensional display algorithms using computer graphics are evaluated for potential clinical utilization. The authors are utilizing triangular tiles for organ surface reconstruction based on contour information generated from computed tomography (CT), ultrasound examinations, and nuclear medicine examinations. Comparisons have been established among several triangular tiling algorithms which include the number of points required to adequately specify the contours, computer execution time, and the errors in reconstruction. The triangular tiling algorithm provides a means for accurately estimating the volume and surface area of the desired anatomic sites. Examples of studies include brain lesions, computed tomography radiation treatment plans, spleen, and nuclear medicine slant hole camera studies.

Measurement accuracy of proximal femoral geometry using biplanar radiography.

Summary: Experimental testing indicates that the neck-shaft angle of the proximal femur can be reliably measured from biplanar radiographs, but torsion cannot. Calculated torsion varies significantly from true torsion as a function of the error created by femoral rotation, while the calculated neck-shaft angle is invariant with respect to rotation even though the calculated neck-shaft angle is mathematically dependent on calculated torsion. Theoretical considerations support this finding and demonstrate for the first time why it is true. This study demonstrates that clinical measurements of frontal plane hip deformities using existing biplanar radiography are quite accurate, but clinical measurements of torsional abnormalities are unreliable. These errors can be minimized if investigators specify the angle of the lateral X-ray beam on the anteroposterior film using methods described in this paper and if patient position is radiographically verified. The magnitude and types of errors inherent in biplanar radiography should be considered in planning preoperative strategies and in postoperative assessments of hip geometry.

Detected Renal Cysts Are Tips of the Iceberg in Adults with ADPKD

BACKGROUND AND OBJECTIVES In autosomal dominant polycystic kidney disease, progressive renal enlargement secondary to expanding cysts is a hallmark. The total cyst load and range of cyst diameters are unknown. The purpose of this study was to quantify the total number and range of diameters of individual cysts in adults with preserved GFR. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A retrospective, morphometric analysis of renal cyst number and diameter using magnetic resonance images from eight adult autosomal dominant polycystic kidney disease patients was performed at baseline and after 6.9 years. Cyst number and diameter were measured in microscopic sections of nephrectomy specimens from five different adults. RESULTS The diameters of 1010 cysts ranged from 0.9 to 77.1 mm in baseline T2 magnetic resonance images, and the mean total number of cysts increased from 682 to 1002 in 6.9 years. However, magnetic resonance imaging detects only cysts above the lower limit of detection. In 405 cysts measured in nephrectomy specimens, 70% had diameters <0.9 mm. Cyst counts by magnetic resonance in eight subjects compared with histology revealed approximately 62 times more cysts below the limit of magnetic resonance imaging detection than above it. CONCLUSIONS This study presents quantitative data indicating that renal cysts develop in a minority of renal tubules. Increased numbers detected by magnetic resonance imaging are caused primarily by cysts below detection at baseline enlarging to a detectable diameter over time. The broad range of diameters, with a heavy concentration of microscopic cysts, may be most appropriately explained by a formation process that operates continuously throughout life.