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CT with 3D-Image Reconstructions in Preoperative Planning
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Computed tomography is one of the most evolving fields of modern radiology. The current CT applications permit among other things angiography, 3D image reconstructions, material decomposition and tissue characterization. CT is an important tool in the assessment of specific patient populations prior to an invasive or surgical procedure. The aim of this dissertation was to demonstrate the decisive role of CT with 3D-image reconstructions in haemodialysis patients scheduled to undergo fistulography, in patients undergoing surgical breast reconstructions with a perforator flap and in patients with complicated renal calculi scheduled to undergo percutaneous nephrolithotomy.

CT Angiography with 3D image reconstructions was performed in 31 patients with failing arteriovenous fistulas and grafts, illustrating the vascular anatomy in a comprehensive manner in 93.5% of the evaluated segments and demonstrating a sensitivity of 95% compared to fistulography.

In 59 mastectomy patients scheduled to undergo reconstructive breast surgery with a deep inferior epigastric perforator flap, the preoperative planning with CT Angiography with 3D image reconstructions of the anterior abdominal wall providing details of its vascular supply, reduced surgery time significantly (p< 0.001) and resulted in fewer complications.

Dual Energy CT Urography with advanced image reconstructions in 31 patients with complicated renal calculi scheduled to undergo PNL, resulted in a new method of material characterisation (depicting renal calculi within excreted contrast) and in the possibility of reducing radiation dose by 28% by omitting the nonenhanced scanning phase. Detailed analysis of the changes renal calculi undergo when virtually reconstructed was performed and a comparison of renal calculi number, volume, height and attenuation between virtual nonenhanced and true nonenhanced images was undertaken. All parameters were significantly underestimated in the virtual nonenhanced images.

CT with 3D-reconstructions is more than just “flashy images”. It is crucial in preoperative planning, optimizes various procedures and can reduce radiation dose. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. , 96 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 826
Keyword [en]
CT Angiography, 3D-image reconstructions, haemodialysis, AVF/AVG, DIEP flap, surgery time, complicated renal calculi, PNL, true nonenhanced images, virtual nonenhanced images, CT Urography
National Category
Radiology, Nuclear Medicine and Medical Imaging
Research subject
Radiology
Identifiers
URN: urn:nbn:se:uu:diva-182080ISBN: 978-91-554-8501-6 (print)OAI: oai:DiVA.org:uu-182080DiVA: diva2:558485
Public defence
2012-11-23, Rosénsalen, Akademiska Sjukhuset, Ing 96, NBV, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2012-11-02 Created: 2012-10-03 Last updated: 2013-01-23Bibliographically approved
List of papers
1. MDCT angiography with 3D image reconstructions in the evaluation of failing arteriovenous fistulas and grafts in hemodialysis patients
Open this publication in new window or tab >>MDCT angiography with 3D image reconstructions in the evaluation of failing arteriovenous fistulas and grafts in hemodialysis patients
2011 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 52, no 9, 935-942 p.Article in journal (Refereed) Published
Abstract [en]

Background: Arteriovenous fistulas and grafts are the methods of choice for vascular access in renal failure patients in need of hemodialysis. Their major complication, however, is stenosis, which might lead to thrombosis.

Purpose: To demonstrate the usefulness of 16-MDCTA with 3D image reconstructions, in long-term hemodialysis patients with dysfunctional arteriovenous fistulas and grafts (AVF and AVG).

Material and Methods: During a 17-month period, 31 patients with dysfunctional AVF and AVG (24 AVF and seven AVG) were examined with MDCTA with 3D image postprocessing. Parameters such as comprehension of the anatomy, quality of contrast enhancement, and pathological vascular changes were measured. DSA was then performed in 24 patients.

Results: MDCTA illustrated the anatomy of the AVF/AVG and the entire vascular tree to the heart, in a detailed and comprehensive manner in 93.5% of the evaluated segments, and depicted pathology of AVF/AVG or pathology of the associated vasculature. MDCTA demonstrated a total of 38 significant stenoses in 25 patients. DSA verified 37 stenoses in 24 patients and demonstrated two additional stenoses. MDCTA had thus a sensitivity of 95%. All 24 patients were treated with percutaneous transluminal angioplasty (PTA) with good technical results.

Conclusion: MDCTA with 3D reconstructions of dysfunctioning AVFs and AVGs in hemodialysis patients is an accurate and reliable diagnostic method helping customize future intervention.

Keyword
CT angiography; hemodialysis; arteriovenous fistula; arteriovenous grafts; 3D reconstructions
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-160999 (URN)10.1258/ar.2011.110255 (DOI)000297489200001 ()21969710 (PubMedID)
Available from: 2011-11-04 Created: 2011-11-04 Last updated: 2017-12-08Bibliographically approved
2. Preoperative CT angiography reduces surgery time in perforator flap reconstruction
Open this publication in new window or tab >>Preoperative CT angiography reduces surgery time in perforator flap reconstruction
Show others...
2009 (English)In: Journal of plastic, reconstructive & aesthetic surgery : JPRAS, ISSN 1748-6815, Vol. 62, no 9, 1112-1117 p.Article in journal (Refereed) Published
Abstract [en]

The use of perforator flaps in breast reconstructions has increased considerably in the past decade. A disadvantage of the perforator flap is difficult dissection, which results in a longer procedure. During spring 2006, we introduced CT angiography (CTA) as part of the diagnostic work-up in perforator flap reconstructions to visualise each perforator more accurately. The main objectives were to reduce surgery time and the number of complications. A chart review was conducted 1 year after CTA introduction to investigate if these objectives were met. MATERIALS AND METHODS: Patients with a deep inferior epigastric perforator (DIEP) flap who underwent preoperative analysis through CTA were retrospectively evaluated. The population <0.001) than in the control group, 264 min (SD+/-62) versus 354 min (SD+/-83), respectively. There was a tendency for fewer complications in the CTA group compared with the control group. All flaps were successful in the CTA group. In the control group, one flap failed and partial necrosis occurred in three flaps. The differences were not statistically significant. CONCLUSIONS: Preoperative CTA in the assessment of vascular anatomy during perforator flap reconstruction was safe and reliable. It helped reduce surgery time, and may prevent the number of postoperative complications.

Keyword
DIEP, Perforator flap, CT angiography, Surgery time
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-108874 (URN)10.1016/j.bjps.2007.12.090 (DOI)000270162600002 ()18675605 (PubMedID)
Available from: 2009-10-01 Created: 2009-10-01 Last updated: 2013-01-23Bibliographically approved
3. A new technique for visualisation of complex renal calculi using Dual Energy CT and image merging, in the preoperative work-up of patients undergoing Percutaneous Nephrolithotomy
Open this publication in new window or tab >>A new technique for visualisation of complex renal calculi using Dual Energy CT and image merging, in the preoperative work-up of patients undergoing Percutaneous Nephrolithotomy
(English)Manuscript (preprint) (Other academic)
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-182092 (URN)
Available from: 2012-10-03 Created: 2012-10-03 Last updated: 2013-01-23
4. Dual Energy CT in patients with complicated renal calculi undergoing Percutaneous Nephrolithotomy: virtual nonenhanced images vs. true nonenhanced images; correlation on calculi number, volume, size and attenuation
Open this publication in new window or tab >>Dual Energy CT in patients with complicated renal calculi undergoing Percutaneous Nephrolithotomy: virtual nonenhanced images vs. true nonenhanced images; correlation on calculi number, volume, size and attenuation
(English)Manuscript (preprint) (Other academic)
National Category
Radiology, Nuclear Medicine and Medical Imaging
Research subject
Radiology
Identifiers
urn:nbn:se:uu:diva-182094 (URN)
Available from: 2012-10-03 Created: 2012-10-03 Last updated: 2013-01-23

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