Validation of two-dimensional vertebral body parameters in estimating patient height in elderly patients

Objectives: Standardised comparison of abdominal muscle and adipose tissue is often utilised in morphometric clinical research. Whilst measurements are traditionally standardised against the patient’s height, this may not be always practically feasible. The aim of this study was to investigate the relationship between measurements of the vertebral body and patient height. Methods: We analysed cross-sectional CT scans. Measurements of the vertebral body area (VBA), anteroposterior vertebral body diameter (APVBD) and lateral vertebral body diameter (LVBD) were made by two independent investigators by manual tracing. Patients were randomly divided into two groups: Group 1 standardisation and Group 2 validation. We compared height and vertebral body parameters from patients in Group 1 and mathematically modelled this relationship. We then utilised the model to predict the height of patients in Group 2 and compared this with their actual height. Observer variability was assessed using Bland–Altman plots and t-tests of differences. Results: CT scans from 382 patients were analysed. No significant intraobserver or interobserver differences were apparent when measuring vertebral body parameters. We describe models which enable the prediction of the patients’ height using the measured VBA, APVBD and LVBD. No significant differences were observed between the patients predicted and actual heights in the validation group. Conclusions: We demonstrate an important relationship between measurements of the patient’s height and the vertebral body. This can be utilised in future research when the patient’s height has not been measured. Advances in knowledge: In the absence of the patient’s height, we demonstrate that two-dimensional vertebral body parameters may be reliably used to standardise morphometric measurements

Pre and per-operative assessment of femoro-distal non-reversed vein grafts.

The expected increase in the elderly population over the next decade or so will result in an increase in the number of patients presenting with lower limb critical ischaemia. The use of non-reversed vein grafting and more distal bypasses has increased the scope for possible limb salvage and improved the quality of life, but case selection has become more difficult. In order to improve patient selection calf vessel runoff and long saphenous vein suitabihty were assessed pre and per-operatively to try and prevent unnecessary reconstructions. In total 88 patients were studied. Conventional arteriography in combination with IA-DSA views of the distal runoff were performed in all cases. Three arteriographic scoring systems were used to grade the runoff. Pulse Generated Runoff (PGR) was used to assess calf vessel and pedal arch patency. Duplex ultrasound was used to assess the long saphenous vein before bypass. At operation peripheral resistance and flow were measured before and after reconstruction. Samples of the LSV were taken before and after valve stripping for both light and electron microscopy. Intra-arterial DSA improved the correlation between the scoring systems and the measured peripheral resistance in the distal popliteal artery, but not in single calf vessels. In contrast PGR correlated much better with peripheral resistance in single calf vessels (rs = -0.82, p 2 had 1 and 2 year patency rates of 79% and 64% respectively which were significantly higher than grafts with a PGR score of < 2 of 14% (Lee-Desu p< 0.002). Grafts with resistances (GR2) of 1 after the administration of papaverine had patency rates of 85% and 14% at one year. PGR will identify patent calf vessel and confirm continuity with the pedal arch. Duplex assessment of the LSV will accurately identify suitable LSV for bypass. Per-operative haemodynamic monitoring will confirm the pre-operative assessment, define the level of the distal anastomosis and exclude the majority of technical errors. Morphological examination of the LSV has shown it to be a potential cause of graft failure and revealed evidence of early atherosclerosis previously thought to develop as a consequence of arterialization. This approach will hopefully improve the selection of patients for femoro-distal bypass and ensure that patients are not rejected on the basis of the arteriogram