Virtualna kolonoskopija i 3d rekonstrukcije u bolesnika s karcinomom kolona i rektuma

Introduction: Virtual endoscopy of the colon or virtual colonoscopy (VC) is a technique for postprocessing high resolution helical CT datasets. 3D surface rendering volume reconstruction that simulates endoscopic views of the inner surface of the colon was performed in real time by means of computer generated ray casting. VC may be performed together with 3D volume rendering (3DVR). VC can be applied in teaching, diagnostics, intervention planning or intraoperative navigation and as a non-invasive technique it is particularly useful when the patient cannot tolerate classical fiberoptic endoscopy. Objectives: To implement VC as a new technique of high resolution helical CT data postprocessing in screening, preoperative diagnostics and management and to discuss advantages and disadvantages of the method. Methods: VC and 3DVR in space analysis were performed using Syngo 2006G platform by Siemens Medical Systems in: a 46-year-old man with a spastic colon and some intestinal diverticula and polyps, a 65-year-old man who underwentendoscopic removal of a large colorectal polyp, a 64-year-old women with large circular cancer stenosis of the rectum and right hepatic lobe metastatic lesion, and a 52-year-old man with a large endoluminal cancer mass in the sigmoid colon. Virtual colonoscopy was performed in real time using ray casting algorithm with space leaping acceleration method. Siemens Somatom Emotion 16 scanner was used for image acquisition. Postprocessing of the images stored in DICOM format was done by dual Xeon workstation. Results: Fly through algorithm and 3DVR were performed on data sets created from axial CT images collected from multislice helical CT scanner archived in DICOM format. Fly through and 3DVR postprocessing produced a series of images that were analyzed by one radiologist, two surgeons and two physicians experienced in virtual endoscopy. Conclusion: VC is a useful non-invasive method in the assessment of malignant and benign lesions of colon. It may provide useful additional information for a surgeon during preoperative management. Furthermore, it allows three dimensional visualization in the lumen beyond areas of narrowing or stenosis and it gives a highly accurate representation of colorectal lesions. Its disadvantages are that it does not provide histology, it requires an air-mucosa interface to produce an image and it cannot identify functional lesions. Using VC, clinicians can appreciate not only the intraluminal proliferation of the tumor but also the extraluminal extension of the mass and its relation to the surrounding organs.Uvod: Virtualna endoskopija kolona ili virtualna kolonoskopija (VC) je metoda postprocesiranja podataka dobivenih kompjutoriziranom tomografijom visoke razlučivosti. VC simulira pogled pravog endoskopa na unutrašnju površinu debelog crijeva, a izvodi se u realnom vremenu na računalnim radnim stanicama s pomoću računalnog algoritma “ray casting”. VC se može izvoditi zajedno sa trodimenzionalnim volumnim renderiranjem (3DVR) koje daje 3D prikaz promatranog dijela tijela. VC se može koristiti u edukaciji, dijagnostici, planiranju endoskopskih zahvata ili operacija, te intraoperacijskoj navigaciji. Kao neinvazivna tehnika VC je naročito korisna ako bolesnik ne može podnijeti klasičnu fiberoptičku endoskopiju ili je ova kontraindicirana.. Ciljevi rada: Uvođenje VC kao nove metode postprocesiranja podataka dobivenih spiralnom kompjutoriziranom tomografijom visoke razlučivosti u ranu dijagnostiku (screening), prijeoperacijsku dijagnostiku i obradu bolesnika, te prikaz prednosti i nedostataka ove metode. Metode rada: VC i 3DVR učinjene su s pomoću specijaliziranog programskog paketa Syngo 2006G Platform proizvođača Siemens Medical Systems u: četrdesetšestogodišnjeg muškarca sa spastičnim kolonom te nekoliko intestinalnih divertikula i polipa, šezdesetpetogodišnjeg muškarca koji je podvrgnut endoskopskom uklanjanju velikog kolorektalnog polipa, šezdesetčetverogodišnje žene s opsežnom cirkularnom stenozom rektuma i metastazama u desnom hepatalnom režnju, te pedesetdvogodišnjeg muškarca s velikom endoluminalnim karcinomom u sigmoidnom kolonu. Virtualna kolonoskopija napravljena je u realnom vremenu s pomoću “ray casting” algoritma uz “space leaping” metodu akceleracije. Siemens Somatom Emotion 16 CT uređaj primijenjen je za prikupljanje podataka. Postprocesiranje slikovnih CT prikaza pohranjenih u DICOM formatu napravljeno je na radnoj stanici s dva Xeon procesora. Rezultati: “Fly through” algoritam i 3DVR primijenjeni su nad skupom slikovnih podataka iz aksijalnih CT prikaza dobivenih višeslojnim CT uređajem i pohranjenim u DICOM formatu. VC i 3DVR postprocesiranje rezultiralo je serijom slikovnih prikaza koje su analizirali jedan radiolog, dva kirurga i dva liječnika s iskustvom u virtualnoj endoskopiji. Zaključak: VC je korisna neinvazivna tehnika za probir i procjenu benignih i malignih lezija kolona. VC može pružiti korisne dodatne informacije kirurgu prilikom prijeoperacijske obrade bolesnika. Nadalje, virtualna kolonoskopija pruža mogućnost trodimenzionalne vizualizacije lumena crijeva iza područja suženja ili stenoze te pruža vrlo pouzdan prikaz kolorektalnih lezija. Njezin nedostatak je da nije moguće napraviti biopsiju, zahtijeva granicu zrak-sluznica za generiranje slikovnog prikaza te ne može identificirati funkcionalne lezije. Primjenom ovih tehnika kliničari mogu procijeniti ne samo intraluminalnu proliferaciju tumora već i ekstraluminalno širenje tumorske mase te odnos prema okolnim anatomskim strukturama

Virtalna endoskopija i trodimenzionalno volumno renderiranje u obradi bolesnika s karcinomom maksilarnog sinusa

Objectives: To find out advantages and disadvantages of virtual endoscopy (VE) and 3D volume rendering (3DVR), helical CT data postprocessing methods, that might be useful in diagnostics and preoperative management of maxillary sinus cancer. Methods: High-resolution helical CT scan (HRCT) of paranasal sinuses (slice thicknes 1.2 and 0.6 mm) was performed in a 41-year-old female with cancer of the right maxillary sinus. Siemens Somatom Emotion 16 scanner was used for data collection. Acquired images were stored in DICOM format. Ray casting fly-through algorithm was applied as well as 3D In-space volume rendering. The processing was done using a professional 3D Syngo CT 2006G software package. Results: During the post-processing of data we made virtual sinusoscopy, virtual rhinoscopy and 3DVR. Image analysis was performed by one radiologist, one ENT specialist and one maxillofacial surgeon. Fly-through of virtual endocamera within the maxillary sinus and nasal cavity was manually driven. Using a mouse pointing device, we interactively changed the camera 3D position and focus. We also controlled the field of view of the camera. We found that inside the sinus, cancer was located on the floor and posterior wall. The surface involved by cancer was uneven, thickened and elevated in comparison to areas covered by healthy sinus mucosa. 3DVR showed cancer advance through the eroded posterior maxillary sinus wall towards the retromaxillary space. Reconstructed virtual images were comparable with those obtained by classical sinusoscopy. CT showed destruction of the posterior wall of the maxillary sinus and further tumor advance to the retromaxillary space. Parts of the hard palate were also involved. There were no cancer spread to other parts of the body. Conclusion: VE accompanied with 3D In space analysis has several advantages in comparison to classical endoscopy. It is completely non-invasive. It is possible to repeat the same procedure hundreds of times, therefore it may be a valuable tool for training. Interactive control of all virtual camera parameters, including the field-of-view is possible. Endoscopic viewing as opposed to real endoscopy is not restricted to the spaces defined by inner surfaces. The viewer may penetrate the walls and see the extent of lesions within and beyond the wall. Finally, it has a potential to stage tumors by determining the location and the extent of transmural extension.Ciljevi rada: Demonstracija prednosti i nedostataka virtualne endoskopije (VE) i trodimenzionalnog volumnog renderiranja (3DVR), tehnika postprocesiranja podataka dobivenih spiralnom kompjutoriziranom tomografijom visoke razlučivosti, koje mogu biti korisne u dijagnostici i preoperativnoj obradi bolesnika s karcinomom maksilarnog sinusa. Metode rada: Spiralni CT visoke razlučivosti (HRCT) paranazalnih sinusa (debljine slojeva 1,2 i 0,6 mm) napravljen je u četrdesetjednogodišnje bolesnice s karcinomom desnog maksilarnog sinusa. Siemens Somatom Emotion 16 CT uređaj je primijenjen za prikupljanje podataka. Dobivene serije slika pohranjene su u DICOM formatu na elektroničkom računalu. U postprocesiranju primijenjen je algoritam “ray-casting” za virtualnu endoskopiju kao i trodimenzionalno “in-space” volumno renderiranje za 3D prikaz promatranog dijela tijela. Obrada podataka napravljena je s pomoću 3D Syngo CT 2006G specijaliziranog programskog paketa. Rezultati: Tijekom postprocesiranja podataka napravili smo virtualnu sinusoskopiju, virtualnu rinoskopiju i 3DVR. Analizu dobivenih slikovnih prikaza napravili su po jedan radiolog, otorinolaringolog i maksilofacijalni kirurg. Let (flythrough)virtualne endokamere unutar maksilarnog sinusa i nosne šupljine je ručno vo|en radi bolje preciznosti. Uz pomoć računalnog miša interaktivno je mijenjan položaj, fokus i pogled kamere u prostoru. Također smo na isti način kontrolirali širinu vidnog polja kamere. Unutar desnog maksilarnog sinusa karcinom bio je smješten na dnu sinusa i na stražnjoj stijenci. Površina zahvaćena tumorom bila je neravna, zadebljana ii izdignuta iznad površine zdrave sluznice sinusa. 3DVR prikaz pokazao je napredovanje karcinoma kroz erodiranu stražnju stijenku maksilarnog sinusa prema retromaksilarnom prostoru. Dijelovi tvrdog nepca tako|er su zahvaćeni tumorom. Nije dokazano širenje tumora u ostale dijelove tijela. Rekonstruirani VE i 3DVR slikovni prikazi slični su onima koji se dobiju prilikom klasične endoskopije sinusa. Zaključak: VE zajedno sa 3DVR ima nekoliko prednosti u odnosu na klasičnu endoskopiju. Potpuno je neinvazivna. Moguće je ponavljati istu proceduru nebrojeno puta bez rizika ili neugodnosti za bolesnika, zbog toga ova tehnika predstavlja vrijedan alat za edukaciju. Moguća je interaktivna kontrola svih parametara virtualne endokamere uključujući i širinu vidnog polja. Za razliku od klasične endoskopije slikovni prikazi nisu ograničeni na prostore definirane stijenkama tjelesnih šupljina. Kliničar može endokameru pomicati kroz stijenke sinusa ili drugih šupljina te pratiti širenje lezije kroz stijenke u okolne anatomske strukture. VE i 3DVR pomažu prilikom staginga tumora svojom mogućnošću određivanja lokacije i opsega transmuralnog širenja tumora.

Hornerov sindrom prouzročen pleuralnim metastazama karcinoma dojke

Horner’s syndrome results from an interruption of the sympathetic nerve supply to the eye, and is characterized by the classic triad of miosis (ie, constricted pupil), partial ptosis, and loss of hemifacial sweating (i.e. anhidrosis). The most common factor producing the preganglionic Horner’s syndrome is a malignant tumor. We report a case of Horner’s syndrome in a young woman with a history of breast cancer. Radiographic methods revealed one-sided metastatic pleural effusion as cause of the sympathetic lesion. Metastatic breast disease usually affects lungs, bone, liver, adrenals and skin, and it is highly unusual for ocular involvement to be the first sign of its existence. This report presents a rare case of pleural metastatic breast cancer causing Horner’s syndrome/Pancoast syndrome without lung involvement.Hornerov sindrom nastaje zbog prekida simpatičke živčane opskrbe oka. Karakteriziran je klasičnom trijadom koju čine mioza (konstrikcija pupile), parcijalna ptoza i hemifacijalna anhidroza. Najčešći uzročnik preganglijskog Hornerovog sindroma su zloćudni tumori. Mi smo prikazali slučaj Hornerovog sindroma u mlade žene s karcinomom dojke. Radiografske pretrage su pokazale jednostrani pleuralni izljev kao uzrok simpatičke lezije. Metastaze karcinoma dojke obično zahvaćaju pluća, kosti, jetru, nadbubrežne žlijezde i kožu, te su krajnje neuobičajeni simptomi od strane oka kao prvi znak postojanja metastaza. U radu je prikazan rijedak slučaj pleuralnih metastaza karcinoma dojke bez zahvaćanja samih pluća koje su prouzročile Hornerov/Pancoastov sindrom

Virtual Endoscopy and 3D Volume Rendering in the Management of Frontal Sinus Fractures

Frontal sinus fractures (FSF) are commonly caused by traffic accidents, assaults, industrial accidents and gunshot wounds. Classical roentgenography has high proportion of false negative findings in cases of FSF and is not particularly useful in examining the severity of damage to the frontal sinus posterior table and the nasofrontal duct region. High resolution computed tomography was inavoidable during the management of such patients but it may produce large quantity of 2D images. Postprocessing of datasets acquired by high resolution computer tomography from patients with severe head trauma may offer a valuable additional help in diagnostics and surgery planning. We performed virtual endoscopy (VE) and 3D volume rendering (3DVR) on high resolution CT data acquired from a 54-year-old man with with both anterior and posterior frontal sinus wall fracture in order to demonstrate advantages and disadvantages of these methods. Data acquisition was done by Siemens Somatom Emotion scanner and postprocessing was performed with Syngo 2006G software. VE and 3DVR were performed in a man who suffered blunt trauma to his forehead and nose in an traffic accident. Left frontal sinus anterior wall fracture without dislocation and fracture of tabula interna with dislocation were found. 3D position and orientation of fracture lines were shown in by 3D rendering software. We concluded that VE and 3DVR can clearly display the anatomic structure of the paranasal sinuses and nasopharyngeal cavity, revealing damage to the sinus wall caused by a fracture and its relationship to surrounding anatomical structures

The prevalence of cardiovascular disease risk factors in patients from Croatian Zagorje County treated at Department of Medicine, Zabok General Hospital from 2000 to 2006

The aim of the study was to assess the prevalence of risk factors for cardiovascular disease in patients treated for coronary heart disease (CHD) at Department of Medicine, Zabok General Hospital during the 2000-2006 period. Cardiovascular diseases are a group of diseases that occur due to arterial. The risk factors that lead to the development and occurrence of cardiovascular disease are hypertension, cigarette smoking, hyperholesterolemia, hypertriglyceridemia, diabetes mellitus and positive family history. Additional factors favoring the occurrence of cardiovascular disease include overweight, inadequate physical activity, and emotional stress. Data on all patients hospitalized and diagnosed with CHD at Department of Medicine, Zabok General Hospital during the 2000-2006 period were analyzed for the prevalence of risk factors for CHD, i.e. hypertension, cigarette smoking, hypercholesterolemia, hypertriglyceridemia, diabetes mellitus and positive family history of cardiovascular disease. Hypercholesterolemia was defined by a cholesterol level higher than 5.1 mmol/L, hypertension from history data and blood pressure measurement on admission greater than 140/90 mmHg, diabetes mellitus from history data, and hypertriglyceridemia by a triglyceride level greater than 1.7 mmol/L. Information on heredity and cigarette smoking was collected from history and a questionnaire filled out on admission. All laboratory values were determined on patient admission to the hospital. Analysis of the risk factors for CHD recorded in patients from Zagorje County during the 2000-2006 period revealed hypertension to be the most common risk factor in our patients. According to sex, CHD was found to show a male preponderance. According to age at admission, CHD predominated in the > 70 age group, which accounted for one third of all patients, followed by a comparable proportion of the 50-60 and 60-70 age groups, i.e. still active population groups. As CHD is one of the leading health threats worldwide, estimated to remain so at least by 2020, it is fully justified to invest all efforts in the study of cardiovascular disease. New research projects should be focused on the prevention and early detection of the disease, improvement of diagnosis procedures, introduction of novel therapeutic options, use of new concepts, and due survey of the measures taken. CHD poses great socioeconomic burden upon every community in industrialized societies because of the ever younger age at onset. Actions should be taken to improve awareness of the CHD risks and morbidity in the population at large, stimulating favorable lifestyle and dietary modifications, and one's own health awareness, in order to upgrade the control of risk factors for and morbidity of cardiovascular disease

Virtualna endoskopija i trodimenzionalno volumno renderiranje primijenjeni u bolesnika s malignim tumorom maksilarnog sinusa

Ciljevi: Prikaz mogućnosti primjene trodimenzionalnog volumnog renderiranja i virtualne endoskopije u obradi bolesnika s malignim tumorom maksilarnog sinusa. Metode rada: MSCT glave uz debljinu slojeva od 0,6 mm napravljen je u bolesnika s karcinomom desnog maksilarnog sinusa. Korišten je Siemens Somatom Emotion 16 skener, uz standardni protokol za snimanje paranazalnih sinusa. Nizovi aksijalnih slika pohranjeni su u DICOM formatu na radnoj stanici na kojoj je obavljeno postprocesiranje podataka 3DVR i VE pomoću programa Syngo 2006G. Rezultati: Tumor je smješten na stražnjem zidu i dnu maksilarnog sinusa, te dijelom na stražnjem dijelu medijalnog zida. Konzumirao je stražnju stijenku i pod sinusa, te dio alveolarnog grebena ispod njega. Trodimenzionalni VR prikaz (3DVR) dao je daljni uvid u širenje tumora prema okolnim anatomskim strukturama. Zaključak: Prikazi dobiveni virtualnom endoskopijom i trodimenzionalnim volumnim renderiranjem su kvalitetni i dobra dopuna klasičnim metodama dijagnostike

Our Experience with Virtual Endoscopy of Paranasal Sinuses

The main goal of our work was to evaluate advantages and disadvantages of virtual endoscopy (VE) techniques in routinely diagnostic and preoperative management of patients with various sinus diseases or head traumas in our practice. Fly-through algorithm was performed using an Xeon based workstation on data sets created from axial CT images acquired from 320 patients with various paranasal sinus disorders. Images were created using Siemens Somatom Emotion 16 continiously rotating helical CT scanner and archived in DICOM format. In comparison with real endoscopy, the VE has several advantages. It is completely non-invasive. It is possible to repeat the same procedure several times, therefore it may be a valuable tool for training. Interactive control of all virtual camera parameters, including the field- -of-view is possible. Endoscopic viewing as opposed to real endoscopy is not restricted to the spaces defined by inner surfaces. The viewer may penetrate the walls and see the extent of lesions within and beyond the wall as well as the adjacent anatomic structures. Virtual endoscopy also has a potential to stage tumors by determining the location and the extent of transmural extension

The Prevalence of Cardiovascular Disease Risk Factors in Patients from Croatian Zagorje County Treated at Department of Medicine, Zabok General Hospital from 2000 to 2006

The aim of the study was to assess the prevalence of risk factors for cardiovascular disease in patients treated for coronary heart disease (CHD) at Department of Medicine, Zabok General Hospital during the 2000–2006 period. Cardiovascular diseases are a group of diseases that occur due to arterial. The risk factors that lead to the development and occurrence of cardiovascular disease are hypertension, cigarette smoking, hyperholesterolemia, hypertriglyceridemia, diabetes mellitus and positive family hystory. Additional factors favoring the occurrence of cardiovascular disease include overweight, inadequate physical activity, and emotional stress. Data on all patients hospitalized and diagnosed with CHD at Department of Medicine, Zabok General Hospital during the 2000–2006 period were analyzed for the prevalence of risk factors for CHD, i.e. hypertension, cigarette smoking, hypercholesterolemia, hypertriglyceridemia, diabetes mellitus and positive family history of cardiovascular disease. Hypercholesterolemia was defined by a cholesterol level higher than 5.1 mmol/L, hypertension from histoy data and blood pressure measurement on admission greater than 140/90 mmHg, diabetes mellitus from history data, and hypertriglyceridemia by a triglyceride level greater than 1.7 mmol/L. Information on heredity and cigarette smoking was collected from history and a questionnaire filled out on admission. All laboratory values were determined on patient admission to the hospital. Analysis of the risk factors for CHD recorded in patients from Zagorje County during the 2000–2006 period revealed hypertension to be the most common risk factor in our patients. According to sex, CHD was found to show a male preponderance. According to age at admission, CHD predominated in the > 70 age group, which accounted for one third of all patients, followed by a comparable proportion of the 50–60 and 60–70 age groups, i.e. still active population groups. As CHD is one of the leading health threats worldwide, estimated to remain so at least by 2020, it is fully justified to invest all efforts in the study of cardiovascular disease. New research projects should be focused on the prevention and early detection of the disease, improvement of diagnosis procedures, introduction of novel therapeutic options, use of new concepts, and due survey of the measures taken. CHD poses great socioeconomic burden upon every community in industrialized societies because of the ever younger age at onset. Actions should be taken to improve awareness of the CHD risks and morbidity in the population at large, stimulating favorable lifestyle and dietary modifications, and one’s own health awareness, in order to upgrade the control of risk factors for and morbidity of cardiovascular disease