Purpose: Diffuse axonal injury (DAI) is clinically defined as a coma of over six hours in a head trauma victim without a focal mass lesion. The emergency physician usually resuscitates and stabilizes a comatose head trauma victim in the emergency Department. After assessment and treatment, the prognosis is very important to both the victim and the physician. The prognosis for DAI is based on Glasgow Coma Scale (GCS) and other imaging data. We investigated the prognostic value of computed tomography (CT) and gradient-echo magnetic resonance imaging (GRI) for head trauma victims with DAI. Methods: Fifty-three(53) head trauma victims of DAI were enrolled in this study from 2007 to 2012. During the study period of six years, data on trauma victims were collected retrospectively. We analyzed the differences in the Glasgow Outcome Scale (GOS) result between the CT and the GRI modalities. Results: We classified the study group by using GOS. Between the good outcome subgroup (GOS scores of 4 and 5) and the poor outcome subgroup (GOS score of 1-3), there were no statistical difference in sex, age, initial vital signs and initial GCS score. The good outcome subgroup had non-hemorrhage on CT(52%), which was correlated with good outcome and a shorter awakening time, while a larger number and a deeper location of hemorrhagic lesions on in GRI were correlated with poor outcome in DAI. Conclusion: We conclude that the existence of hemorrhagic lesions on CT, and the number and location of those lesions on GRI had good prognostic value for head trauma victims with DAI.
Park, Chul Woo;Sung, Ae Jin;Lee, Jun Ho;Hwang, Seong Youn
Journal of Trauma and Injury
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v.22
no.2
/
pp.154-160
/
2009
Purpose: This study aimed to determine new criteria for detecting independent factors with high sensitivity in cases of cervical spine injury. We compared the sensitivity, the specificity, and the false negative predictive value (NPV) of plain radiographs with those of computed tomography for cervical spine injury in patients with minor head injury. Methods: We retrospectively reviewed the cases of 357 patients who underwent both cervical plain radiographs and computer tomography from January 2006, to September 2008. Patients were divided into two groups: the cervical spine injury group and the no cervical spine injury group. New criteria were organized based on variables that had significant differences in the logistic regression test. Results: Among the 357 patients, 78 patients had cervical spine injuries. The average age was $43.9{\pm}15.2$ yrs old, and the male-to-female ratio was 1.90. The most common mechanism of injury was motor vehicle accidents. There was a significant difference in loss of consciousness, Glasgow Coma Scale (GCS)=14, neurologic deficit, posterior neck tenderness, and abnormality of the cervical plain radiographs between the two groups on the logistic regression test. New criteria included the above five variables. If a patient has at least variable, the area under the ROC curve of the new criteria was 0.850, and the sensitivity and the false NPV were 87.2% and 5.2%, respectively. Conclusion: New criteria included loss of consciousness, GCS=14, neurologic deficit, posterior neck tenderness, and abnormality of the cervical plain radiographs. If the patient had at least 1 variable, he or she could have a of cervical spine injury with a sensitivity of 87.2% and a false NPV of 5.2%.
Objectives : The purpose of this investigation was to evaluate the remineralization and acid resistance in fluoride varnish by Micro-computed tomography (micro CT). Methods : Specimens of bovine teeth enamel were embedded in resin, polished and randomly divided into 3 groups (a control group, a NaF solution group, a fluoride varnish group). Each group has 3 specimens that was standardized according to Vickers hardness number (VHN). Specimens were immersed in demineralization solution for 72 hours. The control group had no treatment, the NaF solution group was treated by a 5% NaF solution for 4 minutes, and the fluoride varnish group was treated by a fluoride varnish for one hour. All specimens were subjected to a chemical pH cycling method for 14 days. After a chemical pH cycling method, the density were measured using micro CT. Then, specimens were immersed in each demineralization solution for 72 hours. After demineralization processed, the density were measured using micro CT. Results : 1. The density was significantly higher in the fluoride varnish and 5% NaF solution group than that of the control group after 14 days cycling (p<0.05). And the density value of the fluoride varnish group was higher than that of the 5% NaF solution, with no significant difference. 2. The differences of density after acid resistance treatment were statistically significant among 3 groups(p<0.05). Conclusions : It is suggested that fluoride varnish showed the remineralizing effect and acid resistance effect on the enamel, and micro CT could be used to evaluate the change of enamel lesion.
Kim, Min Sun;Lee, Eun Joo;Song, In Ja;Lee, Jae-Seo;Kang, Byung-Cheol;Yoon, Suk-Ja
Imaging Science in Dentistry
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v.45
no.4
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pp.227-232
/
2015
Purpose: The purpose of this study was to evaluate the influence of methods of establishing the midsagittal reference plane (MRP) on the locations of midfacial landmarks in the three-dimensional computed tomography (CT) analysis of facial asymmetry. Materials and Methods: A total of 24 patients (12 male and 12 female; mean age, 22.5 years; age range, 18.2-29.7 years) with facial asymmetry were included in this study. The MRP was established using two different methods on each patient's CT image. The x-coordinates of four midfacial landmarks (the menton, nasion, upper incisor, and lower incisor) were obtained by measuring the distance and direction of the landmarks from the MRP, and the two methods were compared statistically. The direction of deviation and the severity of asymmetry found using each method were also compared. Results: The x-coordinates of the four anatomic landmarks all showed a statistically significant difference between the two methods of establishing the MRP. For the nasion and lower incisor, six patients (25.0%) showed a change in the direction of deviation. The severity of asymmetry also changed in 16 patients (66.7%). Conclusion: The results of this study suggest that the locations of midfacial landmarks change significantly according to the method used to establish the MRP.
Purpose : To compare and evaluate the diagnostic ability of cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ). Materials and Methods : CBCT and MRI of 46 TMJs of 23 patients with TMJ disorders were evaluated. They were divided into 3 groups according to the position of the articular disc of the TMJ at closed mouth position and the reduction of the disc during open mouth position on MRI: no disc displacement group (NDD), disc displacement with reduction group (DDR), and disc displacement without reduction group (DDWR). With PACS viewing soft-wares, position of mandibular condyle in the articular fossa, osseous change of mandibular condyle, shape of articular fossa, and mediolateral and anteroposterior dimensions of mandibular condyle were evaluated on CBCT and MRI. Each value was tested statistically. Results : The position of mandibular condyle in the articular fossa were concentric in the NDD, DDR, and DDWR of CBCT and NDD of MRI. However, condyle was positioned posteriorly in DDR and DDWR of MRI. Flattening, sclerosis and osteophyte of the mandibular condyle were much more apparent on DDR of CBCT than MRI. And the erosion of the condyle was much more apparent on DDWR of MRI than CBCT. Box and Sigmoid types of articular fossa were found most frequently in DDR of MRI. Flattened type was found most frequently in DDR of CBCT and deformed type was found most frequently in DDWR of CBCT. No significant difference in mediolateral and anteroposterior dimensions were shown on CBCT and MRI. Conclusion : Since MRI and CBCT has unique diagnostic imaging ability, both modalities should be used together to supplement each other to evaluate TMJ.
Purpose: The aim of this study was to compare cone-beam computed tomography (CBCT) and digital panoramic radiography (DPR) for the detection of pulp stones. Materials and Methods: DPR and CBCT images of 202 patients were randomly selected from the database of our department. All teeth were evaluated in sagittal, axial, and coronal sections in CBCT images. The systemic condition of patients, the presence of pulp stones, the location of the tooth, the group of teeth, and the presence and depth of caries and restorations were recorded. The presence of pulp stones in molar teeth was compared between DPR and CBCT images. Results: Pulp stones were identified in 105 (52.0%) of the 202 subjects and in 434 (7.7%) of the 5,656 teeth examined. The prevalence of pulp stones was similar between the sexes and across various tooth locations and groups of teeth (P>.05). A positive correlation was observed between age and the number of pulp stones(${\rho}=0.277$, P<.01). Pulp stones were found significantly more often in restored or carious teeth (P<.001). CBCT and DPR showed a significant difference in the detection of pulp stones(P<.001), which were seen more often on DPR than on CBCT. Conclusion: DPR, as a 2D imaging system, has inherent limitations leading to the misinterpretation of pulp stones. Restored and carious teeth should be carefully examined for the presence of pulp stones. CBCT imaging is recommended for a definitive assessment in cases where there is a suspicion of a pulp stone on DPR.
Purpose: This study was performed to evaluate the influence of voxel size and the accuracy of 2 cone-beam computed tomography (CBCT) systems in the detection of vertical root fracture (VRF) in the presence of intracanal metallic posts. Materials and Methods: Thirty uniradicular extracted human teeth were selected and randomly divided into 2 groups(VRF group, n=15; and control group, n=15). The VRFs were induced by an Instron machine, and metallic posts were placed in both groups. The scans were acquired by CBCT with 4 different voxel sizes: 0.1 mm and 0.16 mm (for the Eagle 3D V-Beam system) and 0.125 mm and 0.2 mm (for the i-CAT system) (protocols 1, 2, 3, and 4, respectively). Interobserver and intraobserver agreement was assessed using the Cohen kappa test. Sensitivity and specificity were evaluated and receiver operating characteristic analysis was performed. Results: The intraobserver coefficients indicated good (0.71) to very good (0.83) agreement, and the interobserver coefficients indicated moderate (0.57) to very good (0.80) agreement. In respect to the relationship between sensitivity and specificity, a statistically significant difference was found between protocols 1 (positive predictive value: 0.710, negative predictive value: 0.724) and 3 (positive predictive value: 0.727, negative predictive value: 0.632) (P<.05). The least interference due to artifact formation was observed using protocol 2. Conclusion: Protocols with a smaller voxel size and field of view seemed to favor the detection of VRF in teeth with intracanal metallic posts.
During excavation work for the construction of a highway bridge in a limestone area in Korea, several cavities were found, and construction work was stopped temporarily. Cavities under the bridge piers might seriously threaten the safety of the planned bridge, because they could lead to excessive subsidence and differential settlement of the pier foundations. In order to establish a method for reinforcement of the pier foundations, borehole radar reflection and tomography surveys were carried out, to locate cavities under the planned pier locations and to determine their sizes where they exist. Since travel time data from the crosshole radar survey showed anisotropy, we applied an anisotropic tomography inversion algorithm assuming heterogeneous elliptic anisotropy, in order to reconstruct three kinds of tomograms: tomograms of maximum and minimum velocities, and of the direction of the symmetry axis. The distribution of maximum velocity matched core logging results better than that of the minimum velocity. The degree of anisotropy, defined by the normalized difference between maximum and minimum velocities, was helpful in deciding whether an anomalous zone in a tomogram was a cavity or not. By careful examination of borehole radar reflection and tomography images, the spatial distributions of cavities were delineated, and most of them were interpreted as being filled with clay and/or water. All the interpretation results implied that two faults imaged clearly by a DC resistivity survey were among the most important factors controlling the groundwater movement in the survey area, and therefore were closely related to the development of cavities. The method of reinforcement of the pier foundations was based on the interpretation results, and the results were confirmed when construction work was resumed.
So, Mun-Seop;Im, Mi-Kyung;Lee, Keon-Il;Lee, Yong-Keun;Lee, Su-Jong
Restorative Dentistry and Endodontics
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v.22
no.2
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pp.659-669
/
1997
The goals of root canal instrumentation are complete debridement of pulp tissue, removal of microbes and affected dentin, and proper cleaning and shaping of the root canal space before obturation. Instrumentation with stainless steel files has been shown to produce undesirable results in canals, regardless of the improved technique or modified file type used. Nickel-Titanium(Ni-Ti) alloy has been shown to be exceptionally elastic, having a lower bending moment and lower permanent set after torsion, compared with similar gauge stainless steel. The purpose of this study was to evaluate the change of root canal prepared by Ni-Ti rotary and stainless steel instruments. Thirty-four single rooted teeth of similar shape and canal size were divided into three groups. The teeth were scanned by computed tomography before instrumentation. In group 1, canals were instrumented using a step-back technique with K-file. In group 2, canals were prepared with K-flex file using the same technique as group 1. Group 3 was prepared with nickel-titanium(Ni-Ti) rotary instrument using a manufacture's instruction. Instrumented teeth were again scanned using computed tomography, and reformated images of the uninstrumented canals were compared with images of the instrumented canals. K-flex file and Ni-Ti file caused significantly less canal transportation than K-file in the 8mm root canal section from the apex(p<0.05). K-flex file and Ni-Ti file produced more centered canal preparation than K-file in the 2mm section(p<0.05). Ni-Ti file maintained more precisely the center of the canal than K-flex file in the 10mm section (p<0.05). There was no difference in the removed volume of canals among each groups.
Purpose: The aim of this sturdy was to assess the prevalence and change in pathologic findings in the maxillary sinus by using preoperative and postoperative cone-beam computed tomography (CBCT). Methods: The subjects included 83 patients with maxillary sinus abnormalities who underwent orthognathic surgery between January 2010 to December 2010. The CBCT analyses were classified according to the thickness of maxillary sinus membrane; Normal (membrane thickness<2 mm), mucosal thickening (membrane thickness ${\geq}2mm$ and <6 mm), partial opacification (membrane thickness>6 mm but not complete), total opacification, and polypoidal mucosal thickening. The diameters of the maxillary sinus ostium on the coronal cross-sectional view were also calculated. Results: Out of 166 maxillary sinuses in 83 patients, 42 (25.3%) maxillary sinuses before surgery and 37 (22.3%) maxillary sinuses after surgery showed abnormalities. A decrease in the diameters of maxillary ostium was observed after surgery (P<0.05). However, there was no significant difference in mucosal thickness both, preoperatively and postoperatively. Conclusion: The orthognathic surgery didn't deteriorate the maxillary sinus abnormaility. Despite the low prevalence of sinus complications in orthognathic surgery, all the patients should be informed of the possibility of sinusitis that could require the surgical intervention before surgery.
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