Surgical and radiologic anatomy : SRA
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Comparative Study
Corticospinal tractography with morphological, functional and diffusion tensor MRI: a comparative study of four deterministic algorithms used in clinical routine.
Diffusion tensor imaging permits study of white matter fibre bundles; however, its main limitation is lack of validation on anatomical data, especially in crossing fibre regions. Our study aimed to compare four deterministic tractography algorithms used in clinical routine. We studied the corticospinal tract, the bundle mediating voluntary movement. Our study seeks to evaluate tractography provided by algorithms through comparative analysis by expert neuroradiologists. ⋯ Different algorithms used in clinical routine failed to show realistic anatomical bundles. The most mathematically robust algorithm was not selected, nor was the algorithm defining more fibres. Validation of anatomical data provided by tractography remains a challenge.
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Safe femoral arterial access is an important procedural step in many interventional procedures and variations of the anatomy of the region are well known. The aim of this study was to redefine the anatomy relevant to the femoral arterial puncture and simulate the results of different puncture techniques. ⋯ Use of dogmatic access techniques is predicted to result in an unacceptably high rate of dangerous high and low punctures. Puncture angle and geometry can be severely affected by patient obesity. The combination of fluoroscopy to identify entry point, ultrasound-guidance to identify the femoral bifurcation and soft tissue compression to improve puncture geometry are critical for safe femoral arterial access.