Rinkinen Jacob, Zhang Peng, Wang Lu, Enchakalody Binu, Terjimanian Michael, Holcomb Sven, Wang Stewart C, Buchman Steven R, Levi Benjamin
Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109-0219, USA.
J Craniofac Surg. 2013 Jan;24(1):250-5. doi: 10.1097/SCS.0b013e31827006f5.
Analytical morphomics is the term we created to describe an innovative, highly automated, anatomically indexed processing of 3D medical imaging data captured during the course of a patients' preoperative CT scan. Our specific aim is to determine the efficacy of craniofacial morphomic indices (CMI) such as temporalis muscle and temporal fat pad morphometric values to predict blood transfusion requirement and hospital stay in a cohort of children with nonsyndromic craniosynostosis (NSC).
High-throughput, semi-automated image analysis was used to reconstruct the 3-dimensional anatomy of the temporalis muscle and temporal fat pad and to quantify CMIs. The prognostic effect of CMI on clinical outcomes were evaluated among all NSC patients and compared across various craniosynostosis subtypes using Wilcoxon nonparametric tests and Kendall's τ to determine significance.
Using preoperative CT images, we evaluated 117 children with NSC from the University of Michigan Health System. Results demonstrate that increased temporal fat pad volume and local temporalis muscle volume are associated with better clinical outcomes in craniosynostosis patients. More specifically, temporal fat pad volume was shown to be a significant predictor of perioperative blood transfusion requirements (P = 0.0033) and increased temporal muscle volume correlated with decreased hospital stay (P = 0.016) when controlling for other covariates including age, sex, weight, and preoperative hematocrit. In addition, the same significant predictors were found when examining individual subtypes of craniosynostosis.
Our findings demonstrate that maxillofacial CT scans provide a useful quantitative index reflecting general patient health, risk stratification, and probabilities of intervention in addition to their previously established ability to determine the specific pathology of the patient. We demonstrate that temporal morphomics predict the incidence of blood transfusion, hospital stay, and serve as a proxy for fitness in patients undergoing craniosynostosis surgery.
分析形态计量学是我们创造的一个术语，用于描述对患者术前CT扫描过程中获取的3D医学影像数据进行创新、高度自动化且具有解剖学索引的处理。我们的具体目标是确定颅面形态计量学指标（CMI），如颞肌和颞脂肪垫的形态测量值，对预测非综合征性颅缝早闭（NSC）患儿队列中输血需求和住院时间的有效性。
采用高通量、半自动图像分析来重建颞肌和颞脂肪垫的三维解剖结构并量化CMI。在所有NSC患者中评估CMI对临床结局的预后影响，并使用Wilcoxon非参数检验和肯德尔τ检验在各种颅缝早闭亚型之间进行比较以确定显著性。
利用术前CT图像，我们评估了来自密歇根大学健康系统的117例NSC患儿。结果表明，颞脂肪垫体积增加和局部颞肌体积增加与颅缝早闭患者更好的临床结局相关。更具体地说，在控制包括年龄、性别、体重和术前血细胞比容等其他协变量时，颞脂肪垫体积被证明是围手术期输血需求的显著预测指标（P = 0.0033），而颞肌体积增加与住院时间缩短相关（P = 0.016）。此外，在检查颅缝早闭的各个亚型时也发现了相同的显著预测指标。
我们的研究结果表明，颌面CT扫描除了具有先前确定的确定患者特定病理的能力外，还提供了一个有用的定量指标，可反映患者的总体健康状况、风险分层和干预概率。我们证明，颞部形态计量学可预测输血发生率、住院时间，并可作为颅缝早闭手术患者健康状况的一个替代指标。
