Abnormal Scans Research Articles

99mTc-MDP Bone Scan Findings of Recurrent Langerhans Cell Histiocytosis in an Adult Involving Femur After Joint Replacement.

Langerhans cell histiocytosis (LCH) is a rare proliferative histiocytic disorder. It mainly occurs in children and is rare in adults. We reported 99mTc-MDP bone scan findings of recurrent LCH in an adult, which involved the right femur after right-side total hip arthroplasty. This case emphasizes that the possibility of LCH should be considered in osteolytic lesions in adults, especially after joint replacement. In addition, LCH should be included in the differential diagnosis of prosthetic joint pain and abnormal 3-phase bone scan after prosthesis arthroplasty.

An Analysis of the Effect of ABCA4 p.Asn1868Ile Genotypes on Retinal Structure in 26,558 Participants in the UK Biobank.

To determine whether the ABCA4 retinopathy-associated variant p.Asn1868Ile (c.5603A>T) is associated with retinal structure or subclinical disease among the general population. UK Biobank participants of European ancestry with available spectral-domain optical coherence tomography (OCT) passing quality control metrics and exome sequencing data were included. Regression analyses using both linear and recessive models tested for the association between the p.Asn1868Ile variant and total retinal thickness, clinically relevant segmented layer thicknesses, and visual acuity. Further regression analyses were performed with automated quality control metrics to determine if the p.Asn1868Ile variant is associated with poor quality or abnormal scans. Retinal layer segmentation and sequencing data for the p.Asn1868Ile variant were available for 26,558 participants, following exclusions. We identified no significant association between the p.Asn1868Ile variant and retinal thickness, any of the segmented layers, or visual acuity. There was also no significant difference for homozygous p.Asn1868Ile when tested under the assumption of a recessive model. No association was identified for any of the quality control metrics, and a χ2 test showed that participants with the p.Asn1868Ile variant were not more likely to be excluded during quality control due to poor quality scans (P = 0.56). The p.Asn1868Ile variant does not appear to affect the retinal structure or have pathogenic or subclinical effects on its own within the general population. The variant is likely to require other specific cis- or trans-acting modifying factors to cause ABCA4 retinopathy.

Automated Brain Tumor Detection from MRI Scans using Deep Convolutional Neural Networks

The brain, as the central nervous system's most critical part, can develop abnormal growths of cells known as tumors. Cancer is the term used to describe malignant tumors. Medical imaging modalities, such as computed tomography (CT) or magnetic resonance imaging (MRI), are commonly used to detect cancerous regions in the brain. Other techniques, such as positron emission tomography (PET), cerebral arteriography, lumbar puncture, and molecular testing, are also utilized for brain tumor detection. MRI scans provide detailed information concerning delicate tissue, which aids in diagnosing brain tumors. MRI scan images are analyzed to assess the disease condition objectively. The proposed system aims to identify abnormal brain images from MRI scans accurately. The segmented mask can estimate the tumor's density, which is helpful in therapy. Deep learning techniques are employed to automatically extract features and detect abnormalities from MRI images. The proposed system utilizes a convolutional neural network (CNN), a popular deep learning technique, to analyze MRI images and identify abnormal brain scans with high accuracy. The system's training process involves feeding the CNN with large datasets of normal and abnormal MRI images to learn how to differentiate between the two. During testing, the system classifies MRI images as either normal or abnormal based on the learned features. The system's ability to accurately identify abnormal brain scans can aid medical practitioners in making informed decisions and providing better patient care. Additionally, the system's ability to estimate tumor density from the segmented mask provides additional information to guide therapy. The proposed system offers a promising solution for improving the accuracy and efficiency of brain tumor detection from MRI images, which is critical for early detection and treatment.

The Function of Magnetic Resonance Imaging in Chronic Epilepsy Prospective Study

Background: Magnetic resonance imaging (MRI) has revolutionised the treatment of intractable epilepsy. ninety nine patients were sent to the KTH Peshawar Radiology Department for an evaluation of the function of MRI in the diagnosis, treatment, and prognosis of their alleged intractable epilepsy. Using a 1.5 Tesla Philips MRI scanner, the patients were examined, and twenty one aberrant findings were found in them, including vascular malformations, tumours, cortical dysplasia, gliosis, and white matter disorders. The ability to diagnose these disorders with MRI has proved to be helpful. The results of the research demonstrate the value of MRI in the diagnosis and management of intractable epilepsy. Using MRI may help with both determining the source of seizures and providing recommendations for possible treatments. Additionally, in epilepsy patients, MRI surveillance can forecast prognosis and illness progression. Aim: Using MRI, it is possible to identify the diagnosis, course of treatment, and prognosis for intractable epilepsy. This makes it possible to identify the underlying cause, direct treatment choices, track the development of the condition, and forecast the prognosis of the patient. Furthermore, it is critical to assess MRI's precision in this field. Methods: The Radiology Department of KTH Peshawar studied possible epilepsy patients between April 2015 and April 2016. The research included ninety-nine patients, each of whom had a thorough medical history, neurological examination, and standard radiographic evaluation. The patients' MRI scans were carried out and examined for any anomalies using a 1.5 Tesla Philips MRI equipment. In order to compare the results of the MRI scans with the clinical data and therapeutic outcomes of the patients. Results: twenty-one of the ninety-nine individuals that were assessed had abnormal MRI scan findings. Cortical dysplasia, gliosis, vascular malformations, tumours, and white matter disorders were among the illnesses that were found. The MRI scans were shown to be a useful tool for detecting and treating instances of untreatable epilepsy. Finding the origin of the seizures helped with the diagnosis and provided the best alternatives for therapy. Additional crucial MRI scan tasks included monitoring the progression of diseases and predicting the prognosis. Keywords: Diagnosis, Management, Prognosis, MRI, Intractable Epilepsy, KTH Peshawar

Detection of tau‐related structural connectivity changes in Alzheimer’s disease

AbstractBackgroundStructural connectivity assessed by diffusion tensor imaging (DTI) is reportedly associated with tau pathology in Alzheimer’s disease. In this study, we aimed to determine whether structural connectivity derived from DTI can reveal tau positivity at the individual level by utilizing a machine learning classifier.MethodAll data were collected from Alzheimer’s Disease Neuroimaging Initiative Phase 3. Sixty subjects (27 females; age range, 56‐94 years old) who underwent tau positron emission tomography (PET) and DTI scans at baseline were included. Tau pathology was assessed by 18F‐Flortaucipir standardized uptake value ratio PET in Braak stage composite regions. The cutoff point denoting positivity was set at 1.23 (Jack et al. 2017), yielding 30 scans each for normal and abnormal scans. DTI scans were acquired with 6 b0 and 48 diffusion‐weighted volumes with b = 1000 s/mm2 at 2.7 × 2.7 × 2.7 mm3 resolution and corrected for head motion and eddy‐current‐induced artifacts. Whole‐brain white‐matter fiber was tracked by deterministic tractography using DSI Studio under Q‐space diffeomorphic reconstruction scheme. The brain was parcellated into 120 regions‐of‐interest (ROIs) based on Automated Anatomical Labeling atlas 2, and each ROI served as a node of the network. Pairwise connectivity strength was quantified by the number of tracts connecting two ROIs and populated as a 120 × 120 connectivity matrix, serving as features for the following classification. A support vector machine classifier with the radial basis function kernel was trained for classification with stratified 10‐fold cross‐validation. Performance was evaluated by accuracy, sensitivity, and specificity.ResultThe average classification accuracy, sensitivity, and specificity were achieved at 65.0%, 86.7%, and 23.2% respectively.ConclusionStructural connectivity achieved high sensitivity in the detection of tau positivity, but it may not enable accurate classification at the individual level.

Grey matter analysis in non-severe COVID-19 points out limbic-related cortex and substantia nigra

Background & Objective: It is unknown whether occult neurological damage exists in mild COVID-19 patients. Obtaining direct histopathological evidence is difficult and often inappropriate. Radiological tools provide important clues regarding this issue. We aimed to investigate any overt or subtle changes in brain magnetic resonance (MR) scans of patients who recovered from non-severe COVID-19 at subacute stage. Methods: Cortical thicknesses/areas were measured in the olfactory bulb (OB), gyri recti, amygdalae, hippocampi, entorhinal cortices, perirhinal cortices, insulae, and substantia nigrae (SN) and compared with controls. Gross findings have also been reported. We assessed the correlations between radiological and clinical parameters. Results: Twenty percent of the patients had abnormal MR scans (mild ventriculomegaly, a hyperintense lesion, a lacune and hydrocephalus) although their relevance to COVID-19 was unknown. We found increased cortical thickness in bilateral OB, left entorhinal cortex, right perirhinal cortex, bilateral insulae, and bilateral gyri recti (p<0.05 for all). Right OB was thinner in patients with anosmia (p=0.015) and ageusia (p=0.004). Left perirhinal cortex and left gyrus rectus were thicker in patients with vertigo (p=0.040; p=0.032 respectively). Sleep disturbance was associated to increased thickness in left perirhinal cortex (p=0.033). Patients with brain fog had smaller SN bilaterally (right p=0.028 and left p=0.011). Patients with anxiety symptoms after COVID-19 had increased right hippocampal area(p=0.023). Neutrophil-to-lymphocyte ratio was correlated to the thickness of right perirhinal cortex (r=-0.57, p=0.02) while CRP, time since COVID-19 and age were not. Conclusion: These changes in limbic areas, insula and SN necessitate close monitoring of patients for autonomic complications, and secondary neurodegenerative processes.

EPS1.07 Impact of elexacaftor/tezacaftor/ivacaftor (ETI) therapy on Aspergillus fumigatus serology in adults with cystic fibrosis

Objectives: Aspergillus fumigatus is the commonest fungi to colonise the airways of people with cystic fibrosis (CF). Colonisation, both with or without the presence of allergic bronchopulmonary aspergillosis (AGPA), has been found to be associated with increased respiratory exacerbations, hospitalisations, reduced pulmonary function and CT scan abnormalities. Management with anti-fungal agents has shown limited clinical benefit, as well as issues with side effects and drug resistance. The effect of CFTR modulator therapies; revolutionary in the management of CF in recent years, on Aspergillus related disease in CF has yet to be established. We aimed to assess whether elexacaftor-tezacaftor-ivacaftor (ETI) therapy impacted on Asp. fumigatus serology in a population of adults with CF.

Supraspinatus muscle atrophy in relation to aging with or without shoulder pathology: A radiographic study

IntroductionSupraspinatus muscle atrophy is commonly associated with shoulder disease, but the effect of ageing on atrophy is not well understood. It was the aim of this study to investigate this effect using MRI scans in older patients. Methods and materialsA retrospective review of MRI scans in patients aged >70 years was performed between Jan 2016–Dec 2018.Both normal and abnormal scans were included in the analysis which included quantifying muscle atrophy of the supraspinatus using Thomazeu's occupation ratio. ResultsThere were 39 normal shoulder MRI scans with a mean age of 75 years (range: 70–88) and 163 abnormal scans with a mean age of 77 years (range: 70–93). The mean supraspinatus occupation ratio for normal MRI scans was 0.57 (range: 0.33–0.86) and abnormal scans 0.35 (range: 0.17–0.90). Occupation ratio was maintained with advancing until the age of 85 years before undergoing a significant declin following this. ConclusionThis study has shown that the occupation ratio is significantly reduced with shoulder disease, but normal shoulders do not undergo significant atrophy of supraspinatus tendon with increasing age. An occupation ratio of <0.32 is unlikely to occur in normal shoulders and this awareness may be useful when planning shoulder surgery, specifically shoulder arthroplasty.

Cortical excitability in patients with REM sleep behavior disorder with abnormal TRODAT-1 SPECT scan: an insight into prodromal Parkinson's disease.

REM Sleep Behavior Disorder (RBD) has been highlighted to identify a patient with prodromal Parkinson's disease (PD). Although many studies focus on biomarkers to predict an RBD patient's evolution from prodromal PD to clinical PD, the neurophysiological perturbation of cortical excitability has not yet been well elucidated. Moreover, no study describes the difference between RBD with and without abnormal TRODAT-1 SPECT. By measuring the amplitude of motor evoked potentials (MEP), the cortical excitability changes after transcranial magnetic stimulation (TMS) were evaluated in 14 patients with RBD and eight healthy controls (HC). Seven of the 14 patients with RBD showed abnormal TRODAT-1 (TRA-RBD), and seven were normal (TRN-RBD). The tested parameters of cortical excitability include resting motor threshold (RMT), active motor threshold (AMT), short-interval intracortical inhibition (SICI), intracortical facilitation (ICF), contralateral silence period (CSP), and input-output recruitment curve. The RMT and AMT showed no difference among the three studied groups. There was only SICI at inter-stimuli-interval 3 ms revealing group differences. The TRA-RBD demonstrated significant differences to HC in these aspects: decreased SICI, increased ICF, shortening of CSP, and augmented MEP amplitude at 100% RMT. Moreover, the TRA-RBD had a smaller MEP facilitation ratio at 50% and 100% of maximal voluntary contraction when compared to TRN-RBD. The TRN-RBD did not present any difference to HC. We showed that TRA-RBD shared similar cortical excitability changes with clinical PD. These findings would provide further insight into the concept that RBD is the highly prevalent entity in prodromal PD.

Prevalencia y significado pronóstico de las alteraciones pulmonares intersticiales precoces en TC de pacientes diagnosticados de enfermedad pulmonar intersticial tratados con antifibróticos

ObjectivesTo describe the prevalence and characteristics of interstitial lung abnormalities (ILA) in CT scans performed prior to the initiation of antifibrotics in a series of patients with interstitial lung disease (ILD), and to identify characteristics apparent on early CT scans that could help to predict outcomes. MethodsWe conducted a retrospective observational study. The original cohort consisted of 101 patients diagnosed with ILD and treated with antifibrotics in a tertiary hospital. Patients were included if they had a thoracic CT scan performed at least one year before initiation of therapy. They were classified radiologically in three groups: without ILA, with radiological ILA and extensive abnormalities. ILA were classified as subpleural fibrotic, subpleural non-fibrotic and non-subpleural. The initial scan and the latest CT scan performed before treatment were read for assessing progression. The relationship between CT findings of fibrosis and the radiological progression rate and mortality were analyzed. ResultsWe included 50 patients. Only1 (2%) had a normal CT scan, 25 (50%) had extensive alterations and 24 (48%) had radiological criteria for ILA, a median of 98.2months before initiation of antifibrotics, of them 18 (75%) had a subpleural fibrotic pattern. Significant bronchiectasis and obvious honeycombing in the lower zones were associated with shorter survival (P=.04). Obvious honeycombing in the lower zones was also significantly (P<.05) associated with a faster progression rate. ConclusionsFibrotic ILAs are frequent in remote scans of patients with clinically relevant ILD, long before they require antifibrotics. Findings of traction bronchiectasis and honeycombing in the earliest scans, even in asymptomatic patients, are related to mortality and progression later on.

Identifying mixed Lewy body and Alzheimer’s disease pathologies using functional neuroimaging (P6-12.002)

<h3>Objective:</h3> To distinguish between Alzheimer’s disease, Lewy body dementia and Parkinson’s disease using functional neuroimaging. <h3>Background:</h3> Lewy body dementia (LBD) and Alzheimer’s disease (AD) are the two most common neurodegenerative causes of dementia. Autopsy studies report many cases with these clinical diagnoses having mixed pathology with alpha-synuclein, tau and amyloid proteinopathies. There is limited research in trying to distinguish these potential mixed pathology conditions prior to death. <h3>Design/Methods:</h3> 43 subjects were recruited from Ohio State University Memory Disorder and Movement Clinics. Subjects were diagnosed based on standard clinical criteria for DLB, PD and AD by fellowship trained cognitive and movement disorders faculty. Cognitive testing performed included MMSE and SAGE. We used neuroimaging methods including FDG PET, amyloid PET, and DaTscan SPECT to evaluate subjects diagnosed with dementia with Lewy bodies (DLB), AD and PD to investigate how often potential mixed pathologies could be present. The neuroimaging evaluations were blinded to clinical diagnosis. <h3>Results:</h3> 28 subjects with clinical diagnosis of Lewy body disease (15 DLB and 13 PD) and 15 subjects with clinical diagnosis AD were compared. The Lewy body subjects were 69.5 ± 7.2 years old, MMSE 26.6 ± 4, and SAGE 18.4 ± 4.7. AD subjects were 68.4 ± 9.3 years old, MMSE 16.3 ± 6.4, and SAGE 7.4 ± 6.1. 5 subjects (33%) of the clinical AD cases showed abnormal DAT scan uptake, 3 subjects (20%) of the clinical AD cases were negative for amyloid with normal DaTscan uptake, 3 subjects (20%) of the clinical DLB cases showed mixed LBD and AD features, 2 subjects (13%) of the clinical DLB cases were positive for amyloid with normal DaTscan uptake, and 1 (8%) subject with clinical PD had normal DAT scan. <h3>Conclusions:</h3> Based on functional neuroimaging, 26% of clinically diagnosed AD or DLB subjects had evidence of potential mixed pathologies and 25% were misdiagnosed. <b>Disclosure:</b> Dr. Bouchachi has nothing to disclose. Ms. Truelove has nothing to disclose. Ms. Rawson has nothing to disclose. Mrs. Icenhour has nothing to disclose. Michael Knopp has nothing to disclose. Prof. Wright has a non-compensated relationship as a Board of Directors Member with American Board of Science in Nuclear Medicine that is relevant to AAN interests or activities. Dr. Scharre has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for BrainTest, Inc. Dr. Scharre has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Vascular Scientific. Dr. Scharre has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acadia. Dr. Scharre has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Scharre has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Acadia. Dr. Scharre has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Scharre has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Hickman &amp; Lowder Co.. The institution of Dr. Scharre has received research support from InSightec. The institution of Dr. Scharre has received research support from Alzheimer’s Therapeutic Research Institute (ATRI). The institution of Dr. Scharre has received research support from Eisai. The institution of Dr. Scharre has received research support from vTv Therapeutics. The institution of Dr. Scharre has received research support from National Institute of Health. The institution of Dr. Scharre has received research support from Eli Lilly. The institution of Dr. Scharre has received research support from Johns Hopkins. The institution of Dr. Scharre has received research support from Biogen. The institution of Dr. Scharre has received research support from Roche. The institution of Dr. Scharre has received research support from AZ Therapies. The institution of Dr. Scharre has received research support from Biohaven. The institution of Dr. Scharre has received research support from Novartis. The institution of Dr. Scharre has received research support from Avanir. The institution of Dr. Scharre has received research support from PrecisionMed, Inc. Dr. Scharre has received intellectual property interests from a discovery or technology relating to health care. Dr. Scharre has received intellectual property interests from a discovery or technology relating to health care.

Assessment of the risk of stroke in children with sickle cell anemia using transcranial doppler ultrasound with imaging in Northwestern Nigeria

Background: Stroke is a major cause of morbidity and mortality affecting about 10% of patients with sickle cell anemia (SCA). Transcranial Doppler (TCD) ultrasonography helps to identify children with SCA who are at an increased risk for stroke. This study aimed to determine the risk of stroke in children with SCA in steady state using Transcranial Doppler with Imaging (TCDI) scan abnormalities and the prevalence of TCDI scan abnormalities among children with SCA in northern Nigeria.&#x0D; Materials and Methods: We conducted acomparative study among 240 persons with SCA who attended a pediatric sickle cell clinic in northern Nigeria and were in steady state condition. We performed a transcranial ultrasound examination and collected blood samples to perform full blood counts and hemoglobin electrophoresis.&#x0D; Results: Abnormal velocities were obtained in 11 (9.3%) children with SCA; while 16 (13.6%) had conditional velocities and 89 (76.7%) of those had normal velocities in one or more of the four vessels studied. Most of the children in the control group 116 (96.7%) had normal velocities and the difference between the groups was not statistically significant (χ 2 = 0.59, p &gt; 0.05).&#x0D; Conclusion: The use of TCDI sonography to predict the risk of stroke should be included in the standard of care in children with SCA in Nigeria and should be included in routine evaluation of disease severity in children with SCA

Placental Mesenchymal Dysplasia Co-existing with High Grade Villitis of Unknown Aetiology (VUE): A Very Rare Case Report and Literature Review

The present case study reports about Placental mesenchymal dysplasia co-existing with high grade villitis of unknown aetiology (VUE). Placental Mesenchymal Dysplasia (PMD) is a rare placental lesion characterized by unusual abnormality of the stem villi of the placenta that could be mistaken for hydatidiform mole due to the presence of both cysts and normal-appearing parenchyma. A 30-year-old G2 P1 (full-term normal delivery) seen in fetal medicine clinic at 20 weeks within view of high risk on combined screening (low PAPP-A and high HCG). An ultrasound scan showed an appropriately grown baby with an abnormal placenta consisting of multiple lacunae more than 50% of the placental mass with increased thickness. A second opinion at tertiary care hospital confirmed the presence of prominent lakes on the placenta. Growth scans also showed IUGR with increasingly abnormal Doppler scans as the pregnancy progressed. At 35 weeks, EFW was &lt; 3rd centile with static growth and patient had Induction of labour at 35 +4 weeks with vaginal delivery of a live male neonate weighing 2325g admitted to the neonatal intensive care unit (NICU) admission due to prematurity. The baby was discharged from NICU at day 5, achieving developmental milestones at the age of 23 weeks post-delivery. On microscopic histological examination, the chorionic plate showed no significant abnormality. The villous architecture was highly abnormal, and some villi were markedly enlarged with myxoid stroma and central degeneration. There were very occasional foci of apparent trophoblastic proliferation with villous architecture abnormalities seen in the form of clusters of large, immature intermediate villi. These features were in keeping with mesenchymal dysplasia. A highly unusual finding in this context was a florid infiltrate of CD3 positive T cells consistent with high-grade villitis of unknown aetiology concluding very rare co-existence of both conditions.

Hypoxia inducible factor-1α (HIF-1α) as an early predictor of acute hydrogen cyanamide (Dormex) poisoning

Hydrogen cyanamide (Dormex) is a plant growth regulator that is classified as a highly toxic poison. There are no definite investigations to help in its diagnosis and follow-up. This study aimed to investigate the role of hypoxia-inducible factor-1α (HIF-1α) in the diagnosis, prediction, and follow-up of Dormex-intoxicated patients. Sixty subjects were equally divided into two groups: group A, the control group, and group B, the Dormex group. Clinical and laboratory evaluations, including arterial blood gases (ABG), prothrombin concentration (PC), the international normalized ratio (INR), a complete blood count (CBC), and HIF-1α, were done on admission. CBC and HIF-1α were repeated for group B 24 and 48 h after admission to track abnormalities. Group B also had brain computed tomography (CT). Patients with abnormal CT scans were referred for brain magnetic resonance imaging (MRI). Significant differences in levels of HB, WBCs, and platelets were also detected in group B up to 48 h after admission, as white blood cells (WBCs) rose with time and hemoglobin (HB) and platelets diminished. The results described a highly significant difference in HIF-1α between the groups, and it depended on the clinical condition; therefore, it can be used in the prediction and follow-up of patients up to 24 h after admission.

Altered Gaze Control During Emotional Face Exploration in Patients With Amyotrophic Lateral Sclerosis.

Up to 50% of patients with amyotrophic lateral sclerosis (ALS) present with cognitive problems and behavioral dysfunctions including recognition of human faces presenting different emotions. We investigated whether impaired processing of emotional faces is associated with abnormal scan paths during visual exploration. Cognitively unimpaired patients with ALS (n = 45) and matched healthy controls (n = 37) underwent neuropsychological assessment and video-based eye tracking. Eye movements were recorded while participants visually explored faces expressing different emotions (neutral, disgusted, happy, fearful, and sad) and houses mimicking faces. Compared with controls, patients with ALS fixated significantly longer to regions which are not relevant for emotional information when faces expressed fear (p = 0.007) and disgust (p = 0.006), whereas the eyes received less attention in faces expressing disgust (p = 0.041). Fixation duration in any area of interest was not significantly associated with the cognitive state or clinical symptoms of disease severity. In cognitively unimpaired patients with ALS, altered gaze patterns while visually exploring faces expressing different emotions might derive from impaired top-down attentional control with possible involvement of subliminal frontotemporal areas. This may account for indistinctness in emotion recognition reported in previous studies because nonsalient features retrieve more attention compared with salient areas. Current findings may indicate distinct emotion processing dysfunction of ALS pathology, which may be different from, for example, executive dysfunction.

Subclinical high-resolution chest CT scan features in psoriasis

BackgroundAlthough psoriasis is considered a systemic disease, no clear association has been established between psoriasis and lung diseases. This study aims to detect and describe subclinical pulmonary involvement in psoriasis patients with various degrees of cutaneous manifestations. MethodsAdult psoriasis patients with no known active pulmonary disease or respiratory symptoms were screened for subclinical pulmonary manifestations and possible parenchymal changes using high-resolution computed tomography (HRCT) scan of the chest. Patients were classified according to the severity of skin manifestations. The clinical characteristics and radiographic findings of these patients were evaluated. ResultsFifty-nine patients with psoriasis were included, among which 47 (79.7%) had abnormal HRCT scan features. Micronodules were the most common detected lung lesions (66.1%), followed by nonspecific interstitial changes (32.2%), including pleuro-parenchymal band/atelectasis, scarring, and focal ground-glass opacities. Other HRCT findings included emphysematous changes and calcified granulomas. Abnormal HRCT findings correlated with older age and duration of psoriasis but not with the severity of skin manifestations. ConclusionsMicronodules and minor focal nonspecific interstitial changes were the most detected lung alterations in patients with psoriasis. These findings of the pilot study highlight a possible pulmonary involvement in patients with psoriasis. Larger multicenter studies are needed to clarify these findings further. LimitationsA major limitation of the study, is the lack of a control group with similar radiologic findings of different conditions done in the same geographical region.

A Patient-Centered Model of Fast-Track Lung Cancer Diagnosis

IntroductionDespite the increasing importance of digital resources in modern life over the past decades, little is known about the impact of internet-based solutions on patient's health. We aimed to study the potential benefit of a digital platform helping patients to deal with abnormal chest CT scan revealing possible lung cancer. MethodsWe set up a fast-track lung cancer diagnosis pathway through a secure online platform. Patient-generated information combined with online review of their imaging enables preplanning of further investigations ahead of clinical assessment. We compared outcomes of “self-referred” patients (patient group), who directly fill out the online questionnaire, to general practitioner-driven patients (GP group), who were referred by their GP. ResultsFrom June 2021 to June 2022, we included 125 patients (61% males, median age 67 years, IQR 56.9-72.5): 41% in the patient group and 59% in the GP group. No difference was found between groups in terms of time from contact to first appointment (median 5 days in both groups, P = .6), percentage of pathways including prebooked tests (94% vs. 92%, P = .6), number of scheduled invasive procedures (median 1, IQR 1-2 vs. 2, IQR 1-2, P = .4) and in final cancer diagnosis (76% vs. 78%, P = .4). ConclusionA lung cancer diagnosis pathway directly accessible by patients through a secure online platform was feasible and as efficient as the usual general practitioner pathway. It demonstrated the benefit of leaning on new digital tools in order to answer to the new challenges of a patient-centered health care system.

Long-Term Sequelae of severe COVID-19: Outpatient assessment of radiological and pulmonary function tests

ObjectiveIdentify lung sequelae of COVID-19 through radiological and pulmonary function assessment. DesignProspective, longitudinal, cohort study from March 2020 to March 2021. SettingIntensive Care Units (ICU) in a tertiary hospital in Portugal. Patients254 patients with COVID-19 admitted to ICU due to respiratory illness. InterventionsA chest computed tomography (CT) scan and pulmonary function tests (PFT) were performed at 3 to 6 months. Main variables of interestCT-scan; PFT; decreased diffusion capacity of carbon monoxide (DLCO). ResultsAll CT scans revealed improvement in the follow-up, with 72% of patients still showing abnormalities, 58% with ground glass opacities and 62% with evidence of fibrosis. PFT had abnormalities in 94 patients (46%): thirteen patients (7%) had an obstructive pattern, 35 (18%) had a restrictive pattern, and 58 (30%) had decreased DLCO. There was a statistically significant association between abnormalities in the follow-up CT scan and older age, more extended hospital and ICU stay, higher SAPS II and APACHE scores and invasive ventilation. Mechanical ventilation, especially with no lung protective parameters, was associated with abnormalities in PFT. Multivariate regression showed more abnormalities in lung function with more extended ICU hospitalization, chronic obstructive pulmonary disease (COPD), chronic kidney disease, invasive mechanical ventilation, and ventilation with higher plateau pressure, and more abnormalities in CT-scan with older age, more extended ICU stay, organ solid transplants and ventilation with higher positive end-expiratory pressure (PEEP). ConclusionsMost patients with severe COVID-19 still exhibit abnormalities in CT scans or lung function tests three to six months after discharge.

Evaluation of the Necessity of CT Scan Requests in Hospitals Affiliated With Birjand University of Medical Sciences, Birjand, Iran, in 2019

Background: A computed tomography (CT) scan is one of the medical imaging methods that is currently used to diagnose and treat numerous diseases in a timely manner. Therefore, the widespread use of ionizing radiation in recent years has raised concerns about cancer. Given that individuals are exposed to ionizing radiation during a CT scan, they might be at a higher risk of developing cancer.&#x0D; Objectives: This study aimed to evaluate the necessity of CT scan requests in hospitals affiliated with Birjand University of Medical Sciences, Birjand, Iran, in 2019.&#x0D; Methods: The statistical population consisted of 1,034 patients, selected by purposive sampling and relevant statistical formula. Patients’ information included gender, age, electronic code, and the imaged area. All the data were extracted by considering all ethical principles and recorded in prepared checklists. Additionally, the normality or abnormality of each CT scan was determined based on a radiologist’s report. The obtained information was analyzed by SPSS software (version 22).&#x0D; Results: Out of 1,034 patients, 547 (52.9%) and 487 (47.1%) subjects were female and male, respectively. The CT scans consisted of 687 (66.44%), 296 (28.62%), and 51 (4.93%) of the brain, abdomen-pelvis, and neck, respectively. The lowest and highest percentages of unnecessary cases belonged to the CT scans of the neck (31.37%) and brain (64.48%).&#x0D; Conclusions: In all tests, 58.6% of CT scans performed on patients were unnecessary. In addition to high doses of radiation endangering the patient’s health, these unnecessary procedures impose additional costs on the hospital and the patient.

Can Anti-Müllerian Hormone levels predict future pregnancy outcomes in recurrent pregnancy loss?

ObjectiveSerum Anti-Müllerian Hormone (AMH) levels have been shown to be lower among women who have experienced recurrent pregnancy loss (RPL) compared with the general population. However, it is unclear whether it can predict livebirth. This study aims to determine whether AMH can predict the likelihood of a livebirth in women with RPL. Study DesignProspective analysis of a consecutive cohort of women undergoing investigation for RPL in a tertiary referral centre over a seven year period (August 2014 -December 2021). Analysis was performed using descriptive statistics, chi-square models and logistic regression models adjusting for maternal age and previous livebirth. Exclusion criteria for the regression analysis included abnormal parental karyotype and abnormal pelvic ultrasound scan. Pregnancy outcome was defined as livebirth or further pregnancy loss. ResultsThere were 488 women who underwent investigation of RPL during the study period. Of these, 65.2% (n = 318) conceived following attendance at the clinic. The majority of these women (69.4%, n = 221) proceeded to have a livebirth. There were no differences in median AMH levels between the livebirth group and the further pregnancy loss group (11 pmol/L vs 9 pmol/L respectively (p = 0.083). AMH did not affect clinical pregnancy rates (p = 0.77, 95% CI = 0.99 [0.98, 1.01]) or pregnancy outcome (p = 0.30, 95% CI = 1.01 [0.99, 1.04]). Abnormal pelvic ultrasonography (p = 0.04) and an abnormal parental karyotype (p = 0.04) were associated with an increased likelihood of a subsequent pregnancy loss. ConclusionAlthough AMH levels may have some utility in counselling of some couples with RPL, these contemporaneous data indicate that low AMH does not negatively influence subsequent pregnancy outcome in women with recurrent pregnancy loss.