Additional Imaging Modalities Research Articles

Three-dimensional transoesophageal echocardiography: how to use and when to use-a clinical consensus statement from the European Association of Cardiovascular Imaging of the European Society of Cardiology.

Three-dimensional transoesophageal echocardiography (3D TOE) has been rapidly developed in the last 15 years. Currently, 3D TOE is particularly useful as an additional imaging modality for the cardiac echocardiographers in the echo-lab, for cardiac interventionalists as a tool to guide complex catheter-based procedures cardiac, for surgeons to plan surgical strategies, and for cardiac anaesthesiologists and/or cardiologists, to assess intra-operative results. The authors of this document believe that acquiring 3D data set should become a 'standard part' of the TOE examination. This document provides (i) a basic understanding of the physic of 3D TOE technology which enables the echocardiographer to obtain new skills necessary to acquire, manipulate, and interpret 3D data sets, (ii) a description of valvular pathologies, and (iii) a description of non-valvular pathologies in which 3D TOE has shown to be a diagnostic tool particularly valuable. This document has a new format: instead of figures randomly positioned through the text, it has been organized in tables which include figures. We believe that this arrangement makes easier the lecture by clinical cardiologists and practising echocardiographers.

Whole-Slide Imaging, Mutual Information Registration for Multiplex Immunohistochemistry and Immunofluorescence

Multiplex immunohistochemistry/immunofluorescence (mIHC/mIF) is a developing technology that facilitates the evaluation of multiple, simultaneous protein expressions at single-cell resolution while preserving tissue architecture. These approaches have shown great potential for biomarker discovery, yet many challenges remain. Importantly, streamlined cross-registration of multiplex immunofluorescence images with additional imaging modalities and immunohistochemistry (IHC) can help increase the plex and/or improve the quality of the data generated by potentiating downstream processes such as cell segmentation.To address this problem, a fully automated process was designed to perform a hierarchical, parallelizable, and deformable registration of multiplexed digital whole-slide images (WSIs). We generalized the calculation of mutual information as a registration criterion to an arbitrary number of dimensions, making it well suited for multiplexed imaging. We also used the self-information of a given IF channel as a criterion to select the optimal channels to use for registration. Additionally, as precise labeling of cellular membranes in situ is essential for robust cell segmentation, a pan-membrane immunohistochemical staining method was developed for incorporation into mIF panels or for use as an IHC followed by cross-registration. In this study, we demonstrate this process by registering whole-slide 6-plex/7-color mIF images with whole-slide brightfield mIHC images, including a CD3 and a pan-membrane stain. Our algorithm, WSI, mutual information registration (WSIMIR), performed highly accurate registration allowing the retrospective generation of an 8-plex/9-color, WSI, and outperformed 2 alternative automated methods for cross-registration by Jaccard index and Dice similarity coefficient (WSIMIR vs automated WARPY, P < .01 and P < .01, respectively, vs HALO + transformix, P = .083 and P = .049, respectively). Furthermore, the addition of a pan-membrane IHC stain cross-registered to an mIF panel facilitated improved automated cell segmentation across mIF WSIs, as measured by significantly increased correct detections, Jaccard index (0.78 vs 0.65), and Dice similarity coefficient (0.88 vs 0.79).

Gestational trophoblastic disease: an update.

Gestational trophoblastic diseases (GTD) encompass a spectrum of rarepre-malignant and malignant entitiesoriginating from trophoblastic tissue. This updated review will highlight important radiological features, pathology and classification, and provide insight into the clinical management of these uncommon disorders. There is a wide geographic variation with the incidence of hydatidiform mole varying between 0.57 and 2 per 1000 pregnancies. The use of ultrasound (US)in the management of early pregnancy symptoms and complications has positively impacted the earlier detection of these diseases and resulted in diminished morbidity. Additional imaging modalities are reserved for problem solving or assessment of pulmonary manifestations of molar pregnancy. Having an awareness of their pleomorphic sonographic presentation and additional pathology that can mimic GTD is critical to avoiding pitfalls. Histologic and molecular analysis further aids in differential diagnosis. Gestational trophoblastic neoplasia (GTN) is inclusive of all malignant GTDs, and arises after 20% of molar pregnancies but can also be seen with non-molar gestations. Biochemical monitoring with human chorionic gonadotrophin is imperative for ongoing monitoring and surveillance and allows early detection of this entity. Doppler US is used for confirmation of diagnosis with magnetic resonance imaging (MRI) reserved for problem solving or assessment of myometrial invasion. This is of heightened relevance in patients undergoing surgical management. Cross sectional imaging is reserved for patients in the setting of GTN for the purposes of staging, prognostication and in the setting of recurrent disease. This may require a combination of computed tomography, MRI and positron emission tomography. Doppler US can provide insight into chemotherapeutic response/predict resistance in patients with GTN. As our understanding of these disorders evolves, there has been maturation in management options with a shift from traditional chemotherapy to innovative immunotherapy, particularly in the setting of resistant or high-risk disease.

Imaging of Central Nervous System Autoimmune, Paraneoplastic, and Neuro-rheumatologic Disorders.

This article provides an overview of the imaging modalities used in the evaluation of central nervous system (CNS) autoimmune, paraneoplastic, and neuro-rheumatologic disorders. An approach is outlined for interpreting imaging findings in this context, synthesizing a differential diagnosis based on certain imaging patterns, and choosing further imaging for specific diseases. The rapid discovery of new neuronal and glial autoantibodies has revolutionized the autoimmune neurology field and has elucidated imaging patterns characteristic of certain antibody-associated diseases. Many CNS inflammatory diseases, however, lack a definitive biomarker. Clinicians should recognize neuroimaging patterns suggestive of inflammatory disorders, as well as the limitations of imaging. CT, MRI, and positron emission tomography (PET) modalities all play a role in diagnosing autoimmune, paraneoplastic, and neuro-rheumatologic disorders. Additional imaging modalities such as conventional angiography and ultrasonography can be helpful for further evaluation in select situations. Knowledge of imaging modalities, both structural and functional, is critical in identifying CNS inflammatory diseases quickly and can help avoid invasive testing such as brain biopsy in certain clinical scenarios. Recognizing imaging patterns suggestive of CNS inflammatory diseases can also facilitate the early initiation of appropriate treatments to diminish morbidity and future disability.

Exploring the landscape of CA-125 testing: A comprehensive analysis of Ministry of Health data.

The aim of this study was to investigate the utilization patterns and clinical implications of cancer antigen 125 (CA-125) testing in the diagnosis of ovarian and endometrial cancers using a large-scale dataset obtained from the Ministry of Health. A retrospective analysis was conducted on anonymized data collected between 2017 and 2021, comprising 3.917.240 individuals who underwent CA-125 testing. The data included demographic information, test results, diagnoses, and clinical characteristics. Descriptive statistics and comparative analyses were performed to assess the utilization trends and clinical outcomes associated with CA-125 testing. Among the study population, CA-125 testing was primarily requested for female individuals, with the highest number of tests performed in the age group of 18-64 years. The overall positive rate for CA-125 was 13.31%, with slightly lower rates observed in females (13.18%) than males (14.07%). The study identified a significant association between elevated CA-125 levels and cancer diagnoses, with 19.88% of positive CA-125 results indicating cancer, whereas 10.51% had no cancer diagnosis. Furthermore, the study revealed a higher likelihood of cancer detection among individuals aged 65 years and above, with a positive rate of 17.79%. Our findings provide valuable insights into the utilization patterns and clinical implications of CA-125 testing in ovarian and endometrial cancer diagnosis. While CA-125 remains a prominent tumor marker, its interpretation should consider age, gender, and clinical context. The study emphasizes the potential benefits of integrating additional markers and imaging modalities to enhance diagnostic accuracy. These findings contribute to optimizing the use of CA-125 testing for early detection and management of gynecological malignancies, thereby improving patient outcomes.

The Natural History of Carotid Artery Occlusions Diagnosed on Duplex Ultrasound

There is a paucity of literature on the natural history of extracranial carotid artery occlusion (CAO). This study reviews the natural history of this patient cohort. This single-institution retrospective analysis studied patients with CAO diagnosed by duplex ultrasound between 2010 and 2021. Patients were identified by searching our office-based IAC accredited vascular laboratory database. Imaging and clinical data were obtained via our institutional Electronic Medical Record. Outcomes of interest included ipsilateral stroke, attributable neurologic symptoms, and ipsilateral intervention after diagnosis. The full duplex database consisted of 5523 patients who underwent carotid artery duplex exam during the study period. The CAO cohort consisted of 139 patients; incidence of CAO was 2.5%. Mean age at diagnosis was 69.7 years; 31.4% were female. Hypertension (72.7%), hyperlipidemia (64.7%), and prior smoking (43.9%) were the most common comorbid conditions. Of the CAO cohort, 61.3% (n=85) of patients were asymptomatic at diagnosis; 38.8% (n=54) were diagnosed after a stroke or transient ischemic attack (TIA) occurring within six months prior to diagnosis, with 21.6% occurring ipsilateral to the CAO and 10.1% occurring contralateral to the CAO. 7.2% (n=10) had unclear symptoms or laterality at presentation. Of the CAO cohort, ninety-five patients (68.3%) had duplex imaging follow-up (mean 42.7±31.3 months). Of those with follow up studies, seven patients (5.0%) developed subsequent stroke ipsilateral to the CAO with mean occurrence 27.8 ±39.0 months post-diagnosis. In addition, five patients (3.6%) developed other related symptoms, including global hypoperfusion, (2.4%) and TIA (1.2%). Of those 95 patients with follow up duplex ultrasound imaging, six (4.3%) underwent eventual ipsilateral intervention, including CEA (n=4), TF-CAS (n=1), and carotid bypass (n=1), with mean occurrence 17.7±23.7 months post-diagnosis. The aggregate rate of ipsilateral CVA, attributable neurologic symptoms, or ipsilateral intervention was 11.5%. Of 95 patients with follow up duplex ultrasound imaging, 5 underwent subsequent duplex studies demonstrating ipsilateral patency, resulting in a 5.3% discrepancy rate between sequential duplex studies. All 6 patients undergoing intervention received periprocedural cross-sectional imaging (MRA or CTA). In 5 of these 6 patients, cross-sectional demonstrated severe stenosis rather than CAO, disputing prior duplex ultrasound findings. In this large, institutional cohort of patients with a CAO diagnosis on duplex ultrasound, a clinically meaningful subset of patients experienced CVA, related symptoms, or intervention. We also found a notable rate of temporal duplex discrepancies among patients with CAO diagnoses, and discrepancies between CAO diagnosis per duplex ultrasound and findings on cross-sectional imaging for those patients who underwent intervention. These results suggest that use of a single duplex ultrasound as a sole diagnostic tool in CAO may not be sufficient, and that physicians should consider close duplex ultrasound surveillance of these patients, potentially in conjunction with additional confirmatory imaging modalities. Further investigation into optimal workup and surveillance protocols for CAO is needed.

Chronic Mild Traumatic Brain Injury: Aberrant Static and Dynamic Connectomic Features Identified Through Machine Learning Model Fusion

Traumatic Brain Injury (TBI) is a frequently occurring condition and approximately 90% of TBI cases are classified as mild (mTBI). However, conventional MRI has limited diagnostic and prognostic value, thus warranting the utilization of additional imaging modalities and analysis procedures. The functional connectomic approach using resting-state functional MRI (rs-fMRI) has shown great potential and promising diagnostic capabilities across multiple clinical scenarios, including mTBI. Additionally, there is increasing recognition of a fundamental role of brain dynamics in healthy and pathological cognition. Here, we undertake an in-depth investigation of mTBI-related connectomic disturbances and their emotional and cognitive correlates. We leveraged machine learning and graph theory to combine static and dynamic functional connectivity (FC) with regional entropy values, achieving classification accuracy up to 75% (77, 74 and 76% precision, sensitivity and specificity, respectively). As compared to healthy controls, the mTBI group displayed hypoconnectivity in the temporal poles, which correlated positively with semantic (r = 0.43, p < 0.008) and phonemic verbal fluency (r = 0.46, p < 0.004), while hypoconnectivity in the right dorsal posterior cingulate correlated positively with depression symptom severity (r = 0.54, p < 0.0006). These results highlight the importance of residual FC in these regions for preserved cognitive and emotional function in mTBI. Conversely, hyperconnectivity was observed in the right precentral and supramarginal gyri, which correlated negatively with semantic verbal fluency (r=-0.47, p < 0.003), indicating a potential ineffective compensatory mechanism. These novel results are promising toward understanding the pathophysiology of mTBI and explaining some of its most lingering emotional and cognitive symptoms.

Rare sites of metastases in patients with differentiated thyroid carcinoma and added value of SPECT/CT over planar whole body radioactive iodine scan

BackgroundBeing aware of the unusual or rare location of thyroid metastases helps in early diagnosis and proper patient management. Rare metastases (RM) can be missed resulting in diagnostic pitfalls and delayed treatment. The use of single-photon emission computed tomography/computed tomography (SPECT/CT) imaging in the follow-up of differentiated thyroid cancer (DTC) patients provides precise anatomical localization and characterization of RM that may be missed or misinterpreted in planar whole body iodine-131 (WBI) scan. There is a lack of knowledge about dealing with such patients, the treatment they should receive, and therapy response due to the rarity of such cases. In this work, we reported these rare cases increasing awareness about them and their methods of treatment with response to therapy and evaluated the added value of SPECT/CT imaging in changing patients’ management.Materials and methodsIn this study we reviewed all patients with DTC referred to our unit either for initial radioactive iodine-131 therapy (RAIT) or under follow-up from January 2019 to January 2022. When a suspected lesion was detected in a conventional planar WBI scan whether follow-up scan or post-therapeutic scan, SPECT/CT was acquired immediately in the same session for that region. Additional imaging modalities were performed for confirmation. Response to the given treatment either disease progression (DP) or favorable response which include complete response (CR), partial regression (PR) and stable disease (SD) recorded for each patient.ResultsTwo hundred and forty patients with DTC referred to our unit over a three-year period (from January 2019 to January 2022) were reviewed. Forty patients developed lung and bone distant metastases. Twenty-one patients were thought to have metastases at unusual sites. Due to incomplete data (no SPECT/CT pictures or confirmatory imaging), 6/21 patients were eliminated. We studied 15 patients with RM (9 females, 6 males) with a median age of 52 years (range 27–79). All patients received the initial RAIT after thyroidectomy in addition to other therapeutic modalities, e.g., radiotherapy (RTH), chemotherapy (CTH) or surgical tumor excision after detection of RM. Ten out of 15 patients (66.67%) showed favorable response to therapy (2 patients had CR, 6 patients had PR and 2 patients had SD), whereas only 5 patients had DP. Additional SPECT/CT changed management in 10/15 patients (66, 67%) of patients.ConclusionRM identification is mandatory to avoid misdiagnosis and delayed therapy. Increasing the awareness about such rare cases allows for better management. SPECT/CT could significantly impact patients' management through its precise anatomic localization and lesion characterization.

Renal neoplasms and computed tomography

Introduction: In recent years the increased utilization of imaging modalities has led to an accelerated diagnosis of renal masses. Initial diagnoses and staging are commonly done with the abdominal Computed Tomography (CT). This study evaluates the various aspects to consider when utilizing CT scan for the diagnosis of renal masses. Discussion: CT scan is the most important imaging modality to evaluate renal neoplasms. Postcontrast acquisitions can be tailored according to the indication for the study. This alongside various techniques, imaging modalities and classification systems may help differentiate the malignant Renal Cell Carcinoma, from benign or metastatic lesions, lymphomas or renal pseudotumor. Finally CT can also be utilized alongside other tools for staging the tumor. Conclusion: Certain CT imaging features are pertinent to evaluate the malignancy potential of renal lesions. However the CT alone may be inconclusive in diagnosing the majority of renal neoplasms, excluding AML with macroscopic fat. Hence it is recommended that the CT aid additional imaging modalities and tools to reach an accurate diagnosis.

Echocardiographic Evaluation of the Athlete's Heart: Focused Review and Update.

The athlete's heart exhibits unique structural and functional adaptations in the setting of strenuous and repetitive athletic training which may be similarly found in pathologic states. The purpose of this review is to highlight the morphologic and functional changes associated with the athlete's heart, with a focus upon the insights that echocardiography provides into exercise-induced cardiac remodeling. Recent studies are aiming to investigate the long-term effects and clinical consequences of an athlete's heart. The "gray-zone" continues to pose a clinical challenge and may indicate scenarios where additional imaging modalities, or longitudinal follow-up, provide a definitive answer. Echocardiography is likely to remain the first-line imaging modality for the cardiac evaluation of elite athletes. Multimodality imaging combined with outcome and long-term follow-up studies both during training and after retirement in both men and women may help further clarify the remaining mysteries in the coming years.

CMB-HUNT: Automatic detection of cerebral microbleeds using a deep neural network

Cerebral microbleeds (CMBs) are gaining increasing interest due to their importance in diagnosing cerebral small vessel diseases. However, manual inspection of CMBs is time-consuming and prone to human error. Existing automated or semi-automated solutions still have insufficient detection sensitivity and specificity. Furthermore, they frequently use more than one magnetic resonance imaging modality, but these are not always available. The majority of AI-based solutions use either numeric or image data, which may not provide sufficient information about the true nature of CMBs.This paper proposes a deep neural network with multi-type input data for automated CMB detection (CMB-HUNT) using only susceptibility-weighted imaging data (SWI). Combination of SWIs and radiomic-type numerical features allowed us to identify CMBs with high accuracy without the need for additional imaging modalities or complex predictive models. Two independent datasets were used: one with 304 patients (39 with CMBs) for training and internal system validation and one with 61 patients (21 with CMBs) for external validation.For the hold-out testing dataset, CMB-HUNT reached a sensitivity of 90.0%. As results of testing showed, CMB-HUNT outperforms existing methods in terms of the number of FPs per case, which is the lowest reported thus far (0.54 FPs/patient). The proposed system was successfully applied to the independent validation set, reaching a sensitivity of 91.5% with 1.9 false positives per patient and proving its generalization potential. The results were comparable to previous studies. Our research confirms the usefulness of deep learning solutions for CMB detection based only on one MRI modality.

Comparison of Machine Learning and Deep Learning Methods for the Prediction of Osteoradionecrosis Resulting from Head and Neck Cancer Radiation Therapy

<h3>Purpose/Objective(s)</h3> To test the hypothesis that deep learning (DL) techniques, using full dose distributions, can outperform machine learning (ML) methods, using dose summary statistics, in the prediction of osteoradionecrosis (ORN) resulting from head and neck cancer (HNC) radiotherapy (RT). <h3>Materials/Methods</h3> 1259 subjects from a single institution were identified who received HNC RT with curative intent. All 1259 subjects were included in the ML study and 1236 subjects with available dose maps and mandible contours were included in the DL study. After two years of follow-up, 173 patients developed ORN of any grade and 1086 remained ORN free (171 ORN+/1064 ORN- in the DL cohort). The ML methods, including logistic regression (LR), random forest (RF), support vector machine (SVM), principal component regression (PCR), and XGBoost, predict ORN status using subject dose summary statistics. The DL methods, including ResNet, DenseNet, DenseNet+ResNet ensemble, and autoencoder architectures, used subject 3D dose maps constrained to a bounding box around the mandible contour to predict ORN status. The autoencoder architecture uses bottleneck features with convolutional layers for prediction. The impact of training set size on DL performance was evaluated by retraining the architectures on decreasing ratios of the original training dataset (100% to 10% in 10% decrements). Model prediction performance was quantified using recall, precision, balanced accuracy, and area under the precision recall curve (AUPRC). The ML results are the average of 10-fold stratified cross-validation with 3 repeats whereas DL results are from a withheld test set (650/217/369 train/validation/test case split with 111/12/48 ORN+ cases per set, respectively). Class imbalance in the DL models was handled by randomly oversampling ORN+ cases in the training set to match the number of ORN- cases. <h3>Results</h3> The table shows the ML and DL ORN prediction results. Decreasing the amount of training data had no impact on DL performance; in the extreme of training the DL models on 10% of the training data, the balanced accuracy and F1 score did not decrease. <h3>Conclusion</h3> The traditional ML models had superior performance compared to the DL models. The lack of improvement in DL performance when increasing the amount of available training data suggests that either significantly more data is needed for DL model construction and/or that low-level dose image features are not powerful for this task. The poor DL performance despite a relatively large training cohort suggest additional imaging modalities in conjunction with 3D dose maps should be explored.

Magnetic resonance imaging features of isolated periventricular heterotopia in pediatric epilepsy: a comparative study

Periventricular nodular heterotopia is a neurodevelopmental disorder in which neurons fail to migrate to the cortical surface, forming discrete areas of grey matter adjacent to the lateral ventricles. Given that periventricular nodular heterotopia is seen as an incidental finding in patients without epilepsy, causality between periventricular nodular heterotopia and epilepsy cannot be assumed. Furthermore, the structural characteristics of periventricular nodular heterotopia in patients with epilepsy are poorly defined and can be misleading. In this article, we investigate whether structural radiological characteristics of heterotopia can predict epileptogenicity in pediatric patients. Pediatric patients with periventricular nodular heterotopia, but no other epilepsy-associated cortical abnormalities on magnetic resonance imaging, were identified and divided into two groups: with epilepsy and without epilepsy. Radiological characteristics of laterality, regionalization, largest dimension and number of nodules were compared between the two groups. Only periventricular nodular heterotopia spreading across several regions was associated with a statistically higher chance of epilepsy. Other features including laterality, individual region, number and largest dimension did not reliably predict epileptogenicity. Most radiological characteristics of periventricular nodular heterotopia are similar in patients with and without epilepsy. The involvement of multiple periventricular regions with heterotopia was the only feature that inferred a higher risk of epilepsy. Periventricular nodular heterotopia requires a comprehensive work-up and should be interpreted in the context of each individual patient and not assumed to be directly causative of epilepsy, nor unrelated to it. Therefore, further studies using additional structural and functional imaging modalities are needed to determine the radiological features of epileptogenic periventricular nodular heterotopia.

Quantitative evaluation by SPECT/CT of Radionuclide Therapy with Radium-223 Chloride of Bone Metastases in Metastatic Castration-resistant Prostate Cancer

Evaluation of the effectiveness of bone metastasis therapy is an urgent problem for patients with prostate cancer, mainly due to the relationship between bone metastases, survival and quality of life, which directly depends on the correct interpretation of the results of treatment response. It is known that some patients may experience a multidirectional therapeutic effect in the form of a positive response of some bone metastases and the progression of others. In addition, there are now many new therapeutics with different action profiles and often extremely expensive, so it is important to quickly recognize whether true or pseudo-disease progression is occurring, and this is more evident in patients enrolled in clinical trials with fixed protocols, often requiring radiographic assessment early after the start of treatment. Therefore, the use of additional imaging modalities in clinical practice along with PSA assessment may help improve early prediction of outcome and monitor response to therapy in patients with metastatic CRPC, optimizing the use of this costly treatment.

Improvement of an interobserver agreement of ARDS diagnosis by adding additional imaging and a confidence scale.

Acute respiratory distress syndrome (ARDS) often is not recognized in clinical practice, largely due to variation in the interpretation of chest x-ray (CXR) leading to poor interobserver reliability. We hypothesized that the agreement in the interpretation of chest imaging for the diagnosis of ARDS in invasively ventilated intensive care unit patients between experts improves when using an 8-grade confidence scale compared to using a dichotomous assessment and that the agreement increases after adding chest computed tomography (CT) or lung ultrasound (LUS) to CXR. Three experts scored ARDS according to the Berlin definition based on case records from an observational cohort study using a dichotomous assessment and an 8-grade confidence scale. The intraclass correlation (ICC), imaging modality, and the scoring method were calculated per day and compared using bootstrapping. A consensus judgement on the presence of ARDS was based on the combined confidence grades of the experts, followed by a consensus meeting for conflicting scores. In total, 401 patients were included in the analysis. The best ICC was found using an 8-grade confidence scale for LUS (ICC: 0.49; 95%-CI: 0.29–0.63) and CT evaluation (ICC: 0.49; 95%-CI: 0.34–0.61). The ICC of CXR increased by 0.022 and of CT by 0.065 when 8-grade scoring was used instead of the dichotomous assessment. Adding information from LUS or chest CT increased the ICC by 0.25 when using the 8-grade confidence assessment. An agreement on the diagnosis of ARDS can increase substantially by adapting the scoring system from a dichotomous assessment to an 8-grade confidence scale and by adding additional imaging modalities such as LUS or chest CT. This suggests that a simple assessment of the diagnosis of ARDS with a chart review by one assessor is insufficient to define ARDS in future studies.Clinical trial registrationTrialregister.nl (identifier NL8226).

Imaging Intertrochanteric Extension of Greater Trochanteric Fracture in a 59-year-old Man: A Case Report

Intertrochanteric fractures occur in the region between the greater and the lesser trochanters along the junction of the femoral neck and the shaft. Isolated greater trochanteric fractures seen on initial radiographs may be shown to have intertrochanteric extension on additional imaging modalities, including magnetic resonance imaging (MRI), computed tomography, and bone scintigraphy. We report a case of intertrochanteric extension of greater trochanteric fracture in a 59-year-old man who presented with acute worsening of chronic left hip pain after a minor fall. Radiographs of the hips revealed a left greater trochanteric fracture with suspected intertrochanteric extension. Computed tomography of the left hip, one day later, showed a minimally displaced fracture of the left greater trochanter without intertrochanteric extension. The same-day MRI of the hip showed an acute nondisplaced intertrochanteric extension of a minimally displaced greater trochanteric fracture. While the greater trochanteric fracture was seen on all three imaging modalities, the intertrochanteric extension was distinctly visualized only on MRI.

Pituitary adenoma & nuclear medicine: Recent outcomes and ongoing developments

In order to explore pituitary adenoma (PA), magnetic resonance imaging (MRI) remains the cornerstone. However, there are some limitations and MRI can be non-conclusive. The development of additional imaging modalities like nuclear medicine explorations may help to confirm PA diagnosis, guide management and follow up. Nuclear medicine uses radiopharmaceuticals for imaging with single photon emission computed tomography (SPECT), or positron emission tomography (PET), coupled to CT scan. Radiopharmaceuticals products target specific cellular elements which allow to explore several biological pathways. Nuclear medicine may also be used for therapeutic purposes and recent developments of approach based on Peptide Receptor Radionuclide Therapy (PRRT) for treatment of aggressive PA and pituitary carcinoma will be reviewed. Several radiotracers have been studied in the context of PA, and the aim of this paper is to discuss their respective performances and clinical interest.

Rare case of a mixed type total anomalous pulmonary venous return – benefits of a patient specific 3D model in the preoperative preparation

Accurate imaging of the morphology in a child with a rare and complex congenital heart disease (CHD) is crucial for the surgical planning and, if possible &amp;ndash; the minimization of operative risk. We present a case of a 3-month-old child with a rare variant of Total Anomalous Pulmonary Venous Return (TAPVR) &amp;ndash; mixed type &amp;ndash; which illustrates the bene&amp;#64257; t of additional imaging modalities and techniques for the operative planning. The patient&amp;rsquo;s anomalous drainage of the pulmonary veins (PV) is as follows: left and right lower PVs drained in the coronary venous sinus, left upper PV drained via a vertical vein into the innominate vein and the right upper PV drained into the superior vena cava (SVC). Clinical &amp;#64257; ndings consist of heart failure (HF), pulmonary venous congestion and mild hypoxemia developing within the &amp;#64257; rst days after birth. Transthoracic echocardiography (TTE) demonstrates the features of TAPVR, but the modality is unable to differentiate all of the described anatomic details. Accurate morphological diagnosis is obtained via contrast Computed Tomography (CT). The. additional&amp;nbsp;techniques of 3D modelling and 3D printing of a patient-speci&amp;#64257; c model, based on the acquired CT, contributed to the planning of the surgical strategy. The patient underwent a radical operation at age of 3 months. The unique aspect of the case is the application of all possible operative techniques for correction of TAPVR &amp;ndash; coronary sinus deroo&amp;#64257; ng, anastomosis of a draining vessel into the left atrial appendage and Warden procedure which involves tunnelling of the right upper PVs from the SVC into the left atrium. Feedback from the surgical team shows that the additional imaging methods and the printed 3D model represent the pathology in detail that completely corresponds to the intra-operative &amp;#64257; ndings

Imaging for Diagnosis and Assessment of Necrotizing Enterocolitis.

Necrotizing enterocolitis (NEC) is inflammatory bowel necrosis of preterm and critically ill infants. The disease is seen in 6-10% of preterm infants who weigh less than 1500 g at birth and carries considerable morbidity, mortality, and healthcare cost burden. Efforts focused on timely mitigation remain restricted due to challenges in early diagnosis as clinical features, and available laboratory tests remain nonspecific until late in the disease. There is renewed interest in the radiological and sonographic assessment of intestinal diseases due to technological advances making them safe, cost-efficient, and supporting Web-based transmission of images, thereby reducing time to diagnosis by disease experts. Most of our experience has been with plain abdominal radiography, which shows characteristic features such as pneumatosis intestinalis in up to 50-60% of patients. Many patients with advanced disease may also show features such as portal venous gas and pneumoperitoneum. Unfortunately, these features are not seen consistently in patients with early, treatable conditions, and hence, there has been an unfulfilled need for additional imaging modalities. In recent years, abdominal ultrasound (AUS) has emerged as a readily available, noninvasive imaging tool that may be a valuable adjunct to plain radiographs for evaluating NEC. AUS can allow real-time assessment of vascular perfusion, bowel wall thickness, with higher sensitivity in detecting pneumatosis, altered peristalsis, and characteristics of the peritoneal fluid. Several other modalities, such as contrast-enhanced ultrasound (CEUS), magnetic resonance imaging (MRI), and near-infrared spectroscopy (NIRS), are also emerging. In this article, we have reviewed the available imaging options for NEC evaluation.

Konjenital portosistemik şantların BT anjiyografi ve doppler ultrason ile değerlendirilmesi

Aim: The aim of the study was to describe the Doppler ultrasonography and computed tomography findings that should be considered in the diagnosis and treatment of congenital portosystemic shunts.Methods: Archive retrospectively scanned. In consideration of shunts: communication type and aneurysm were defined. Additional imaging modalities were utilized.Results: 11 patients were included in the study. The ages ranged from 0 to 158 months. There were two patients with shunt connecting segment-4 portal vein - middle hepatic vein, two patients with segment-3 portal vein - left hepatic vein, two patients with left portal vein – middle hepatic vein, two patients with portal vein - left renal vein, two patients with portal vein -inferior vena cava, and one patient with portal vein - perirectal venous plexus.Conclusion: Some classifications used in congenital portosystemic shunts are insufficient in guiding treatment. Elaborate definition of the imaging findings including the involved vessels, type of communication, and presence of aneurysm or dilated vessels is of the prime importance for tailoring clinical management of the patients.