Adjacent Vessels Research Articles

12315 Unveiling A Paraganglioma: Catecholamine-Induced Hyperglycemia Masquerading As Type 2 Diabetes Mellitus

Abstract Disclosure: S. Salman: None. M. Hussine: None. J. Tibaldi: None. Background: Excessive catecholamines have been demonstrated to exert adverse effects on insulin homeostasis and carbohydrate metabolism, potentially resulting in the onset of secondary DM. We present a case of a patient who had been previously misdiagnosed with T2DM for an extended period. Clinical Case: A 34-year-old woman with history of T2DM, HTN, and chronic tachycardia on beta blockers, presented with complaints of palpitations, headaches, and abdominal pain for two weeks. Upon admission, she was found to be in DKA, necessitating transient administration of insulin drip. Furthermore, she exhibited persistent tachycardia and intermittent episodes of hypertensive urgency. Notably, thyroid levels revealed euthyroidism. Although DKA resolved, her fasting blood sugar levels remained elevated and refractory to escalating insulin therapy. CT abdomen with contrast revealed a large enhancing mass in the RUQ. MRI abdomen confirmed an 8.1 cm heterogeneously enhancing T2 hyperintense mass located in the RUQ, abutting the right hepatic lobe, right adrenal gland, extrahepatic biliary ducts, and adjacent vessels. Given suspicions of a neuroendocrine tumor, she was transferred to the surgical service for tumor excision. Hormonal analysis revealed elevations in plasma metanephrines (620 pg/mL, n 0-88 pg/mL), plasma normetanephrines (9954 pg/mL, n 0-210.1 pg/mL), 24-hr urine normetanephrines (10,952 μg/24hr, n 110-720 μg/24hr) and 24-hr urine metanephrines (1406 μg/24hr, n 35-278 μg/24hr). Additionally, she exhibited elevated 24-hr urine epinephrine fraction (218 μg/g Cr, 0-20 μg/g Cr) and 24-hr urine norepinephrine fraction (2775 μg/g Cr, 0-45 μg/g Cr). Preoperatively, appropriate alpha and beta blockade were administered, followed by successful retroperitoneal tumor resection. Postoperatively, her glucose levels normalized without the need for further insulin therapy, and no episodes of hypoglycemia were reported. Histopathological examination of the excised mass revealed an 11 cm sympathetic paraganglioma with retention of SDHB staining. Genetic testing for SDHB, SDHD, VHL, and RET mutations is pending. Conclusion: This case underscores the potential oversight of pheochromocytomas and paragangliomas due to their nonspecific symptomatology, often mimicking more prevalent conditions, thereby presenting diagnostic challenges. The catecholamines secreted by these tumors can lead to both impaired insulin secretion and increased insulin resistance, resulting in clinically significant manifestations. The exact mechanism underlying the glycemic dysregulation remains controversial, necessitating further investigation through large-scale multicenter prospective studies to enhance understanding and inform diagnostic and therapeutic strategies for these tumors, which can manifest with severe and potentially fatal glycemic disturbances. Presentation: 6/1/2024

Comparative study of CTA/CTV and MRTA for preoperative simulation of microvascular decompression in neurovascular compression syndromes.

Neurovascular compression syndrome (NVCS), characterized by cranial nerve compression due to adjacent blood vessels at the root entry zone, frequently presents as trigeminal neuralgia (TN), hemifacial spasm (HFS), or glossopharyngeal neuralgia (GN). Despite its prevalence in NVCS assessment, Magnetic Resonance Tomographic Angiography (MRTA)'s limited sensitivity to small vessels and veins poses challenges. This study aims to refine vessel localization and surgical planning for NVCS patients using a novel 3D multimodal fusion imaging (MFI) technique incorporating computed tomography angiography and venography (CTA/CTV). A retrospective analysis was conducted on 76 patients who underwent MVD surgery and were diagnosed with single-site primary TN, HFS, or GN. Imaging was obtained from MRTA and CTA/CTV sequences, followed by image processing and 3D-MFI using FastSurfer and 3DSlicer. The CTA/CTV-3D-MFI showed higher sensitivity than MRTA-3D-MFI in predicting responsible vessels (98.6% vs. 94.6%) and NVC severity (98.6% vs. 90.8%). Kappa coefficients revealed strong agreement with MRTA-3D-MFI (0.855 for vessels, 0.835 for NVC severity) and excellent agreement with CTA/CTV-3D-MFI (0.951 for vessels, 0.952 for NVC). Resident neurosurgeons significantly preferred CTA/CTV-3D-MFI due to its better correlation with surgical reality, clearer depiction of surgical anatomy, and optimized visualization of approaches (p < 0.001). Implementing CTA/CTV-3D-MFI significantly enhanced diagnostic accuracy and surgical planning for NVCS, outperforming MRTA-3D-MFI in identifying responsible vessels and assessing NVC severity. This innovative imaging modality can potentially improve outcomes by guiding safer and more targeted surgeries, particularly in cases where MRTA may not adequately visualize crucial neurovascular structures.

Positional differences in the micro- and ultra-structural variations of ray parenchyma cells during the transformation from sapwood to heartwood.

Ray parenchyma cells are involved in the initiation of heartwood formation. The position within a ray influences the timing of ray parenchyma cell differentiation and function; however, there is little information concerning the positional influence on the cellular changes of ray parenchyma cells from sapwood and heartwood. In this study, radial variations in morphology, size, and ultrastructure of ray parenchyma cells were studied by combined transmission electron microscopy and optical microscopy. Results showed that cellular traits of ray parenchyma cells in Populus tomentosa were all affected by both radial position in the secondary xylem and position within a ray. Specifically, radial variations in cellular traits were more evident in isolation cells, which were not adjacent to vessel elements. Both cell length and cell width/length ratio of isolation cells were bigger than contact cells, which contacted adjacent vessel elements via pits. Moreover, the secondary wall thickening and lignification of contact cells developed in the current-year xylem, much earlier than isolation cells. Secondary walls in contact cells were in a polylamellate structure with a protective layer on the inner side. No alteration in the ultrastructure of contact cells occurred in the sapwood-heartwood transition zone, except that most contact cells died. By contrast, in the transition zone, isolation cells still lived. A thin secondary wall began to deposit on the thick primary wall of isolation cells, with two isotropic layers on the inner side of the primary wall and secondary wall respectively being characteristic. Meanwhile, starch grains in isolation cells were depleted, and dark polyphenolic droplets lost their spherical shape and flowed together. Furthermore, the intercellular spaces of isolation cells became densified in the transition zone. Overall, cellular changes suggested that the positional information of ray parenchyma cells appeared to be an important factor in the transformation from sapwood to heartwood. Unlike contact cells, isolation cells were more elongated, specialized in radial transport, had a delayed formation of secondary walls, and were involved in the synthesis of heartwood substances. Our result promotes the elucidation of the involvement of xylem rays in heartwood formation.

Vascular network-mediated systemic spread of Pseudomonas syringae pv. actinidiae causes the bacterial canker of kiwifruit

Pseudomonas syringae pv. actinidiae (Psa) causes destructive kiwifruit bacterial canker by invading vascular tissues across multiple plant organs. However, the cellular mechanism underlying its systemic transmission and cell-to-cell movement within these specialized vascular conduits remains unclear. In this study, a Psa-GFP strain and various microscopic techniques were used to investigate the interaction between kiwifruit and Psa. Our results reveal that Psa strategically exploits host vascular conduits for systemic movement, with the xylem vessel being the predominant avenue. In the phloem, Psa exhibits adaptive alteration in bacterial shape to traverse sieve pores, facilitating its systemic spread along sieve tubes and inducing phloem necrosis. Within the xylem, Psa breaches pit membranes to migrate between adjacent vessels. Furthermore, phloem fibers act as an initial barrier at the early stages of infection, delaying Psa's entry into vascular tissues during its journey to the xylem. Additionally, at the junctions of stem–stem or stem-leaf, branch trace or leaf trace mediates the bacterial organ-to-organ translocation, thus facilitating the systemic progression of disease. In conclusion, our findings shed light on the cellular mechanism employed by Psa to exploit the woody plant's vascular network for infection, thereby enhancing a better understanding of the biology of this poorly defined bacterium. These insights carry implications for the pathogenesis of Psa and other vascular pathogens, offering theoretical guidance for effective control strategies.

Abstract MP05: A Preliminary 10X Genomics Xenium Profiler Spatial Transcriptomics Map of Renin-Angiotensin System Genes in the Mouse Subfornical Organ

The subfornical organ (SFO) is a brain region rich in angiotensin-II (ANG) AT1 receptors (AT1R) which regulates water and salt intake and communicates with other hypothalamic nuclei to regulate blood pressure (BP). Activation of the classical G protein-mediated AT1R signaling in the brain induces pressor and natri-dipsogenic responses. TRV027, a synthetic AT1R β-arrestin-biased agonist, decreases BP and increases saline avoidance. We examined the spatial transcriptomic makeup of the SFO to balanced or biased AT1R activation using 10X Genomics Xenium. We treated C57BL/6J mice with either aCSF, ANG (0.64 µg/h), or TRV027 (0.56 µg/h) through continuous ICV infusion for 11-days. Water intake was monitored on days 6-11. ANG caused an increase in water intake compared to aCSF or TRV027 groups (7.0±2.0, 3.0±0.2, and 1.9±0.6 mL/day, respectively, n=4, p&lt;0.05). On day 11, brains were perfused, collected, and fixed. Subsequently, 5 µm paraffin-embedded coronal sections were mounted on Xenium slides and tested with the 10X mouse brain set of 247 genes plus 100 custom add-on genes including all RAS genes. A third of the cells expressed AT1R, and the pattern of AT1R-expressing cells Xenium-detected was qualitatively similar to NZ44 mice, which express GFP under the control of the AT1R locus. Expression of the prorenin receptor ( Atp6ap2 ) was abundant throughout the SFO. A few cells in the SFO and more prominently in the adjacent blood vessels were angiotensinogen positive. Single cells were identified that expressed the ANG type 2 receptors (AT2R). Expression of Mas receptor was undetectable. Most of the AT1R-expressing cells were excitatory glutamatergic neurons (expressing Slc17a6 , VGLUT2) but a few were inhibitory GABAergic neurons co-expressing Slc32a1 (VGAT). Each section had cells classified as astrocytes, neurons, ependymal cells, and immune cells (e.g., microglia or macrophages). Increased numbers of immune cells were detected in the SFO of ANG-treated mice. Interestingly, although there was no evidence for expression of renin in the SFO, renin-expressing cells were identified in the choroid plexus which is consistent with highly sensitive in situ RNA hybridization data. Additional qualitative and quantitative analyses are ongoing to compare gene expression patterns in AT1R-positive cell types. Future studies will identify gene expression patterns in SFO neurons with connectivity to other brain regions controlling water/salt intake and BP.

Preoperative Evaluation of Neurovascular Relationship in Primary Trigeminal Neuralgia(PTN) by Magnetic Resonance Virtual Endoscopy(MRVE) Combined with 3D-FIESTA-c and 3D-TOF-MRA.

This study aims to evaluate the effectiveness of Magnetic Resonance Virtual Endoscopy combined with 3D-FIESTA-c and 3D-TOF-MRA in preoperative assessment of MVD for PTN, with a focus on accurately detecting neuromuscular contact. We retrospectively analyzed clinical and imaging data from 240 patients with unilateral primary trigeminal neuralgia undergoing MVD surgery between April 2016 and July 2023. Preoperative scans with 3D-FIESTA-c and 3D-TOF-MRA were performed, and MRVE images were obtained to analyze the relationship between the trigeminal nerve and adjacent vessels. Using the findings during microvascular decompression (MVD) surgery as the gold standard, the diagnostic results of 3D-TOF-MRA + 3D-FIESTA-c were considered as group I, while the combined use of MRVE, 3D-TOF-MRA + 3D-FIESTA-c was considered as group II. In 240 cases, group I had a positive rate of 96.25% and an accuracy rate of 86.25% for identifying responsible blood vessels, while group II had a positive rate of 98.3% and an accuracy rate of 94.17%. There were no statistically significant differences in positive rates between group I and group II, group I and MVD, or group II and MVD (P > 0.05). However, there were statistically significant differences in accuracy rates (P < 0.05). The accuracy for single and multiple arteries with group I was 99.38% and 80.0%, respectively, while with group II, it was 100% and 95.0%. No statistically significant difference was found in accuracy for single or multiple arteries (P>0.05). The accuracy of evaluating responsibility veins with or without other vessels was 52.73% and 80.0%, respectively, with a statistically significant difference (P<0.05). MRVE combined with 3D-TOF-MRA + 3D-FIESTA-c significantly improves the accuracy of identifying responsibility vessels, especially veins, in preoperative assessment for MVD. This has important clinical implications for preoperative decision-making and surgical planning.

The Role of Advanced Post-processing Techniques in Computed Tomography Pulmonary Angiography for the Accurate Diagnosis of Pulmonary Thromboembolism: A Retrospective Study.

Background Computed tomography pulmonary angiography (CTPA) isthe standard diagnostic tool for evaluating patients with suspected pulmonary thromboembolism (PTE) in many institutions. This condition, whether acute or chronic, results in both partial and complete intraluminal filling defects, which exhibit sharp interfaces with intravascular contrast material. Acute PTE that leads to complete arterial occlusion may cause the affected artery to appear enlarged. Chronic PTE often manifests as complete occlusive disease in vessels that are smaller than the adjacent patent vessels. CT imaging with iodinated contrast medium is crucial for many CT applications, including vascular CT angiography and CTPA. A comprehensive review of a case necessitates an integrated approach known as volume visualization, wherein the entire case is treated as a volume of information to be thoroughly reviewed. Advanced post-processing 3D CT techniques, such as maximum intensity projection (MIP), volume rendering (VR), and minimum intensity projection (MinIP) images, are essential for the detailed detection and assessment of the pulmonary vasculature. Materials and methods In this retrospective study, data from 50 patients with suspected PTE were analyzed over a six-month period from March 15 to August 30, 2023, at Saveetha Medical College and Hospital. Patients were selected based on previously recorded clinical symptoms and elevated D-dimer levels. CTPA images, acquired using multi-detector CT imaging with iodinated contrast, were reviewed. Various post-processing techniques were employed, including multiplanar reconstruction (MPR), MIP, MinIP, and VR. The aim of this study was to evaluate the effectiveness of CTPA combined with advanced post-processing techniques in improving early detection, reducing diagnostic time, and increasing accuracy through the detailed visualization of the pulmonary arterial vasculature. Results The study included patients aged from 10 years to70 years, with the highest prevalence of PTE in the 21-35-year age group (46%). Males constituted 56% of the cases. CTPA with advanced post-processing techniques revealed filling defects in 90% of patients, confirming PTE. MPR, MIP, MinIP, and VR effectively highlighted anatomical structures and thrombi, enhancing diagnostic accuracy. These techniques demonstrated high accuracy in identifying PTE, emphasizing their critical role in the early diagnosis and management of thromboembolic events. Conclusion The findings of the study revealed a relatively high incidence of PTE especially in the 21-35-year age group with a slight male predominance. Thesignificant majority of the patients (90%) had filling defects on their CTPA scan. CTPA, in conjunction with the use of post-processing techniques, the localization of thromboembolism sites, as well as the measurement of thrombus width and length, and the calculation of the percentage of blockage were achieved more easily. This facilitatedaccurate diagnosis, leading to improved patient outcomes.

Initial findings using high-resolution magnetic resonance imaging for visualisation of the sural nerve and surrounding anatomy in healthy volunteers at 7 Tesla.

Histopathological diagnosis is the gold standard in many acquired inflammatory, infiltrative and amyloid based peripheral nerve diseases and a sensory nerve biopsy of sural or superficial peroneal nerve is favoured where a biopsy is deemed necessary. The ability to determine nerve pathology by high-resolution imaging techniques resolving anatomy and imaging characteristics might improve diagnosis and obviate the need for biopsy in some. The sural nerve is anatomically variable and occasionally adjacent vessels can be sent for analysis in error. Knowing the exact position and relationships of the nerve prior to surgery could be clinically useful and thus reliably resolving nerve position has some utility. 7T images of eight healthy volunteers' (HV) right ankle were acquired in a pilot study using a double-echo in steady-state sequence for high-resolution anatomy images. Magnetic Transfer Ratio images were acquired of the same area. Systematic scoring of the sural, tibial and deep peroneal nerve around the surgical landmark 7 cm from the lateral malleolus was performed (number of fascicles, area in voxels and mm2, diameter and location relative to nearby vessels and muscles). The sural and tibial nerves were visualised in the high-resolution double-echo in steady-state (DESS) image in all HV. The deep peroneal nerve was not always visualised at level of interest. The MTR values were tightly grouped except in the sural nerve where the nerve was not visualised in two HV. The sural nerve location was found to be variable (e.g., lateral or medial to, or crossing behind, or found positioned directly posterior to the saphenous vein). High-resolution high-field images have excellent visualisation of the sural nerve and would give surgeons prior knowledge of the position before surgery. Basic imaging characteristics of the sural nerve can be acquired, but more detailed imaging characteristics are not easily evaluable in the very small sural and further developments and specific studies are required for any diagnostic utility at 7T.

Adverse Effects Associated with Dermal Filler Treatments: Part II Vascular Complication.

Vascular complications arising from dermal filler treatments pose significant risks, including ischemia, tissue necrosis, and severe outcomes like blindness and pulmonary embolism. This study investigates the mechanisms of vascular complications, categorizing them into extravascular compression and intravascular emboli. Extravascular compression occurs when injected fillers compress adjacent blood vessels, leading to ischemia and potential necrosis, while intravascular emboli result from fillers entering blood vessels, causing blockages. The study emphasizes the importance of anatomical knowledge, careful injection techniques, and early intervention. Management strategies include the use of hyaluronidase to dissolve HA fillers, vasodilators to improve blood circulation, and hyperbaric oxygen therapy. The regions most susceptible to complications align with major arterial pathways, particularly the nasolabial folds and nasal region. The study also highlights the need for meticulous injection techniques, the use of cannulas over needles in high-risk areas, and the aspiration test to detect vessel penetration. Early detection and immediate intervention are crucial to mitigate adverse outcomes. Continuous education and training for practitioners, along with advancements in filler materials and injection methods, are essential for improving the safety of cosmetic procedures. This comprehensive understanding aids in preventing and managing vascular complications, ensuring better patient outcomes. The field of dermal filler treatments is advancing with new techniques and technologies, such as High-Resolution Ultrasound, Infrared Imaging, self-crossing hyaluronic acid filler, biodegradable microspheres, and microinjection.

The Role of CT in Differentiating the Non Pediatric Renal and Adrenal Region Fatty Masses

Abstract Background CT is indicated in many abdominal conditions because of its excellent morphological resolution and its ability to image many different structures, such as abdominal viscera, pelvic organs, lungs and bones, with a single examination. Aim of the Work The aim of this study is to highlight the accuracy of multi-detector computed tomography scan in diagnosing the different fatty lesions of the renal and adrenal regions by comparing the CT study of the benign lesions with their follow up CT scan and comparing the CT study of the malignant cases with their histo-pathological results. Patients and Methods The study was conducted on 34 patients most of them had unrelated complaints(incidental findings) and were referred to Radiology department, Theodor Bilharz Research Institute. Their age ranged from 20 years to 81 years old (mean age 56.35 years±13.61). Most of the patients were males 21cases while female were 13 cases. The patients were referred from oncology, general surgery, and urology departments of Theodor Bilharz Research Institute hospital as well as the outpatient clinics to perform MDCT in the period from September 2021 to June 2022. Results MDCT examinations were done for 34 patients and concluded that MDCT should be used in the first place in the course of diagnostic procedures of patients with renal and adrenal region fatty lesions and this was justified by an overall diagnostic accuracy of 100% for benign lesions and 82% for malignant lesions, where MDCT could correctly diagnose (33/34) cases and only 1 case was misdiagnosed, confirming the ability of MDCT to show up the accurate diagnosis, the exact location, extent of tumor, along with involvement of adjacent organs and vessels. Conclusion It also has a high accuracy in differentiation of malignant from benign lesions and detection of lymph node involvement &amp; metastasis. There by improving the prognosis.

Composite error event-triggered-based finite-time safe formation control of underactuated vessels

For the problems of limited communication bandwidth and frequent triggering of actuators during the formation navigation, comprehensively considering the safety performance and coordinated control performance, a novel composite error event-triggered-based formation control strategy is proposed. Firstly, design an event-triggered-based finite-time extended state observer, which can not only quickly estimate the compound disturbances and velocity information simultaneously, but also reduce the communication frequency between sensor and observer. Secondly, considering the communication frequency and coordinated control performance of the whole formation system, a composite error based on the state information of adjacent underactuated vessels is defined, and it is used as a factor of the event-triggered mechanism. Then, by combining the exponential potential energy function, the composite error event-triggered-based formation controller is designed. And through stability analysis, we known that all signals of the system are uniformly ultimately bounded. Furthermore, the Zeno phenomenon that exists in event-triggered control can also be avoided completely. Finally, through simulation results and comparative analysis, the effectiveness of the composite error event-triggered-based formation control scheme for safe navigation control and reducing communication frequency and triggering frequency has been verified.

Pulsative venous return from the branchial vessels to the heart of the bivalve Mytilus galloprovincialis supports the constant-volume mechanism.

In bivalves and gastropods, ventricle contraction causes a negative pressure in the auricles and increases venous return from the afferent oblique vein (AOV): the constant-volume (CV) mechanism. The flow in the AOV should be a pulsative flow synchronized with the ventricular contraction. The flow in the heart and adjacent vessels of Mytilus galloprovincialis were measured by magnetic resonance imaging to confirm this hypothesis. Under a regular heartbeat, pulsative flows in the AOV and branchial vessels (BVs) were almost completely synchronized with the flow in the aorta, while filling of the ventricle was in the opposite phase. Flows in the BVs were directed to the posterior direction, and a pair of BVs in the gill axes (the efferent BVs) were connected to the AOV. Based on the images of the whole pathway of the AOV in an oblique slice, we confirmed that haemolymph flow was evoked from the efferent BVs and flow into the ventricle via the auricle was completed in a single heartbeat. Therefore, the walls of the AOV and BVs could resist negative transmural pressure caused by the ventricular contraction. In conclusion, the auricle, the AOV and the BVs, including the gill filaments, act as a suction pump. The pulsative venous return is driven by the negative pressure of the AOV as in the CV mechanism, and the negative pressure in the efferent BVs could draw haemolymph from the sinus via the gill and the afferent BVs. Therefore, Mytilus can start and stop its heartbeat as necessary.

Fixed-time event-triggered sliding mode time-varying formation control for multiple surface vessels with fast convergence

ABSTRACT This paper proposes a new fixed-time sliding mode time-varying formation control strategy for multiple surface vessels (MSVs) to improve control performance and ensure navigation safety. First, a fixed-time extended state observer (FxESO) is designed to provide estimations of velocities and lumped disturbances. Then, the event-triggered fixed-time distributed time-varying formation control law is designed based on prescribed performance function (PPF) and fixed-time nonsingular terminal sliding mode (FxNTSM) manifold. Finally, system stability is analyzed based on Lyapunov theory. The salient features of the proposed scheme are as follows. First, a novel hyperbolic cosecant PPF is incorporated into the control scheme to enhance control performance. Then, the proposed scheme is combined with relative threshold event-triggered strategy to reduce unnecessary updates of actuators. Finally, a uniform exact differentiator is introduced to avoid the formation control law including the acceleration of adjacent vessel. Comparative results are given to demonstrate the superiority of the proposed scheme.

Medial End Clavicular Osteochondroma- An Unusual Case

Abstract Osteochondroma is the most common benign bone tumor, which could present as a sessile or pedunculated type and, in solitary or multiples, hereditary multiple exostoses (a genetic disorder, autosomal dominant inheritance). Clinical presentation is mostly asymptomatic, but if symptomatic, it presents in a wide spectrum, such as compression of adjacent vessels, nerves, deformities, fractures, bursa formation, and malignant transformation. Cancerous transformation is indicated by the thickness of the cartilage cap of &gt;3 cm in children, &gt;2 cm in adults, sudden onset of pain, and sudden/rapid growth of lesion (after growth plate closure). Surgical management is indicated for typical symptomatic lesions, complications, malignant transformation, and cosmetic reasons. The common treatment of choice is the excision of a tumor with a significant free margin.

Dual-Energy Computed Tomography Virtual Noncalcium Imaging of Intracranial Arteries in Acute Ischemic Stroke: Differentiation Between Acute Thrombus and Calcification.

Hyperdense artery sign (HAS) on noncontrast brain computed tomography (CT) indicates an acute thrombus within the cerebral artery. It is a valuable imaging biomarker for diagnosing large-vessel occlusion; however, its identification may be challenging with the presence of vascular calcification. Dual-energy CT virtual noncalcium (VNCa) imaging using a 3-material decomposition algorithm is helpful for differentiating between calcification and hemorrhage. This study aimed to clarify the potential of VNCa imaging for differentiating HAS from vascular calcification. Patients with acute ischemic stroke and large-vessel occlusion identified on MR angiography, who also underwent noncontrast dual-energy CT, were included. The 80 kV/Sn 140 kV mixed images, with a weighting factor of 0.4, were considered 120 kVp-equivalent images. Postprocessing using a 3-material decomposition algorithm to differentiate between calcium (Ca), cerebrospinal fluid, and hemorrhage was performed via a commercially available 3-dimensional workstation. A mixed image, VNCa image, color-coded Ca image, and color-coded Ca image with VNCa image overlay (color-coded Ca-overlay image) were obtained, and axial reconstruction with a 1-mm slice thickness was performed for each image type. Two experienced neuroradiologists conducted imaging evaluations in consensus. Thirty-four patients (mean age, 76.0 years; 21 male and 13 female patients) were included. The mixed and VNCa images revealed an HAS (indicating an acute clot) corresponding to the large-vessel occlusion site in 30 patients. Among them, the VNCa and color-coded Ca-overlay images enabled clear differentiation between the acute thrombus and adjacent vessel wall calcification in 5 patients. Among the other 4 patients, the VNCa, Ca-overlay, and Ca images identified calcified cerebral emboli in the M1 segment in 1 patient. For the other 3 patients, no high attenuation corresponding to magnetic resonance angiography findings was observed in any of the mixed, VNCa, Ca-overlay, or Ca images. VNCa and color-coded Ca-overlay images obtained via dual-energy brain CT enabled differentiation of acute thrombus from vessel wall calcification and calcified cerebral emboli in patients with acute ischemic stroke.

Hepatic and portal vein segmentation with dual-stream deep neural network.

Liver lesions mainly occur inside the liver parenchyma, which are difficult to locate and have complicated relationships with essential vessels. Thus, preoperative planning is crucial for the resection of liver lesions. Accurate segmentation of the hepatic and portal veins (PVs) on computed tomography (CT) images is of great importance for preoperative planning. However, manually labeling the mask of vessels is laborious and time-consuming, and the labeling results of different clinicians are prone to inconsistencies. Hence, developing an automatic segmentation algorithm for hepatic and PVs on CT images has attracted the attention of researchers. Unfortunately, existing deep learning based automatic segmentation methods are prone to misclassifying peripheral vessels into wrongcategories. This study aims to provide a fully automatic and robust semantic segmentation algorithm for hepatic and PVs, guiding subsequent preoperative planning. In addition, to address the deficiency of the public dataset for hepatic and PV segmentation, we revise the annotations of the Medical Segmentation Decathlon (MSD) hepatic vessel segmentation dataset and add the masks of the hepatic veins (HVs) andPVs. We proposed a structure with a dual-stream encoder combining convolution and Transformer block, named Dual-stream Hepatic Portal Vein segmentation Network, to extract local features and long-distance spatial information, thereby extracting anatomical information of hepatic and portal vein, avoiding misdivisions of adjacent peripheral vessels. Besides, a multi-scale feature fusion block based on dilated convolution is proposed to extract multi-scale features on expanded perception fields for local features, and a multi-level fusing attention module is introduced for efficient context information extraction. Paired t-test is conducted to evaluate the significant difference in dice between the proposed methods and the comparingmethods. Two datasets are constructed from the original MSD dataset. For each dataset, 50 cases are randomly selected for model evaluation in the scheme of 5-fold cross-validation. The results show that our method outperforms the state-of-the-art Convolutional Neural Network-based and transformer-based methods. Specifically, for the first dataset, our model reaches 0.815, 0.830, and 0.807 at overall dice, precision, and sensitivity. The dice of the hepatic and PVs are 0.835 and 0.796, which also exceed the numeric result of the comparing methods. Almost all the p-values of paired t-tests on the proposed approach and comparing approaches are smaller than 0.05. On the second dataset, the proposed algorithm achieves 0.749, 0.762, 0.726, 0.835, and 0.796 for overall dice, precision, sensitivity, dice for HV, and dice for PV, among which the first four numeric results exceed comparingmethods. The proposed method is effective in solving the problem of misclassifying interlaced peripheral veins for the HV and PV segmentation task and outperforming the comparing methods on the relabeleddataset.

Thyroid Papillary Carcinoma Invasion of the Ipsilateral Internal Jugular Vein: A Case Report

Thyroid cancer is the common malignancy of the endocrine system. Thyroid neoplasms are usually asymptomatic and slow growing. Uncommonly, aggressive thyroid neoplasms may invade adjacent blood vessels. Internal jugular vein invasion is a rare complication of an aggressive thyroid malignancy. Careful sonographic examination of a thrombus-like structure inside a blood vessel adjacent to the affected thyroid could reveal that the “thrombus” is part of the thyroid mass. The continuity of a thyroid neoplasm into the vascular lumen and inner-“thrombus” vascularity confirms the cancerous invasion. Ultrasound-guided fine-needle aspiration biopsy is standard for differentiating benign versus malignant thyroid nodules. Genetic testing of thyroid nodules provides valuable clinical information in addition to the routine cytological analysis.

Treatment for middle cerebral artery bifurcation aneurysms: in silico comparison of the novel Contour device and conventional flow-diverters

Endovascular treatment has become the standard therapy for cerebral aneurysms, while the effective treatment for middle cerebral artery (MCA) bifurcation aneurysms remains a challenge. Current flow-diverting techniques with endovascular coils cover the aneurysm orifice as well as adjacent vessel branches, which may lead to branch occlusion. Novel endovascular flow disruptors, such as the Contour device (Cerus Endovascular), are of great potential to eliminate the risk of branch occlusion. However, there is a lack of valid comparison between novel flow disruptors and conventional (intraluminal) flow-diverters. In this study, two in silico MCA bifurcation aneurysm models were treated by specific Contour devices and flow-diverters using fast-deployment algorithms. Computational fluid dynamic simulations were used to examine the performance and efficiency of deployed devices. Hemodynamic parameters, including aneurysm inflow and wall shear stress, were compared among each Contour device, conventional flow-diverter, and untreated condition. Our results show that the placement of devices can effectively reduce the risk of aneurysm rupture, while the deployment of a Contour device causes more flow reduction than using flow-diverters (e.g. Silk Vista Baby). Besides, the Contour device presents the flow diversion capability of targeting the aneurysm neck without occluding the daughter vessel. In summary, the in silico aneurysm models presented in this study can serve as a powerful pre-planning tool for testing new treatment techniques, optimising device deployment, and predicting the performance in patient-specific aneurysm cases. Contour device is proved to be an effective treatment of MCA bifurcation aneurysms with less daughter vessel occlusion.

Prediction of tumor recurrence after surgical resection of ampullary adenocarcinoma using magnetic resonance imaging.

To predict tumor recurrence in patients who underwent surgical resection of ampullary adenocarcinoma using preoperative magnetic resonance (MR) imaging findings combined with clinical findings. In this multicenter study, a total of 113 patients (mean age, 62.9 ± 9.8 years; 58 men and 55 women) with ampullary adenocarcinoma who underwent preoperative MR imaging and surgery with margin-negative resection between 2006 and 2017 were retrospectively included. The MR imaging findings were evaluated by two radiologists. Preoperative clinical findings were obtained. Cox proportional regression analyses were used to identify the independent prognostic factors for recurrence-free survival (RFS). A nomogram was created based on the multivariable analysis and was internally validated. Multivariable analysis revealed that presence of infiltrative tumor margin (hazard ratio [HR]: 2.18, p = 0.019), adjacent organ invasion (HR: 3.31, p = 0.006), adjacent vessel invasion (HR: 5.42, p = 0.041), peripancreatic lymph node enlargement (HR: 2.1, p = 0.019), and jaundice (HR: 1.93, p = 0.043) were significantly associated with worse RFS of ampullary adenocarcinoma after surgical resection. These MR imaging and clinical findings were used to construct a nomogram. On internal validation, the calibration plots showed excellent agreement between the predicted probabilities and the actual rates of tumor recurrence, with Harrell's c-index of 0.746. Combination of preoperative MR imaging and clinical findings can be useful for predicting tumor recurrence after surgical resection of ampullary adenocarcinoma. Identifying these features before surgery may aid in better treatment planning and management of these patients. A predictive nomogram using preoperative MR imaging and clinical findings can be useful in estimating the recurrence-free survival after surgical resection of ampullary adenocarcinoma. • Presently, tumor size on imaging is the only non-invasive factor that correlates with recurrence-free survival from ampullary adenocarcinoma; other factors are obtained postoperatively. • Infiltrative tumor margin, adjacent organ invasion, adjacent vessel invasion, peripancreatic lymph node enlargement on MRI, and jaundice are significant predictors for recurrence. • A nomogram incorporating significant MR imaging and clinical findings showed good performance in predicting recurrence-free survival, which can help in treatment planning.

Adipofascial Perforator Flaps for Peripheral Nerve Resurfacing after External Neurolysis.

Background: External neurolysis is an important approach to treating symptomatic peripheral nerve entrapment. In cases of recurrent neurolysis or particularly extensive neurolysis, a paucity of overlying soft tissue for closure over the freshly liberated nerve presents a challenge to long-term surgical success as primary closure of this tissue may predispose the patient to recalcitrant epineural scarring. We report the intermediate term outcomes of the use of adipofascial perforator flaps as a means of vascularised tissue resurfacing of nerves in these difficult scenarios. Methods: We retrospectively reviewed patients undergoing external neurolysis for painful peripheral nerve lesions who subsequently had soft tissue reconstruction with local adipofascial flaps. Data with regard to age, gender, limb involved, duration of symptoms, number of prior surgeries, operative time, type of flap, vascular basis of flap, duration of follow-up, visual analogue pain score, monofilament sensory testing and complications were collected. Results: We included six patients (four women) with a minimum follow-up period of 17 months (range: 17-25 months). Age ranged from 39 to 60 years of age. Four cases involved the upper extremity and two the lower extremity. Symptoms had been present between 1 and 10 years. All operations utilised a local adipofascial flap perfused by a named perforating vessel emanating from an adjacent axial vessel. Operative time for flap creation and inset was 74 minutes, on average. There was one minor complication owing to superficial wound dehiscence. All patients reported substantial pain relief (≥five-point reduction on visual analogue scale; scores 0-3 at last follow-up) and objective sensory testing demonstrated improvement. Conclusions: Our report pays particular attention to surgical technique that is applicable to both upper and lower extremities in addition to intermediate term safety and pain outcomes. Level of Evidence: Level IV (Therapeutic).