Advanced Imaging Studies Research Articles

Clinical examination and imaging resources in children and adolescent back pain.

Back pain is a relatively common complaint in children and adolescents. The pediatric patient presenting with back pain can often be challenging, and there are many well-known organic diagnoses that should not be missed. In younger children, an organic cause of back pain can often be found. However, back pain in older children and adolescents is often "non-specific." The differential diagnosis of back pain in children includes neoplasms, developmental, and inflammatory conditions. Basic steps should include an in-depth anamnesis, a systematic physical examination, and standard spine radiographs (anteroposterior and lateral). Nevertheless, advanced diagnostic imaging and laboratory studies should be included when indicated to avoid missing or delaying a serious diagnosis. If other types of imaging tests are necessary (magnetic resonance imaging, computed tomography, bone scan, or single photon emission computed tomography), they should be guided by diagnostic suspicion.

NIMG-15. COMBINED ADVANCED IMAGING AND MGMT STATUS FOR DISTINCTION BETWEEN EARLY TUMOR PROGRESSION AND PSEUDOPROGRESSION IN GLIOBLASTOMA

Abstract BACKGROUND Within 3-6 months of completing initial chemoradiotherapy, up to 50% of glioblastomas (GBM) develop worsening contrast enhancement on surveillance imaging, which could represent early progression (EP) or pseudoprogression (PsP). Reports suggest EP is more common in MGMT unmethylated (uMGMT) cases. While multiple advanced imaging studies have tried to address this issue (including magnetic resonance with perfusion [MRP], with spectroscopy [MRS], and FDG-PET), no non-invasive test reliably differentiates EP from PsP, yet the distinction is critical for subsequent management. We aimed to develop a multiparametric score including advanced imaging and MGMT status to improve interpretation. METHODS We retrospectively reviewed records of patients diagnosed with GBM from 2016-2022 who had changes on anatomic imaging concerning for EP vs. PsP ≤6 months after chemoradiotherapy and underwent ≥ 2 advanced imaging sequences (MRP, MRS, FDG-PET); definitive distinction between EP and PsP was made by either histology from surgical resampling or subsequent clinico-radiographic evolution. Associations between clinical factors and EP were investigated with logistic regression. Sensitivity and specificity of each imaging modality and of a composite score (1 point each for MRP consistent with EP, MRS consistent with EP, and uMGMT) were calculated. RESULTS 46 evaluable patients (57% male; median age 58.5 years, range 31-80) were included; outcome (EP in 29 [63%], PsP in 17 [37%]) was determined histologically and clinically in 15 (33%) and 31 (67%) of cases, respectively. In multivariate analysis, uMGMT was predictive of EP (OR=2.63, 95% CI=1.29-37.55, p< 0.05). Sensitivity/specificity to predict EP were 78%/77% for uMGMT, 76%/29% for MRP, 85%/67% for MRS, 86%/0% for FDG-PET (8 patients) and 88%/75% for composite score of 2-3 (vs. 0-1). CONCLUSION Combining MRS, MRP and MGMT results can improve accuracy in distinguishing EP from PsP in GBM. MGMT status should be incorporated in the interpretation of advanced imaging to distinguish EP from PsP.

The DeOrio One Finger Test: Does a Patients Ability To Localize Their Pain Lead to Different Clinical and Patient Reported Outcomes Than Those That Cannot?

Category: Other Introduction/Purpose: A basic requirement during a history and physical examination, in a foot and ankle clinic, is the ability to pinpoint where a patient experiences discomfort. Infrequently, patients are unable to localize their pain and “paint” over a non- anatomic distribution or point to multiple, independent areas across the foot. The ability to diagnose and treat a problem become significantly more difficult in these circumstances. In this study, the treatment course, clinical and patient reported outcomes(PROs) of patients who can pinpoint where they feel pain and those that “paint” over a non-anatomic area are compared. We hypothesize that patients unable to pinpoint are more likely to require advanced imaging studies, additional diagnostic modalities, and also less likely to improve in PROs at conclusion of treatment. Methods: Patients who presented in a foot and ankle clinic with foot pain between August 2021 and August 2022 were prospectively enrolled in this IRB approved study. The senior author completed a questionnaire after consultation identifying the patient as “able to pinpoint location of pain” or “unable to pinpoint location of pain.” Patients were excluded if they were < 18 years old, had neuropathy, or had pain as a result of a trauma (where does a trimalleolar ankle fracture hurt for example?). In cases where patients couldn’t pinpoint, they were counseled on localizing their symptoms and seen again 6 weeks later and given another chance to pinpoint. Diabetic patients had monofilament exams during presentation to control for undiagnosed neuropathy. Patients were followed for clinical outcomes, need for advanced imaging, need for additional diagnostic testing and finally PROs. All statistical analysis was conducted using GraphPad Prism(Ver 9.0, GraphPad Software, San Diego CA USA). Results: Overall, 423 patients were included (342 patients pinpointed and 91 patients did not). Patients unable to pinpoint were more likely to smoke (odds ratio=1.46) and to be diabetic (odds ratio=3.0). Patients with rheumatoid arthritis were more likely to be able to pinpoint(odds ratio=0.82) Patients unable to pinpoint presented with lower initial PROMIS Physical Function (40.0 vs. 43.3, p< 0.01) and increased Pain Interference (56.3 vs. 53.3, p< 0.01) and Depression (50.4 vs. 43.3, p< 0.01) then those that could localize. These patients were more likely to require advanced imaging (p=0.039) and diagnostic testing(EMG/image-guided injection) (p=0.044). Patient reported outcomes, in addition to starting out worse at presentation, did not see the same improvements at the conclusion of treatment. See the table for a summary of the key study findings. Conclusion: The ability to localize pain during a history and physical examination has direct bearing on a patients’ treatment course and outcomes in this single center study. Patients unable to pinpoint a location have lower initial and final PROs and also require more advanced imaging and diagnostic testing. Practitioners should continue to strive to better elucidate patient symptoms in hopes of more efficiently treating these patients. However, further research is needed to truly identify whether this presenting characteristic is truly indicative of patient outcomes.

Ten-Year Trend in Advanced Imaging Utilization for Suspected Pulmonary Embolism in Pregnancy

PurposeAdvanced imaging is essential to diagnose pulmonary embolism (PE) in pregnancy, but there are associated maternal and fetal radiation risks. The purpose of this study was to evaluate the 10-year trend in advanced imaging utilization for the evaluation of suspected PE in pregnancy. MethodsThe authors evaluated pregnant women with advanced imaging using CT pulmonary angiography (CTPA) or lung scintigraphy (LS) for evaluation of suspected PE presenting to two tertiary hospitals from 2007 to 2016. The rate of imaging was evaluated relative to positive PE rate and local pregnancy rate. positive PE was defined as a new acute PE finding on any advanced imaging within 3 days of first advanced imaging test. Local pregnancy rates were defined per 1,000 pregnancies in the county serviced by both hospitals. Chi-square testing was used to evaluate statistical significance (P < .05) in the utilization trend of advanced imaging and relative to local pregnancy rates and evaluations positive for PE. ResultsA total of 707 pregnant patients were identified, of whom 92.5% (n = 654) underwent CTPA and 7.5% (n = 53) underwent LS. Regression analysis showed an average increase of 5.2 advanced imaging studies per year (P < .001), with 61 and 105 studies performed in 2007 and 2016, respectively. Additionally, there was an average increase of 0.08 (P < .001) advanced imaging studies per 1,000 local pregnancies per year, doubling from 0.7 in 2007 to 1.4 in 2016 (P < .001). Finally, there was a decrease of 0.004 (P = .009) in advanced imaging positive for PE, from 3% (2 of 61) in 2007 to 0% (0 of 100) in 2016. ConclusionsAdvanced imaging utilization increased by 72% over the 10-year window, driven by higher use of CTPA. Although the detection rate of PE on advanced imaging has decreased, the utilization rate among pregnant patients doubled during this period. These results highlight the need to consider the radiation risks and costs of advanced imaging in specific patient populations.

Surgical Management of the Hostile Abdomen: A Comprehensive Current Review of Literature

This comprehensive review delves into the intricate landscape of surgical management in cases of a hostile abdomen. A hostile abdomen represents a formidable challenge characterized by factors such as severe adhesions, inflammation, abscesses, or the presence of foreign bodies, complicating surgical interventions. The preoperative phase is pivotal, requiring meticulous assessment and planning, often involving advanced imaging studies to anticipate potential complications. Surgeons must adapt to the unpredictable intraoperative challenges they encounter, such as dense adhesions and abscess drainage, employing skillful techniques to ensure patient safety. Minimally invasive approaches may be advantageous in select cases, minimizing surgical trauma and expediting recovery. Interdisciplinary collaboration among surgical specialties, anesthetists, radiologists, and nurses is essential to navigate these complex scenarios seamlessly. Potential complications, including prolonged operative times, increased blood loss, inadvertent injury, and postoperative infections, demand proactive management and comprehensive postoperative care. In conclusion, managing a hostile abdomen necessitates meticulous planning, adaptability, and interdisciplinary teamwork. Surgeons must navigate unpredictable intraoperative challenges while prioritizing patient safety and optimizing outcomes in this complex clinical entity.

Sizing SGLT2 Inhibitors Up: From a Molecular to a Morpho-Functional Point of View.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i), or gliflozins, have recently been shown to reduce cardiovascular death and hospitalization in patients with heart failure, representing a revolutionary therapeutic tool. The purpose of this review is to explore their multifaceted mechanisms of actions, beyond their known glucose reduction power. The cardioprotective effects of gliflozins seem to be linked to the maintenance of cellular homeostasis and to an action on the main metabolic pathways. They improve the oxygen supply for cardiomyocytes with a considerable impact on both functional and morphological myocardial aspects. Moreover, multiple molecular actions of SGLT2i are being discovered, such as the reduction of both inflammation, oxidative stress and cellular apoptosis, all responsible for myocardial damage. Various studies showed controversial results concerning the role of SGLT2i in reverse cardiac remodeling and the lowering of natriuretic peptides, suggesting that their overall effect has yet to be fully understood. In addition to this, advanced imaging studies evaluating the effect on all four cardiac chambers are lacking. Further studies will be needed to better understand the real impact of their administration, their use in daily practice and how they can contribute to benefits in terms of reverse cardiac remodeling.

Transthoracic Echocardiography in the Preoperative Assessment of Newborn Coarctation: Limiting Risks Associated with Advanced Imaging Techniques.

A newborn male child with prenatally identified aortic arch hypoplasia presented to our facility for cardiac management. He had been started on prostaglandins at the delivery facility and was subsequently placed on a high-flow nasal cannula due to associated apnea. On the day of life three, the patient underwent cardiac computed tomography scan for delineation of his anatomy. The patient remained intubated after his imaging study in anticipation of surgical intervention, which took place at the age of 5 days. The patient required a peritoneal dialysis catheter placement 2 days after his procedure due to oliguria. He progressed into renal failure requiring continuous renal replacement therapy. This patient was subsequently discussed at our departmental morbidity and mortality conference. The short time frame between contrast administration for the computed tomography and surgical intervention was thought to have contributed to his renal failure. We discussed the adequacy of transverse aortic arch imaging by echocardiogram and the utility of advanced imaging in the fragile neonatal period. This discussion resulted in our department asking, "Is transthoracic echocardiography accurate when diagnosing and characterizing aortic coarctation at our institution? Are advanced imaging studies necessary in instances of simple coarctation?"

Neuroscience Needs Network Science.

The brain is a complex system comprising a myriad of interacting neurons, posing significant challenges in understanding its structure, function, and dynamics. Network science has emerged as a powerful tool for studying such interconnected systems, offering a framework for integrating multiscale data and complexity. To date, network methods have significantly advanced functional imaging studies of the human brain and have facilitated the development of control theory-based applications for directing brain activity. Here, we discuss emerging frontiers for network neuroscience in the brain atlas era, addressing the challenges and opportunities in integrating multiple data streams for understanding the neural transitions from development to healthy function to disease. We underscore the importance of fostering interdisciplinary opportunities through workshops, conferences, and funding initiatives, such as supporting students and postdoctoral fellows with interests in both disciplines. By bringing together the network science and neuroscience communities, we can develop novel network-based methods tailored to neural circuits, paving the way toward a deeper understanding of the brain and its functions, as well as offering new challenges for network science.

The Medicare Appropriate Use Criteria Program: A Review of Recommendations for Testing in Coronary Artery Disease.

Congress established the Appropriate Use Criteria (AUC) Program to reduce unnecessary advanced imaging studies. Organizations that wish to develop AUC can apply to the Centers for Medicare & Medicaid Services (CMS) to qualify as provider-led entities (PLEs) under this program. Variable methods, content, and formatting of PLE-generated AUC could lead to clinician uncertainty about whether an advanced imaging test is appropriate or not. To review AUC published by CMS-qualified PLEs focused on advanced imaging tests for coronary artery disease (CAD), a "priority clinical area" identified by CMS. Publicly available data from the worldwide web searched on 29 August 2022. Approved AUC with recommendations related to testing for CAD. Manual review of published AUC by all authors. Among the 17 CMS-qualified PLEs, only 7 had published AUC related to CAD. Substantial variation in the methods and formatting of these AUCs was observed. The number of clinical scenarios covered ranged from 6 to 210, and the number of advanced imaging methods covered ranged from 1 to 25. When specifically applied to clinical scenarios, many AUC offered no guidance on appropriateness; those that did conflicted with respect to appropriateness. Other CMS-identified priority clinical areas were not evaluated. CMS-qualified AUC for imaging of CAD are heterogeneous and sometimes discrepant, creating substantial potential for uncertainty among clinicians seeking to provide their patients with appropriate imaging tests. No funding was received for this study.

OA02 Validation of newly proposed ACR/EULAR classification criteria for pediatric chronic nonbacterial osteomyelitis

Abstract Background Chronic nonbacterial osteomyelitis (CNO) is an aseptic autoinflammatory bone disease of unknown aetiology. This diagnosis can be delayed due to the non-specific nature of symptoms, referral patterns to non-rheumatology specialists and normal imaging studies. New ACR/EULAR classification criteria have been proposed for CNO and were presented at the American College of Rheumatology scientific meeting in 2022. This study seeks to validate these new classification criteria. Methods This is a retrospective case-series of paediatric patients diagnosed with CNO (n = 34). They were diagnosed and managed between 2012 and 2022 at the University of Virginia in Charlottesville, Virginia and Bon Secours Mercy Health in Richmond, Virginia. The entry criteria of chronic bone pain, age &amp;lt; 18 years, abnormal radiograph and/or MRI were used prior to applying the newly proposed ACR/EULAR classification criteria. Ten domains were evaluated to indicate whether a patient has CNO; those who scored 55 points or higher qualified (see table). The clinical manifestations, laboratory results, and imaging studies that lead to a diagnosis of CNO were reviewed in detail. We applied and validated the newly proposed classification criteria for CNO to this Virginia cohort of previously diagnosed paediatric CNO patients. We also reviewed the characteristics of those that did not fulfill these classification criteria. Result Upon application of the newly proposed ACR/EULAR classification criteria for CNO, 31 out of 34 patients (91%) were found to meet these classification criteria. Of the three patients diagnosed with CNO that did not fulfill the criteria, none had ‘least specific sites’ such as hands or neurocranium, all had elevated ESR and two out of three had an initial response to antibiotics. Their scores were 49, 51 and 53 with classification criteria being met with 55 or higher. The average age at diagnosis was 10 (range 2–17) years-old with the average time between onset of symptoms to confirmed radiographic evidence being 25 (range 1–120) months. The most common presenting symptoms were bone pain (100%) and arthritis (52%) with fever (23%) and rash (3%) being less common. Elevated ESR (39%) and CRP (39%) were found at initial visit with rheumatology. Evidence of commonly seen radiographic abnormalities leading to CNO diagnosis was found with regional MRI (65%), bone scan (42%) with some requiring full body MRI (26%) to confirm other lesions. Some patients did have multiple imaging studies including X-ray, CT, bone scan, MRI and bone biopsy in their workup. Conclusion This retrospective chart review validates the newly proposed ACR/EULAR classification criteria for CNO. We conclude that these criteria are easy to apply even in the absence of a bone biopsy or advanced imaging studies. This will aid in the development of a homogeneous cohort for future studies in CNO. Implication The newly proposed ACR/EULAR classification criteria can be easily applied to a cohort of CNO patients. These criteria have taken into account the lack of advanced imaging availability in certain institutions and lack of availability of a bone biopsy. Our work is ethically approved.

The Hoffmann parallax: a prospective study to determine the benefit of Hoffmann's sign.

Degenerative cervical myelopathy (DCM) is the most common cause of age-related spinal cord dysfunction worldwide. Despite the widespread use of provocative physical exam maneuvers in the workup of DCM, the clinical significance of Hoffmann's sign is controversial. The purpose of this study was to prospectively assess the diagnostic performance of Hoffmann's sign for DCM in a cohort of patients treated by a single spine surgeon. Patients were divided into two groups based on the presence of a Hoffmann sign on physical examination. Advanced imaging studies were independently reviewed by four raters for confirmation of a diagnosis of cervical cord compression. Prevalence, sensitivity, specificity, likelihood, and relative risk ratios for the Hoffmann sign were calculated, with subsequent Chi-square and receiver operator characteristic (ROC) analysis to further characterize correlative findings. Fifty-two patients were included - of whom, thirty-four (58.6%) patients presented with a Hoffmann sign, and eleven (21.1%) patients demonstrated cord compression on imaging. The Hoffmann sign demonstrated a sensitivity of 20% and a specificity of 35.7% (LR = 0.32; 0.16-1.16). Chi-square analysis revealed that imaging findings positive for cord compression were proportionally greater for patients lacking a Hoffmann sign than those with a confirmed Hoffmann sign (p =0.032) ROC analysis demonstrated that a negative Hoffmann sign performed moderately well in predicting cord compression (AUC.721; p =0.031). The Hoffmann sign is an unreliable marker for cervical cord compression, and the lack of a Hoffmann sign may be more predictive of cervical cord compression.

Complete androgen insensitivity syndrome with Sertoli cell tumour in a 27-year-old married woman: a case report

BackgroundAndrogen insensitivity syndrome is a rare X-linked disorder of sex development that results from mutations in the androgen receptors leading to failure of normal masculinization of the external genitalia in genetically male individuals. Our aim was to report this rare case of complete androgen insensitivity syndrome with Sertoli cell tumour, and our objective was to relate our experience on the challenges of the case and its successful management of the case.Case presentationWe report a case of a 27-year-old married Nigerian woman who presented at the surgical outpatient of our centre with a complaint of primary amenorrhea. She had an attendant history of coital difficulty following marriage. Clinical examination revealed a female phenotype with left groin swelling. A diagnosis of complete androgen insensitivity syndrome was made following hormonal evaluation, advanced imaging studies, karyotyping, and cytogenetic study. She and her parents including her husband were duly counselled on the natural history and principles of treatment of this clinical condition. She subsequently had a bilateral orchidectomy, and she was placed on oestrogen replacement therapy as well as serial vaginal dilation. The outcome was satisfactory.ConclusionWe reported a rare case of complete androgen insensitivity syndrome in a married woman. We documented our experience with successful conservative vaginal dilatation, which allowed satisfactory vaginal sexual intercourse.

Soft Tissue Benign Hand Masses in the First Web Space: A Retrospective Case Series.

Hand masses arefairly common. While most of these massesare either ganglion cysts or benign tumors, masses in the first web space are not rare, and they may in fact represent a variety of lesions. These include both benign and malignant tumors, metastases, or congenital and anomalous structures, and may involve nerves, vascular structures, connective tissue, and joints. In this retrospective case series, data on 12 cases of first dorsal web space hand mass treated at our center over a period of five years were collected and analyzed. Twelve consecutive patients presenting with a first dorsal web space hand massover a period of five years were reviewed.This represented a group of nine females and three males, with a mean age of 53 years (range = 16-70 years). Seven patients had a mass on the right side and five on the left side. The surgical approach to resect the mass in all 12 patients was dorsal. The most common diagnosis was ganglion cyst(50%), followed by lipoma(25%) and aneurysm(16.6%).There was one case of eccrinespiradenoma. Firstdorsal web space hand masses can encompass multiple different pathologies, and the first web space has an intricate anatomy.Both of these factors mandatea careful approach that includes meticulous preoperative planning with appropriate advanced imaging studies, which helps to make the surgical procedure more efficient and accurate.

MRI AS A DIAGNOSTIC TOOL FOR LOW BACK PAIN: ADVANTAGES AND LIMITATIONS-OBSERVATIONAL STUDY

Low back pain (LBP) is one of the most common health problems among the population all over the world including all age groups. LBP has become an epidemiological burden globally. It is the number one cause of years leading with disability. The most common age group affected includes 31-50 years. Advanced imaging studies, including computerized tomography (CT) and magnetic resonance imaging (MRI), are frequently ordered in the setting of LBP. Structural abnormalities are commonly identied by CT and MRI in patients complaining of low back pain, however, these ndings are also found in asymptomatic patients. [1] The study aims to evaluate the cause of low back pain using MRI as a diagnostic tool. This is an observational study conducted in The Department of Radiology, at Mahatma Gandhi Memorial Government Hospital, Trichy. The study was conducted over a period of 1 month. The study population size is 100 and includes the 10-70 years age group. Low back pain can have a variety of underlying causes, including spinal pathologies and other abnormal ndings involving organs beyond the spine. While spinal or vertebral pathologies can contribute the majority to LBP, they may not always be signicantly associated with it. As a result, MRI should not be the rst line of investigation for LBP. Instead, a comprehensive evaluation should be conducted to identify all possible pathologies. It is crucial to work closely with the patient's primary care physician to determine the most appropriate course of investigation and treatment for each case of low back pain.

311 A Feasibility Study for a Multicenter Phase-III Randomized Clinical Trial of Encephaloduroarteriosynagiosis Revascularization for Symptomatic Intracranial Atherosclerosis

INTRODUCTION: Stroke due to intracranial-atherosclerotic-disease (ICAD) remains a major public health concern, accounting for more than one-tenth of all ischemic-strokes in the US. METHODS: New data from advanced cerebral imaging and angiographic studies showed that revascularization after indirect-bypass occurs earlier than appreciated before. A pilot study of EDAS in ICAD patients demonstrated angiographic neovascularization as early as 1 month. An NINDS-funded phase-II objective-performance-criterion trial demonstrated reduction in the rate of stroke and death from 21.1% in the medical group to 9.6% in the surgical group at 2 years, passing the threshold for advancement to phase III. In collaboration with the NIH-StrokeNet, a national feasibility survey was sent to sites across the country to evaluate the feasibility of a phase-III clinical trial of EDAS in ICAD. RESULTS: Among 72 surveys completed by prospective sites, 90% (n = 65) indicated interest in participating and 96% of these (n = 63) had neurosurgeons and anesthesiologists with sufficient experience in EDAS and cerebrovascular disorders. The mean number of direct/indirect cerebral bypass surgeries per year completed at the prospective 40 sites was 19 (Range = 10-37). StrokeNet sites cared for a median of 42.5 patients/site/year (IQR = 25-100 patients/site/year) who met enrollment criteria. With 40 participating sites, the rate of enrollment needed for successful recruitment of 516 patients in a phase-III trial is 0.28 patients/site/month (3-4 patients/year), which is an order of magnitude less than the number of relevant cases receiving care at the sites (3.54 patients/month). CONCLUSIONS: EDAS is a promising technique in the management of ICAD and its performance is feasible within 40 high volume institutions. Engagement of the neurosurgical community on revitalizing a surgical form of revascularization can expand the role of neurosurgery in stroke management.

Low Back Pain Patients' Perceptions Regarding Their Own Radiology Reports: Pre-Intervention Survey.

While advanced medical technology and unlimited access to medical information might benefit and empower patients, these same advantages may pose some risks, especially in the cases where patients have direct access to advanced imaging studies. The aim of this work was to evaluate three domains related to patients with lower back pain: the patients' perceptions, misconceptions and the experience of anxiety-related symptoms following direct access to their thoraco-lumbar spine radiology report. An additional aim was the assessment of possible associations with catastrophization. Patients who were referred to the spine clinic, following the completion of a CT or MRI of their thoraco-lumbar spine were surveyed. Patient perceptionsof the importance of having direct access to their imaging report and of the concern they attribute to the medical terms found in their report were evaluated using a set of questionnaires. The medical terms severity scores were then correlated to a reference clinical score created for the same medical terms by spine surgeons. Lastly, patients' anxiety-related symptoms and Pain Catastrophizing Scale (PCS) after reading their radiology report were evaluated. Data from 162 participants (44.6% female), with mean age of 53.1 ± 15.6 years, were collected. Sixty-three percent of the patients stated that reading their report helped them gain better understanding of their medical condition and 84% agreed that having early access to the report helped improve communication with the physician. Patients' degree of concern associated with the medical terms in their imaging report ranged between 2.07 and 3.75, on a scale of 1-5. The patient's degree of concerns were significantly higher for six common medical terms and significantly lower in one, when compared to experts' opinions. A mean (± SD) of 2.86±2.79 anxiety-related symptoms was reported. The mean Pain Catastrophizing Scale (PSC) score was 29.18 ±11.86, ranging from 2 to 52. Both the degree of concerns and the number of symptoms reported were significantly associated with the PCS. Direct access to radiology reports might provoke anxiety symptoms, especially in patients with a tendency for catastrophic thinking. Increasing awareness amongst spine clinicians and radiologist about possible risks associated with direct access to radiology reports could contribute to preventing patients' misconceptions and unnecessary anxiety-related symptoms.

Evaluation of the Painful Total Shoulder Arthroplasty.

Despite the overall success of anatomic and reverse total shoulder arthroplasties (aTSA and rTSA), some patients continue to have or develop pain postoperatively. As the number of shoulder arthroplasties continues to increase in the United States, it is important that surgeons are able to recognize, diagnose, and treat the various pathologies. Some painful etiologies are specific to either aTSA or rTSA, and others can occur with both implant types. Infections, stiffness, neurologic syndromes, polyethylene wear, aseptic implant loosening, and metal allergies occur, regardless of implant choice. However, after an aTSA, subscapularis repair failure, superior rotator cuff tear, and joint overstuffing can result in shoulder pain. After a rTSA, specific causes of postoperative pain include instability, scapular notching, acromial or scapular spine fractures, subcoracoid pain, and neurologic injury. Regardless of the diagnosis, the surgeon must be methodical in the evaluation and, when appropriate, use blood work, advanced imaging studies, joint aspirations, shoulder arthroscopy, and nerve studies. Once diagnosed, appropriate treatment should be undertaken to resolve the cause of the pain or at least minimize the effect of the pain on the patient's outcome.

Wear debris in metal-on-metal bearings and modular junctions : What have we learned from the last decades?

Metal-on-metal (MoM) bearing hip arthroplasty saw increasing utilization and peaked in the 1990s and early 2000s. Although the linear and volumetric wear rate for aMoM bearings was lower than its polyethylene counterpart, metal ion particles were found to be approximately 10 × smaller and 500 × higher in quantity compared to polyethylene wear debris. Research into these articulations have demonstrated their relationship to the formation of lymphocyte-mediated adverse local tissue reactions. The work-up for metal particle-associated conditions (metallosis) includes athorough patient history and physical examination, blood laboratory studies for metal ion concentrations, and advanced imaging studies including magnetic resonance imaging (MRI). The treatment of metallosis and adverse local tissue reactions ranges from close serial observation to extensive debridement and full revision of arthroplasty components, when indicated.

Advances in Imaging Studies of Human Epidermal Growth Factor Receptor 2 in Gastric Cancer

Advances in Imaging Studies of Human Epidermal Growth Factor Receptor 2 in Gastric Cancer

Pseudotumor deltoideus: An unusual and rare case treated in rural coal mine hospital

Abstract Pseudotumor deltoideus is a relatively recently coined term to describe the condition of the spectrum of eccentric bone irregularities around the deltoid tubercle region of the humerus. Usually, these patients complain of varying degrees of pain, swelling, and discomfort in and around the deltoid tuberosity region of the humerus. The radiological findings of these patients are characterized by relative cortical lucency in and around the deltoid tuberosity of humerus, cortical irregularity, and adjacent eccentric marrow abnormality in computed tomography and magnetic resonance imaging scans. Most probably, these are previously less-reported anatomical variations of the deltoid tuberosity region of the humerus. Advanced imaging studies and extended follow-up suggest that this clinical entity has got an indolent process, which can be managed conservatively. The purpose of this presentation is to highlight this lesser known and reported cause of shoulder and arm pain and to make this cause be considered while formulating a management protocol.