Alternative Imaging Research Articles

Diagnostic Accuracy of a Combination of Preoperative 68-Ga Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography and Multiparametric Magnetic Resonance Imaging in Localized Prostate Cancer

Introduction: Prostate cancer (PCa) is a common and leading course of cancer-related death in men. Although there are studies on multiparametric magnetic resonance imaging (MpMRI) with good diagnostic results in detecting clinically significant PCa, new methods have been investigated due to the low positive predictive values. In this context, prostate-specific membrane antigen positron emission tomography (PSMA PET) emerges as an alternative imaging method to MpMRI. This study aimed to compare 68Ga PSMA I&T-PET/CT and MpMRI in determining tumor location. Methods: Preoperative MpMRI and 68Ga PSMA I&T-PET/CT scans and pathology specimens of patients who underwent radical prostatectomy for PCa at our clinic between 2018 and 2021 were retrospectively evaluated. PSMA I&T-PET/CT, MpMRI, combined imaging were compared for tumor localization according to histopathological data. Results: In terms of tumor localization, MpMRI demonstrated overall accuracy rates of 75.9% (p kappa [κ] 0.0001* [0.525]). 68Ga PSMA I&T-PET/CT showed 71.5% (p κ 0.0001* [0.438]). For the combined imaging approach, the overall accuracy rate was calculated as 79.2% (p κ 0.0001* [0.576]). Additionally, high diagnostic accuracy was achieved for the combined imaging approach, particularly in the intermediate ISUP group. Moreover, SUVmax was calculated as 6.37. Conclusion: The combined use of 68Ga PSMA I&T-PET/CT and MpMRI has high diagnostic rates. However, the high cost is a significant disadvantage that limits their routine combined use.

Jejunogastric intussusception associated with jejunojejunal intussusception (double telescoping) occurring 20 years after gastrojejunostomy.

Jejunogastric intussusception (JGI) is a rare but potentially lethal complication following gastrectomy or gastrojejunostomy surgeries. Diagnosis of this condition can be challenging due to its rarity and non-specific symptoms. This article presents a case report of a 60-year-old male with a history of trans mesocolic gastrojejunostomy who developed acute symptoms of JGI. The patient presented with acute epigastric pain, vomiting, and hematemesis. Physical examination and laboratory tests indicated dehydration, tachycardia, and leukocytosis. Computed tomography (CT) revealed intussuscepted loops within the stomach. Emergency laparotomy was performed, and the intussusception was manually reduced without the need for resection. The patient recovered well and was discharged five days post-surgery. Retrograde jejunogastric intussusception is a rare complication, often occurring years after gastric surgery. It can be classified into acute and chronic forms, with the former presenting with intense pain and potential hematemesis. The condition can arise in different surgical contexts and even spontaneously. The cause of JGI remains unclear, but factors such as hyperacidity, abnormal motility, and increased intra-abdominal pressure have been implicated. Diagnosis can be made through endoscopy or alternative imaging modalities such as CT. Surgical intervention is the treatment of choice, with various options available based on intraoperative findings. Retrograde jejunogastric intussusception is challenging to diagnose and treat due to its rarity and lack of understanding of its causes. Imaging techniques and endoscopy play important roles in diagnosis, while surgery remains the primary treatment option. Vigilance is necessary among medical professionals to consider JGI in cases of acute abdominal pain and vomiting following gastric surgery, allowing for prompt diagnosis and intervention to prevent bowel necrosis. Further research is needed to establish optimal surgical strategies and evaluate recurrence rates.

The Diagnostic Accuracy of Transcranial Color-Coded Doppler Ultrasound Technique in Stratifying Intracranial Cerebral Artery Stenoses in Cerebrovascular Disease Patients: A Systematic Review and Meta-Analysis.

The early and accurate stratification of intracranial cerebral artery stenosis (ICAS) is critical to inform treatment management and enhance the prognostic outcomes in patients with cerebrovascular disease (CVD). Digital subtraction angiography (DSA) is an invasive and expensive procedure but is the gold standard for the diagnosis of ICAS. Over recent years, transcranial color-coded Doppler ultrasound (TCCD) has been suggested to be a useful imaging method for accurately diagnosing ICAS. However, the diagnostic accuracy of TCCD in stratifying ICASs among patients with CVD remains unclear. Therefore, this systematic review and meta-analysis aimed at evaluating the diagnostic accuracy of TCCD in the stratification of intracranial steno-occlusions among CVD patients. A total of six databases-Embase, CINAHL, Medline, PubMed, Google Scholar, and Web of Science (core collection)-were searched for studies that assessed the diagnostic accuracy of TCCD in stratifying ICASs. The meta-analysis was performed using Meta-DiSc 1.4. The Quality Assessment of Diagnostic Accuracy Studies tool version 2 (QUADAS-2) assessed the risk of bias. Eighteen studies met all of the eligibility criteria. TCCD exhibited a high pooled diagnostic accuracy in stratifying intracranial steno-occlusions in patients presenting with CVD when compared to DSA as a reference standard (sensitivity = 90%; specificity = 87%; AUC = 97%). Additionally, the ultrasound parameters peak systolic velocity (PSV) and mean flow velocity (MFV) yielded a comparable diagnostic accuracy of "AUC = 0.96". In conclusion, TCCD could be a noble, safe, and accurate alternative imaging technique to DSA that can provide useful diagnostic information in stratifying intracranial steno-occlusions in patients presenting with CVD. TCCD should be considered in clinical cases where access to DSA is limited.

Synthesizing Contrast-Enhanced MR Images from Noncontrast MR Images Using Deep Learning.

Recent developments in deep learning methods offer a potential solution to the need for alternative imaging methods due to concerns about the toxicity of gadolinium-based contrast agents. The purpose of the study was to synthesize virtual gadolinium contrast-enhanced T1-weighted MR images from noncontrast multiparametric MR images in patients with primary brain tumors by using deep learning. We trained and validated a deep learning network by using MR images from 335 subjects in the Brain Tumor Segmentation Challenge 2019 training data set. A held out set of 125 subjects from the Brain Tumor Segmentation Challenge 2019 validation data set was used to test the generalization of the model. A residual inception DenseNet network, called T1c-ET, was developed and trained to simultaneously synthesize virtual contrast-enhanced T1-weighted (vT1c) images and segment the enhancing portions of the tumor. Three expert neuroradiologists independently scored the synthesized vT1c images by using a 3-point Likert scale, evaluating image quality and contrast enhancement against ground truth T1c images (1 = poor, 2 = good, 3 = excellent). The synthesized vT1c images achieved structural similarity index, peak signal-to-noise ratio, and normalized mean square error scores of 0.91, 64.35, and 0.03, respectively. There was moderate interobserver agreement between the 3 raters, regarding the algorithm's performance in predicting contrast enhancement, with a Fleiss kappa value of 0.61. Our model was able to accurately predict contrast enhancement in 88.8% of the cases (scores of 2 to 3 on the 3-point scale). We developed a novel deep learning architecture to synthesize virtual postcontrast enhancement by using only conventional noncontrast brain MR images. Our results demonstrate the potential of deep learning methods to reduce the need for gadolinium contrast in the evaluation of primary brain tumors.

Accuracy of cone-beam breast computed tomography for assessing breast cancer tumor size-comparison with breast magnetic resonance imaging.

Accurate preoperative assessment of tumor size is important in developing a surgical plan for breast cancer. The purpose of this study was to evaluate the accuracy of cone-beam breast computed tomography (CBBCT) and magnetic resonance imaging (MRI) in the assessment of tumor size and to analyze the factors influencing the discordance. In this retrospective study, patients with breast cancer who underwent preoperative contrast-enhanced CBBCT (CE-CBBCT) and dynamic contrast-enhanced MRI (DCE-MRI) and received a complete pathologic diagnosis from August 2020 to December 2021 were included, using the pathological result as the gold standard. Two radiologists assessed the CBBCT and MRI features and measured the tumor size with a 2-week washout period. Intraclass correlation coefficient (ICC) and Bland-Altman analyses were used to assess inter-observer reproducibility and agreement based on CBBCT, MRI and pathology. Univariate analyses of differences in clinical, pathological and CBBCT/MRI features between the concordant and discordant groups was performed using the t-test, Mann-Whitney U-test, Chi-squared test and Fisher's exact test. Multivariate analyses were used to identify factors associated with discordance of CBBCT/MRI with pathology. A total of 115 female breast cancer patients (115 lesions) were included. All patients had a single malignant tumor of the unilateral breast. The reproducibility and the agreement ranged from moderate to excellent (ICC =0.607-0.983). Receiver operating characteristic (ROC) analyses showed that the cut-off values of CBBCT-pathology and MRI-pathology discordance were 2.25 and 2.65 cm, respectively. CBBCT/MRI-pathology concordance was significantly associated with the extent of pathology, lesion type, presence of calcification, human epidermal growth factor receptor 2 (HER2) status and fatty infiltration (P<0.05). In lesions containing calcification, the difference of CBBCT-pathology was significantly smaller than MRI-pathology (P=0.021). Non-mass enhancement (NME) was the main predictor of CBBCT- or MRI-pathology discordance [odds ratio (OR) =3.293-6.469, P<0.05], and HER2 positivity was a predictor of CBBCT-pathology discordance (OR =3.514, P=0.019). CBBCT and MRI have comparable accuracy in measurement of tumor size, and CBBCT is advantageous in assessing the size of calcified lesions. NME and HER2 positivity are significant predictors of CBBCT-pathology discordance. This suggests that CBBCT might serve as an alternative imaging technique to assess tumor size when patients do not tolerate MRI.

Low-value MRI of the knee in Norway: a register-based study to identify the proportion of potentially low-value MRIs and estimate the related costs

ObjectivesThe objective of this study is to investigate the proportion of potentially low-value knee MRI in Norway and to provide an estimate of the related costs.DesignRegister study based on conditional...

Usefulness of Intraoperative Infrared Thermography in Intracranial Surgeries: Past, Present, and Future

AbstractWith the advancement of technology in Neurosurgery, imaging guidance for surgical planning and intraoperative assessment has become relevant. Currently, two major methods of imaging guidance are generally explored in the literature, namely based on imaging and fluorescence. These techniques, however, are not without limitations. Thermal imaging has potentially broad applications in clinical practice, especially for intracranial diseases. Infrared thermography (IT) has been an underestimated tool with few reports on its usefulness during intracranial surgeries. In this article, we aim to provide a brief discussion on the limitations of current intraoperative imaging techniques for intracranial surgeries and to provide an in-depth state-of-the-art review on intraoperative IT (IIT) for intracranial lesions. High-resolution IIT is a non-invasive alternative imaging method that provides real-time estimation of regional cerebral blood flow. For brain tumors, the studies were mostly directed to diagnostic purposes and occasionally for lesion-localization. The use of IIT to address the extent of resection is a potential new application. Clinical data in this issue suggests that IIT might detect residual tumors, occasionally not assessed by other imaging technologies. Thermographic measurements during vascular and epilepsy surgeries comprise an interesting field for future research with potential clinical implications. Further experimental and clinical studies should be addressed to provide technical refinements and verify the usefulness of this noninvasive technology in neurosurgery.

Radiolabeling, Characterization, And In Vitro Cell Culture Studies of Donepezil-Loaded Niosome Formulations For Brain Imaging

Dementia has posed a significant public health challenge for aging populations in developed countries for many years. Alzheimer's Disease (AD) is the most prevalent cause of dementia, marked by cognitive and behavioral irregularities resulting from cholinergic dysfunction, a progressive and irreversible neurodegenerative disorder. Restoring cholinergic neurotransmission can alleviate impaired cognitive and behavioral symptoms in AD patients. Donepezil (DNP) is an acetylcholinesterase inhibitor utilized to treat mild to moderate AD symptoms. Niosomes, non-ionic surfactant vesicles, present an array of benefits as drug delivery systems, including stability, non-immunogenicity, permeation potential, and controlled release ability. In this research, we prepared, characterized, radiolabeled with 99mTc, and evaluated DNP-loaded niosome formulations as radiopharmaceuticals for brain imaging agents. The findings suggest that this innovative radiopharmaceutical ([99mTc]Tc-formulation) has the potential to serve as a promising alternative imaging agent for neurological disorders.

Detecting suspected scaphoid fractures? the role of different imaging modalities within a district general hospital during the pandemic

Background: This study evaluates the effectiveness of magnetic resonance imaging (MRI) versus computerised tomography (CT) scans for persistent wrist pain at the thumb base following injury in adults and children during covid. This was part of a pathway introduced as access to MRI scan was limited. Methods: Patients were identified as having possible scaphoid fractures within the emergency department but had no fracture identified on initial imaging over a 3-month period. These were triaged to a scaphoid pathway during the covid pandemic from a virtual clinic. Patients were reviewed clinically and radiographically within the hand clinic using further imaging with CT or MRI scan. Results: During the study time 45 patients with scaphoid fractures were detected on initial radiography in ED and 187 with suspected scaphoid fractures were selected for further review. Ninety (48%) were referred to the hand clinic where 2 (1%) scaphoid fractures were diagnosed on a second radiograph and ninety-seven (52%) were to be seen in an upper limb clinic where 2 (1%) further fractures were detected. 92% of scaphoid fractures were identified on radiography either in ED or orthopaedic clinic. Of the remaining 178 with two negative radiographs further imaging was requested in 45 cases (25%). Pathology was found in 17 (58%) MRI scans and in 7 (39%) CT scans. Conclusions: Imaging needs to be timely to enable effective treatment. Obtaining MRI scans while diagnostically superior is not always achievable especially in times of resource depletion. Back up pathways using alternative imaging can be effective.

Comparison of three recent discrete stochastic inversion methods and influence of the prior choice

Groundwater flow depends on subsurface heterogeneity, which often calls for categorical fields to represent different geological facies. The knowledge about subsurface is however limited and often provided indirectly by state variables, such as hydraulic heads of contaminant concentrations. In such cases, solving a categorical inverse problem is an important step in subsurface modeling. In this work, we present and compare three recent inverse frameworks: Posterior Population Expansion (PoPEx), Ensemble Smoother with Multiple Data Assimilation (ESMDA), and DREAM-ZS (a Markov chain Monte Carlo sampler). PoPEx and ESDMA are used with Multiple-point statistics (MPS) as geostatistical engines, and DREAM-ZS is used with a Wasserstein generative adversarial network (WGAN). The three inversion methods are tested on a synthetic example of a pumping test in a fluvial channelized aquifer. Moreover, the inverse problem is solved three times with each method, each time using a different training image to check the performance of the methods with different geological priors. To assess the quality of the results, we propose a framework based on continuous ranked probability score (CRPS), which compares single true values with predictive distributions. All methods performed well when using the training image used to create the reference, but their performances were degraded with the alternative training images. PoPEx produced the least geological artifacts but presented a rather slow convergence. ESMDA showed initially a very fast convergence which reaches a plateau, contrary to the remaining methods. DREAM-ZS was overly confident in placing some incorrect geological features but outperformed the other methods in terms of convergence.

CGAN-ECT: Reconstruction of Electrical Capacitance Tomography images from capacitance measurements using Conditional Generative Adversarial Networks

Due to the rapid growth of applications of Electrical Capacitance Tomography (ECT) across diverse industrial sectors, there is a pressing demand for swift and high-fidelity methodologies for image reconstruction from raw capacitance measurements. Deep learning, as an effective non-linear mapping tool for complicated functions, has been going viral in many fields including electrical tomography. This paper introduces a pioneering contribution by proposing a Conditional Generative Adversarial Network (CGAN) model explicitly tailored for the purpose of reconstructing ECT images from capacitance measurements. We propose a novel modulator to transform the raw input capacitance measurements into a 2D image. To the best of our knowledge, this is the first time to represent the capacitance measurements in an image form. We have created a new massive ECT dataset of synthetic image-measurements pairs for training and testing purposes of the proposed model. This extensive ECT dataset comprises 320,000 synthetic image-measurement pairs. It forms the basis for evaluating the feasibility and generalizability of the CGAN-ECT model, with assessments conducted on testing data, contaminated data, and flow patterns which are intentionally excluded from the model’s training phase. The evaluation results prove the efficacy of the proposed CGAN model in generating ECT images with heightened accuracy compared to traditional methods and alternative deep learning-based image reconstruction algorithms. The CGAN-ECT model has succeeded in a achieving an average image correlation coefficient exceeding 99.3%, coupled with an average relative image error of approximately 0.07.

Bridging the gap: improving correspondence between low-field and high-field magnetic resonance images in young people.

Portable low-field-strength magnetic resonance imaging (MRI) systems represent a promising alternative to traditional high-field-strength systems with the potential to make MR technology available at scale in low-resource settings. However, lower image quality and resolution may limit the research and clinical potential of these devices. We tested two super-resolution methods to enhance image quality in a low-field MR system and compared their correspondence with images acquired from a high-field system in a sample of young people. T1- and T2-weighted structural MR images were obtained from a low-field (64mT) Hyperfine and high-field (3T) Siemens system in N = 70 individuals (mean age = 20.39 years, range 9-26 years). We tested two super-resolution approaches to improve image correspondence between images acquired at high- and low-field: (1) processing via a convolutional neural network ('SynthSR'), and (2) multi-orientation image averaging. We extracted brain region volumes, cortical thickness, and cortical surface area estimates. We used Pearson correlations to test the correspondence between these measures, and Steiger Z tests to compare the difference in correspondence between standard imaging and super-resolution approaches. Single pairs of T1- and T2-weighted images acquired at low field showed high correspondence to high-field-strength images for estimates of total intracranial volume, surface area cortical volume, subcortical volume, and total brain volume (r range = 0.60-0.88). Correspondence was lower for cerebral white matter volume (r = 0.32, p = 0.007, q = 0.009) and non-significant for mean cortical thickness (r = -0.05, p = 0.664, q = 0.664). Processing images with SynthSR yielded significant improvements in correspondence for total brain volume, white matter volume, total surface area, subcortical volume, cortical volume, and total intracranial volume (r range = 0.85-0.97), with the exception of global mean cortical thickness (r = 0.14). An alternative multi-orientation image averaging approach improved correspondence for cerebral white matter and total brain volume. Processing with SynthSR also significantly improved correspondence across widespread regions for estimates of cortical volume, surface area and subcortical volume, as well as within isolated prefrontal and temporal regions for estimates of cortical thickness. Applying super-resolution approaches to low-field imaging improves regional brain volume and surface area accuracy in young people. Finer-scale brain measurements, such as cortical thickness, remain challenging with the limited resolution of low-field systems.

Imaging of cylindrical inhomogeneites in a parallel plate waveguide with reverse time migration method

Abstract While reverse time migration (RTM) algorithm is commonly used in geophysical explorations, this paper addresses the RTM imaging procedure for reconstructing of lossy dielectric discontinuities in a planar waveguide using electromagnetic waves at a single frequency. The direct problem of the related configuration is solved via method of moments (MoM) to produce the synthetic scattered data to be used in RTM. The achievements of the method are examined and verified by including different numerical examples. It is shown that the RTM approach can be used as an alternative imaging methodology in parallel plate waveguide problems.

Point of care thoracic ultrasound versus chest computed tomography in the approach of febrile neutropenia patients: A diagnostic accuracy cohort study.

Single-center prospective cohort diagnostic accuracy study. Our study aimed to evaluate the accuracy and reproducibility of Thoracic Ultrasound (TUS) in detecting pulmonary pathology in immunosuppressed patients. We conducted a single-center prospective study. Consecutive patients with febrile neutropenia who underwent CT (Computerized Tomography) underwent TUS evaluation within 24h of CT. Both studies were performed by an expert who was blinded to the clinical information and results of the alternative imaging modalities. 34 patients met the inclusion criteria. The median age was 39.9 years (±17 standard deviation). TUS as a diagnostic test had a sensitivity of 92.9% and specificity of 83.3%, negative predictive value of 71.4%, and positive predictive value of 96.3%. Substantial between-method agreement was demonstrated with a kappa of 0.71 (P = .001) between the TUS and chest CT findings. We obtained a kappa of 1 (P = .001) for the final diagnosis of Pleural Effusion (PE). We concluded that TUS is a promising screening test for immunocompromised individuals. The results showed good diagnostic performance of TUS compared to CT for the detection of pulmonary findings highly suggestive of pathology with high accuracy and reproducibility.

Кинематографичность как особенность поэтики романов Кадзуо Исигуро

The aim of the study is to identify the features of implementation of the cinematic chronotope by means of creating literary cinematic quality in Kazuo Ishiguro’s novels aimed at ensuring an audiovisual and emotional impact of the literary text on the reader. Despite the interest in this writer, at the moment, there is a gap in research on the interaction between literature and cinema based on the material of Kazuo Ishiguro’s creative work. The scientific originality of the study lies in the fact that the identified set of literary means of creating cinematic poetics makes it possible to determine how Kazuo Ishiguro’s work with screenplays, personal interest in cinema and focus on the “reader-viewer” determines his individual style. As a result, the study revealed the implementation of the cinematic code in Kazuo Ishiguro’s texts at several levels, which indicates the artistic value of these means for blurring the boundary between cinema and the modern intellectual novel. The pragmatic function of cinematic techniques in Kazuo Ishiguro’s novels helps to dynamically develop scenes, rhythmically alternate images and paintings, deepens the range of problems and contributes to the visualization of psychological experiences of characters, affects the readers, immersing them in a unique fictional world.

Self-guided imagery rescripting for worry images: A preliminary experimental investigation.

Mental images of feared events are overactive and intrusive in generalized anxiety disorder (GAD). Imagery rescripting involves integration of positive or neutral imagery and corrective information into images to facilitate emotional processing, reduce imagery intrusions, and re-structure underlying schema. Yet only one known study has applied the technique to treatment of worry. The present study aimed firstto examine the relationship between trait worry and properties of future-oriented worry images, and secondto examine the efficacy of a self-guided imagery rescripting intervention in improving individuals' response to their worries. Participants recruited through Amazon Mechanical Turk (N = 365) identified their major worry and wrote the script of a worst-case scenario mental image. Participants were randomized to three conditions: re-writing the same worry image script (exposure), or writing scripts of either one or three positive alternative future-oriented images (rescripting conditions). In preliminary analyses, trait worry negatively predicted participants' ratings of worry images, including valence and ability to cope, and positively predicted distress, anticipated cost, and belief in their negative meaning. In experimental analyses, linear mixed-effects models revealed anxious response and cognitive appraisal of the threat were significantly lower among participants allocated to rescripting relative to exposure. There was no effect of rescripting type. This investigation demonstrated the impact of a future-oriented imagery rescripting task on anxiety and cognitive biases associated with real worries in an unselected sample. Results may contribute to the development of imagery rescripting interventions for GAD.

A comparative study of EM-CCD and CMOS cameras for particle ion trajectory imaging

High-resolution and real-time imaging of particle ion trajectories is essential in nuclear medicine and nuclear engineering. One potential method to achieve high-resolution real-time trajectory imaging of particle ions involves utilizing an imaging system that integrates a scintillator plate with a magnifying unit and a cooled electron multiplying charge-coupled device (EM-CCD) camera. However, acquiring an EM-CCD camera might prove challenging due to the discontinuation of CCD sensor manufacturing by vendors. As an alternative imaging approach, a low-noise, high-sensitivity camera utilizing a cooled complementary metal-oxide-semiconductor (CMOS) sensor offers a promising solution for imaging particle ion trajectories. Yet, it remains uncertain whether CMOS-based cameras can perform as effectively as CCD-based cameras in capturing particle ion trajectories. To address these concerns, we conducted a comparative analysis of the imaging performance between a CMOS-based system and an EM-CCD-based system for capturing alpha particle trajectories. The results revealed that both systems could image the trajectories of alpha particle, but the spatial resolution with the CMOS-based camera exceeded that of the EM-CCD-based camera, primarily due to the smaller pixel size of the sensor. While the signal-to-noise ratio (SNR) of the trajectory image from the CMOS-based camera initially lagged behind that from the EM-CCD-based camera, this disparity was mitigated by implementing binning techniques on the CMOS-based camera images. In conclusion, our findings suggest that a cooled CMOS camera could serve as a viable alternative for imaging particle ion trajectories.

The Role of Contrast-Enhanced Mammography After Cryoablation of Breast Cancer.

Image-guided cryoablation is an emerging therapeutic technique for the treatment of breast cancer and is a treatment strategy that is an effective alternate to surgery in select patients. Tumor features impacting the efficacy of cryoablation include size, location in relation to skin, and histology (e.g., extent of intraductal component), underscoring the importance of imaging for staging and workup in this patient population. Contrast-enhanced mammography (CEM) utilization is increasing in both the screening and diagnostic settings and may be useful for follow-up imaging after breast cancer cryoablation, given its high sensitivity for cancer detection and its advantages in terms of PPV, time, cost, eligibility, and accessibility compared with contrast-enhanced MRI. This Clinical Perspective describes the novel use of CEM after breast cancer cryoablation, highlighting the advantages and disadvantages of CEM compared with alternate imaging modalities, expected benign postablation CEM findings, and CEM findings suggestive of residual or recurrent tumor.

New Prospects on Neuroimaging in Von Hippel Lindau Disease—A Narrative Review

(1) Background: Hemangiomas in Von Hippel-Lindau (VHL) syndrome patients are typically benign but pose threats due to their vital locations involving the central nervous system and the retina. An MRI is currently recommended as the gold standard for tumors associated with VHL in the head region. This narrative review aims to comprehensively outline current standards and recent findings related to imaging of retinal and CNS hemangiomas in Von Hippel-Lindau syndrome. (2) Material and Methods: A review in adherence to PRISMA guidelines using the search string “Von Hippel-Lindau hemangioblastoma imaging” was conducted on PUBMED and SCOPUS databases. (3) Results: After reviewing 455 titles and abstracts, 20 publications fulfilling the inclusion criteria were analyzed. The analysis included studies describing MRI, CT, optical coherence tomography, and PET/CT. (4) Conclusion: While MRI remains the gold standard for diagnosing head tumors in Von Hippel-Lindau syndrome, various PET/CT methods show promise as alternative imaging modalities.

Acromion and scapular spine fractures after reverse shoulder arthroplasty: rate of detection by computed tomography

BackgroundAcromion and scapular spine fractures (ASFs) after reverse total shoulder arthroplasty have been reported at a rate of 3.9 percent. Radiographs have been shown to be unreliable at identifying these fractures, with an estimated 20% false negative rate. A computed tomography (CT) scan is typically performed when initial radiographs are inconclusive and clinical suspicion for ASF remains high. However, the accuracy of identifying ASF fractures after reverse shoulder arthroplasty (RSA) with CT has not been studied. The purpose of this paper is to evaluate the ability of CT scans to detect clinically suspected ASF fractures after RSA when initial radiographs are inconclusive. MethodsA retrospective review of our institution’s shoulder and elbow repository identified 111 patients treated with RSA from 2006 to 2022 that subsequently sustained an ASF. Upon clinical suspicion of an ASF, a 4-view radiographic series was obtained. If no fracture was clearly identified, a thin-cut CT was obtained. Additional four-view radiographic series were taken at each subsequent follow-up. Rate of detection by CT scan was defined using the number of cases with positive scans out of the number in which both a CT scan was performed, and a fracture was identified on either CT scan or other additional follow-up imaging. ResultsAfter inconclusive radiographs, a CT was ordered for 61 patients (55%) at a median of 1.3 weeks after the onset of signs/symptoms suspicious for ASF. Fractures were identified in 52 cases (85.2%) at a median of 1.6 weeks after the onset of sign/symptoms. The fracture was not seen on CT in 9 cases at a median of 0.9 week after the onset of sign/symptoms, representing a false negative rate of 14.8%. These fractures were later identified on radiographs at a median of 5.9 weeks following the CT scan. No statistical differences were observed in sensitivity of CT scan between fracture types. Fractures initially missed on CT scan eventually displaced and became nonunions. ConclusionCT scans can be helpful in identifying and characterizing ASF following RSA, with an overall rate of detection (sensitivity) of 85%. Consideration of alternative advanced imaging may be needed for patients with negative CT scans and a high index of clinical suspicion for ASF.