Features Of Lesions Research Articles

Incidence and Characteristics of Dermatophytosis Lesions in Cats (Felis catus) at Go Pet Care Animal Clinic (2020-2022)

Dermatophytosis, a dermatological condition caused by dermatophyte fungi, affects the superficial keratinized structures of the skin. The primary etiological agents include the genera Microsporum, Trichophyton, and Epidermophyton. This study examines the incidence and characteristics of dermatophytosis lesions in domestic cats (Felis catus) at Go Pet Care Animal Clinic from 2020 to 2022. The research utilized secondary data from the clinic's medical records, which is a significant reference institution in Kabupaten Bandung Barat, to assess the prevalence and features of dermatophytosis within this population. The findings revealed a prevalence of 7.5% in 2020, 11.3% in 2021, and 3.7% in 2022. The incidence was highest in cats under 1 year of age, with a notable frequency in Persian breed cats and males. Common lesions identified included localized alopecia primarily in the ear region, alopecia in the back region, and crust formation also in the back area. This study provides critical insights into the epidemiology and clinical presentation of dermatophytosis in domestic cats, offering guidance for improved diagnosis and management of the condition.

Advancements in radiosurgery for the treatment of arteriovenous malformations

Arteriovenous malformations (AVMs) are complex vascular anomalies with high risks of hemorrhage and neurological deficits. The evolution of stereotactic radiosurgery (SRS) represents a significant advancement in their management, offering a less invasive alternative to traditional surgical approaches. This study aims to evaluate recent developments in SRS techniques for treating AVMs by conducting an integrative literature review. Utilizing the PICO strategy, a systematic search was performed across databases like LILACS, MEDLINE, and SCIELO, focusing on clinical trials, observational studies, meta-analyses, and systematic reviews. The analysis revealed that while microsurgical excision remains a definitive approach, SRS—particularly with advanced systems like Gamma Knife, Linac, CyberKnife, and Zap-X—has shown promising results in reducing hemorrhage rates and lesion volumes with lower complications. The findings indicate that SRS, bolstered by improved imaging and radiation precision, provides a viable alternative to invasive methods, though its effectiveness varies among different systems. This review underscores the need for a multidisciplinary approach in AVM management, emphasizing tailored treatment strategies based on lesion characteristics and patient-specific factors.

News on the imaging of large vessel vasculitis

Large vessel vasculitis, including giant cell arteritis (GCA) and Takayasu arteritis (TAK), are autoimmune diseases primarily affecting the aorta and its branches. GCA is the most common primary vasculitis. Inflammatory changes in the vessel walls can cause serious complications such as amaurosis, stroke, and aortic dissection and rupture. Imaging techniques have become an integral part for the diagnosis and monitoring of large vessel vasculitis, allowing for effective disease monitoring. GCA and TAK exhibit similar patterns of vascular distribution. However, the temporal arteries are never involved in TAK, and axillary arteritis occurs more frequently in GCA. In most centers, ultrasound of the temporal and axillary arteries has replaced temporal artery biopsy as the primary diagnostic tool for GCA. In addition to ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and [18F]-FDG (fluorodeoxyglucose) positron emission tomography-computed tomography (PET) are important, particularly for visualizing the aorta. Moreover, PET-CT is now also capable of assessing the temporal arteries, although it is not yet widely available. In polymyalgia rheumatica (PMR), ultrasound of the shoulder and hip regions is part of the ACR/EULAR classification criteria. MRI allows detailed visualization of additional inflammatory extraarticular manifestations, showing characteristic inflammatory lesions in entheses, tendons, and ligaments. [18F]-FDG-PET-CT also enables the visualization of musculoskeletal inflammation, especially in the shoulder and hip regions, as well as paravertebral areas. Ultrasound can detect subclinical GCA in up to 23% of patients with PMR, which should be treated like GCA. Technological innovations such as new radiotracers and improved MRI imaging could further enhance the diagnosis and monitoring of large vessel vasculitis and PMR, thus playing acrucial role in improving the prognosis through faster initiation of therapy.

Fine-Needle Aspiration versus the CytoCore® Motorized Rotating Needle Device for Thyroid Nodule Biopsies: A Retrospective Cohort Study

Introduction: Recently, an FDA cleared motorized fine-needle aspiration device (CytoCore®, Praxis Medical) has become available which is designed to reduce sample variability by enabling more consistent sampling due to the rotational drilling action of the device in combination with the standard in and out motion used to access the thyroid nodule with a needle. The rotation of the needle permits the ability to collect a higher quantity of intact cellular material, which is optimal for determining adequacy and, ultimately, for making a diagnosis. The present study compares the diagnostic performance of a motorized fine needle aspiration (FNA) device to a historical cohort of patients biopsied using ultrasound-guided fine needle aspiration (US-FNA). Methods: Data from 120 patients with thyroid nodules biopsied using a motorized FNA device was retrospectively analyzed. Patient demographics, lesion characteristics, number of passes, Bethesda category, and cellularity scores were compared to a historical control cohort of 100 patients who underwent US-FNA. Nondiagnostic and indeterminate samples rates for motorized FNA were separately compared to literature controls. Results: A significantly reduced median number of passes were required with motorized FNA compared to US-FNA (1.48 ± 0.62 vs. 2.64 ± 1.63, p < 0.001). Adequate samples were obtained after the first pass for 58% of biopsies with motorized FNA compared to 11% with US-FNA. The cumulative percentage of adequate samples increased to 98% after two passes for motorized FNA versus 58% for the US-FNA group. The mean cellularity score was also significantly greater for motorized FNA (3.42 ± 0.63 vs. 1.9 ± 0.59; p < 0.001). A determinant diagnosis was possible for a greater number of samples in the motorized FNA group compared to the control group (91.6% vs. 78%; p = 0.05). The motorized FNA also had a lower nondiagnostic rate compared to US-FNA (2.0% vs. 10%) and a lower indeterminate rate compared to published rates associated with the use of FNA (8.3% vs. 20.0%; p = 0.05). Conclusion: The motorized FNA device required less passes to obtain an adequate biopsy than US-FNA. Its use is also associated with obtaining samples with a higher cellularity and lower nondiagnostic and indeterminate sample rates.

Feasibility and Exploration of a Standardized Protocol for Cardiac CT Assessment of Rheumatic Mitral Disease.

Rheumatic mitral valve disease often requires surgical interventions, such as percutaneous mitral commissurotomy, surgical mitral valve repair, or replacement, especially in severe cases. This necessitates a precise preoperative assessment of the extent of mitral valve disease. Currently, transthoracic echocardiography, the gold standard for preoperative assessment, has limitations, such as restricted acoustic windows and dependence on the operator, which can affect the evaluation of subvalvular structures and calcification of the mitral valve. Previous studies have shown that cardiac computed tomography (CT), with its high resolution, strong multiplanar reconstruction capabilities, and sensitivity to calcifications, can effectively overcome these limitations. Therefore, this study aims to summarize and evaluate the effectiveness of cardiac CT in examining mitral valve leaflets, annulus, and subvalvular structures. It also reviews the feasibility and guiding significance of using cardiac CT to assess characteristic rheumatic mitral valve lesions.

Clinical outcomes and coronary artery lesion characteristics of young patients with ST elevation myocardial infarction and no standard modifiable risk factors.

Among ST-elevation myocardial infarction (STEMI) patients, those with no standard modifiable risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, and smoking) have higher 30-day mortality than those with SMuRFs. Differences in coronary lesion characteristics remain unclear. Data from STEMI patients aged ≤60 years from the Asia Pacific Evaluation of Cardiovascular Therapies Network (Australia, Hong Kong, Malaysia, Singapore, and Vietnam) was retrospectively analysed. Exclusion criteria included incomplete SMuRF data, prior myocardial infarction, or prior coronary revascularisation. Lesion type was defined using the American College of Cardiology criteria. Major adverse cardiovascular events (MACE) were defined as peri-procedural myocardial infarction, emergency coronary artery bypass surgery, cerebrovascular event, or mortality. Multiple logistic regressions were used. Of 4404 patients, 767 (17.4%) were SMuRFless. SMuRFless patients were more frequently younger (median age 51 vs. 53 years; p < 0.001), female (22.6% vs. 15.5%; p < 0.001), thrombolysed (20.1% vs. 12.5%; p < 0.001), and in cardiogenic shock (11.2% vs. 8.6%; p = 0.020). SMuRFless patients had significantly higher in-hospital MACE (7.2% vs. 4.3%; adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.24-4.08; p = 0.008) but 1-year mortality was not significantly different (3.6% vs. 5.7%, aOR 0.58; 95% CI 0.06-6.12; p = 0.549). Compared with patients with SMuRFs (4918 lesions), the SMuRFless (940 lesions) had fewer type B2/C lesions (60.8% vs. 65.6%; p = 0.020) and fewer lesions ≥20 mm (51.1% vs. 57.1%; p = 0.002) but more procedural complications (5.1% vs. 2.7%; p < 0.001). Among young STEMI patients, the SMuRFless have shorter and less complex lesions, but worse procedural and short-term MACE outcomes.

Patency and factors related to patency after percutaneous transluminal angioplasty for inflow arterial stenosis in native arteriovenous fistula dysfunction: a single-center retrospective study

Controversy still exists regarding how much the inflow arterial percutaneous transluminal angioplasty (PTA) contributed to maintaining fistula function for hemodialysis. We aimed to analyze patency and risk factors after inflow arterial PTA. Hemodialysis patients with inflow arterial primary stenosis who were admitted to our institution from January 2017 to December 2022 were examined. One group had arterial-venous fistula with inflow artery stenosis alone (AVF + iAS) and another group had AVF with inflow artery stenosis and any vein stenosis (AVF + iAS + VS). The characteristics of patients, stenotic lesions, and PTA procedures were recorded. Kaplan–Meier analysis was used to compare primary patency, assisted primary patency, and secondary patency in the two groups. Cox proportional hazard analysis was used to identify risk factors associated with patency. We examined 213 patients, 53 in the AVF + iAS group (51 radial arterial stenosis and 2 ulnar arterial stenosis) and 160 in the AVF + iAS + VS group (159 radial arterial stenosis and 1 ulnar arterial stenosis). Kaplan–Meier analysis indicated the AVF + iAS group had better primary patency and assisted primary patency (both P < 0.05), but the groups had similar secondary patency. Cox proportional hazard analysis indicated that none of the analyzed clinical and biochemical indexes had clinically meaningful effects on primary patency, assisted primary patency, or secondary patency in either group. The patency and safety after PTA for inflow arterial stenosis were satisfactory, and none of the examined risk factors had a major clinical impact on patency. We recommend PTA as treatment for inflow stenosis of an AVF.

A plasmid-mediated type III secretion system associated with invasiveness and diarrheagenicity of Providencia rustigianii.

We have recently described a clinical isolate of Providencia rustigianii strain JH-1 carrying the genes for cytolethal distending toxin (CDT) in a conjugative plasmid. A cdtB mutant of strain JH-1, which lost CDT activity, was still found to retain invasiveness and diarrheagenicity. The strain was subjected to phenotypic and genetic analyses including whole genome sequencing (WGS) to explore the genetic determinants of the observed invasiveness and diarrheagenic properties. Analysis and annotation of WGS data revealed the presence of two distinct type III secretion systems (T3SS) in strain JH-1, one of which was located on the chromosome designated as cT3SS (3,992,833 bp) and the other on a mega-plasmid designated as pT3SS (168,819 bp). Comparative genomic analysis revealed that cT3SS is generally conserved in Providencia spp. but pT3SS was limited to a subset of Providencia spp., carrying cdt genes. Strain JH-1 was found to invade HeLa cells and induce fluid accumulation with characteristic pathological lesions in rabbit ileal loops. Remarkably, these phenomena were associated with the pT3SS but not cT3SS. The plasmid could be transferred by conjugation from strain JH-1 to other strains of P. rustigianii, Providencia rettgeri, and Escherichia coli with concomitant transfer of these virulence properties. This is the first report of a functional and mobile T3SS in P. rustigianii and its association with invasiveness and diarrheagenicity of this bacterium. These data suggest that P. rustigianii and other CDT-producing Providencia strains might carry T3SS and exert their diarrheagenic effect by exploiting the T3SS nano-machinery.IMPORTANCEThe precise mechanism of virulence of Providencia rustigianii is unclear, although some strains produce cytolethal distending toxin as a putative virulence factor. We have detected the presence of a type III secretion system (T3SS) for the first time on a plasmid in a P. rustigianii strain. Plasmid-mediated T3SS seems to be directly involved in virulence of P. rustigianii and may serve as a means of horizontal transfer of T3SS genes. Our results may have implication in understanding the mechanism of emergence of new pathogenic strains of P. rustigianii.

Solitary medial proximal tibial osteochondromas cause pes anserinus syndrome in adolescents.

Osteochondromas are common bone tumors with hyaline cartilage-covered heads, arising from cortical and medullary bone. Solitary medial proximal tibial osteochondromas (MPTOs) can cause pes anserinus syndrome via compression. However, the literature lacks comprehensive studies on MPTO-related pes anserinus syndrome and its surgical outcomes. The study reviewed 227 patients diagnosed with osteochondroma between January 2018 and January 2022, with 21 patients meeting inclusion criteria: under 19 years, MPTO, surgical excision, histological diagnosis, ≥1-year follow-up. Cases with irregular follow-ups and multiple hereditary exostoses were excluded. Different surgical techniques were employed based on lesion characteristics. Postoperative weight bearing was allowed, and follow-ups involved postoperative complications assessment, clinical data collection, imaging, and functional evaluations using the International Knee Documentation Committee (IKDC) and Hospital for Special Surgery Pediatric Functional Activity Brief Scale scoring systems. The study involved 21 adolescents (15 ± 2 years). Lesion types were predominantly pedunculated (86%) and surgical interventions involved pes anserinus split (76%) or tenoplasty (24%). No significant correlations were observed between lesion dimensions and IKDC scores. Split intervention led to a significant improvement in IKDC scores (p < 0.01), while tenoplasty showed similar results (p < 0.05). Athlete status did not affect IKDC scores significantly, but both athletes and non-athletes demonstrated improvements (p < 0.05). The negative impact of MPTOs causing pes anserinus tendinitis on the patient's quality of life and activity can be completely corrected with surgical treatment. Complete pes anserinus tendon cutting and subsequent repair are recommended if they facilitate surgery. The study underscores the importance of surgical management for MPTO-related pes anserinus syndrome and provides insights into the effectiveness of different surgical techniques.

Contrast-enhanced magnetic resonance neurography for diagnosing brachial plexopathy: improved visualization and additional imaging features

Contrast-enhanced magnetic resonance neurography (CE-MRN) holds promise for diagnosing brachial plexopathy by enhancing nerve visualization and revealing additional imaging features in various lesions. This study aims to validate CE-MRN’s efficacy in improving brachial plexus (BP) imaging across different patient cohorts. Seventy-one subjects, including 19 volunteers and 52 patients with BP compression/entrapment, injury, and neoplasms, underwent both CE-MRN and plain MRN. Two radiologists assessed nerve visibility, with inter-reader agreement evaluated. Quantitative parameters such as signal intensity (SI), contrast-to-noise ratio (CNR), and contrast ratio (CR) of the C7 nerve were measured. Both qualitative scoring and quantitative metrics were compared between CE-MRN and plain MRN within each patient group. Patient classification followed the Neuropathy Score Reporting and Data System (NS-RADS), summarizing additional imaging features for each brachial plexopathy type. Inter-reader agreement for qualitative assessment was strong. CE-MRN significantly enhanced BP visualization and nerve-tissue contrast across all cohorts, particularly in volunteers and patients with injuries. It also uncovered additional imaging features such as hypointense signals in ganglia, compressed nerve sites, and neoplastic enhancements. CE-MRN effectively mitigated muscle edema and vascular contamination, enabling precise classification of BP injuries. Overall, CE-MRN consistently enhances BP visualization and provides valuable imaging features for accurate diagnosis.

CHARACTERISTICS OF RADIOLUCENT LESIONS ASSOCIATED WITH IMPACTED TEETH AT RSGM UNPAD

Background: Impacted teeth occur when teeth fail to erupt or cannot fully erupt along the dental arch in the normal pattern of dental growth. Untreated impacted teeth can cause pain, tooth decay, inflammatory lesions, odontogenic cysts, and tumors. Pathological lesions in impacted teeth that are not clinically visible are usually found on routine radiographic examinations. Panoramic radiography is used as an initial imaging technique to evaluate impacted teeth and associated lesions. Purpose: This study aims to see the characteristics of radiolucent lesions associated with impacted teeth based on panoramic radiographic archives of patients at RSGM Unpad. Methods: This is an observational descriptive study with purposive sampling technique using secondary data of panoramic radiographs from the Dental Radiology Installation RSGM Unpad. The radiographs were inverted to enhance the visualization of characteristics such as location, shape, borders and associations. The data is presented in the table of frequency and distribution. Results: 346 samples of radiolucent lesions associated with impacted teeth were obtained from 8034 impacted teeth. There were 323 (93,4%) pericoronal lesions, 344 (99,4%) monolocular lesions, 218 (63%) had well-defined borders, and 345 (99,7%) lesions caused bone destruction. The prevalence of radiolucent lesions associated with impacted teeth is 4.3%. Conclusion: The characteristics of radiolucent lesions associated with impacted teeth at the Dental Radiology Installation RSGM Unpad most common are pericoronal lesions, monolocular shape, well-defined borders, and the effect on the surrounding structure is bone destruction.Impacted, Panoramic Radiograph, Radiolucent Lesion

Geographic diversity in chronic total occlusion percutaneous coronary intervention: insights from the PROGRESS-CTO registry.

There is variability in clinical and lesion characteristics as well as techniques in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We analyzed patient and lesion characteristics, techniques, and outcomes in 11 503 CTO-PCI procedures performed in North America (NA) and in the combined regions of Europe, Asia, and Africa from 2017 to 2023 as documented in the PROGRESS-CTO registry. Eight thousand four hundred seventy-nine (74%) procedures were performed in NA. Compared with non-NA patients, NA patients were older, with higher body mass index and higher prevalence of diabetes, hypertension, dyslipidemia, family history of coronary artery disease, prior history of PCI, coronary artery bypass graft surgery and heart failure, cerebrovascular disease, and peripheral arterial disease. Their CTOs were more complex, with higher J-CTO (2.56 ± 1.22 vs 1.81 ± 1.24; P less than .001) and PROGRESS-CTO (1.29 ± 1.01 vs 1.07 ± 0.95; P less than .001) scores, longer length, and higher prevalence of proximal cap ambiguity, blunt/no stump, moderate to severe calcification, and proximal tortuosity. Retrograde (31.0% vs 22.1%; P less than .001) and antegrade dissection and re-entry (ADR) (21.2% vs 9.2%; P less than .001) were more commonly used in NA centers, along with intravascular ultrasound (69.0% vs 10.1%; P less than .001). Procedure and fluoroscopy times were longer in NA, while contrast volume and radiation dose were lower. Technical (86.7% vs 86.8%; P > .90) and procedural (85.4% vs 85.8%; P = .70) success and in-hospital major adverse cardiovascular events (MACE) (1.9% vs 1.7%; P = .40) were similar in NA and non-NA centers. Compared with non-NA patients, NA patients undergoing CTO PCI have more comorbidities, higher CTO lesion complexity, are more likely to undergo treatment with retrograde and ADR, and have similar technical success and MACE.

Risk Factors for Nonunion After Nonoperative Treatment for Pediatric Lumbar Spondylolysis: A Retrospective Case-Control Study

Background: Pediatric lumbar spondylolysis, a stress fracture of the lumbar spine, frequently affects young athletes, and nonoperative treatment is often the first choice of management. Because the union rate in lumbar spondylolysis is lower than that in general fatigue fractures, identifying risk factors for nonunion is essential for optimizing treatment. Purpose: To determine the risk factors for nonunion after nonoperative treatment of acute pediatric lumbar spondylolysis through multivariate analysis. Study Design: Case-control study; Level of evidence, 3. Methods: We analyzed 574 pediatric patients (mean age, 14.3 ± 1.9 years) with lumbar spondylolysis who underwent nonoperative treatment between 2015 and 2022. Nonoperative treatment included the elimination of sports activities, bracing, and weekly athletic rehabilitation, with follow-up computed tomography. Patient data, lesion characteristics, sports history, presence of spina bifida occulta at the lamina with a lesion or at the lumbosacral spine excluding the lesion level, and lumbosacral parameters were examined. Differences between the union and nonunion groups were investigated using multivariate analysis to determine the risk factors for nonunion. Results: Of the 574 patients, 81.7% achieved bone union. Multivariate analysis revealed that an L5 lesion and the progression of the main and contralateral lesion stages were significant independent risk factors for nonunion. An L5 lesion had a lower union rate than non-L5 lesions. As the main lesion progressed, the likelihood of nonunion increased significantly, and the progression of the contralateral lesion also showed a similar trend. Spina bifida occulta and lumbosacral parameters were not significant predictors of nonunion in this study. Conclusion: We identified the L5 lesion level and the progression of the main and contralateral lesion stages as independent risk factors for nonunion in pediatric lumbar spondylolysis after nonoperative treatment. These findings aid in treatment decision-making. When bone union cannot be expected with nonoperative treatment, symptomatic treatment is required without prolonged external fixation and rest, and without aiming for bone union. Individualized treatment plans are crucial based on identified risk factors.

Comparison of Angiographic Success and Clinical Outcomes Based on Different Percutaneous Coronary Intervention Techniques.

Introduction Primary percutaneous coronary intervention (PCI) is the standard treatment for patients with ST-segment elevation myocardial infarction (STEMI). Various PCI techniques exist, including balloon angioplasty, bare-metal stents (BMS), drug-eluting stents (DES), thrombus aspiration, direct stenting, rotational atherectomy (Rotablation), and cutting balloon angioplasty. Specific approaches for patients with STEMI and multivessel coronary artery disease may involve: 1) culprit vessel-only (CVO) primary PCI, 2) primary PCI followed by multivessel intervention of additional noninfarct lesions at the same procedure, or 3) CVO primary PCI followed by staged PCI of noninfarct lesions later during the index hospitalization or after discharge. However, their impact on angiographic success and clinical outcomes remains unclear. Methodology A retrospective study (n=90) evaluated the effectiveness of various PCI techniques during primary PCI. Data included demographics, clinical profiles, PCI strategies, and outcomes. Techniques such as thrombus aspiration, direct stenting, balloon angioplasty, and DES deployment were assessed. Descriptive statistics and chi-square tests were employed, with logistic regression for adjustment. Results The comparison of angiographic success and clinical outcomes based on different PCI strategies during primary PCI (n=90) revealed distinct differences. Successful procedures were associated with lower mean values for age (56.00 vs. 60.20), hypertension (165.50 vs. 170.30), weight (74.00 vs. 77.50), BMI, 26.80 vs. 28.70, KILLIP class (1.30 vs. 1.50), ejection fraction (45.80 vs. 47.90), creatinine (0.95 vs. 1.00), creatinine clearance (83.50 vs. 86.70), pulse rate (84.00 vs. 87.50), oxygen saturation (95.80 vs. 94.50), and blood sugar (170.00 vs. 182.00). Risk factors like hypertension (mean = 1.40 vs. 1.60), diabetes (mean = 1.60 vs. 1.70), and hyperlipidemia (mean = 1.85 vs. 1.95) also showed differences between successful and failed procedures. Significant variations were observed across PCI strategies for outcomes including angina within 30 days (Chi square = 18.75, p < 0.001), cerebrovascular accident (CVA, Chi square = 15.42, p = 0.001), acute left ventricular failure (LVF, Chi square = 12.67, p = 0.005), and cardiogenic shock (Chi square = 8.93, p = 0.029). Conclusion Patient demographics and clinical profiles influence PCI success. Techniques such as thrombus aspiration, direct stenting, balloon angioplasty, and DEShave varied impacts on clinical outcomes. While conventional balloon angioplasty remains a viable option, newer techniques such as DES and mechanical thrombectomy demonstrate superior angiographic success rates and improved clinical outcomes, particularly in complex lesion subsets. However, the selection of PCI technique should be guided by careful consideration of patient-specific factors, lesion characteristics, and procedural feasibility.

Standardized IETA criteria enhance accuracy of junior and intermediate ultrasound radiologists in diagnosing malignant endometrial and intrauterine lesions.

To transform the standardized descriptions of the ultrasound characteristics of endometrial and intrauterine lesions devised by the International Endometrial Tumor Analysis (IETA) group into a practical scoring method and to investigate whether application of this method enhances the diagnostic accuracy of ultrasound radiologists with different levels of experience in detecting malignancy compared with subjective assessment. This was a retrospective study of 855 patients with endometrial and/or intrauterine lesions, who were divided into a training (n = 600) and a validation (n = 255) set. Ultrasound radiologists with varying levels of experience (expert, intermediate and junior) evaluated all lesions by subjective assessment and according to IETA rules. Using IETA rules, the experts identified signs of malignancy in the training set, assigned scores for each indicator and validated the scoring method in the validation set. The intermediate-level and junior ultrasound radiologists reassessed the malignancy of the lesions using the IETA scoring method and compared their classifications with those made previously by subjective assessment. Postsurgical pathological evaluation was used as the reference standard. Using subjective assessment, the experts demonstrated the highest level of diagnostic accuracy, with a sensitivity of 85.0%, specificity of 94.3% and an area under the receiver-operating-characteristics curve (AUC) of 0.897. Applying the IETA scoring method (comprising eight ultrasound characteristics that contributed to the total score) with a threshold of > 25 points for the diagnosis of malignancy achieved a sensitivity of 84.7%, specificity of 94.7% and AUC of 0.9533 in the training set, with similar performance in the validation set, when performed by experts. Using the IETA scoring method, both junior and intermediate ultrasound radiologists showed improvement in sensitivity (from 55.5% to 74.8% and from 70.2% to 77.1%, respectively), specificity (from 88.4% to 91.5% and from 87.4% to 92.2%, respectively) and AUC (from 0.704 to 0.827 and from 0.793 to 0.841, respectively) for diagnosing malignant lesions. The IETA scoring method exhibits high diagnostic efficacy for malignant endometrial and intrauterine lesions. This method compensates for the lack of experience among junior and intermediate-level ultrasound radiologists, enhancing their diagnostic skill to a level nearing that of experienced senior ultrasound radiologists. Further research is essential to validate the practicality of implementing this method and to confirm its clinical value. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

487. A RARE CASE OF BRONCHOGENIC CYST ESOPHAGUS

Abstract Introduction Bronchogenic cyst is a relatively rare congenital malformation that develops from abnormal budding of the ventral foregut during the early stage of gestation. Histologically, the cyst wall is covered by respiratory-type ciliated epithelium that may include cartilage and bronchial glands. Case report We present a 20 yrs male with chest discomfort during swallowing for 6 months. Evaluated with Upper GI scopy showed smooth mucosal elevation 30-35 cm from incisors. CECT Chest Showed features of Intramural cystic lesion of size 7x7cm.Patient was evaluated and taken up for surgery. Robotic Thoracoscopic cyst excison was done. Intraoperatively 7x7cm cystic lesion in lower esophagus infra carinally. Cyst has no communication with mucosa. Post operatively patient recovered well, Drin removed on 3 rd Post operative day and Patient was discharged on 4 th day. Histopathology showed the cyst wall is covered by respiratory-type ciliated epithelium that may include cartilage and bronchial glands https://1drv.ms/v/s!AklfEcoVwf9chCmLN-FSXBA2yV3B

Real-world first round results from a charity lung cancer screening program in East Asia.

Screening with low-dose computed tomography (LDCT) has been proven to potentially reduce the rate of mortality of lung cancer. Lack of real-world data outside of protocolized trials has been cited as an impediment to its more widespread implementation, especially in Asia. This report aims to provide such real-world data. A single round of LDCT was provided through a community-based charity program in Hong Kong, China to asymptomatic adults with a family history of lung cancer and/or smoking history. Anonymized data from this program were analyzed. LDCT was performed for 99 participants, including 98 (99%) who had one or more family members with history of lung cancer, and 70 (71%) who were never-smokers. After a single round of screening, a positive LDCT was noted in 47 participants (47%). A sister with a history of lung cancer (28% vs. 8%, P=0.01) and a multiplex family (MF) (47% vs. 23%, P=0.02) were factors associated with a positive LDCT. After a median period of 10 months (range, 5-16 months) following LDCT, lung cancer (all adenocarcinoma) was diagnosed as a direct consequence of positive LDCT findings in six participants (6%), of whom four had stage I disease and five received surgery with curative intent. In the 47 participants with a positive LDCT, having a sister with a history of lung cancer was associated with an increased risk of lung cancer (relative risk =5.23; 95% confidence interval: 1.09-25.21). Detected lesions categorized as Lung Imaging Reporting and Data System (Lung-RADS) 3 or above (odds ratio =12.08; 95% confidence interval: 1.27-114.64) or deemed by an experienced specialist to be suspicious (odds ratio =63.33; 95% confidence interval: 5.48-732.29) were significantly more likely to turn out to be a lung cancer. This real-world data demonstrates that a single round of LDCT screening at a community level in East Asia can detect potentially curable lung cancer at a rate comparable to those reported by protocolized trials. When considering future LDCT screening programs in East Asia, a family history of lung cancer may be a key factor indicating a person for screening, and how features of a LDCT-detected lesion should trigger further intervention warrant further definition.

FBENet: Feature-Level Boosting Ensemble Network for Hashimoto's Thyroiditis Ultrasound Image Classification.

Distinguishing Hashimoto's thyroiditis (HT) lesions from ordinary thyroid tissues is difficult with ultrasound images. Challenges in achieving high performance of HT ultrasound image classification include the low resolution, blurred features and large area of irrelevant noise. To address these problems, we propose a Feature-level Boosting Ensemble Network (FBENet) for HT ultrasound image classification. Specifically, to capture the features of suspicious HT lesions efficiently, an Ensemble Feature Boosting Module (EFBM) is introduced into the feature-level ensemble to boost the blurred features. Then, the spatial attention mechanism is adopted in backbone models to improve the feature focusing performance and representation ability. Furthermore, feature-level ensemble technique is employed in the training process to achieve more comprehensive feature representation ability. Experimentally, FBENet was trained on 6,503 HT ultrasound images, and tested on 1,626 HT ultrasound images with 82.92% accuracy and 89.24% AUC on average.

Comparison of high-risk characteristics of non-culprit plaques in relation to plaque severity in acute coronary syndrome

IntroductionPatients with acute coronary syndrome (ACS) have high event rates related to non-culprit (NC) lesions, therefore plaque composition of these lesions is of great interest. Although marginal atherosclerotic lesions were studied extensively, more significant lesions might have more high-risk characteristics. AimTo compare differences in high-risk lesion characteristics between significant versus non-stenotic NC plaques in ACS and the discrepancies with chronic coronary syndrome (CCS) patients. MethodsNon-culprit vessels of 26 ACS patients with 26 angiographically significant lesions and 37 patients (17 ACS and 20 CCS) with 48 non-stenotic lesions were investigated with intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS). Overall, 74 segments of 30 mm length were analyzed in 1 mm intervals. External elastic lamina (EEM), plaque burden (PB), minimal luminal area (MLA), percent atheroma volume (PAV) and lipid core burden index maximum 4 mm (maxLCBI4mm) were determined for each segment. ResultsCardiovascular risk factors were similar in all groups. PB was higher and MLA smaller in significant non-culprit ACS lesions vs non-stenotic lesions: PB 73.5% (IQR 68.7–78.5) vs 59.2 (IQR 49.6–71.5), p = 0.003, MLA 3.0 mm2 (IQR 2.3–3.9) vs 4.0 mm2 (IQR 2.8–4.7). MaxLCBI4mm was similar 308.1 (±155.4) vs 287.8 (±165.7), p = 0.67.Among non-stenotic plaques, MaxLCBI4mm was comparable between ACS and CCS patients, 275.7 (±151.5) in CCS patients vs 287.8 (±165.7) in ACS patients, p = 0.79. ConclusionAlthough visually significant non-culprit lesions had a higher plaque burden compared to non-stenotic lesions, a significant relation between MaxLCBI4mm and hemodynamic significance of the plaques couldn’t be established.

Importance of gap evaluation in the ossification of posterior longitudinal ligament lesions using 3-dimensional computed tomography

BACKGROUND CONTEXTEvaluating the gaps within the ossification of the posterior longitudinal ligament (OPLL) lesions, which may contribute to neurological symptoms, using conventional imaging techniques is challenging. OBJECTIVEThis study aimed to investigate the importance of evaluating gaps using 3-dimensional computed tomography (3D-CT) and their association with the occurrence of magnetic resonance imaging (MRI) T2 high intensity in the spinal cord. STUDY DESIGN/SETTINGRetrospective cohort study. PATIENT SAMPLERetrospective analysis of 116 patients diagnosed with cervical OPLL. OUTCOME MEASURESPresence of gaps in OPLL, presence of T2 high intensity in the cervical spinal cord, and OPLL thickness were evaluated. METHODSLateral X-ray, CT, and reconstructed 3D-CT images were reviewed to assess lesion characteristics and the presence of gaps. MRI was used to evaluate the change in spinal cord signal intensity. The relationship among gap presence, lesion morphology, and MRI T2 high intensity in the spinal cord was examined. RESULTSA significant difference in gap detection accuracy was observed between CT and 3D-CT (p=.0054). CT demonstrated false-positive results in the detection of gaps as compared with 3D-CT. The presence of gaps was significantly associated with an increased likelihood of MRI T2 high intensity in the spinal cord (p=.037). Patients with thicker lesions and smaller space available for the spinal cord (SAC) were more likely to exhibit T2 high intensity. Meanwhile, patients with gaps co-occurring with T2 high intensity exhibited significantly thinner lesions (p=.011) and larger SACs (p=.0002). Patients with gaps had a significantly lower JOA scores (p=.0035), which indicates that patient with gaps are likely to exhibit more severe clinical neurological symptoms. CONCLUSION3D-CT showed superiority in accurately identifying gaps within OPLL lesions, while CT demonstrated false-positive results in the detection of gaps. Furthermore, the gap presence was a risk factor for MRI T2 high intensity in the spinal cord, independent of lesion thickness. In addition, gaps are related to more severe clinical symptoms. This study highlighted the importance of evaluating gaps within OPLL lesions using 3D-CT to clarify neurological pathogenesis.