Computed Tomography Scan Research Articles

Extensor Pollicis Longus Entrapment on CT in Acute Distal Radius Fracture May Be a Predictor of Tendon Rupture.

Extensor pollicis longus (EPL) rupture is a well-described complication after volar plate fixation of distal radius fractures. Although protrusion of screw tips through the dorsal cortex of the distal radius is likely the cause of a substantial proportion of EPL ruptures, it is probably not the sole cause for EPL rupture after distal radius fracture. The purpose of this study was to evaluate preoperative computed tomography (CT) scans of distal radius fractures to characterize the incidence of EPL damage at the time of injury. This retrospective study included adults with operatively treated distal radius fractures and a preoperative CT scan within 2 weeks of injury between January 1, 2017 and July 31, 2018. The cohort consisted of 96 wrists in 95 patients. The median age was 54 (interquartile range, IQR 38-64) years, 68% (65/95) were women, and median follow-up was 56 (IQR 22-61) months. The fracture involved Lister's tubercle in 75% (72/96) of fractures. Of these 72 fractures, 11 had an EPL tendon entrapped by fracture fragments (18%). Within the cohort, two EPL injuries manifested clinically. We present evidence that not all EPL ruptures after Open reduction and internal fixation (ORIF) of the distal radius are related to prominent dorsal screws. Extensor pollicis longus entrapment in Lister's tubercle fracture fragments is relatively frequent and may be a potential contributor to tendon rupture. When a CT scan is obtained for the treatment of distal radius fractures, attention to the EPL and its relation to Lister's tubercle may be helpful to characterize the risk of late rupture.

Full-Percutaneous Trans-Kambin Lumbar Interbody Fusion With a Large-Footprint Interbody Cage.

Exploratory prospective observational cohort. Aim of this study was to evaluate clinical and radiologic outcome, and surgical efficiency of a novel universal delivery system that allows full-percutaneous extraforaminal, trans-Kambin lumbar interbody fusion with a large-footprint lumbar interbody cage using only fluoroscopic imaging and open-surgery instrumentation. We prospectively evaluated patients that underwent elective trans-Kambin TLIF surgery with a large-footprint interbody cage using a novel universal delivery system. Clinical follow-up was evaluated pre-and post-operatively with Visual Analogic Scale (VAS) and Oswestry Disability Index (ODI) scores, while radiologic follow-up was performed with a computed tomography scan and standing films post-operatively at hospital discharge and 1year follow-up. A total of 47 patients were evaluated. Clinically, post-operative VAS and ODI scores significantly (P < 0.001) improved compared to pre-operative scores and 29.4months mean follow-up. Radiologic evaluation yielded an intervertebral fusion rate of 90% of the operated levels and a significant increase in segmental lordosis by 3.7°. Median surgical time for interbody cage insertion per level was 28minutes. Complications included 14 (29%) cases with transitory post-operative radiculitis, 4 (8%) cases with partial muscle weakness and 2 (4%) cases that required revision surgery. Post-operative ambulation started at a median 5hours and median hospital length of stay was 28hours. A new universal delivery system allows overcoming most limitations of current full-endoscopic trans-Kambin fusion as it allows a time- efficient full-percutaneous insertion of a large-footprint interbody cage under fluoroscopy imaging only, with standard open-surgery instruments and optional endoscopic visualization.

The Role of Diagnostic Nasal Endoscopy and Computed Tomography Scan in Chronic Rhinosinusitis in Adults: A Study of Clinical Correlation

The Role of Diagnostic Nasal Endoscopy and Computed Tomography Scan in Chronic Rhinosinusitis in Adults: A Study of Clinical Correlation

Spatial Correlates of Dementia and Disability After Intracerebral Hemorrhage.

Dementia and disability are highly prevalent after spontaneous intracerebral hemorrhage (ICH). Previous studies categorizing ICH by large anatomic boundaries have demonstrated that lobar ICH is associated with dementia, while ICH in the basal ganglia is associated with disability. This study aims to refine our understanding of the association between ICH location and post-ICH dementia and disability at a voxel level, which could improve the prognostic accuracy of these outcomes and provide mechanistic insights into post-ICH functional outcomes. In this cohort study, we segmented the ICH lesions from the noncontrast computed tomography scans from 882 patients from the MGH-ICH (Massachusetts General Hospital ICH Study) as the discovery data set and from 146 patients from the Yale-ICH cohort as the validation data set. Using electronic health records and follow-up telephone interviews, incident dementia (International Classification of Diseases, Ninth Revision [ICD-9] codes of dementia or modified telephone interview for cognitive status <20) and disability (modified Rankin Scale score >2) were identified. The median follow-up times of the MGH-ICH and Yale-ICH cohorts were 2.9 (interquartile range, 1.0-5.8) years and 1.0 (interquartile range, 0.6-1.0) years, respectively. Two techniques of lesion symptom mapping were applied on the ICH lesions: sparse canonical correlation analysis for neuroimaging and voxel-based lesion symptom mappings. Dementia conversion after ICH was associated with ICH in the left temporo-occipital region (mean hazard ratio [HR], 3.62 [95% CI, 2.71-4.63]) and left superior longitudinal fasciculus (mean HR, 2.91 [95% CI, 2.40-3.52]). Development of disability after ICH was linked to the right cerebral peduncle (mean HR, 3.10 [95% CI, 2.44-3.94]), right pallidum (mean HR, 2.96 [95% CI, 1.99-4.25]), and right posterior limb of the internal capsule (mean HR, 2.54 [95% CI, 1.88-3.96]). Specific distribution of ICH lesions is linked to development of dementia and disability after ICH. These insights have the potential to enhance clinical prognostic models for patients with ICH, facilitating more precise predictions of outcomes based on hemorrhage location.

Novel CT Image-Based Intracerebral Bleeding Risk Score for Patients With Acute Ischemic Stroke Undergoing Thrombolysis.

Symptomatic intracerebral hemorrhage (sICH) after intravenous recombinant tissue plasminogen activator in patients with acute ischemic stroke (AIS) remains a feared yet unpredictable complication. We aimed to develop and validate a new predictive model incorporating clinical variables and noncontrast head computed tomography imaging features to predict sICH in patients with AIS receiving intravenous recombinant tissue plasminogen activator. The predictive model was derived from 808 patients with AIS in the derivation cohort in Southeast China, based on multivariable logistic regression analysis. External validation was conducted in a validation cohort from Central China. Discrimination, calibration, and clinical usefulness of the predictive model were assessed. We observed 32 sICH events among 808 patients with AIS in the derivation cohort, and 21 sICH events out of 612 participants in the validation cohort. The variables in the predictive model included cerebral small vessel disease burden and early infarct signs on head computed tomography scan, atrial fibrillation, age, systolic blood pressure, and initial National Institutes of Health Stroke Scale score. The fitted model showed promising discrimination (optimism-corrected C statistic of 0.80) and acceptable calibration (Hosmer and Lemeshow goodness of fit P=0.816) in the derivation cohort. External validation showed similar discrimination (C statistic 0.82 [95% CI, 0.72-0.91]) and calibration (Hosmer and Lemeshow goodness of fit P=0.866). Our internally and externally validated prediction model for sICH in patients with AIS who received intravenous thrombolysis may facilitate individualized prediction for intracerebral bleeding risk after intravenous thrombolysis for acute ischemic stroke.

Visualization and prediction of the pleura and thoracic duct: elucidation of changes due to respiration using arterial landmarks and CT images

PurposeThe thoracic duct uses the pulsation of accompanying arteries to facilitate lymphatic flow. However, the lymphatic flow mechanism cannot be explained when it does not accompany the arteries. This study aimed to clarify the anatomical position of the thoracic duct and surrounding structures and determine the differences in the thoracic duct length and course during inspiration and expiration.MethodsSix cadavers were dissected to observe the positional relationship between the thoracic duct and surrounding structures. Image sequences of anatomical sections from the Visible Korean Human Open Resource were observed and reconstructed to understand their three-dimensional positioning. Inspiratory and expiratory computed tomography scans were used to measure and examine respiratory variations in the distance between the arterial landmarks to predict the thoracic duct length.ResultsThe thoracic duct accompanied the arteries for most of its course and was sandwiched between the arteries and pleura, entering the mediastinum. However, there was an area on the cranial side of the aortic arch where the thoracic duct did not accompany the arteries. The distance between the arterial landmarks in this area, which approximate the thoracic duct length, was significantly longer during inspiration (39.3 ± 7.81 mm) than during expiration (31.49 ± 7.01 mm).ConclusionThis study suggests that the pleura entering the mediastinum pushes the thoracic duct toward the arteries to promote lymphatic flow generation by arterial pulsation. Additionally, this study suggests that the lymphatic flow in the thoracic duct is generated by the expansion and contraction of the thoracic duct with respiratory movement.

Neurocritical Care Organization in the Low-Income and Middle-Income Countries.

This study aimed to assess the organization, infrastructure, workforce, and adherence to protocols in neurocritical care across low- and middle-income countries (LMICs), with the goal of identifying key gaps and opportunities for improvement. We conducted a cross-sectional survey of 408 health care providers from 42 LMICs. The survey collected data on the presence of dedicated neurointensive care units, workforce composition, access to critical care technologies, and adherence to evidence-based protocols. Data were analyzed using descriptive statistics, and comparisons were made across different geographical regions (East Asia and the Pacific, Europe and Central Asia, Latin America and the Caribbean, the Middle East and North Africa, and South Asia and sub-Saharan Africa) and economic strata [low-income countries (LICs), lower middle-income countries (LoMICs), and upper middle-income countries (UMICs)]. Only 36.8% of respondents reported access to dedicated neurointensive care units: highest in the Middle East (100%), lowest in sub-Saharan Africa (11.5%), highest in LoMICs (42%), and lowest in LICs (13%). Access to critical care technologies, such as portable computed tomography scanners (9.3%; UMICs 11%, LICs 0%) and tele-intensive care unit services (14.9%; UMICs 19%, LICs 10%), was limited. Workforce shortages were evident, with many institutions relying on anesthesia residents for 24-h care. Adherence to protocols, including those for acute ischemic stroke (61.7%) and traumatic brain injury (55.6%), was highest in Latin America and the Caribbean (72% and 73%, respectively) and higher in UMICs (66% and 60%, respectively) but remained low in LICs (22% and 32%, respectively). The study highlights critical gaps in infrastructure, workforce, and technology across LMICs, yet it also underscores the potential for improvement. Strategic investments in neurointensive care unit capacity, workforce development, and affordable technologies are an unmet need in resource-limited settings. These findings offer a road map for policymakers and global health stakeholders to prioritize neurocritical care and reduce the disparities in patient outcomes globally.

Radiomics and molecular analysis: Bridging the gap for predicting hepatocellular carcinoma prognosis.

This editorial examines a recent study that used radiomics based on computed tomography (CT) to predict the expression of the fibroblast-related gene enhancer of zeste homolog 2 (EZH2) and its correlation with the survival of patients with hepatocellular carcinoma (HCC). By integrating radiomics with molecular analysis, the study presented a strategy for accurately predicting the expression of EZH2 from CT scans. The findings demonstrated a strong link between the radiomics model, EZH2 expression, and patient prognosis. This noninvasive approach provides valuable insights into the therapeutic management of HCC.

Concomitant Sphenopterygoid Canal and Duplicated Foramen Rotundum Detected on Computed Tomography Scan.

The middle cranial fossa exhibits an interesting typical and variant anatomy. Accessory foramina frequently or rarely exists and transmits emissary veins. The sinus computed tomography scan of a 63-year-old male patient was further examined for its unique morphology. An accessory foramen rotundum (FR) was identified on the left side, 2.67mm laterally to the typical foramen. Posterolaterally to the typical FR (10.33mm distance), the intracranial opening of a sphenopterygoid canal was detected. This canal had a length of 22.85mm and opened extracranially through a pterygoid foramen on the lateral pterygoid plate. The right side of the patient was typical. The unusual coexistence of 2 rare skull base variants was recorded. The accessory FR and sphenopterygoid canal presence were described only in a few case reports in the current literature, while their coexistence has not been reported. Anatomists and clinicians should remember that rare variant foramina can transmit emissary veins, such as the ones presented in the current imaging case.

Evaluation of patient immunocompetence for immune checkpoint inhibitor therapy using the psoas muscle index: a retrospective cohort study

IntroductionIn patients with cancer, sarcopenia is an indicator of poor prognosis and is associated with an increased risk of chemotherapy-related adverse events. Skeletal muscle interacts with the immune system, and sarcopenia is associated with immune senescence. However, the association between sarcopenia and the response to immune checkpoint inhibitor (ICI) therapy remains unclear.MethodsThis retrospective study included patients with advanced or recurrent non-small cell lung cancer treated with nivolumab or pembrolizumab monotherapy. The association between the psoas muscle index (PMI) and both clinical response and immune-related adverse events (irAEs) was assessed using logistic regression. The PMI was calculated as the cross-sectional area of the psoas muscle divided by the square of the height based on computed tomography scans performed before the initial administration of ICI therapy.ResultsA total of 67 patients were included in the analysis. Logistic regression analysis showed that PMI was associated with the overall response (odds ratio [OR]: 1.52; 95% confidence interval [CI]: 1.04–2.22; p = 0.030) and the risk of severe irAEs (OR: 1.72; 95% CI: 1.05–2.80; p = 0.031).ConclusionThese findings suggest that PMI is both an indicator of prognosis and a surrogate marker of immunocompetence in predicting the clinical response to ICI therapy.

Appendicolith as a sign of complicated appendicitis - a myth or reality? A retrospective study.

Appendicolith can be incidentally detected on abdominal computer tomography (CT) without any signs of appendicitis. However, it has also been found to be a risk factor for failure of nonoperative management in acute appendicitis. The present retrospective study aimed to evaluate whether appendicolith predicts complicated appendicitis in patients with any appendicitis. A retrospective chart review was conducted for patients undergoing appendectomy from January 2016 to December 2018. Appendicolith was considered to be present when it was described in a CT scan. Of the 267 patients, appendicolith was found in 120 cases, while there were no in 147 cases in preoperative CT scans. In the case of complicated appendicitis (gangrenous or gangrenous perforated appendicitis), appendicolith was visible in CT scans in 57.7% of the patients. Of the patients with uncomplicated appendicitis, 38.3% had appendicolith in CT scan (p=0.002). In univariate logistic regression analysis, based on the finding of the histological specimen, appendicolith was associated with complicated appendicitis (OR 2.12; 95% CI 1.28-3.51 p=0.004). When adjusting for sex, age group (age ≤50 vs >50 years), and duration of symptoms (≤24 vs >24 hours), the odds ratio was 3.52 (95% CI 1.88-6.58; p<0.001). Our study found that appendicolith can be considered an independent risk factor for complicated appendicitis. Therefore, in the presence of appendicolith, surgical treatment should probably be preferred over non-surgical treatment in acute appendicitis.

Impact of Sensitive Circulating Tumor DNA Monitoring on CT Scan Intervals During Postoperative Colorectal Cancer Surveillance

Objective: This study investigated whether digital polymerase chain reaction (dPCR)-based circulating tumor DNA (ctDNA) monitoring can allow longer intervals between computed tomography (CT) scans during postoperative surveillance of colorectal cancer (CRC). Background: Practical guidelines still recommend intensive postoperative surveillance of CRC using periodical CT scans and serum carcinoembryonic antigen testing. Methods: The longitudinal dynamics of ctDNA for 52 patients with CRC as measured by dPCR using probes targeting 87 individual tumor-specific mutations (1–5 per patient) were compared with results from conventional (ie, clinical) surveillance using serum tumor markers and CT. Results: A total of 382 CT procedures were carried out for the patient cohort (3.3/year per patient) and the median lead time from ctDNA relapse to clinical relapse was 182 days (range, 0–376 days). If the CT interval was annual, potential delays in the detection of clinical relapse would have occurred for 7 of the 10 patients who experienced clinical relapse (9 of 13 events), with a median delay of 164 days (range, 0–267 days). If annual CT surveillance was performed together with ctDNA monitoring, 218 (57.1%) CTs would not have been needed to detect the first clinical relapse. In addition, the ctDNA monitoring would have provided a lead time of 339 days for detection of clinical relapse (range, 42–533 days). Conclusions: Our findings suggest that the ctDNA monitoring as part of postoperative surveillance and clinical relapse detection for patients with CRC could allow the CT interval to be lengthened. Trial Registration: This trial was registered with University Hospital Medical Information Network Clinical Trial Registry (UMIN000045114).

Combined Correction of Coronal and Rotational Deformities of the Femur With Distal Femoral Osteotomy Using Patient-Specific Instrumentation.

Distal femoral osteotomy (DFO) can be used to simultaneously correct coronal and rotational deformities. Patient-specific instruments (PSIs) are known to be helpful in such complex osteotomies, but data on surgical accuracy for the combined correction of coronal and rotational deformities of the femur are missing. To investigate the radiological results of DFO for simultaneous correction of coronal and rotational deformities using PSIs. Case series; Level of evidence, 3. All included patients underwent DFO (34 patients, 36 knees) using PSIs for combined correction of coronal and rotational deformities. The hip-knee-ankle angle (HKA) was measured in weightbearing long-leg radiographs, and the femoral torsion was assessed using computed tomography scans, both pre- and postoperatively. The achieved corrections of HKA and femoral torsion were determined for each knee, and surgical accuracy was calculated. HKA and femoral torsion changed significantly from preoperatively to postoperatively (from 2.4° ± 3.6° vs 0.1° ± 1.8° [P < .001] and 31.2° ± 17.2° vs 18.7° ± 7.4° [P < .001]). The difference from planned to achieved correction was statistically greater for HKA (-2.9° ± 3.8° vs -2.3° ± 3.5°; P = .018) than for femoral torsion (-12.4° ± 11.8° vs -12.3° ± 12.2°; P = .771), which did not reach significance. The accuracies of HKA and femoral torsion correction were 1.1° ± 1° and 2.4° ± 1.9°, respectively. Coronal and rotational deformities of the femur can accurately be corrected simultaneously by a DFO, utilizing PSIs. High accuracy was achieved for the correction of both coronal and rotational deformities, with absolute mean differences from planned to achieved correction of 1.1° and 2.4°, respectively.

Successful resolution of gastric pneumatosis due to a strangulated hiatus hernia and malrotation through non-surgical management: a case report

Abstract Gastric pneumatosis is a rare finding, and clinicians, when under pressure, find it challenging to immediately identify the cause and decide if the patient requires emergency surgery. We present a case where an initial Computed Tomography (CT) scan demonstrated gastric pneumatosis involving only the greater curvature of the antrum caused by a strangulated hiatus hernia and malrotation of the distal stomach. The CT features suggested the patient required immediate surgery; however, a conservative approach was taken, and a follow-up CT scan four days after the onset demonstrated complete resolution and no long-term complications.

Association Between Renal Pelvis Urine Density and the Risk of Infectious Complications after Retrograde Intrarenal Surgery.

Introduction: Renal pelvis urine density (RPUD), as measured by computed tomography (CT), may serve as an effective predictor for pyonephrosis. Our objective was to evaluate the correlation between the likelihood of developing infectious complications post-retrograde intrarenal surgery (RIRS) and RPUD measurements obtained from preoperative CT scans. Materials and Methods: We retrospectively reviewed data from patients who underwent RIRS for kidney stone treatment at a tertiary care facility between June 2017 and June 2024, using the hospital's database. The patients were divided into two groups based on the development of postoperative infective complications. The groups were compared in terms of preoperative (demographic data, stone characteristic, and RPUD) and operation data. RPUD was measured by creating an ellipse much as possible area encompassing the renal pelvis on the treated side area encompassing the renal pelvis on the treated side, and the average Hounsfield unit (HU) value was recorded. Results: Postoperative infection developed in 31 of 588 patients (5.3%). The median RPUD value was 15 in the infective group and 8 in the noninfective group, with a statistically significant difference between the groups (p = 0.001). Body mass index, stone burden, stone density, and RPUD were associated with postoperative infection in the multivariate analysis (p = 0.001, p = 0.008, p = 0.007, and p = 0.001, respectively). Each unit increase in RPUD increased the risk of postoperative infection 1.107-fold. The receiver operating characteristic (ROC) analysis demonstrated a significant relationship between RPUD value and the risk of postoperative infection, with an area under the curve of 0.742 (p = 0.001). When the RPUD cut-off value was accepted as 14, sensitivity was 0.613 and specificity was 0.779. Conclusion: This study showed a significant association between HU values in RPUD and the risk of infectious complications following RIRS. This finding suggests that incorporating urine HU values from CT images into preoperative risk assessment could be crucial for infection prevention and management.

Computed Tomography Assessment of Os Trigonum in the Omani Population and Its Clinical Relevance

Background: Os trigonum (OT) is an accessory ossicle that develops from the failure of the secondary ossification center of the posterior talar process fusion. It is clinically significant due to its association with posterior ankle pain and impingement syndromes. Despite its tremendous clinical relevance, limited data exist on the frequency of OT in Middle Eastern populations. Objectives: This study aimed to determine the frequency, morphological variations, and dimensions of OT in Omani subjects using computed tomography (CT) imaging and to evaluate the sex and laterality differences in its occurrence. Methods: A retrospective cross-sectional study of 352 foot and ankle CT scans were conducted to assess the OT at Sultan Qaboos University Hospital. OT presence, dimensions, and classification along with patient demographics, including age and sex, were recorded. Descriptive statistical analysis and the chi-square test were employed to present the data. Results: The overall prevalence of OT was 10.2%, with a frequency of 11.2% on the left side and 8.9% on the right side. Type IIA was the most prevalent subtype in both feet (41.2% right, 44.4% left). The average minor-axis and macro-axis dimensions were 7.88 ± 2.998 mm and 10.76 ± 4.280 mm on the right side, while they were 8.06 ± 2.600 mm and 11.50 ± 4.997 mm on the left side. No statistically significant sex or laterality differences were observed with regard to the OT frequency (p &gt; 0.05). Conclusions: This study provides the first detailed evaluation of OT in the Omani population, highlighting its frequency and morphological variability. These findings emphasize the importance of CT imaging in identifying OT and guiding clinical management. Future studies should explore OT’s clinical correlations to enhance its diagnostic and therapeutic implications.

Anatomical regions of residual hemorrhage in chronic subdural hematoma

BackgroundChronic subdural hematoma (CSH) is a persistent challenge for neurosurgeons, with current relapse, mortality, and morbidity rates not meeting desired outcomes. This study aims to identify the anatomical regions of postoperative residual hemorrhage and discuss their potential implications for surgical practice.MethodsThis retrospective, observational study reviewed the demographic, clinical, functional, and radiographic outcomes of 74 patients who underwent surgery for CSH between January 1, 2017, and October 1, 2021, at a single-center. Data were collected from the hospital's electronic database, including patient history, physical examination records, and preoperative and postoperative imaging.ResultsPostoperative day 1 computed tomography scans revealed the most common region for residual hemorrhage was the inferior frontal gyrus in 17 cases (23.0%; valid percentage: 42.5%). Residual hemorrhage was detected in the superior parietal lobe in 9 cases (12.2%; valid percentage: 22.5%). High valid percentages of residual hemorrhage were also noted in the temporal (62.5%) and occipital (66.6%) regions.ConclusionsThe inferior frontal gyrus, temporal, and occipital regions are the most common sites for postoperative residual hemorrhage in CSH patients. Identifying these regions can guide surgical planning and intraoperative focus, potentially improving patient outcomes. This study provides valuable insights for refining presurgical strategies and targeting specific anatomical areas during surgery.

A case report: interstitial pneumonia following treatment of gastric cancer with sintilimab in combination with S-1

BackgroundInterstitial pneumonia is a group of pathologies affecting the pulmonary interstitium, characterized by interstitial fibrosis and extensive alveolar consolidation. This disease can extend to the surrounding blood vessels and pulmonary interstitium, sometimes affecting the entire lung, resulting in functional limitations, including restrictive ventilatory defect, impaired gas exchange, and hypoxemia. Severe interstitial pneumonia can lead to death. Antitumor drugs can induce interstitial pneumonia. Sintilimab is an immune checkpoint inhibitor, a recombinant fully human immunoglobulin G-type programmed death protein-1 monoclonal antibody inhibitor. S-1 is a compound preparation consisting of gimeracil, oteracil potassium, and ftorafur. There have been cases of interstitial pneumonia caused by treatment with sintilimab or S-1 in clinical settings, but no cases of interstitial pneumonia caused by treatment with a combination of sintilimab and S-1 have been reported.Case reportA patient diagnosed with gastric cancer underwent nine courses of treatment using a chemotherapy regimen of combined oxaliplatin S-1., Due to severe bone marrow suppression and gastrointestinal adverse reactions, the treatment was switched to sintilimab in combination with S-1therapy., This change resulted in the development of interstitial pneumonia, as revealed by non-contrast chest Computed Tomography scans. Following a review of blood test results and a multidisciplinary consultation, we suspect that the interstitial pneumonia may have been caused either by Sintilimab alone or by the combined effects of sintilimab and S-1. The treatment was discontinued, and after receiving adequate glucocorticoid therapy, the pulmonary lesions showed slight improvement.ConclusionThis case provides a clinical reference, indicating that prior touse of sintilimab in combination with S-1 antitumor regimen, a comprehensive baseline assessment should be conducted, including blood routine examination, enzyme tests, and pulmonary imaging examination, with close monitoring of the patient’s pulmonary condition. If drug-induced lung injury is suspected, the medication should be discontinued immediately, and appropriate treatment should be initiated promptly.

Livernet based segmentation of lesions from computed tomography scan for liver tumor detection

Livernet based segmentation of lesions from computed tomography scan for liver tumor detection

Radiation Exposure in Operatively Treated Pediatric Femur Fracture Patients.

Children who sustain femur fractures are exposed to medical radiation as part of their treatment. In addition to standard radiographs and fluoroscopy, computerized tomography (CT) is a major source of ionizing radiation (IR). These patients frequently undergo CT scans during their treatment. The aim of the current study was to quantify the factors associated with greater IR exposure in children with operatively treated femur fractures and compare radiation exposure among those who received CT scans versus those who did not. Thirty-eight patients below 18 years old with operatively treated traumatic femur fractures were included in the study. They fell into one of 2 groups: 1 received 1 or more CT scans (CT group), and the other did not receive a CT scan (non-CT scan). The 2 groups were then compared by total quantitative radiation exposure, age, BMI, location of the femur fracture, open versus closed fracture, and the presence versus absence of fracture displacement. The effective dose of IR exposure that occurred within the operating room (OR) made up 75.7%±27.4% of the total IR exposure among all patients. Patients in the CT group had over a 5-fold greater quantitative cumulative IR exposure compared with the non-CT group (P<0.0001). Furthermore, patients in the CT group were significantly older than (P=0.004) and had a greater BMI (P=0.045) than the non-CT group. Children with pediatric femur fractures often exceed what is considered a low level of radiation. There is a significant difference in radiation exposure between pediatric femur fracture patients who receive 1 or more CT scans compared with those who do not receive a CT scan. Level III-retrospective cohort study.