Computed Tomography Of Abdomen Research Articles

Differential Impact of Subcutaneous and Visceral Fat on Bone Changes after Gastrectomy.

Osteoporosis and fragility fractures are crucial musculoskeletal complications in long-term survivors of gastric cancer. However, the relationship between changes in body composition after gastrectomy and bone loss has not been investigated. Therefore, this study aimed to explore whether computed tomography (CT)-derived body composition parameters are associated with bone loss after gastrectomy in patients with gastric cancer. We retrospectively reviewed medical records and abdomen CT scans of patients who underwent gastrectomy at Yonsei University Severance Hospital between 2009 and 2018. Patients with non-metastatic gastric adenocarcinoma and preoperative and postoperative non-contrast CT scans were analyzed. Section area of skeletal muscle (SMA), visceral fat (VFA), and subcutaneous fat (SFA) were assessed using semi-automatic segmentation software. Changes in trabecular bone attenuation of L1 mid-vertebra level (L1 Hounsfield units [HU]) were measured. Fifty-seven patients (mean age, 65.5±10.6; 70.2% males) were analyzed, and the median duration was 31 months. Fortyseven patients (82.5%) lost weight after gastrectomy. Baseline SMA and VFA did not differ between the bone loss and preserved groups; however, baseline SFA was significantly higher in the bone preserved group than in the bone loss group (P=0.020). In a multivariable linear regression model adjusted for confounding factors, one standard deviation higher VFA at baseline was associated with greater annualized L1 HU loss (%) (P=0.034). However, higher preoperative SFA was associated with protection against bone loss after gastrectomy (P=0.025). Higher preoperative SFA exhibited a protective effect against bone loss after gastrectomy in patients with non-metastatic gastric cancer, whereas VFA exhibited a negative effect.

Ionizing Radiation-Induced Oxidative Stress in Computed Tomography-Effect of Vitamin C on Prevention of DNA Damage: PREVIR-C Randomized Controlled Trial Study Protocol.

Exposure to ionizing radiation (IR) is inevitable in various X-ray imaging examinations, with computed tomography (CT) being a major contributor to increased human radiation exposure. Ionizing radiation may cause structural damage to macromolecules, particularly DNA, mostly through an indirect pathway in diagnostic imaging. The indirect pathway primarily involves the generation of reactive oxygen species (ROS) due to water radiolysis induced by IR, leading to DNA damage, including double-strand breaks (DSB), which are highly cytotoxic. Antioxidants, substances that prevent oxidative damage, are proposed as potential radioprotective agents. This Study Protocol article presents the rationale for selecting vitamin C as a preventive measure against CT-associated IR-induced DNA damage, to be investigated in a randomized placebo-controlled trial, with a full in vivo design, using an oral easy-to-use schedule administration in the outpatient setting, for the single CT examination with the highest total global IR dose burden (contrast-enhanced abdomen and pelvis CT). The study also aims to explore the mediating role of oxidative stress, and it has been written in adherence to the Standard Protocol Items recommendations.

Lemniscate intestinal loop through an internal hernia after Roux-en-Y gastric bypass cause of coecum mobile. A case report

The internal hernia is a typical complication after laparoscopic Roux‑en‑Y gastric bypass surgery. In most cases, there are chronic symptoms that only lead to a diagnostic laparoscopy during the diagnostic exclusion procedure. Less common is acute internal hernia with devastating pain, ileus symptoms and even the development of intestinal gangrene. Although this case describes a typical constellation, it posed a particular challenge because it resulted in mesenteric lemniscate‑like torsion through the Petersen pouch. Case presentation. A 29‑year‑old patient presented to our emergency department with abdominal pain, complained of sudden epigastric pain that lasted overnight, and radiated into the back with a permanent belching every 10 seconds. Four weeks ago, the patient received an abdominoplasty, complaining of postprandial nausea, meterorism and constipation afterwards. 19 months ago, a Roux‑en‑Y gastric bypass with a weight of 109 kg and a body mass index of 42.6 kg/m2 was done. The current body weight was 60 kg and the body mass index was 23.4 kg/m2. After focused assessment with sonography for trauma and the detection of dilated intestinal loops, an abdominal computer tomography (CT) was performed. Radiologically, the suspicion of mesenteric malrotation was confirmed. The SWELL (CT‑graphic swirl sign, excess weight loss >95%, liquid in abdomen CT scan) score was positive with a CT‑graphic swirl sign and an excess weight loss of 108.9% (> 95%), no chylus or ascites. We discussed an immediate, necessary diagnostic laparoscopy. Based on the ileocoecalpol, it was not possible to establish a proper assignment of the detached gastrointestinal tract. The exploration of the sigmoid colon as the only fixed point revealed that this was a complete fixed twisting of the right intestinal part with a twist of the caecum into the right upper abdomen through the Petersen space. This necessitated a laparotomy to manually cancel Bernoulli’s lemniscate‑like loop and perform a mesenteric defect suture of the mesenteric space of Brolin and the Petersen space with a non‑absorbable suture. The intestinal loops and patient recovered quickly. The dismission was on the 4th post‑operative day. Conclusions. The internal hernia after gastric bypass remains a diagnostic challenge despite advances in imaging. Due to the increasing number of patients undergoing bariatric surgery, this differential diagnosis must always be considered in the case of abdominal complaints. In addition to the excess weight loss of >95%, this case shows that a recent abdominoplasty can also provoke an internal hernia.

Clinical decompensation after trauma laparotomy: It's probably not a pulmonary embolus

Introduction Computed Tomography (CT) to rule out pulmonary embolus (PE) is often ordered during post-trauma laparotomy clinical decompensation (CD) involving fever, tachycardia, tachypnea, and/or leukocytosis. We hypothesize this diagnostic modality is low-yield in the postoperative period when surgery-related sequelae are more probable.Methods This is a single-center retrospective cohort study of patients who underwent trauma laparotomy and had subsequent CT for CD from March 19, 2019 to June 30, 2022. Descriptive statistics and multiple logistic regression were performed. The primary outcome was saddle and lobar PE incidence.Results 1032 adult patients underwent trauma laparotomy with 434 undergoing CT for CD: 137 CT abdomen and pelvis only, 30 CTPE, 265 both. The majority (80.2 %) was male, age 33[interquartile range (IQR) 24–45], suffered penetrating mechanism (57 %), and had ISS 23[IQR16–30]. Injuries at laparotomy included 47 % solid organ, 62 % GI tract, 7 % biliary, 11 % vascular, and 42 % other. 176 (41 %) required damage control laparotomy. Median time to CT post-laparotomy was 174 h [111–235] with saddle and lobar PE in 3 (1 %), peripheral PE 18 (5 %), and abdominal abscess, leak, fluid, or pseudoaneurysm in 222 (51 %). Clinical management was altered (40 %) by antibiotics, therapeutic anticoagulation, drainage, aspiration, filter, thrombectomy, or surgical operation. Patients for whom CT findings changed management were more likely to have had GI tract surgery (69% vs 57 %, p = 0.021), higher white blood cell (WBC) (16.4 [13.1–20.5] vs 15.1 [9.9–19.5], p = 0.002), more hours between CT and laparotomy (184 [141–245] vs 162 [89–230], p = 0.002), and lower mortality (2% vs 8 %, p = 0.008). In-hospital mortality was 5 %; none were PE-related. Predictors of clinical intervention required based on CT imaging were GI tract injury (AOR: 1.65, p = 0.0182), and elevated WBC (AOR: 1.038, p = 0.010Conclusion Saddle and lobar PE incidence post-trauma laparotomy is low. SIRS-type symptoms prompting postoperative CT commonly have no procedural or antibiotic requirement. Postoperative decompensation is more likely related post-operative complications, and less likely a PE.

Task-based assessment for radiation dose optimization in CT abdominal examinations: A phantom study

Recent advancements in Computed Tomography (CT) imaging technology have significantly enhanced healthcare delivery. However, public concern regarding the safety and health risks associated with increased exposure to ionizing radiation has escalated. In response, this study performs a quantitative analysis comparing the image quality of the standard CT abdomen protocol (P1 protocols) with alternative optimization techniques. Adjustments to standard CT scan parameters, including tube potential (P2 protocols), effective mAs value (P3), and pitch factor (P4, P5, P6 protocols), were made to evaluate the effectiveness of these optimization strategies. A 64-slice CT scanner (Canon, Japan) and a polymethylmethacrylate (PMMA) textural water phantom was utilized in this study. CT dose descriptors, volume weighted CT Dose Index (CTDIvol) and dose-length product (DLP) alongside evaluation parameters such as Hounsfield Unit (HU) number, noise levels, Signal-to-Noise Ratio (SNR), and Contrast-to-Noise Ratio (CNR) were measured and analysed. Furthermore, this research introduced a Figure of Merit (FOM) based on the ratio of image quality parameters (SNR and CNR) to the CTDIvol, establishing a quantitative measure for optimization. A notable reduction in radiation dose—34.85% below the standard protocol (P1)—was observed in protocol P6, attributed to an increased pitch factor. Conversely, increase the effective mAs value has improved SNR and CNR values. The findings reveal that protocols P1 and P2 deliver the highest FOM for soft tissue and fat imaging, respectively. Protocol P1, with its higher attenuation factor, is optimal for abdominal examinations targeting soft tissues. Meanwhile, protocol P2's increase effective mAs value enhances beam intensity, improving CT numbers for fat tissues with their high-density composition. The study also found a strong correlation between FOM based on SNR and CNR values. In conclusion, adjustments to primary CT parameters significantly influence image quality. The FOM serves as an effective tool for measuring the overall performance of image quality, facilitating post-optimization assessment and contributing to the development of safer, more efficient CT imaging protocols.

Dose verifications in several organs in abdominal computed tomography (CT) scan by using Al2O3 OSL dosimeters

The study investigated the dose of several organs in the computed tomography (CT) scan by using Al2O3 optically stimulated luminescent (OSL) dosimeters. The organs of right and left kidney, right pancreas, spleen and liver in an anthropomorphic human phantom were investigated for the dose received during the scan. The OSL dosimeters are embedded into custom-made wax and replace onto two selected slices of human body phantom where the selected organs are located. The phantom was scanned with by using adult abdomen protocol. The percentage differences of OSL doses reading compared to the previous study data and the international dose reference level (DRL). The doses obtained from OSL NanoDots® showed excellent agreement compared to XRQA film dosimeters with percentage differences within 5%. The doses measured by using OSL dosimeters in five organs were also within the range of the national DRL values by the Ministry of Health of Malaysia (MOH). These findings suggest that our results can be utilized to verify the doses received by internal organs during computed tomography abdomen protocols. The overall results indicated the suitability of OSL dosimeters for the indirect dose verification in the CT scan.

Primary Disseminated Peritoneal Hydatidosis: A Rare Presentation of Common Infectious Disease

Introduction: Human hydatidosis, being caused by the larvae of Echinococcus granulosus, rarely presents as disseminated peritoneal disease which can be either primary or secondary. Iatrogenic secondary peritoneal echinococcosis is more common while primary form of infection is found occasionally. Radiological imaging including ultrasonography or computed tomography (CT) scan is considered the most essential diagnostic modality. The mainstay of treatment for localized hydatid cysts or infected cysts and multiple septations is the surgical management in the form of excision. Disseminated hydatid disease presents with varied manifestations involving multiple organs. However, primary peritoneal hydatidosis is being rare entity, accounting for only 2% of cases of abdominal hydatidosis. The dissemination to multiple organs usually occurs through either lymphatic or systemic circulation. Case Report: In this case report, we present an uncommon presentation of primary disseminated peritoneal hydatidosis. On further evaluation, the patient was diagnosed to have peritoneal hydatidosis with hepatic and lung hydatid cyst involvement on contrast-enhanced CT abdomen. The patient was managed conservatively with oral tablet albendazole 400 mg twice a day during his 1st admission and later presented again with acute abdomen, and then, radical surgery in the form of pericystectomy was carried out but patient developed large gastric perforation, for which again surgery was attempted, but patient succumbed to his illness. In this case, the rare presentation of primary disseminated peritoneal hydatidosis as acute abdomen was observed. Conclusion: Primary disseminated peritoneal hydatidosis as the presentation of acute pain abdomen is rare entity. This case emphasizes an atypical presentation of hydatidosis.

Decreased portal vein attenuation and liver enhancement with reduced intravenous contrast dosage during the national iodinated contrast shortage of 2022.

The worldwide shortage of intravenous (IV) Omnipaque iodinated contrast (Iohexol, GE Healthcare; Milwaukee, WI, USA) forced institutions to adopt various policies regarding contrast allocation. We sought to evaluate the impact of our hospital's response to the shortage, which was to decrease the dose of IV contrast from 100 mL to 75 mL for patients weighing between 45.4 and 136 kg (100-300 lbs) undergoing abdominal computed tomography (CT) examinations. The main objective was to assess for any differences in liver attenuation and enhancement between contrast dosages. Secondary outcomes included assessing differences in aortic and portal vein attenuation, the variance in attenuation measurements, and whether radiology reports included the correct IV contrast dose. Consecutive CT abdomen or CT abdomen and pelvis examinations without and with contrast were analyzed for the 3 months before the contrast shortage and for 3 months during the contrast shortage. Attenuation in Hounsfield units (HUs) was measured in the liver on pre-contrast and portal venous phase images. Vessel attenuation was measured in the aorta (arterial phase) and main portal vein (portal venous phase). Standard deviation of liver attenuation measurements was recorded as an indicator of signal-to-noise. Liver enhancement was calculated as the difference between liver portal venous phase attenuation and pre-contrast attenuations. Thirty-nine fixed dose (100 mL) and 36 reduced dose (75 mL) consecutive CT studies were included in the study. There were no significant differences between the two groups with respect to baseline characteristics such as age, weight, body mass index, and gender. There was no significant difference in pre-contrast liver attenuation between groups, but there was statistically significant greater liver attenuation (99.6 vs. 91.2 HU, P = 0.04) and liver enhancement (51.5 vs. 39.1 HU, P < 0.0001) during the portal venous phase for the fixed-dose group compared to the reduced dose group. There was significantly greater main portal vein opacification during the portal venous phase for the fixed dose group (146.6 vs. 122.2 HU, P < 0.0001). No significant difference was found in aortic opacification during the arterial phase (245 vs. 254 HU, P = 0.52). There was no difference in the standard deviation of liver attenuation measurements on the portal venous phase between the groups. The dose was reported correctly in all the patients receiving the fixed dose and in 92% of patients receiving the reduced dose, which was not statistically significant (P = 0.11). Reducing the IV contrast dose from 100 mL to 75 mL Omnipaque 350 in patients weighing 45.4-136 kg (100-300 lbs) undergoing an abdominal CT examination resulted in significantly decreased portal vein opacification and liver enhancement. In particular, liver enhancement and calculated iodine concentrations fell below suggested thresholds for adequate conspicuity of liver lesions. The change in contrast administration protocol also led to more errors in contrast dose reporting in the radiologist's report. These findings are broadly applicable to many practice settings and can help inform strategies in response to any potential future-iodinated contrast shortage.

Comparison and Utility of Intravenous Iodinated Contrast in Chest, Abdomen, Pelvis Computerized Tomography for Trauma Patients With Blunt Mechanism of Injury Before and After the May 9, 2022 Global Contrast Shortage at a Level II Trauma Center.

Background: Intravenous (IV) contrast improves the sensitivity and specificity of injury detection in computerized tomography (CT). Its use is recommended in the workup of trauma patients by the American College of Surgeons and American College of Radiology. On May 9, 2022, the Food and Drug Administration declared a shortage of iodinated contrast due to the COVID-19 pandemic. Although the shortage has ended, the temporary lack of IV contrast forced physicians to be prudent in ordering CT scans with IV contrast. We sought to determine if there was a change in the percentage of CT contrast studies performed during the contrast shortage and if this change affected patient outcomes.Methods: Retrospective chart review was performed on all adult tier 2 trauma patients at a 619-bed community-based level II trauma center who received CT chest, abdomen, and pelvis imaging as initial workup for blunt trauma from 5/9/2021-6/30/2021 (pre-shortage) and 5/9/2022-6/30/2022 (during shortage).Results: Patients were predominantly male with median age of 31-52 and of White or Hispanic ethnicity. Before the contrast shortage, all 110 trauma patients were scanned with contrast. During the shortage, 29 of 114 patients were scanned with contrast (P < 0.001). Injuries were identified in 59% of patients scanned with contrast (P < 0.001). There were no significant differences in blood transfusion needs, repeat CT, disposition, or mortality when comparing pre-shortage to during shortage or when comparing between non-contrast and contrast studies during the shortage.Discussion: There was a decrease in the percentage of CT contrast studies performed during the shortage. A higher percentage of injuries were identified in the patients scanned with contrast. However, there were no significant differences in patient outcomes. Certain trauma patients may be safely scanned without contrast.

Presentations, management and outcomes of postoperative bariatric patients seen in the emergency department

BackgroundBariatric surgery is becoming increasingly common and postoperative patients often present to the emergency department (ED) with complications. We sought to describe the presenting complaints, management, and outcomes of postoperative bariatric surgery patients seen in the ED. MethodsWe conducted a health records review of 300 consecutive postoperative Roux-en-Y bypass surgery patients who presented to two tertiary care EDs of a major bariatric surgery center within one year of surgery. Cases were identified using a data analytic tool, and two evaluators abstracted clinical variables, imaging, treatments, and outcomes using the electronic health record. Attending emergency physicians verified the data and an experienced bariatric surgeon interpreted the computed tomography (CT) results and surgical procedures. ResultsWe included 300 patients with mean age 43.0 years, 89.7% female. Of these, 70.0% presented within 30 days of surgery and 41.7% were admitted to hospital. ED treatments included intravenous fluids (67.0%), antiemetics (53.3%), and analgesia (61.9%). Patients presenting within 30 days of surgery were more likely to undergo a CT (74.3% vs 63.3%; p = 0.06) and to have clinically important CT findings (31.9% vs 6.6%; p ≤0.001). More of the ≤30-day patients were admitted to hospital (46.2% vs 31.1%; p = 0.02). While a higher proportion of patients presenting after 30 days underwent a procedure, a large number of those were not directly related to bariatric surgery, such as appendectomy and cholecystectomy. Of the 34 patients undergoing a procedure, the majority presented with abdominal pain (76.5%). ConclusionThis is the first detailed health records review of postoperative bariatric patients seen in the ED in the emergency medicine literature. Those presenting with abdominal pain were more likely to undergo CT abdomen and a surgical procedure. Similarly, those presenting within 30 days of surgery were more likely to have significant CT findings and require hospital admission. Others presenting with primarily nausea and vomiting may improve with ED symptom management and be discharged home with bariatric team follow-up.

SeRL: Style-embedding representation learning for unsupervised CT images synthesis from unpaired MR images

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide, and the fastest-growing cause of cancer deaths in the United States. Computed tomography (CT) and magnetic resonance (MR) imaging are the key image-based examination methods for HCC patients. Patients may alternatively undergo CT and MR exams given a radiation dose of the former and the cost of the latter. Due to organ representation differences between CT and MR, it’s a great challenge to detect the tumors from a time series of data consisting of both CT and MR by a single model. The annotations for these time series data will consume much time and labor for the physicians. Thus, we propose our style-embedding representation learning (SeRL) for unsupervised and unpaired abdomen CT and MR translation. Different from current medical image translation models, the style-representation information from real CT and real MR images has been embedded in the translation process to bypass some local minima during the convergence process and improve the synthesis results. Our patch-corrosion augmentation method enhances the style-embedding representation learning by bringing more diversity to the training data. Combined with the self-attention module, SeRL eliminates the noise caused by low grayscale pixel values during translation. Results on the unpaired HCC patient's CT and MR images show that our proposed SeRL is able to generate high quality CT images from MR ones. Evaluations such as Frechet Inception Distance (FID), Sliced Wasserstein Distance (SWD), and liver segmentation dice score are utilized to demonstrate our advantages over other state-of-the-art unsupervised methods.

Optimization of Routine Pediatric Computed Tomography Examinations in Hawassa City, Sidama Regional State, Ethiopia

Computed tomography (CT) has considerable impact in patient care. However, it is the most irradiating medical imaging technique in diagnostic radiology department. Optimization of pediatric CT is not well-practiced in developing countries. Protocols for some age groups were missed, and scan parameters are not adapted to the patient body size and age group. Furthermore, there are no established diagnostic reference levels to enhance dose optimization for pediatric patients at the local, regional, and national levels. Therefore, this study aimed to assess the optimization of routine pediatric CT examinations in Hawassa city, Ethiopia. A total of 360 pediatric dose records were reviewed for routine pediatric CT performed between January 1st, 2021 - May 30th, 2022. The data were analyzed using the statistical package for social science version 25 software. The Local Diagnostic Reference Levels (LDRLs) were established at the 75th percentile of CT dose quantities. The average KVp, mAs, and scan length used for pediatric head, chest, and abdomen CT were (112.8, 260.6, and 19.8), (112.9, 64.7, and 31.5), and (113.3, 79.4, and 32.9) respectively. The range of the established LDRLs in terms of volumetric CT dose index for the head, chest, and abdomen CT were (31.5 to 47, 2.3 to 6.1, 1.7 to 4.7) mGy. Whereas the range in terms of dose length product per scan for the head, chest, and abdomen CT were (723.4 to 1126.7, 55.9 to 258.9, and 38.1 to 242.5) mGy cm respectively. The obtained results show that the LDRLs for volumetric CT does index for head and chest CT were equivalent to the international studies. Whereas the local DRLs in terms of dose length product per scan were higher than the reports other studies except in Japan where the values for chest CT were comparable to the results of this study. Finally, the findings suggested that non-optimized pediatric head and chest CT were performed across all age groups.

Urinary bladder involvement in IgG4-related disease: A case-based review.

Immunoglobulin G4-related disease (IgG4-RD) is an immune-driven fibroinflammatory disease that presents as tumefactive lesions that not only commonly affects the pancreas, lacrimal and salivary glands, lung, liver and kidney but can also affect any organs. However, involvement of the urinary bladder in IgG4-RD is rarely reported. We describe a case of IgG4-RD involving the urinary bladder mimicking carcinoma and review the published literature-a 39-year-old male presented with complaints of dysuria, urgency and hesitancy. Ultrasound revealed a hyperechoic lesion protruding from the anterior of the urinary bladder wall with partial obstruction to bladder outflow, likely to be a pedunculated bladder mass with high suspicion for malignancy. A contrast-enhanced computed tomography abdomen showed a large irregular lobulated heterogeneously enhancing lesion involving the anteroinferior wall of the urinary bladder extending from mid-body up to the neck region with significant perivesical fat stranding and multiple ill-defined perivesical deposits along with hypodense soft tissue lesion in the perigastric region at the level of the body of the stomach. CT-guided perigastric and ultrasound-guided biopsy from the urinary bladder mass confirmed the diagnosis of IgG4-RD. The patient was treated with glucocorticoids. He is doing well after a 1-year follow-up without recurrence, and a repeat ultrasound showed a significant reduction in the size of the urinary bladder mass. The diagnosis of IgG4-RD should be considered in the differential diagnosis of a urinary bladder mass. High index of suspicion and prompt initiation of therapy are required to minimise residual damage and the need for surgical intervention.

Liver volumetry in cirrhotic patients with or without hepatocellular carcinoma: Its correlation with Child-Pugh, model for end-stage liver diseases and indocyanine green dye test.

To evaluate the correlation between non-tumoral liver volume (NTLV) by computed tomography (CT) volumetry and indocyanine green retention at 15minutes (ICG-r15%), Child-Pugh score (CTP) and model for end-stage liver diseases (MELD) score in cirrhotic patients having hepatocellular carcinoma (HCC) (group A) and in cirrhotics without HCC (group B). As many as 111 consecutive patients with liver cirrhosis, who underwent triple-phase CT abdomen, were retrospectively included in our study. They were classified into group A (cirrhosis with HCC, n = 69) and group B (cirrhosis only, n = 42). Segmental liver volume, tumor and NTLV were calculated using Myrian XP-Liver segmentation software. In group B, NTLV was the same as the total liver volume (TLV). The correlation of NTLV with ICG-r15%, CTP and MELD scores was analyzed using appropriate correlation tests for each group. NTLV had a good and significant negative correlation with ICG-r15% (ρ = - 512; p < 0.001) in group A, but not in group B. It also had a significant negative correlation with CTP (ρ = - 251; p = 0.038) and MELD (ρ = - 323; p = 0.007) scores only in group A. Furthermore, ICG-r15% had a good and significant positive correlation with CTP and MELD scores in both groups (p < 0.05). NTLV showed a significant negative correlation with ICG-r15% in cirrhotic patients with HCC, but not in cirrhotic patients without HCC. Therefore, CT volumetry can be a valuable tool to predict the functional hepatic volume in patients of cirrhosis with HCC subjected for hepatectomy, where a facility of ICG-r15% is not available. However, further studies are needed to validate our findings in cirrhotic only patients.

Retrorectal tailgut cyst: a case report

Background: Tailgut cysts are rare congenital malformation lesions, also known as retrorectal cystic hamartoma is defined as a remnant part of postnatal hindgut. Because of their rare incidence and nonspecific presentation, tailgut cysts are misdiagnosed. The symptoms depend on the size and the location of the tumor. Surgical intervention is always required because of the complications of these tumors. Case Presentation: We report a 40-year-old female patient with an uneventful past surgical and medical history. Presented to the outpatient clinic with vague abdominal pain and constipation for 1 and a half years. The rectal digital examination, computed tomography abdomen, and pelvis with contrast and magnetic resonance imaging pelvis indicated the presence of the tailgut cyst, intraoperative we found two retrorectal cysts, and complete surgical resection using a posterior approach was performed. The histopathology examination showed a 5 * 5 cm cyst filled with putty-like material, defined as an epidermal inclusion cyst. The patient recovered well and was discharged 6 days after surgery. Out patient clinic follow up was uneventful and the patient was discharged from the surgical side. Conclusion: Tailgut cysts originate from the postanal gut of the embryo. These cysts are typically asymptomatic, surgical removal via a posterior or anterior approach is recommended once these lesions are detected due to the possibility of malignant development, infection, retrorectal abscesses formation, and rarely anal fistulas. A variety of surgical techniques can be employed, and the course of treatment can be customized to fit the anatomy and suspected lesion diagnosis of each patient.

DIAGNOSIS OF KIDNEY CYST, TUMOR AND STONE FROM CT SCAN IMAGESUSING FEATURE FUSION HYPERGRAPH CONVOLUTIONAL NEURAL NETWORK (F2HCN2)

The development of a computational tool to diagnose kidney disorders in their early stages is necessary due to the rise in chronic kidney diseases (CKDs) and the global shortage of nephrologists. The three common renal disorders covered in this study are kidney stones, cysts, and tumors. Early diagnosis of these diseases from the computed tomography (CT) images is a challenging task. Yet, present graph convolutional neural network (GCNN) approaches have the issue of overdependence on the adjacency matrix. Moreover, compared to deep convolutional neural network (CNN) models, a single modal feature results in low accuracy and robustness. In this paper, we proposed the feature fusion hypergraph CNN (F&lt;sup&gt;2&lt;/sup&gt;HCN&lt;sup&gt;2&lt;/sup&gt;) to accurately diagnose kidney diseases in the early stage based on CT scan images. The discriminative features of the images are extracted using DarkNet19 and residual features are extracted using ResNet50. The extracted features are classified using feature fusion hypergraph CNN. The proposed model is trained with 12,446 CT whole urogram and abdomen images. The hypergraph representation learning is performed to train the network with the fused features. Deep learning metrics including accuracy, F1 score (F1), recall, positive predictive value (PPV), receiver operating characteristic curve, and area under curve (AUC) are used to validate the proposed model. It outperforms compared to other state-of-the-art algorithms with accuracy of 99.71&amp;#37;. The proposed F&lt;sup&gt;2&lt;/sup&gt;HCN&lt;sup&gt;2&lt;/sup&gt; is a robust computer-aided tool for the early diagnosis of kidney diseases. It will assist the radiologist for better prognosis for kidney related abnormalities.

Correlation of Liver Attenuation with Visceral Fat Area on Computed Tomography Scan: An Analytical Study

Introduction: In the modern world, owing to rapid urbanisation and changes in lifestyles and dietary habits, obesity has emerged as a leading problem. As a result, various morbid conditions have come into the picture which have severe effects on an individual’s life expectancy. Visceral fat plays an important role in causing fatty liver. Aim: To determine the relationship between visceral fat area and liver fat using Computed Tomography (CT). Materials and Methods: A retrospective analytical study was conducted at Dr. D.Y. Patil Medical College, Hospital, and Research Centre Pune, Maharashtra, India. The CT scans of 134 patients who underwent CT scans of the abdomen pelvis and CT KUB/CT IVU between January 2022 and June 2022 were assessed by two experienced body imaging medical doctors. Subjects aged between 18 and 75 years were included without any co-morbidities like diabetes or hypertension. Waist circumference, subcutaneous fat area, and visceral fat area were calculated at the umbilical level. The CT attenuation value was measured in the right hepatic lobe, devoid of focal lesions and vessels, using a standard ROI of approximately 200 mm2 . Similarly, as an internal control, splenic attenuation was also recorded. Statistical tests were employed to determine the significance of the obtained values, including Spearman’s coefficient and Cohen’s criteria. Results: The CT attenuation of the liver (fatty liver) showed a moderate correlation with visceral fat (Spearman’s coefficient: 0.329). The association was statistically significant (p-value=0.0001). The CT attenuation of the liver (fatty liver) showed a weak correlation with subcutaneous fat (Spearman’s coefficient: -0.269). The association was statistically significant (p-value=0.0016). The CT attenuation of the liver (fatty liver) demonstrated a weak-moderate correlation with waist circumference (Spearman’s coefficient: -0.305). The association was statistically significant (p-value=0.0003). Conclusion: Visceral fat area has a stronger correlation with fatty liver than waist circumference and subcutaneous fat. Visceral fat should be considered a risk factor in the development of fatty liver, which may further lead to metabolic syndrome, in order to reduce mortality and morbidity related to it.

'Testicular masquerade': a case report of testicular malignancy with persistent Müllerian duct syndrome and transverse testicular ectopia.

Persistent Müllerian duct syndrome (PMDS) is a rare sexual development disorder. It is even more rarely associated with transverse testicular ectopia (TTE), a rare form of testicular ectopia, in which both testes descend through a single inguinal canal and are present in the same hemiscrotum. PMDS with TTE is associated with 18%-33% malignant transformation. Here we report the case of a 48-year-old man who presented with a large right inguinoscrotal swelling and on evaluation was found to have a large right testicular mass with complete right inguinal hernia, undescended left testis and a central abdominal mass. On evaluation with contrast-enhanced computed tomography abdomen and pelvis and image-guided biopsy he was diagnosed with mixed germ cell tumour of the right testis (predominantly a seminoma) with a retroperitoneal nodal mass and absent left testis, for which he received chemotherapy. Post-chemotherapy he underwent surgery and was diagnosed intraoperatively with PMDS along with TTE and testicular malignancy arising from the ectopic left testis. Postoperative recovery and follow-up were uneventful. Most cases of PMDS are diagnosed early in life. They present clinically with unilateral or bilateral undescended testis with inguinal hernia. In adults, PMDS is usually associated with male infertility. However, TTE is associated with an increased risk of testicular tumours if undiagnosed until adulthood. In adults PMDS with TTE is usually an intraoperative finding and is commonly associated with malignancy in the ectopic/undescended testis.

Extracting Clinical Information From Japanese Radiology Reports Using a 2-Stage Deep Learning Approach: Algorithm Development and Validation.

Radiology reports are usually written in a free-text format, which makes it challenging to reuse the reports. For secondary use, we developed a 2-stage deep learning system for extracting clinical information and converting it into a structured format. Our system mainly consists of 2 deep learning modules: entity extraction and relation extraction. For each module, state-of-the-art deep learning models were applied. We trained and evaluated the models using 1040 in-house Japanese computed tomography (CT) reports annotated by medical experts. We also evaluated the performance of the entire pipeline of our system. In addition, the ratio of annotated entities in the reports was measured to validate the coverage of the clinical information with our information model. The microaveraged F1-scores of our best-performing model for entity extraction and relation extraction were 96.1% and 97.4%, respectively. The microaveraged F1-score of the 2-stage system, which is a measure of the performance of the entire pipeline of our system, was 91.9%. Our system showed encouraging results for the conversion of free-text radiology reports into a structured format. The coverage of clinical information in the reports was 96.2% (6595/6853). Our 2-stage deep system can extract clinical information from chest and abdomen CT reports accurately and comprehensively.

Diagnostic Accuracy of FAST Scan in Hemodynamically Stable Blunt Abdominal Injury Patients; Is it "Fast" enough?

Objective: To determine the diagnostic accuracy of a Focused Assessment with Sonography for Injury (FAST) scan in blunt abdominal injury with suspected hollow viscus organ perforation, keeping a computed tomography (CT) scan of the abdomen as a reference. Study Design: Cross-sectional study. Place and Duration of Study: Radiology Department, Combined Military Hospital, Peshawar Pakistan, from Aug 2017 to Feb 2018. Methodology: One hundred forty-seven hemodynamically stable patients aged 20-60 years of either gender presenting in the Emergency Department (ED) with clinical suspicion of blunt abdominal injury were included. FAST scan and CT abdomen reporting were done by two separate consultants blinded to each other. Results: The mean age was 35.84±8.44 years, ranging from 21-60 years. Among 72 FAST-positive patients, 68(46.3%) were true positive, and 4(2.7%) were false positive. Among 75 FAST negative patients, 6(4.1%) were false negative, and 69(46.9%) were true negative. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of FAST compared to CT was 91.89%, 94.52%, 94.44% and 92.00%, respectively; FAST scan was correct in 93.20%. Conclusions: FAST Ultrasound is a sensitive and specific tool in the screening and diagnosing of abdominal injury resulting from blunt abdominal injury.