Computed Tomography Scan Examination Research Articles

Increasing use of computed tomography scans in the North Denmark Region raises patient safety concern

PurposeUse of computed tomography (CT) scans raises safety concern as lifetime cumulative ionising radiation exposure is associated with risk of developing malignancies. This study aimed to investigate use of abdominal CT scans in the Danish health care sector. MethodsData on abdominal CT scans performed annually in the North Denmark Region between 2005 and 2018 were extracted from the regional registry with emphasis on patients with a medical history of a repeated abdominal CT scan within 28 days. An audit of the medical files was subsequently conducted in 100 randomly selected patient cases to evaluate clinical information being provided, in addition to justification for a repeated abdominal CT scan, and finally if other radiology modalities could have been applied. ResultsNumber of annually performed abdominal CT scans in this demographically stable regional population increased by a factor 4.3 from 15 in 2005 to 65 in 2018 per 1,000 inhabitants. The audit revealed that 31% of the secondabdominal CT scans within a 28 days period were categorized as either doubtful whether justified or not justified. Moreover, 20% of theCT scans were considered replaceable by ultrasonography. ConclusionsAnnual performance of abdominal CT scans increased fourfold during the 14 years period. This tendency is probably attributable to changes in the Danish health care sector by which CT scan examination are used more frequently aiming at more accelerated patient investigation flow in conjunction with shorter length of hospitalization stay. Alertness is strongly warranted towards the associated risk of cancer due to life-time cumulative ionising radiation exposure by this strategy.

Fine_Denseiganet: Automatic Medical Image Classification in Chest CT Scan Using Hybrid Deep Learning Framework

Medical image classification is one of the most significant tasks in computer-aided diagnosis. In the era of modern healthcare, the progress of digitalized medical images has led to a crucial role in analyzing medical image analysis. Recently, accurate disease recognition from medical Computed Tomography (CT) images remains a challenging scenario which is important in rendering effective treatment to patients. The infectious COVID-19 disease is highly contagious and leads to a rapid increase in infected individuals. Some drawbacks noticed with RT-PCR kits are high false negative rate (FNR) and a shortage in the number of test kits. Hence, a Chest CT scan is introduced instead of RT-PCR which plays an important role in diagnosing and screening COVID-19 infections. However, manual examination of CT scans performed by radiologists can be time-consuming, and a manual review of each individual CT image may not be feasible in emergencies. Therefore, there is a need to perform automated COVID-19 detection with the advances in AI-based models. This work presents effective and automatic Deep Learning (DL)-based COVID-19 detection using Chest CT images. Initially, the data is gathered and pre-processed through Spatial Weighted Bilateral Filter (SWBF) to eradicate unwanted distortions. The extraction of deep features is processed using Fine_Dense Convolutional Network (Fine_DenseNet). For classification, the Softmax layer of Fine_DenseNet is replaced using Improved Generative Adversarial Network_Artificial Hummingbird (IGAN_AHb) model in order to train the data on the labeled and unlabeled dataset. The loss in the network model is optimized using Artificial Hummingbird (AHb) optimization algorithm. Here, the proposed DL model (Fine_DenseIGANet) is used to perform automated multi-class classification of COVID-19 using CT scan images and attained a superior classification accuracy of 95.73% over other DL models.

Ways of transformation of typical X-ray signs of community acquired pneumonia of viral etiology (COVID-19) according to radiomics data

For 3 years since the announcement of the coronavirus disease (COVID-19) pandemic, doctors around the world have been studying the complications caused by different strains of SARS-CoV-2. To study the structure of the lung parenchyma in patients with a complicated course of community acquired viral pneumonia of COVID-19 and different ways of transformation, the most informative is the digital software processing of computed tomography (CT) images of the chest organs (CT).
 Objective — to investigate the ways of transformation of typical radiological signs in patients with community-acquired pneumonia of viral etiology (COVID-19) and the possibility of their transformation into bronchioloalveolar cancer (BAC) by the radiomics method.
 Materials and methods. Chest CT data in the dynamics of 112 patients with a complicated course of community-acquired viral pneumonia COVID-19 were analyzed. Chest CT was performed on an Aquilion TSX-101A Tochiba scanner (Japan) with subsequent digital software processing of CT images using the Dragonfly program from Obyect Research Systems (ORS), Montreal, Canada. The diagnosis of BAC was made based on the data of the pathomorphological examination. Transbronchial biopsy of lung tissue was performed during diagnostic fibrobronchoscopy.
 Results and discussion. As a result of the analysis of possible ways of transformation of typical X-ray changes of COVID-19 community-acquired pneumonia, we identified 3 main ways. In 71 (64.0 %) subjects, according to the chest CT scan, there was gradual resorption of pathological changes and recovery of the lung parenchyma. In 35 (31.2 %) patients, the formation of signs of «vanishing lung syndrome» was detected. 5 (4.5 %) patients were diagnosed with BAC according to the CT scan and pathomorphological examination. Digital software processing of chest CT in dynamics allows to track the process of transformation of the lung parenchyma structure in patients with a complicated course of COVID-19 community-acquired viral pneumonia into BAC and in some cases to confirm the secondary nature of the oncological process.
 Conclusions. Digital software processing of the chest CT data is a highly informative research method that clearly reflects the morphological structure of the lung parenchyma and allows diagnosis and differential diagnosis of diseases.

ASSESSMENT OF OUTCOME OF FUNCTIONAL ENDOSCOPIC SINUS SURGERY IN PATIENTS WITH CHRONIC SINUSITIS WITH OR WITHOUT SINONASAL POLYPOSIS

Introduction:- Chronic rhinosinusitis is a multifactorial disease causing inammation of sino-nasal mucosa. Functional endoscopic sinus surgery (FESS) causes less morbidity, complication and less recurrence rates. This study aims to assess various presenting symptoms, nasal endoscopic and Computed tomography (CT) ndings, to compare relief of various symptoms & to conrm the effectiveness of FESS as standard modality of treatment. Methodology:- In this study we include 100 cases of chronic sinusitis with or without sinonasal polyposis age between 15 to 65 years attending otorhinolaryngology outpatient department which full our inclusion criteria & undergoing Functional endoscopic sinus surgery. All the patients were pre- & post-operatively evaluated clinically using Rhinosinusitis symptom inventory score in to major & minor criteria, radiologically and endoscopically. The overall result reveal male is to fe Results:- male ratio was 1:1.27. Preoperatively on CT scan and endoscopic examination most commonly involved sinus was max illary sinus 99% & anterior ethmoid sinus (70%), most common anatomical variation was Deviated nasal septum/spur seen in (98%) & Concha bullosa in (82%). Most common symptoms observed was Nasal obstruction (93%), headache (81%) & Nasal discharge (72%). Post-operatively 91.66% of the patients were asymptomatic at the end of the 3 months with p value <0.0001 (statistically signicant) and 8.33% of patients were still symptomatic at the end of 3 months. No major complication directly related to FESS occurred. Conclusion:- In conclusion FESS is minimally invasive, safe and effective procedure & has better impact in relieving symptoms of chronic rhinosinusitis, as it clears only the involved sinus pathology, establishing normal mucociliary drainage of the paranasal sinuses

Computed tomographic evaluation of head injury patients in Umuahia, Abia State Nigeria

Background: Trauma to the scalp, skull and brain is defined as head injury. Head injury is a silent killer, especially in patients that have intracranial hemorrhage with mass effect on the brain parenchyma. It is a major health challenge worldwide especially in places where there is lack of medical insurance, ignorance and non availability of the right imaging modality. Before the advent of Computed Tomography (CT), plain radiographs had been the imaging modality available for the evaluation of head injury. Plain radiographs give limited information about head injury because apart from skull fractures, plain radiographs cannot confirm diagnosis of intracranial collections, brain contusions and others. CT scan was chosen because its four dimensional images can be reconstructed with volume rendering, bone details can be evaluated, and with the Hounsfield unit, measurements of collections, haematomas can be evaluated. There are not much reports on head injury findings in Umuahia and hence this study is set to contribute to the data on head injury in and around Umuahia.
 Materials and methods: This is a retrospective study of patients with head injury that came for head CT scan examination in Umuahia from January 2022 to December 2022. Patients were scanned with 160 slides Canon Aquilion CT Scanner; patients were made to lie in supine position. 3mm axial slices were taken from the base of the skull to the vertex with reformatted images. No contrast was used because it is contraindicated in traumatic brain injury. Patients gender, age, aetiology of injury and findings of radiologists were collected as data and entered into Microsoft Excel data base and statistically analyzed using statistical package for social sciences for windows (SPSS inc., USA) version 21.0, and results tabulated.
 Results: Out of the total population studied (108), 82.4% were males while 17.6% were females. Majority of the cases fell within the age group of 51yrs- 60yrs(20.4%), followed by 21yrs-30yrs(19.4%) and the least being below1yr (1.9%). Road traffic accident was the commonest cause of head injury (64%), followed by fall from height (19.4%), trauma to the head with weapons (13.9%) while glass bottle trauma and unknown causes were the least having (0.9%) and (1%) respectively. CT findings revealed that 52.1% of the cases resulted in hemorrhages, 18.6% resulted in hematoma formations, 6.5% were soft tissue injuries, 5.4% were pneumo-cephalus and 1.6% resulted in cerebral edema.
 Conclusions: Computed Tomography (CT) scan is a very useful tool in the evaluation of patients with head injury. The study showed that more males were involved with head injuries than females and that the most common cause of head injury in Umuahia, Abia State, is road traffic accident with intra-cerebral haemorrhage being the commonest CT finding.

Multidetector computed tomography in evaluation of buccal mucosa cancer

Background: Squamous cell carcinoma is the most prevalent kind of tumor of the buccal mucosa. For the purpose of planning surgery and radiotherapy for tumors of the tongue, floor of the mouth, and oropharyx, imaging to locate the size and extent of the original tumor is essential. Therefore, it is beneficial to determine the radiation field, to ensure adequate tumor margin excision, and overall to improve the patient’s prognosis. Aims and Objectives: The aim of the study was to evaluate the role of computed tomography (CT) scan in diagnosis of buccal mucosal malignancies and its characteristics. Materials and Methods: Total 50 patients suspecting buccal mucosa cancer were referred to Radiology Department. They were subjected for CT scan examination on 16 slice CT scanner. CT scan evaluation was made for size and extent of primary mass lesion. The staging of disease was performed with TNM classification. Results: In our study, out of 50 patients, the fourth decade (30%) and fifth decade (26%) saw the highest incidence of buccal mucosa cancer. The majority of the patients were suffering from severe disease; 44% had T4 stage and 58% had Stage IV. Conclusion: CT plays a very important role in staging of buccal mucosa malignancy and effectively detects bone erosion (98% sensitive) and invasion to infratemporal fossa. However, during the early stages of cancer, a CT scan might not be very helpful.

Метод оценки радиационного риска медицинского облучения при прохождении компьютерной томографии детей и подростков на основе данных протоколов сканирования

Computed tomography (CT) scan is a fairly accurate and reliable method for diagnosing various diseases, however, based on irradiation of the patient with ionizing radiation, it can lead to an excess risk of developing malignant neoplasms. According to the safety standards of the International Atomic Energy Agency, no patient can be exposed to medical radiation unless he or she has been informed of the risks associated with radiation exposure. This requirement is also contained in the Russian Radiation Safety Standards (NRB-99/2009). Radiation risk is estimated on the basis of calculated values of equivalent doses in the patient's organs and tissues using radiation risk models of the International Commission on Radiological Protection. This article is devoted to the improvement of the method for calculating equivalent doses in the organs and tissues of patients with computed tomography scan for further assessment of radiation risks. For 15 modern computed tomography scanners, with different geometry of patient scanning, the data necessary for calculating the equivalent doses in organs and tissues based on the parameters of the children's phantom were updated. The coefficients of conversion of the surrogate measure of the patient's radiation dose for the entire CT scan study, namely, the value of the "Dose Length Product" (DLP), into the values of equivalent doses in individual organs and tissues exposed to radiation were determined. The results of the calculation are given for five typical scan areas: chest, abdomen, pelvis, head and neck. In the course of simulation numerical modeling, organs and tissues with the highest equivalent doses were determined during CT scan examinations of children and adolescents. Unlike adult patients, for children and adolescents, the dose load on the surface of the bone is significantly lower and does not stand out in any of the considered types of CT scan examinations. It should be noted that with CT scan of the cervical spine, due to the specifics of the geometry of scanning new types of tomography scanners, the dose load on the thyroid gland of boys increased. The dose conversion factors obtained in this paper with estimates of standard deviations make it possible to assess the radiation risks of children and adolescents during examinations on modern CT scanners and optimize their dose loads.

Establishment of institutional diagnostic reference levels for 6 adult computed tomography examinations: Results from preliminary data collection

Computed tomography (CT) is the leading source of the cumulative effective doses to the general populace from medicinal and artificial sources. With the increased use of CT examinations comes the concern regarding the health effects of unnecessary radiation exposure and the need to optimize the doses that patients receive. The current study evaluates the patients' doses during specific CT procedures and establishes institutional diagnostic reference levels (DRLs) for the frequent CT scans performed. 8156 CT scan examinations were performed during three years from 2015 to 2018 using a single CT scan machine at our institution. Data from the six most common examinations were analyzed. The volume CT dose index (CTDIvol (mGy)) and dose length product (DLP) distribution's median and 75th percentile values were computed. The results were descriptively compared with DRLs from different countries and regions. The six most common examinations constituted 5815 studies. We established our DRLs as the median value of CTDIvol (mGy)| and DLP (mGy × cm) as follows: CT of the brain: 35.0 mGy and 839 mGy× cm, respectively; chest with contrast: 4 mGy and 148 mGy-cm, respectively; chest without contrast: 5 mGy and 190 mGy-cm, respectively; abdomen and pelvis with contrast: 8 mGy and 636 mGy-cm, respectively; abdomen and pelvis without contrast 8 mGy and 568 mGy-cm, in that order; abdomen, pelvis, and kidneys: 11 mGy and 458 mGy× cm, respectively. Our values for brain and chest CTs were lower than the international DRLs, while those for abdominal imaging were higher. The established DRLs offer an opportunity for us to optimize the dose delivered to patients and compare them to the national benchmarks when they are issued. The study revealed that CT dose showed wide discrepancies for the same procedures at the department levels suggesting that the practice was neither optimized nor harmonized. Therefore, DRL should be reassessed after the operators' training and awareness to reduce the patients' dose and related radiogenic risk to its minimal value.

A Review on Diagnostic Reference Levels for Adult Patients Undergoing Chest (Coronary Angiography) Computed Tomography Scan in North-East India

In the radiological department, the computed tomography (CT) scan process has become a greater radiation dosage that contributes to all medical X-ray treatments. Many studies throughout the world have found that CT accounts for just 5% of all operations conducted yet accounts for 34% of yearly radiation exposures in all medical X-ray treatments. Similarly, other studies have found that CT accounts for 17% of all operations conducted worldwide but accounts for 49% of total yearly doses in all medical X-ray treatments. Because diagnostic reference levels (DRLs) are one of the ways of optimizing a dose in a CT procedure, the goal of this review is to provide a DRLs for adults who undergo chest and abdomen CT scan examinations in northern India, based on research for this region and comparing with international values to see if better optimization protocol is being practiced. DRLs for the chest are 18.35mGy for CT dose index volume (CTDIvol) and 765 mGy.cm for dose length product (DLP), according to this review, while DRLs for the abdomen are 18.25 mGy and 1870.75 mGy.cm for CTDI (vol) and DLP, respectively. As a result, all of the DRLs examined had greater values than the international values compared, with the exception of CTDI (vol) of International Commission on Radiological Protection 2007 publications. CT technology is in desperate need of an update. In the northern region, optimizing methods, including exposure and technical parameter selection, should reduce dose fluctuations.

A Simple Method for Foramen Ovale Puncture Based on Preoperative Image Simulation in Percutaneous Microcompression of the Trigeminal Ganglion.

The classic puncture method of percutaneous microcompression using fluoroscopy might be difficult to precisely locate and visualize the foramen ovale. Various new surgical tools to increase the accuracy of finding the foramen ovale location have been introduced. However, all of these systems require some complicated operating steps and/or advanced devices to complete the work. To describe the use of a simple method for foramen ovale puncture by percutaneous microcompression based on preoperative image simulation. Forty-five patients were included in the study. All patients underwent a computed tomography examination. Among them, the simulated preoperative puncture pathway was reconstructed on the basis of computed tomography scan examination for 22 patients. Procedures were performed by 2 surgeons: one experienced surgeon and another young surgeon with surgical qualification. The puncturing time and cumulative radiation exposure dose, from start of the puncturing until reaching the foramen ovale, were recorded. Postoperative pain relief, facial hypoesthesia, masticatory muscle weakness, and other complications were recorded. In all cases, the procedure of cannulation was completed successfully. The puncturing time for both the experienced and young surgeon with the use of preoperative image simulation seemed to be time-saving. The young surgeon had less cumulative radiation exposure with the use of preoperative image simulation. Moreover, the intraoperative puncture pathways were almost consistent with the preoperative simulated images. The rest of the process went smoothly. Short-term outcomes of all the 45 patients were satisfactory. Based on our preliminary experience, the preoperative image simulation-guided technique is useful during these cases.

Correlation between Head Computed Tomography Scan Examination and Cranial Index Measurement in Pediatric Hydrocephalus

Hydrocephalus in children can inhibit child growth. However, if treated immediately, the patient will develop normal intelligence. In radiology, the most important problem is to detect hydrocephalus early. Currently, radiology examinations can detect hydrocephalus accurately with a CT scan to identify the presence of blockages and assess the degree. Skull radiography is used to assess the presence of advanced hydrocephalus. A comparison is carried out and assesses the relationship between hydrocephalus measurement on the ventricular and cranial index by scanogram. The study used a cross-sectional analytics design, using Picture Archiving and Communication System (PACS) data. There were 68 samples taken using consecutive sampling, obtaining ventricular index measurement results above 0.30, and patients under 12 years old. Spearman rank test showed a correlation between the ventricular index measurements and cranial index, with Spearman’s Rho (r) = 0.856 and p0.001 with linear equation Y= 2.973 + 0.005X. It revealed that the constant 2.973 indicated that if there is no B coefficient value, the participation value will be 2.973. Furthermore, regression coefficient X of 0.005 indicated that the participation value grows by 0.005 for every 1 addition of the B coefficient value with R2= 0.340.

Scan factors and practices associated with radiation doses for chest CT: current Brazilian scenario

The main purpose of this study was to compare the parameters of computed tomography (CT) and the corresponding patient doses undergoing chest CT scan examinations in different regions of Brazil, providing the current scenario of how these procedures are being carried out in the country as well as the patient dose distribution. Thirty institutions, across 17 states and the Federal District, participated in the survey. The evaluation included 30 multislice CTs of seven different models, manufactured by General Electric (GE) Healthcare. For each institution, data from 10 adult chest CT examinations, performed without contrast, were collected remotely. The analysis of the results showed a significant difference of the CTDIvol values, ranging from 1.1 mGy to 46.6 mGy in seven institutions. The mean value of CTDIvol was higher than values found in the literature and the UK Reference Levels. It was also observed that, regardless of the region of the country, for the same CT model, different scanning parameters were used, which resulted in CTDIvol up to 5 times higher in some institutions. Repetitions of CT acquisitions and scouts with radiation field dimensions larger than the region of interest were found in 25% of chest examinations, resulting in higher absorbed doses. The results of this work show a mapping of the chest CT procedures, which enables the establishment of strategic plans for the country. In addition, each institution will be able to implement an appropriate optimization program and establish institutional reference levels.

Fully automated unified prognosis of Covid-19 chest X-ray/CT scan images using Deep Covix-Net model.

SARS-COV2 (Covid-19) prevails in the form of multiple mutant variants causing pandemic situations around the world. Thus, medical diagnosis is not accurate. Although several clinical diagnostic methodologies have been introduced hitherto, chest X-ray and computed tomography (CT) imaging techniques complement the analytical methods (for instance, RT-PCR) to a certain extent. In this context, we demonstrate a novel framework by employing various image segmentation models to leverage the available image databases (9000 chest X-ray images and 6000 CT scan images). The proposed methodology is expected to assist in the prognosis of Covid-19-infected individuals through examination of chest X-rays and CT scans of images using the Deep Covix-Net model for identifying novel coronavirus-infected patients effectively and efficiently. The slice of the precision score is analysed in terms of performance metrics such as accuracy, the confusion matrix, and the receiver operating characteristic curve. The result leans on the database obtainable in the GitHub and Kaggle repository, conforming to their endorsed chest X-ray and CT images. The classification performances of various algorithms were examined for a test set with 1800 images. The proposed model achieved a 96.8% multiple-classification accuracy among Covid-19, normal, and pneumonia chest X-ray databases. Moreover, it attained a 97% accuracy among Covid-19 and normal CT scan images. Thus, the proposed mechanism achieves the rigorousness associated with the machine learning technique, providing rapid outcomes for both training and testing datasets.

A case report of duodenal carcinoid tumor causing gastric outlet obstruction

Carcinoids are tumours of neuroendocrine origin. Commonly found in gastrointestinal and respiratory tracts, however, duodenal carcinoids among them are comparatively rare. Duodenal carcinoids presenting as acute gastric outlet obstruction are even rarer. Clinically difficult to diagnose due to their non-specific presentation. Endoscopic ultrasound (EUS), computed tomography (CT) and immunohistochemistry (IHC) for markers like chromogranin A, neuron specific enolase (NSE), synaptophysin helps in making a definitive diagnosis. Management is influenced by multiple factors like size, site, metastases and regional lymph node involvement. Here is a case report of solitary duodenal carcinoid complicated with acute gastric outlet obstruction. A middle-aged female with chronic history of intractable dyspepsia, bloating and occasional vomiting, on thorough evaluation with upper GI endoscopy, EUS guided biopsy, CT scan and histopathological examination was diagnosed of a solitary 2.2×1.2×1.6 cm sized duodenal carcinoid tumour. Patient had no past, family or genetic history supporting the diagnosis. Patient presented with features of acute gastric outlet obstruction 1 week after the diagnosis which required a distal gastrectomy with resection of first part of duodenum followed by a Roux-en-Y gastrojejunostomy with an uneventful 6 month follow up. As the size in this case was more than 2 cm with AJCC staging of T2N0M0, distal gastrectomy with Roux-en-Y gastrojejunostomy was done to ensure an R0 resection and to relieve the gastric outlet obstruction. Duodenal carcinoids presenting as gastric outlet obstruction are not common. Early management is essential to prevent complications like gastric outlet obstruction despite of indolent course of the disease.

Review on Diagnostic Reference Levels (DRLs) for Adult Patients Undergoing Chest and Abdomen Computed Tomography Scan in Northern Nigeria

Computed tomography (CT) scan procedure has become a higher radiation dose that contributes to all medical x-ray procedures in the radiological department. Many researches in the world suggested that computed tomography presents a small fraction (5%) of the total procedures performed but contributes 34% of annual radiation doses in all medical x-ray procedures. Likewise, other investigations reported that computed tomography presents 17% of the total number of procedures performed worldwide but contributes 49% of the annual collective doses in all medical x-ray procedures. Therefore, the aim of this review is to provide a diagnostic reference level for adults that undergo chest and abdomen CT scan examinations in northern Nigeria, using the research for this region and comparing with international values to see if better optimization protocol is being practiced, since diagnostic reference levels are part of the ways of optimizing a dose in CT procedure. Based on this review, the results obtained for DRLs for the chest are 17.25mGy for CTDIvol and 735mGy.cm for DLP, while the results for the abdomen are 19.25mGy and 1670.75mGy.cm for CTDIvol and DLP respectively. Therefore, all the DRLs’ values reviewed are higher than the international values compared except CTDIvol of ICRP 2007 publications. There is an urgent need for an upgrade in CT technology. Optimization of protocols, including exposure and technical parameter selection, should help reduce dose variations in the northern part of Nigeria.

Nanoparticles: Untying the Gordian Knot in Conventional Computed Tomography Imaging

X-ray computed tomography (CT) imaging plays an essential role in disease diagnosis due to its noninvasive, painless mode and superior penetration depth. However, the resolution of the soft tissue ...

Evaluation of the Anatomical Locations of Stroke Events From Computed Tomography Scan Examinations in a Tertiary Facility in Ghana.

IntroductionStroke events are leading causes of mortalities globally and currently increasing alarmingly in low- and middle-income nations including Ghana, thus overburdening national healthcare delivery sectors. This trend is predicted to ultimately have an impact on the socio-economic development of these countries, thus gaining the attention of policy-makers and implementers. This study was therefore conducted to evaluate the anatomical locations of stroke events from CT scan examinations and the possibly associated variables to assist in managing this non-communicable pandemic.MethodsAll computed tomography (CT) scans performed for stroke events at the Cape Coast Teaching Hospital from June 2016 to June 2020 were retrieved and reviewed for this study. The socio-demographics and the presence of hypertensive risk factor were also retrieved. Data were then collated, grouped, coded, inputted, and used for analysis. Chi-square test of independence was employed for assessing possible associations, and logistic regression analysis was performed to predict the anatomical locations of stroke events using sex and hypertension. Statistical significance level was specified at p ≤ 0.05.ResultsA total of 1,750 stroke cases were recorded during the study period, comprising 1,237 (70.7%) ischemic strokes and 513 (29.3%) hemorrhagic strokes. Majority (54.3%) of the patients were males. The average age of participants was 62.46±14.74 years. Basal ganglia (43.0%), parietal lobe (26.7%), and frontal lobe (6.9%) were the commonest anatomical locations. The elderly (≥ 60 years) were significantly affected at the basal ganglia (p=0.006), parietal lobe (p=0.005), frontal lobe (p=0.013), temporal lobe (p=0.048), and cerebellum (p=0.049). Basal ganglia lesions were significantly recorded in men, whereas lesions located at the pons were significantly seen in females. The regression model revealed that the risk of stroke at the pons increased by 2.155-folds in males (p=0.043; 95% CI=1.026-4.528). Generally, gender and hypertension were not significant predictors of stroke lesion locations.ConclusionsThe basal ganglia area, which falls under the middle cerebral artery territory, was the commonest anatomical location for stroke events in our setting. Knowing the anatomical locations of these stroke events has an impact on the type of interventions needed, especially at the early stages of these stroke events. CT perfusion, CT angiography, and magnetic resonance imaging (MRI) with MR angiography (MRA) when available can further assist in determining the exact cause so that urgent interventions such as endovascular treatments can be offered.

Incidence rate and age of onset of first stroke from CT scan examinations in Cape Coast metropolis

IntroductionThe trends in the incidence and age of onset of first stroke is lacking in Ghana and with an increasing elderly population, such trends are projected to increase in developing countries. Through the review of Computed Tomography (CT) scan examinations and patients’ records; we assessed the incidence rate and age of onset of first stroke in Cape Coast Metropolis. MethodsThis study retrospectively reviewed all imaging records and clinical data of all stroke patients referred for CT scans in the radiology department of the Cape Coast Teaching Hospital (CCTH) between January 2017 and December 2019. All CT confirmed cases of stroke were classified as either hemorrhagic stroke or ischemic stroke. Age adjusted annual incidence rate with 95% Confidence Intervals (CIs) were calculated assuming a Poisson distribution. Mean difference were tested using one way Analysis of Variance (ANOVA). Results840 patients with first onset of stroke were identified, comprising 417 (49.6%) males and 423 (50.4%) females. There was a statistically significant difference in the mean age of onset of first stroke in males (61.47 ± 13.36 years) and in females (63.41 ± 15.41 years), p = 0.049. The incidence of first stroke for the entire age categories were higher in males compared to the same age categories in females, except for patients aged 35–44 years in 2017, 25–34 years in 2018, 15–24 years and 75 years or older age groups in 2019. Males had hemorrhagic stroke at an older age (64.41 ± 15.31 years) compared to ischemic stroke (60.40 ± 12.42 years) in this study. This difference was statistically significant (p = 0.014). There was no significant difference in the mean age of onset of first stroke for the respective years under study: F (3, 836) = 0.693, P = 0.500. ConclusionThe findings of this study imply that the incidence rate of stroke is higher in males than in females and increases with age. The majority of the strokes were ischemic.

Osteolytic lesions on the os petrosum of a Bronze Age individual from La Llana cave (Northern Spain) compatible with a possible case of otitis media. A multifaceted methodological approach

ObjectiveTo encourage the use of different methodological approaches for the identification of paleopathological lesions and to evaluate osteolytic lesions found on a temporal bone from La Llana cave (Spain). MaterialsCranial remains recovered from from La Llana cave (Spain) dated to the Bronze Age, 3300 ± 25 BP (1631−1509 cal BC). MethodsThe cranium underwent macroscopic, microscopic and computed tomography scan examinations. ResultsThe Tegmen tympani of the left temporal bone is present but is missing on the right. Both cochleae are intact. Both the right and left temporal bones display osteolytic lesions, with the left Tegmen tympani displaying deep and profuse pits on the endocranial surface, exposing the ear channel. ConclusionsThe lesions are compatible with otitis media (atticitis). By using different methods of analysis, the presence and effects of infection were identified. SignificanceThis systematically described case contributes to our understanding of disease in the past and describes otitis-related lesions in archeological contexts for comparative purposes. LimitationsThe fragmentary and damaged cranial remains rendered evaluation difficult and diagnosis tentative. Suggestions for Further ResearchThe use of different approaches to diagnose otitis media in archeological skeletal collections is recommended to improve the knowledge of health status and lifestyle of past populations.

PLEXIFORM AMELOBLASTOMA IN THE POSTERIOR MAXILLA: A CASE REPORT

A 36-year-old male patient attended the oral and maxillofacial surgery service presenting ulcer in the left upper alveolar ridge after extraction performed 5 months ago. At clinical examination, swelling was observed in the upper left alveolar ridge, near the hamular notch. The aspiration puncture was positive, exhibiting a yellowish liquid. Computed tomography scan examination revealed a lesion with a cystic appearance, containing a tooth in the interior located in the medial wall of the maxillary sinus. An incisional biopsy was performed with a clinical hypothesis of dentigerous cyst. Histopathologic examination revealed benign neoplasia of odontogenic origin characterized by the proliferation of ameloblast-like cells arranged in cords, nests, and sheets delimited by tall cylindrical cells with loosely arranged cells in the center, resembling the star reticulum of the enamel organ, confirming the diagnosis of plexiform ameloblastoma. The patient is waiting for definitive treatment.