Computed Tomography Scan Research Articles

Cholecystogastric fistula presenting as pyloric obstruction - a Bouveret’s syndrome: A case report

BACKGROUND Bouveret’s syndrome is a rare (1%-4%) form of cholelithiasis characterized by gastric outlet obstruction. It presents mainly in elderly women with nausea, vomiting, and abdominal pain. On physical examination, common findings include dehydration signs such as tachycardia, decreased urine output, abdominal discomfort, and distention. Diagnosis relies on computed tomography (CT) and magnetic resonance imaging, with Rigler's triad (pneumobilia, ectopic gallstone, gastric distension) being highly specific. This report aims to improve understanding of Bouveret’s syndrome and inform better management and treatment strategies. CASE SUMMARY A 60-year-old male patient presented with a three-day history of nausea, vomiting, upper abdominal pain, and loss of appetite. An upright abdominal X-ray revealed a gas shadow in the intrahepatic and extrahepatic bile ducts. Endoscopy revealed a brown and black stone measuring approximately 3030 mm in diameter in the gastric pylorus, incompletely obstructing the gastric outlet. The diagnosis of Bouveret’s syndrome was accurately confirmed via an abdominal CT scan. Endoscopic removal of the stone was successful, owing to the stone being fragmented and extracted in pieces using a crushing basket. Three weeks later, laparoscopy was attempted but failed because of severe tissue adhesions. Consequently, the procedure was converted to a laparotomy, and fistula repair and cholecystectomy were performed. He returned to the outpatient clinic for follow-up, and no further concerns were noted. CONCLUSION This case highlights the importance of timely diagnosis and adaptable endoscopic and surgical approaches for effectively managing Bouveret’s syndrome.

Fever and Floaters in a 56-Year-Old Woman

A 56-year-old woman presents with fever, headache, nausea, and vomiting. Computed tomography scan of the head shows multiple coarse, dystrophic calcifications, and she reports floaters with normal vision. What would you do next?

Hypothalamic Hamartoma Presenting as Gelastic Epilepsy: When it Goes Unnoticed

A 5-year-old boy presented with episodes of ocular retroversion occurring over the past 4 weeks. Further investigation revealed frequent bilateral epileptiform frontal activity on electroencephalogram and a nodular formation in the hypothalamus on cerebral computed tomography scan. Magnetic resonance imaging characterized the lesion as a hamartoma of the tuber cinereum. After questioning, episodes of unprovoked laughter since the first year of life, consistent with gelastic seizures, were reported. During follow-up, an increase in testicular volume was noted, and a GnRH stimulation test confirmed the diagnosis of central precocious puberty. The boy underwent treatment with antiepileptic drugs and GnRH analogs. Surgical resection of the hamartoma was performed, resulting in cessation of seizures and behavior’s improvement. Hypothalamic hamartomas can present with precocious puberty and gelastic epilepsy. Diagnosis is challenging and often the symptoms go unnoticed for years. Long-term follow-up and multidisciplinary management are essential for optimal patient care and monitoring.

Beyond the Surface: A Multidetector Computer Tomography Scan Investigation into Age and Gender Differences.

Background The identification of an individual after mass calamities poses challenges to experts when bones are fragmented. Dense bones, such as the maxilla, surpass this challenge and remain intact with sinuses even after incineration, thereby making the sinuses an ideal and reliable forensic science tool. No-ninvasive imaging techniques, such as Computed Tomography (CT), can be used to evaluate such cases and help detect fractures and further locate foreign bodies. This study aimed to estimate the dimensions and volumes of the frontal (FS), maxillary (MS), and sphenoidal air sinuses (SS) on CT scans and investigate age- and sex-related differences. Methods CT scans of the paranasal sinuses were acquired from 158 patients ranging in age from 19 to 73 years, and written consent was obtained from all participants. This study was approved by the Institutional Ethical Committee (ethical clearance number IEC 064/2010). All parameters were statistically analyzed using SPSS 20 version and the significance level was set at p<0.05. Results The bilateral anteroposterior length and height of the FS were significantly larger in men than females (p<0.05). The overall dimensions of the MS and SS were substantially greater in males than females (P <0.05). Likewise, the overall volumes of the fFS, MS, and SS were significantly greater in males than females (p<0.05). However, no significant age-related correlation was observed in the dimensions and volumes of the sinuses. Conclusion The results of this study showed that imaging could be a reliable instrument for personal identification in forensic anthropology. Countries that do not allow autopsies may implement this method to clarify the cause of death.

Diffuse cortical atrophy in young males with alcohol dependence

ABSTRACT Background: One of the most common and significant issues associated with alcohol consumption is its consequences, and one of the organs most affected is the brain. Numerous chronic drinkers in their fifth and sixth decades have demonstrated cortical atrophy in radiological examinations; nevertheless, there is little study in the young age range. Aim: To assess the degree of cortical atrophy in young male adults with alcohol dependence compared to those who have no history of alcohol consumption and its correlation with the severity of alcohol dependence. Materials and Methods: This cross-sectional study included a purposive sampling of 30 patients aged 18–45 years, fulfilling the diagnostic criteria of alcohol-dependence syndrome, and having no prior history of brain damage-causing substances other than alcohol. An equal number of age- and sex-matched control subjects were taken who did not have any history of alcohol consumption. Computed tomography (CT) scans were done for both groups. Alcohol Use Disorders Identification Test C (AUDIT-C), Severity of Alcohol Dependence Questionnaire (SADQ), and Global Cortical Atrophy (GCA) scale were applied to measure alcohol dependence and its severity and the degree of cortical atrophy. Results: All 30 male patients who fulfilled the criteria of alcohol dependence showed significant cortical atrophy in CT scans as compared to control subjects. Out of the 30 alcohol-dependence patients, 4 had only frontal lobe atrophy, while 26 patients had diffuse cortical atrophy, among which 19 patients showed frontal lobe predominance. The degree of atrophy and the severity of alcohol dependency also showed a strong association. Conclusion: There is a persistent pattern of neuroradiological evidence of diffuse cortical atrophy with frontal predominance in young people having alcohol dependence with a mean total duration of alcohol consumption of around 21 ± 5.5 years as compared to those who have no history of alcohol consumption.

Multiple liver metastases of unknown origin: A case report

BACKGROUND The liver is the most common site of digestive system tumor metastasis, but not all liver metastases can be traced back to the primary lesions. Although it is unusual, syphilis can impact the liver, manifesting as syphilitic hepatitis with inflammatory nodules, which might be misdiagnosed as metastasis. CASE SUMMARY This case report involves a 46-year-old female who developed right upper abdominal pain and intermittent low fever that persisted for more than three months. No definitive diagnosis of a tumor had been made in the past decades, but signs of multiple liver metastases were recognized after a computed tomography scan without evidence of primary lesions. With positive serological tests for syphilis and a biopsy of the liver nodules, a diagnosis of hepatic syphilis was made and confirmed with follow-up nodule reduction after anti-syphilis therapy. CONCLUSION Clinicians must be aware of the possibility that syphilis can cause hepatic inflammatory masses, especially when liver metastasis is suspected without evidence of primary lesions. A definitive diagnosis should be established in conjunction with a review of the patient’s medical history for accurate therapeutic intervention.

Exploring 3D Modeling for Enhanced Visualization and Analysis of Pediatric Pelvic Ring Fractures: A Pilot Study

Introduction Pediatric pelvic fractures are high energy injuries that present substantial treatment challenges due to their propensity for plastic deformation, complex fracture patterns, and lack of consensus on surgical indications. There is potential for negative long-term outcomes in patients with residual deformity, but our understanding of acceptable alignment is limited. Plain radiographs and computed tomography (CT) are frequently employed for pre- and post-operative assessment of injury patterns, but are limited to two-dimensional analysis. Three dimensional (3D) modeling offers an opportunity for improved assessment of pelvic anatomy. Methods Two pediatric patients who sustained unstable pelvic ring injuries requiring operative fixation, with both pre- and post-operative CT scans, were identified from an existing IRB-approved trauma database. Utilizing 3D Slicer, 3D segmentations were rendered from DICOM data and specific landmarks were identified to calculate deformity pre- and post-operatively including displacement at the sacroiliac (SI) joints, pubic symphysis, and iliac crest. A modified Keshishyan deformity index was also calculated. Mesh overlay was performed using Autodesk Maya in x, y and z planes to provide visual representation of post-operative changes. Results 3D renderings successfully illustrated complex pelvic fractures in a 9 year old female and 12 year old. Measurements made on 3D models showed similar improvements in diastasis and symmetry to measurements made in standard 2D imaging, but with generally smaller magnitudes. Graphic overlap allow for sophisticated representation of improvement in deformity. Measurements on plain radiographs and 2D CT differed from 3D measurements by anywhere from 0.1 mm to 6.7 mm. Conclusion This proof-of-concept pilot study demonstrates that 3D renderings enhance the ability to measure displacement and deformity in pediatric pelvic trauma for both pre-operative planning and post-operative evaluation. Future applications of this technology include evaluation of pelvic deformity remodeling after trauma in both operative and non-operatively treated pediatric patients.

Effects of Microsatellite Instability on the Clinical and Pathological Characteristics of Colon Cancer and the Diagnostic Accuracy of Preoperative Abdominal CT Scans

Background: Microsatellite-stable (MSS) and microsatellite-instable (MSI) colon cancer (CC) cases have different characteristics. These characteristics may impact the accuracy of abdominal computed tomography (CT) scan examinations in MSI CC. Methods: A retrospective analysis was conducted to examine the effects of MSI CC on patients’ clinical and tumor characteristics. We determined the accuracy of radiological T and N staging compared to pathological T and N staging in CC patients and evaluated the influence of tumor- and patient-related factors on this accuracy. Results: A total of 131 CC patients who had undergone surgical resection were analyzed. Mismatch repair-deficient (dMMR) CC was predominantly found in the right hemicolon (p = 0.023); it was more likely to exhibit moderate (80.8%) or low-grade differentiation (p = 0.01) and had higher rates of mucinous differentiation (p = 0.001). The median neutrophil and platelet counts and C-reactive protein (CRP) levels at diagnosis were significantly higher in patients with dMMR CC (p = 0.022, p = 0.022, and p = 0.018). The depth of invasion influenced the CRP levels in dMMR CC cases (p = 0.015). The abdominal CT exam was accurate regarding the depth of colonic wall invasion in 58.1% and 38.5% of patients with mismatch repair-proficient (pMMR) and dMMR CC, respectively. The assessment of lymph node invasion was accurate in 44.8% of those with pMMR and 50.0% of those with dMMR CC. There was no significant difference in the accuracy in predicting the T and N statuses between the two groups. The accuracy in the determination of the T and N statuses was not affected by the parameters examined. Conclusions: dMMR CC has specific characteristic features. MSI does not affect the accuracy of preoperative abdominal CT.

Assessment of tissue-air ratios in epoxy resin and PMMA phantoms for radiation dosimetry: findings from experimental measurements and Monte Carlo simulations.

This study assesses radiation doses in multi-slice computed tomography (CT) using epoxy resin and PMMA phantoms, focusing on the relationship between TAR (tissue air ratio) and kilovoltage peak (kVp). The research was conducted using a Hitachi Supria 16-slice CT scanner. An epoxy resin phantom was fabricated from commercially available materials, to simulate human tissue. The phantom contained four peripheral inserts and one central insert for dose measurement, with optically stimulated luminescent dosimeters positioned at various depths (2 to 10cm). Monte Carlo simulations were executed using the Geant4 Application for Tomographic Emission toolkit (GATE) to model photon transport, with the x-ray spectrum generated using SpekPy software. A non-linear fitting model was developed to describe the TAR-kVp relationship across different depths for epoxy resin and PMMA. Results indicated that TAR values were higher at low depths (2cm) and decreased with increasing depth, reflecting the x-ray beam's attenuation. For instance, at 80 kVp and 2cm depth, the experimental TAR for PMMA was 1.102 ± 0.011, closely matching the MC simulation value of 1.110 ± 0.036, resulting in a small difference of 0.7%. At a depth of 10cm, the experimental TAR for PMMA decreased to 0.245 ± 0.006, while the MC TAR was 0.248 ± 0.016, with a relative difference of 1.2%. Similar trends were observed for epoxy resin, where the experimental TAR ranged from 1.070 ± 0.014 at 2cm to 0.235 ± 0.009 at 10cm, while MC simulation values ranged from 1.080 ± 0.038 to 0.238 ± 0.017. Bland-Altman analysis confirmed these results, with mean differences of 0.008 for PMMA and 0.006 for epoxy resin, indicating high agreement between the experimental and simulated TAR values. This study highlights the importance of phantom material selection in dose assessment and the implications of TAR in dose correction within the context of diagnostic radiology.

The Use of Coronoid Process as a Free Graft for Condylar Reconstruction in a Patient With Condylar Osteoma: A Condylar Reconstruction Technical Note (Technical Strategy)

Osteoma is a rare, asymptomatic, and slowly growing benign tumor of bone. Upon reviewing the literature, only 21 cases were previously reported in the mandibular condyle. A 19-year-old male patient presented to the Department of Oral and Maxillofacial Surgery of Ain Shams University complaining of hypomobility and facial asymmetry involving the lower jaw. He stated that he was involved in a road traffic accident (RTA) and sustained a traumatic injury to the head a few years ago. Upon examination, it was noticed that the chin deviated to the right side with some discomfort during function. Computed tomography scans revealed the presence of a hyperdense mass medial to the right condylar pole. Condylectomy was carried out using a preauricular approach. A diagnosis of osteoma was confirmed histopathologically. The defect was reconstructed using the coronoid process as an autogenous-free graft.

Leukemic Phase of ALK-Negative Anaplastic Large Cell Lymphoma Presenting as Leukostasis: The First Case Report in Thailand

Anaplastic large cell lymphoma (ALCL) is an aggressive T-cell lymphoma characterized by hallmark cells that are CD30-positive. ALCL is subcategorized as anaplastic lymphoma kinase (ALK)-positive and ALK-negative types. The leukemic phase of ALK-negative ALCL is extremely rare and usually has a poor prognosis. We report the first case of the leukemic phase of ALK-negative ALCL in Thailand. A 60-year-old man presented bilateral cervical lymphadenopathy and night sweats for 6 months. He was admitted to the hospital with acute fever, progressive dyspnea on exertion, severe headache and blurred vision. His complete blood count revealed marked leukocytosis (352.5 x 109/L) with numerous atypical medium- to large-sized mononuclear cells. The results of his laboratory investigations were compatible with spontaneous tumor lysis syndrome and disseminated intravascular coagulation. The flow cytometry analysis from bone marrow aspiration along with histopathologic findings and immunohistochemistry from bone marrow study were consistent with ALK-negative ALCL. The patient was treated with leukapheresis, renal replacement therapy and high-dose dexamethasone. After achieving hemodynamic stability, a computed tomography scan of the brain was performed due to persistent alteration of consciousness. The results showed extensive intracerebral hemorrhage with severe brain edema and tonsillar herniation. Due to this complication, the treatment plan was adjusted to palliative care with supportive treatment after discussion with his family. The patient subsequently passed away from septic shock.

Opportunistic Hounsfield units measurements on computed tomography scans can predict the number of prevalent vertebral compression fractures in older adults.

There is a growing interest in using computed tomography (CT) scans to opportunistically assess bone mineral density via Hounsfield units (HU). Previous studies have shown lower HU in patients with vertebral compression fractures (VCFs) and that HU can predict pre-existing VCFs. This study evaluated whether HU from CT scans can predict the number of prevalent VCFs. We studied 353 patients (199 females) aged 58 and older who underwent thorax-abdomen-pelvis or thoracic-lumbar CT scans. HU were measured at T11 and L1. Inter- and intra-observer agreement measuring HU was assessed. We compared mean HU values using the T-test, performed Spearman's correlation between HU and VCFs, and conducted logistic and linear regression analyses to determine the independent effect of sex, age, and HU on the presence and number of VCFs. The median age was 73years. Ninety-eight patients had at least one VCF, with 46 having one and 52 having two or more VCFs. Inter- and intra-observer agreement assessing HU was excellent (ICC = 0.98 and 0.99 respectively). Mean HU were significantly lower in patients with VCFs (91.14 ± 39.33) than in patients without VCFs (145.03 ± 41.07, p < 0.01). HU negatively correlated with the number of VCFs (r = - 0.54, p < 0.01). Logistic regression showed that age (p < 0.01) and HU (p < 0.01) predicted the presence of VCFs. Linear regression found that HU independently predicted the number of VCFs (p < 0.01), while age (p = 0.67) and sex (p = 0.12) did not. HU from CT scans can predict the presence and number of VCFs.

Leveraging Artificial Intelligence as a Safety Net for Incidentally Identified Lung Nodules at a Tertiary Center.

Artificial intelligence (AI)-powered platforms may be used to ensure that clinically significant lung nodules receive appropriate management. We studied the impact of a commercially available AI natural language processing tool on detection of clinically significant indeterminate pulmonary nodules (IPNs) based on radiology reports and provision of guideline-consistent care. All computed tomography (CT) scans performed at a single tertiary care center in the outpatient or emergency room setting between 20-Feb-2024 and 20-March-2024 were processed by the AI natural language processing algorithm. CT radiology reports mentioning a lung nodule or focal indeterminate lesion were flagged. All flagged reports were reviewed by a lung nodule expert two weeks after nodule identification. IPNs were classified as "appropriately followed" if follow-up imaging, referral to a nodule clinic, or other guideline-consistent care was ordered. IPNs were classified as "not appropriately followed" if no acknowledgement of the reported nodule was documented in the electronic health record within two weeks of being flagged. The AI software processed 76,507 unique radiology reports, identified 2,585 CT scans with chest imaging, and found 389 IPNs. Review determined that 272 (70%) nodules were appropriately followed while 117 (30%) were not appropriately followed. Of the 117 nodules without documented follow-up, 67 (57%) were > 8mm and 24 (20.5%) were > 15mm. IPNs that would not have received follow-up in the absence of the AI software generated 43 additional clinical appointments and 3 procedures. At a large tertiary care center, 30% of clinically significant incidental pulmonary nodules that would have otherwise been missed were brought to the attention of lung nodule clinicians by an AI software, allowing for initiation of appropriate follow-up.

Association of Increased CT-Attenuation of Visceral Adipose Tissue After Surgery with Poor Survival Outcomes in Patients with Stage II–III Gastric Cancer: A Retrospective Cohort Study

Background/Objectives: This study aimed to investigate whether post-operative changes in the computed tomography (CT)-attenuation of subcutaneous (SAT) and visceral (VAT) adipose tissues were significantly associated with recurrence-free survival (RFS), peritoneal RFS, and overall survival (OS) in patients with stage II–III gastric cancer. Methods: This retrospective study analyzed 243 patients with stage II–III gastric cancer who underwent curative surgery. CT-attenuation values of SAT (SAT HU) and VAT (VAT HU) were measured from non-contrast-enhanced abdominopelvic CT images taken pre-operatively and 6 months post-operatively. Changes in SAT HU (ΔSAT HU) and VAT HU (ΔVAT HU) between the two CT scans were calculated. The prognostic value of these variables for predicting survival outcomes was assessed. Results: Correlation analyses showed that both ΔSAT HU and ΔVAT HU were significantly positively correlated with T stage, TNM stage, and tumor size (p &lt; 0.05). In the multivariate survival analysis, ΔVAT HU emerged as an independent significant predictor for RFS (p = 0.002, hazard ratio, 2.437), peritoneal RFS (p = 0.023, hazard ratio, 2.457), and OS (p = 0.043, hazard ratio, 2.204) after adjusting for age, sex, histopathological classification, T stage, and N stage. Patients with high ΔVAT HU had worse RFS, peritoneal RFS, and OS compared to those with low ΔVAT HU. Conclusions: Change in CT-attenuation of VAT following surgery was significantly correlated with tumor characteristics and was a significant predictor of RFS, peritoneal RFS, and OS in patients with stage II–III gastric cancer.

Comparative Analysis of Spreader Grafts and Spreader Flaps on Intranasal Drug Delivery Efficiency to Posterolateral Nasal Wall

Background: This study compared the impact of spreader grafts (SG) and spreader flaps (SF) on the transport of intranasal drug delivery to target the posterolateral nasal wall. Method: SG and SF were each performed in sequence on two cadaveric specimens after soft tissue elevation technique. Computed tomography scans were acquired following each procedure to generate anatomic models for computational fluid dynamics simulation of intranasal sprays under the following conditions: inhalation rate (15 and 30 L/min), spray velocity (1, 5, and 10 m/s), spray released location (center, lateral, medial, top, and bottom), head position (upright, tilted-forward, tilted-backward, and supine), and particle diameter (1-100 µm). Percentage of particles deposited on the posterolateral nasal wall were calculated. Results: For Specimen 1, highest posterolateral wall depositions were Pre-Op: left = 74%, right = 74%; SF: left = 53%, right = 22%; SG: left = 60%, right = 61%. For Specimen 2, highest posterolateral wall depositions were Pre-Op: left = 25%, right = 83%; SF: left = 29%, right = 76%; SG: left = 14%, right = 72%. In general, posterolateral wall deposition was higher at 30 L/min inhalation rate and at 1 m/s spray velocity. Conclusions: Drug delivery targeting the posterolateral nasal wall appears to be dependent on many factors. However, midvault nasal reconstruction does not increase drug delivery to the posterolateral nasal wall.

Managing Late-Onset ERF-Related Craniosynostosis With Cranial Vault Distraction Osteogenesis

Introduction: ETS2 Repressor Factor (ERF) gene-related craniosynostosis is a rare condition characterized by pre- and/or post-natal fusion of 1 or more cranial sutures. In this report, we present our center’s experience managing ERF-related craniosynostosis in 2 patients with intracranial hypertension using cranial vault distraction osteogenesis (CVDO). Methods: Both patients underwent genetic testing and 24 hour intracranial pressure monitoring prior to surgery. Additionally, they were followed with regular clinical and dilated eye exams for a minimum of 2 years after surgery. Morphological and volumetric analysis were performed using pre- and post-operative computed tomography (CT) scans. Results: Both patients presented with late-onset, multisuture craniosynostosis. Patient 1 underwent lateral expansion of 2 frontoparieto-occipital bone segments at 5 years of age. A total expansion of 28 mm was performed (14 mm on each side) over a period of 12 days. Pre- and post-operative CIs were 69.3 and 81.3, respectively, and volumetric analysis revealed a 24.4% increase in his intracranial volume. Patient 2 underwent posterior expansion of a single parieto-occipital bone segment at 4 years and 10 months of age. A total expansion of 25.2 mm was performed over a period of 21 days. Pre- and post-operative CIs were 72.8 and 69.9, respectively. Volumetric analysis could not be performed owing to the poor resolution of the patient’s post-operative CT scan that was obtained from an outside institution. Both patients had their distractors removed following a 2 month consolidation period. No complications, signs of intracranial hypertension, or bony defects were noted for both patients at 2 years post-operatively. Conclusions: CVDO provides a tested option with excellent outcomes for treating patients with ERF-related craniosynostosis. Continued education of clinicians and families regarding ERF-related craniosynostosis is key to ensuring that patients with this genetic mutation promptly establish care for close surveillance and, in turn, prompt treatment if necessary.

Computed Tomography Scan of the Chest Is a Reliable Screening Investigation for Structural Cardiac and Pericardial Injury in Patients With Trauma

Computed Tomography Scan of the Chest Is a Reliable Screening Investigation for Structural Cardiac and Pericardial Injury in Patients With Trauma

A benchmark of deep learning approaches to predict lung cancer risk using national lung screening trial cohort

Deep learning (DL) methods have demonstrated remarkable effectiveness in assisting with lung cancer risk prediction tasks using computed tomography (CT) scans. However, the lack of comprehensive comparison and validation of state-of-the-art (SOTA) models in practical settings limits their clinical application. This study aims to review and analyze current SOTA deep learning models for lung cancer risk prediction (malignant-benign classification). To evaluate our model’s general performance, we selected 253 out of 467 patients from a subset of the National Lung Screening Trial (NLST) who had CT scans without contrast, which are the most commonly used, and divided them into training and test cohorts. The CT scans were preprocessed into 2D-image and 3D-volume formats according to their nodule annotations. We evaluated ten 3D and eleven 2D SOTA deep learning models, which were pretrained on large-scale general-purpose datasets (Kinetics and ImageNet) and radiological datasets (3DSeg-8, nnUnet and RadImageNet), for their lung cancer risk prediction performance. Our results showed that 3D-based deep learning models generally perform better than 2D models. On the test cohort, the best-performing 3D model achieved an AUROC of 0.86, while the best 2D model reached 0.79. The lowest AUROCs for the 3D and 2D models were 0.70 and 0.62, respectively. Furthermore, pretraining on large-scale radiological image datasets did not show the expected performance advantage over pretraining on general-purpose datasets. Both 2D and 3D deep learning models can handle lung cancer risk prediction tasks effectively, although 3D models generally have superior performance than their 2D competitors. Our findings highlight the importance of carefully selecting pretrained datasets and model architectures for lung cancer risk prediction. Overall, these results have important implications for the development and clinical integration of DL-based tools in lung cancer screening.

Intracardiac lymphoma in a cat: Diagnosis and response to chemotherapy treatment

AbstractA three‐year‐old female cat presented for further investigations for pleural effusion following a short period of weight loss, lethargy and hyporexia. A computed tomography scan and echocardiography showed a right atrial wall mass, of which cytology was consistent with lymphoma. The heart was the sole organ infiltrated based upon extensive staging confirming a primary cardiac lymphoma. The cat was started on a multidrug chemotherapy protocol and achieved complete remission with a good quality of life prior to relapsing of her lymphoma in the kidneys and intestine. She died shortly after relapse, 5 months following diagnosis, with no response to the rescue chemotherapy.

Percutaneous hallux fusion with calcaneus bone autograft: a retrospective cohort study of clinical and radiographic outcomes.

In the case of end-stage hallux rigidus, first metatarsophalangeal (MTP) joint arthrodesis is the gold-standard and is traditionally performed via an open approach. However, complications such as nonunion have been reported to be as high as 30%. Recently, there have been reports demonstrating a percutaneous approach to be effective and safe. Forty-nine patients with end-stage hallux rigidus underwent percutaneous first MTP joint arthrodesis with calcaneus autograft performed by a single surgeon. Each patient underwent a minimum of 24 month clinical and radiographic follow up, including 3 month post operative computed tomography scans. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and Foot Function Index (FFI) preoperatively and at final follow-up. Mean follow-up was 27.3 months. Bone union was observed in 46 patients (93.9%). Mean time to union was 3.1 months. Nonunion rate was 6.1%. Overall complication rate was 12.2%. Mean pre- and postoperative VAS scores were 7.5 and 0.2, respectively (P < .0001). Mean pre- and postoperative total FFI values were 56.3 and 15.7 (P < .0001), respectively. Patient satisfaction after the procedure was 93.9%. Observed union rate is comparable to the average fusion rate previously reported for open and minimally invasive procedure union rates. Mean time to union was observed to be comparable to open procedures union time. Observed overall complication rate is similar to those reported for open techniques as well. Patient reported outcomes demonstrated a significant reduction in postoperative VAS and FFI for the percutaneous metatarsophalangeal arthrodesis with calcaneus bone autograft. Patient satisfaction rates compared favorably to those reported following open surgery.