Computed Tomography Scan Research Articles

The Value of Positron Emission Tomography Scan in Staging of Lymphoma in a Sample of Iraqi Patients

Abstract Background: A diverse range of illnesses known as lymphomas are caused by immune system constituent cells or their progenitors.18F-Fluorodeoxyglucose positron emission tomography (PET)/computerized tomography has been routine practice to improve the characterization and prognosis of both Hodgkin and non-Hodgkin lymphomas (NHLs). Objectives: The objective of the study was to assess the role of positron emission tomography (PET) scan in clinical evaluation of lymphoma and its ability to identify the correct stage of lymphoma. Patients and Methods: cross-sectional follow-up study was conducted on 50 patients with pathologically proven lymphoma in 2021 who were admitted to the hospital. All patients included in the study performed computed tomography (CT) and PET scan for initial staging. Results: In NHL, PET scan staging differed significantly from clinical in two stages; there were 7 patients versus none with Stage II according to clinical and PET scan staging, respectively. Furthermore, only five patients had Stage IV according to clinical staging versus 17 patients in PET scan staging. Accordingly, there was no agreement between the two modalities (κ = 0.085, 95% = 0.045–0.123, P = 0.394). In Hodgkin lymphoma (HL), the two modalities differ significantly in the appraisal of Stage IV, in which there were 2 patients based on clinical staging and 11 patients according to PET scan staging. Thus, there was a poor agreement between the two modalities (κ = 0.314, 95% confidence interval = 0.283–0.376, P = 0.002). PET scan upstaged 50% and 61.54% of the patients with HL and NHL, respectively, with a highly significant difference, whereas there was no change in staging for 50% and 34.62%, respectively, with a highly significant difference. In NHL, PET scan demonstrated higher positive bone marrow (BM) involvement than biopsy (34.62% vs. 19.23%) with a highly significant difference. Similarly, in HL, PET scan revealed far more positive BM involvement than biopsy (45.83% vs. 8.33%) with a highly significant difference. Conclusions: There is poor or no agreement between PET scan and clinical staging of lymphoma, with high detection with PET scan for BM involvement compared with CT scan, which leads to the identification of additional involved sites of patients with lymphoma.

Avian telencephalon and cerebellum volumes can be accurately estimated from digital brain endocasts.

For studies of the evolution of vertebrate brain anatomy and potentially associated behaviours, reconstructions of digital brain endocasts from computed tomography scans have revolutionized our capacity to collect neuroanatomical data. However, measurements from digital endocasts must be validated as reflecting actual brain anatomy, which is difficult because the collection of soft tissue information through histology is laborious and time-consuming. In birds, the reliability of digital endocast measurements as volume proxies for the two largest brain regions-the telencephalon and cerebellum-remains to be validated despite their use as proxies, e.g. of cognitive performance or flight ability. We here use the largest dataset of histology and digital endocasts to date, including 136 species from 25 avian orders, to compare digital endocast surface area measurements with actual brain volumes of the telencephalon, cerebellum and whole-brain endocast. Using linear and phylogenetically informed regression analyses, we demonstrate that endocast surfaces are strongly correlated with their brain volume counterparts for both absolute and relative size. This provides empirical support for using endocast-derived cerebellar and telencephalic surface areas in existing and future studies of living and extinct birds, with potential to expand to the dinosaur-bird transition in the future.

A comprehensive assessment of headache characteristics, management, and burden of migraine in comparison with tension-type headache in Türkiye: Results of a cross-sectional survey of adult patients.

Migraine is a common cause of headache and a leading cause of morbidity in Türkiye. This study aimed to describe the clinical characteristics and management of migraine and to compare migraine with tension-type headache (TTH) regarding the burden of disease and healthcare resource utilization. A total of 1368 patients (aged 18-65 years) with migraine or TTH were surveyed regarding sociodemographics, headache characteristics, clinical management, disease burden, quality of life, and healthcare resource utilization within the previous 12 months. Data from 1053 patients meeting the criteria for definite migraine (dMIG) or definite TTH (dTTH) were analyzed. The frequency and duration of attacks, the number of monthly headache days, days with analgesic consumption, and headache severity were significantly higher in dMIG compared to dTTH. Only 36.8% of definite migraineurs experiencing ≥4 monthly headache days were on preventive treatment. The negative impact on quality of life and economic loss were also higher in dMIG. Although more patients with dTTH visited a physician in the previous year, the number of physician visits was higher in dMIG. The groups were comparable regarding the percentage of patients who underwent radiological investigations due to headache; however, patients with dMIG had more brain magnetic resonance imaging and computed tomography scans. Timely and accurate diagnosis and optimal management of migraine are crucial due to its significant burden. Educational programs for patients and healthcare providers, along with adherence to and persistence with preventive medications, may improve clinical outcomes.

Spread of local anaesthetic after erector spinae plane block: a randomised, three-dimensional reconstruction, imaging study.

Spread of local anaesthetic solution in the paravertebral space after erector spinae plane block (ESPB) is variable. We evaluated whether paravertebral spread of local anaesthetic is affected by patient position after ESPB. We randomised 84 patients to receive ESPB at T7 with a mixture of 0.375% ropivacaine and radiocontrast dye (30 ml). Participants were positioned supine, prone, or lateral for 30 min after ESPB before computed tomography scanning. The primary outcome was paravertebral space local anaesthetic spread, with secondary assessments of craniocaudal spread and distribution to neural foramina, and intercostal and epidural spaces. Loss of sensation to cold was recorded. Local anaesthetic-contrast mix reached the paravertebral space, intercostal space, and neural foramina in 96.5%, 94.2%, and 77.9% of individuals, respectively. Epidural space spread occurred in 20 cases. Prone positioning consistently allowed paravertebral and intercostal spread in all patients, with more thoracic level spread compared with supine positioning (5.0 [1.9] vs 3.1 [1.7], difference [95% confidence interval, CI]: 1.9 [0.8-3.0] levels, P<0.001 for paravertebral space spread; 2.8 [1.9] vs 1.4 [1.4], difference [95% CI] levels: 1.4 [0.4-2.5], P=0.004 for neural foramina spread; 4.3 [1.3] vs 3.2 [1.5], difference [95% CI] levels: 1.0 [0.1-1.9], P=0.019 for intercostal space spread). Local anaesthetic-contrast extended to the intercostal space further in the prone than in the lateral position group (4.3 [1.3] vs 2.6 [1.5] thoracic levels, difference [95% CI]: 1.7 [0.8-2.6], P<0.001). Sensory block in ventral dermatomes was variable in all participants. Prone positioning after ESPB significantly enhanced local anaesthetic-contrast spread to the paravertebral space, intercostal space, and neural foramina, suggesting that gravity plays a substantial role in spread. Clinical Trials.gov (NCT06142630).

Evaluation of Root Canal Diameters and Radicular Wall Thickness of the Human Primary Molars by using Multidetector Computed Tomography: A Cross-sectional Study

Introduction: Paediatric endodontics is critical for preserving the primary tooth until its physiologic exfoliation and ensuring the child’s quality of life. Endodontic treatment of human primary molars with varying internal geometry of the root canal necessitates extensive knowledge and skills. Aim: To evaluate the diameters of the root canals and the radicular wall thickness of human primary molars using Multidetector Computed Tomography (MDCT). Materials and Methods: This cross-sectional study study was performed in the Department of Paediatric and Preventive Dentistry in collaboration with the Department of Oral and Maxillofacial Surgery, Department of Antaomy of Guru Nanak Institute, Kolkata, West Bengal,India on selected 64 human primary maxillary and mandibular molars through inclusion and exclusion criteria and grouped them (Group 1, maxillary 1st molars; Group 2, maxillary 2nd molars; Group 3, mandibular 1st molars; and Group 4, mandibular 2nd molars). After proper sterilisation, the teeth were mounted on a wax platform, and the mounted teeth block was scanned by a computed tomography scanner. Analysis of these Computed Tomography (CT) scan images was done through Denta Scan (GE Healthcare, USA) software. In each of the corresponding cross-sections, the diameters of the root and the root canals were measured at their greatest diameter. The radicular wall thickness of the roots was derived by subtracting the measured diameter of the root canals from that of the roots in their respective cross-sections. Descriptive statistical analysis (Student’s t-test) was performed. A p-value less than equal to 0.05 was considered statistically significant. Results: The maximum mean diameter of the canal was found in the mesiobuccal root canal of both primary mandibular first molars (1.16±0.22 mm at cervical third) and second molars (1.12±0.16 mm at cervical third); and the minimum diameter was found in the distolingual root canal of both primary mandibular first molars (0.87±0.12 mm at cervical third) and second molars (0.89±0.16 mm at cervical third). The mean radicular wall thickness of the roots gradually increased from the apical third to the cervical third of both primary molars. Conclusion: The maximum root canal diameter and radicular wall thickness were found in the cervical third of the palatal root of maxillary second molars. The study evaluates the mean maximum and minimum diameters of each canal of human primary molars and radicular wall thickness in different crosssections, which enables paediatric dental practitioners to establish effective paediatric endodontic treatment.

The Association Between Body Composition, Overall Survival, Treatment Decisions, and Patient-Reported Outcomes in Metastatic Non-Small-Cell Lung Cancer.

The purpose of this study was to evaluate the association between body composition, overall survival, odds of receiving treatment, and patient-reported outcomes (PROs) in individuals living with metastatic non-small-cell lung cancer (mNSCLC). This retrospective analysis was conducted in newly diagnosed patients with mNSCLC who had computed-tomography (CT) scans and completed PRO questionnaires close to metastatic diagnosis date. Cox proportional hazard models and logistic regression evaluated overall survival and odds of receiving treatment, respectively. Hazard ratios (HR) and odds ratios (OR) were evaluated as the interquartile range for body composition compartments. Multiple linear regression evaluated the association between PROs and body composition. Models were adjusted for gender, age at diagnosis, smoking history, and mutation status. The survival model also included adjustment for tumor histology. Our sample (n = 69) included men (52%) and women (48%), with a median age of 67.4-years, history of smoking (67%), wild-type genotype (75.4%), and a tumor histology of adenocarcinoma (68%). Greater skeletal muscle area was associated with higher physical function scores. Larger intermuscular adipose tissue area was associated with higher mortality risk (HR 2.03, 95% CI 1.32, 3.11), lower odds of receiving treatment (OR 0.76, 95% CI 0.61, 0.93), and higher fatigue. Larger subcutaneous adipose tissue area was associated with lower mortality risk (HR 0.42, 95% CI 0.22, 0.82) and higher odds of receiving treatment (OR 1.03, 95% CI 1.01, 1.06). Larger total adipose tissue area was linked with improved survival (HR 0.59, 95% CI 0.36, 0.96). Findings support an association between different body composition compartments at mNSCLC diagnosis and survival, decisions to treat, and PROs. This work supports the use of data collected in routine CT scans and PROs to inform treatment decisions and supportive care options.

High concordance of PET-CT treatment response evaluation according to PERCIST 1.0 when comparing images reconstructed with OSEM vs. BSREM.

Positron emission tomography (PET) response criteria in solid tumours (PERCIST 1.0) is a systematic assessment of therapy response with fluorine 18 fluorodeoxyglucose ([18F]FDG) PET. The ordered subset expectation maximization (OSEM) and block sequential regularized expectation maximization (BSREM) reconstruction algorithms are both commonly used. The impact of using OSEM or BSREM on PERCIST 1.0 is not fully determined. This study aimed to compare treatment response evaluation between the reconstructions OSEM and BSREM according to PERCIST 1.0. The highest peak standardized uptake value corrected for lean body mass (SULpeak) in a lesion were measured in PET-CT scans from 90 patients with metastatic breast cancer or malignant melanoma, who had undergone two [18F]FDG PET with computer tomography (CT) scans for treatment evaluation purpose. SUL measurements in the reference organ were also calculated. All scans were reconstructed with OSEM and BSREM. Bland Altman plots and Spearman correlation coefficient were used for comparing measurements obtained from OSEM and BSREM images. Patients were categorized as a complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), or progressive metabolic disease (PMD). The mean standard deviation (SD) of SULmean in the reference organ was slightly lower for BSREM images, resulting in a slightly lower threshold. Lesion SULpeak was slightly higher for BSREM images compared with OSEM images. Only 5 out of 90 patients had different response evaluations for the different reconstructions. PERCIST 1.0 serves as a robust response evaluation criterion and is only marginally dependent on the reconstruction used.

A finite element analysis to assess tibial bone fracture in malleolar regions following total ankle replacement: Influences of implant designs and implant-bone interfacial conditions.

Tibial bone fractures in the malleolar regions are a major concern during the early postoperative period of total ankle replacement (TAR), affecting patient outcomes such as stability and recovery. Design, placement, and anatomic misalignment of implant components can contribute to malleolar fractures. The aim of this study is to understand the influence of implant design features, including keel, peg, stem, and bar type design, and bone-implant interfacial conditions on malleolar fracture following TAR. Three-dimensional finite element (FE) models were generated for the intact and implanted tibia bone using computer tomography (CT) scan data. In the present study, both bonded (fully osseointegration) and debonded (non-osseointegration) implant-bone interface conditions were considered. The proximal part of the tibia was fixed. Finite element models of the intact and implanted tibia were solved for three distinct loading situations that correspond to three ankle positions throughout the gait cycle (GC). The influences of implant design and implant-bone interface conditions on malleolar fracture were examined by evaluating stress distribution in tibia bone post-implantation. Finite element (FE) analysis revealed that for the medial region, the tibia bone stress elevated to 10 MPa for the medial keel type design, indicating a possible fracture along the medial region. The risk of a medial malleolar fracture is highest for the medial keel type implant design compared to other designs. The bars, central keel, and stem type TAR implant designs also elevate stress on both the medial and lateral regions of the tibia bone. In the case of fully osseointegrated implant-bone interface conditions, the stress is slightly higher than in the case of non-osseointegrated implant-bone interfacial conditions. The study highlights the potential influence of specific implant designs on malleolar fracture. The current findings are crucial for designing new implants to mitigate tibial bone fracture risks and improve TAR outcomes.

Reducing Sedation for Pediatric Thoracic CT Imaging Using Volumetric Target-mode EKG Gating.

Many children require sedation for imaging. We aimed to reduce sedation for thoracic (chest and cardiac) computed tomography (CT) scans in children 0-4 years old from 65% to 20% by December 2018 and to sustain. We counted baseline, intervention, and a follow-up period thoracic CT scans performed with sedation in children 0-4 years old. We developed a new volumetric target-mode electrocardiogram-gated CT imaging protocol to reduce scan time and control for factors that decrease image quality. Additional interventions included technologist training, communication to radiologists and clinicians, and eliminating a default request for sedation accompanying the electronic order for most thoracic CT scans. A statistical process control chart tracked data to study process changes over time. During the baseline and intervention periods, 232 of 357 and 217 of 794 scans required sedation. Interventions created 2 centerline shifts. Overall, thoracic CT scans in children 0-4 years old requiring sedation decreased from 65% to 24% and was sustained 5 years later. No patients during the baseline period, one (1 of 794, 0.1%) during the intervention period and 2 (2 of 480, 0.4%) during the audit period 5 years later, initially had nondiagnostic nonsedated scans that required an additional scan with sedation. We developed a volumetric target-mode electrocardiogram-gated CT protocol, eliminated default sedation ordering, and trained and educated staff to reduce sedation in young children undergoing thoracic CT scans. The frequency of sedation for thoracic CT in children 0-4 years old decreased from 65% to 24% and was sustained after revising imaging parameters and eliminating a default sedation order.

3D modeling to predict vascular involvement in resectable pancreatic adenocarcinoma.

Current management of patients with borderline resectable pancreatic adenocarcinoma (BR-PDAC) depends on the degree of involvement of the major arterial and venous structures. The aim of this study was to evaluate 3D segmentation and printing to predict tumor size and vascular involvement of BR-PDAC to improve pre-operative planning of vascular resection and better select patients for neoadjuvant therapy. We retrospectively evaluated 16 patients with BR-PDAC near vascular structures who underwent pancreatoduodenectomy (PD) with or without vascular resection between 2015 and 2021. The pre-operative computed tomography (CT) images were processed by segmentation with 3D reconstruction and printed as 3D models. Two radiologists specialized in pancreatic imaging and two pancreatic surgeons blindly and independently analyzed the pre-operative CT scans and 3D models using a defined checklist. Their evaluations were compared to the pre-operative 2D-CT reports utilized for patient management. A positive delta was defined by the 3D analysis resulting in greater accuracy in predicting vascular involvement as proven intraoperatively or histopathologically. Fourteen PD, one total pancreatectomy, and one exploratory laparotomy were performed. Ten patients had a positive delta concerning vascular involvement of the superior mesenteric or portal vein. Tumor extension was also more accurately evaluated by 3D modeling than by 2D-CT (p<0.05). Our pilot study demonstrates that 3D segmentation can provide additional information for choosing the best treatment strategy and surgical plain in patients with BR-PDAC. Especially for upcoming mini-invasive techniques like laparoscopic and robotic resections, better pre-operative planning is essential to allow safety and prevent vascular injury.

Computed tomography-based prediction of interval cytoreduction in advanced ovarian cancer.

Our retrospective study aimed to investigate the role of computed tomography (CT) using both the tomographic Fagotti index and the Sugarbaker peritoneal cancer index (PCI) in predicting the feasibility of optimal interval debulking surgery in epithelial ovarian cancer. Patients with advanced ovarian cancer treated in our institution who were eligible for interval debulking surgery were identified and included in the study. A retrospective image collection was operated, and CT scan evaluations were conducted by 2 independent radiologists to establish both scores (Fagotti index and Sugarbaker PCI). The workflow included a third radiologist who resolved discrepancies. The receiver operating characteristics curve followed by the Youden J statistic was calculated to determine cutoff points that best differentiated complete/optimal versus suboptimal cytoreduction. The Fagotti index and Sugarbaker PCI cutoffs' accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated and represented as 95% CIs. A total of 60 consecutive patients who had complete information in their charts with evaluable images and complete information about surgery were evaluated; of these, 35 had a complete/optimal interval debulking surgery. The receiver operating characteristic curve of the Fagotti index scoring system showed that a cutoff of ≥3 can identify 100% of inoperable patients. However, 29% of patients were falsely labeled as inoperable. A cutoff point of ≥5 avoids 88% of unnecessary laparotomies, reducing the rate of false inoperable designation from 29% to 17%. A Sugarbaker PCI of ≥8 predicts the risk of unnecessary laparotomies in 68%, with 26% falsely labeled as inoperable. The score of ≥7 is most effective in avoiding unnecessary surgeries (80%), but the chance of false positives increases from 26% to 32%. CT-based scoring systems used in the present work can help determine which patients with advanced ovarian cancer are suitable for interval debulking surgery with high precision. Future studies are needed to enhance accuracy, thereby amplifying the radiologists' competency in using a systematic CT-based scoring system.

A Reproducible Method for Donor Site Computed Tomography Measurements in Abdominally Based Autologous Breast Reconstruction.

We present an approach for evaluating abdominal computed tomography (CT) scans that generates reproducible measures relevant to donor site morbidity after abdominally based breast reconstruction. Seventeen preoperative CT metrics were measured in 20 patients with software: interanterior superior iliac spine distance; abdominal wall protrusion; interrectus distance; rectus abdominis width, thickness, and width-to-thickness ratio; abdominal wall thickness; subcutaneous fat volume; visceral fat volume; right/left psoas volumes and densities; and right/left rectus abdominis volumes and densities. Two operators performed measures to determine interrater reliability (n = 10). Interclass coefficients (ICCs) were calculated, and Bland-Altman plots were fashioned. Intrarater reliability was excellent (ICC > 0.9, 0.958-1) for 15 measures, and good (0.75 < ICC < 0.9, 0.815-0.853) for 2 measures. Interrater reliability was excellent (ICC > 0.9, 0.912-0.995) for 12 measures and good (0.75 < ICC < 0.9, 0.78-0.896) for 5 measures. Bland-Altman plots confirmed intra/interrater agreement. Our study meets its objective of establishing a protocol for obtaining abdominal CT measurements with high reproducibility and intrarater and interrater reliability. Although this study is not meant to weigh the particular influences of various CT measurements on clinical outcomes, we are now actively studying this with the intention of reporting our findings in the near future. Larger patient cohorts must be leveraged to determine correlations between abdominal CT scan findings and donor site outcomes using machine learning algorithms that generate models for predicting abdominal donor site complications.

Artificial intelligence models assisting physicians in quantifying pancreatic necrosis in acute pancreatitis.

Acute pancreatitis (AP) is a potentially life-threatening condition characterized by inflammation of the pancreas, which can lead to complications such as pancreatic necrosis. The modified computed tomography severity index (MCTSI) is a widely used tool for assessing the severity of AP, particularly the extent of pancreatic necrosis. The accurate and timely assessment of the necrosis volume is crucial in guiding treatment decisions and improving patient outcomes. However, the current diagnostic process relies heavily on the manual interpretation of computed tomography (CT) scans, which can be subjective and prone to variability among clinicians. This study aimed to develop a deep-learning network model to assist clinicians in diagnosing the volume ratio of pancreatic necrosis based on the MCTSI for AP. The datasets comprised retrospectively collected plain and contrast-enhanced CT scans from 144 patients (6 with scores of 0 points, 42 with scores of 2 points, and 65 with scores of 4 points) and the National Institutes of Health contrast-enhanced CT scans from 45 patients with scores of 0 points. An improved fully convolutional neural networks for volumetric medical image segmentation (V-Net) model was developed to segment the pancreatic volume (i.e., the whole pancreas, necrotic pancreatic tissue, and non-necrotic pancreatic tissue) and to quantify the split volume ratios. The improved strategy included three stages of body up- and down-sampling adapted to the task of segmentation in AP, and the selection of objects, loss function, and smoothing coefficients. The model interpretations were compared with those of clinicians with different levels of experience. The reference standard was manually segmented by a pancreatic radiologist. Accuracy, macro recall, and macro specificity were employed to compare the diagnostic efficacy of the model and the clinicians. In total, 144 patients (mean age: 44±13 years; 40 females, 104 males) were included in the study. Optimal training results were obtained using the necrotic pancreatic tissue and whole pancreas as the input objects, and combining dice loss and 500 smoothing coefficients as the loss function for training. The dice coefficient for the whole pancreas was 0.811 and that for the necrotic pancreatic tissue was 0.761. The performance of the artificial intelligence model and clinicians were compared. The accuracy, macro recall, and macro specificity of the improved V-net were 0.854, 0.850 and 0.923, respectively, which were all significantly higher than those of the senior and junior clinicians (P<0.05). Our proposed model could improve the effectiveness of clinicians in diagnosing pancreatic necrosis volume ratios in clinical settings.

Association of lung function with visceral adiposity and skeletal muscle mass considering myosteatosis.

Changes in body composition, including loss of muscle mass and obesity, adversely affect lung function. What is the relationship between lung function, visceral adiposity, and skeletal muscle mass, considering myosteatosis measured using computed tomography (CT) scans in middle-aged Korean adults? We reviewed 15,827 participants (9237 men and 6590 women), with a mean age of 52.5 ± 8.3 years, who underwent comprehensive health examinations, including abdominal CT and spirometry. Selected CT scans were automatically segmented to quantify total abdominal muscle area (TAMA), visceral fat area (VFA) and subcutaneous fat area. Muscle quality was assessed by categorizing TAMA into three regions based on CT density: good-quality muscle (normal attenuation muscle area; NAMA), fatty muscle (low attenuation muscle area), and inter/intramuscular fat areas. Low lung function was defined as forced vital capacity (FVC %) and forced expiratory volume in one second (FEV1 %) < 80 of predicted values. Standardized residuals for CT-derived measurements, adjusted for age and body mass index (BMI) using linear regression, were calculated and stratified into quartiles for lung function comparison. Multivariate logistic regression was employed to analyze associations between low lung function and variables. NAMA was positively correlated with FVC and FEV1, whereas VFA was negatively correlated with both. In men, low FVC and FEV1 were significantly associated with lower NAMA and higher VFA. Among women with obesity (BMI ≥ 25 kg/m2), low FVC and FEV1 were significantly associated with higher VFA and lower NAMA (FVC only); among women without obesity, low FVC and FEV1 were negatively associated with NAMA. Lung function was significantly associated with visceral adiposity and skeletal muscle quality, which differed according to sex and BMI. Improving lung function may require tailored management, including reducing visceral fat and/or enhancing skeletal muscle quality based on CT-body composition analysis.

Non-alcoholic fatty liver disease is a strong predictor of carotid high-risk plaques as assessed by high-resolution magnetic resonance imaging.

Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease with a high prevalence. Recent data suggest that NAFLD may be an independent risk factor for cardiovascular disease (CVD). This study aimed to investigate the association between NAFLD and carotid high-risk plaque (HRP) as assessed by high-resolution magnetic resonance imaging (MRI), and to examine the diagnostic value of NAFLD. A total of 125 patients with carotid plaques who underwent high-resolution MRI and unenhanced abdominal computed tomography (CT) examinations were included in this retrospective study. NAFLD was defined as a liver/spleen Hounsfield unit (HU) ratio <1.0 on a non-contrast CT scan. The criteria for defining HRP were at least one of the following features: fibrous cap rupture (FCR); a large lipid-rich necrotic core (LRNC) (occupying >40% of the wall area); or intraplaque hemorrhage (IPH). Univariable and multivariable logistic regression analyses were conducted to examined the association between HRP and NAFLD. The adjusted receiver operating characteristic (aROC) curve and the adjusted area under the curve (aAUC) with the 95% confidence interval (CI) were calculated for each model. Compared with the patients without NAFLD, those with NAFLD had a higher prevalence of IPH, large LRNC, and FCR (all P<0.001). HRP was more commonly observed in the plaques of the NAFLD patients than the non-NAFLD patients (P<0.001). The multivariate analyses showed that NAFLD was an independent predictor of carotid HRP [odds ratio (OR) =12.06, 95% CI: 3.66-39.76, P<0.001]. The aROC curve analysis showed that NAFLD had an outstanding diagnostic ability (aAUC =0.95) in identifying HRP after adjusting for risk factors. NAFLD is associated with carotid HRP as assessed by high-resolution MRI. CT-defined NAFLD may be a novel and robust predictor for identifying HRP.

Deep Fibrous Histiocytoma of the Prostate Masquerading as Benign Prostatic Hyperplasia

Abstract Fibrous histiocytoma is an uncommon clinical entity that arises in the subcutaneous or deep tissues. Rarely, it arises from the prostate. Although the malignant subtype has been reported by some authors, the benign subtype is scarce in the literature. We present the case of a 66-year-old male who had bladder outlet obstruction secondary to a huge pelvic mass. Initially, his symptoms were thought to be due to benign prostatic hyperplasia, however, an abdominopelvic computed tomography scan and pelvic magnetic resonance imaging showed a huge cystic pelvic mass that originated from the prostate. Eventually, he had open drainage of the mass and part of the sac was excised for examination. Histologically and immunohistochemically, this was confirmed to be a deep (benign) fibrous histiocytoma of the prostate.

Impact of Preoperative Sarcopenia on Survival and Postoperative Outcomes in Esophageal Cancer Patients Undergoing Esophagectomy: A Single-Center Retrospective Study.

Background Sarcopenia is the progressive and generalized loss of skeletal muscle and its associated function. Whilst it is typically associated with advanced age, it is also prevalent in patients with chronic diseases including cancer. Patients with esophageal cancer are at high risk of developing malnutrition and sarcopenia due to impaired oral intake, the effects of neoadjuvant treatment, and cancer-related cachexia. Sarcopenia has been associated with worse postoperative outcomes. The aim of this study was to investigate the impacts sarcopenia had on the short- and long-term outcomes of patients undergoing esophagectomy in a regional Australian context. Methods A single-center retrospective analysis was performed for 48 patients who underwent esophagectomy, most of which were for esophageal cancer. All eligible patients received neoadjuvant treatment prior to surgery. Patients were classified as sarcopenic based on their calculated skeletal muscle index (SMI) on a preoperative computed tomography scan. SMI criteria for sarcopenia were <52.4 cm2/m2 for males and <38.5 cm2/m2 for females. Outcomes measured included overall and disease-free survival, postoperative complications, and length of hospital stay. Results Of the 44 patients who met inclusion criteria and underwent esophagectomy, 27 were sarcopenic based on preoperative computed tomography skeletal muscle measurements at L3. The average overall survival for the sarcopenic group was 20.1 months (95% CI 13.3-26.9) with a one-, two-, and three-year overall survival rate of 59.3%, 29.6%, and 22.2%, respectively. The non-sarcopenic group had an average overall survival rate of 28.8 months (95% CI 19.6-38.1) with a one-, two-, and three-year overall survival rate of 82.4%, 41.2%, and 29.4%, respectively. The average disease-free survival for the sarcopenic group was 14.1 months (95% CI 8.4-19.8) with a one-, two-, and three-year disease-free survival rate of 37.0%, 18.5%, and 11.1%, respectively. The average disease-free survival rate for the non-sarcopenic group was 27.2 months (95% CI 19.7-34.7) with a one-, two-, and three-year disease-free survival rate of76.5%, 41.2%, and 29.4%, respectively. The sarcopenic group had an increased average length of hospital stay (23.9days (CI 95% 16.5-31.3) vs. 14.6 days (95% CI 12.2-17.0)). A higher proportion of the sarcopenic patients had restricted dietary intake and required either pureed or enteral feeding (36% vs. 9%). No difference in postoperative complications was detected between the groups. Conclusions Patients with preoperative sarcopenia had a lower overall and disease-free survivaland an increased length of hospital stay when compared with non-sarcopenic patients. Additionally, sarcopenic patients had a higher likelihood of requiring pureed or enteral feeds preoperatively.

Giant Hydatid Cyst Originating From Psoas Muscle Extending to the Iliac Bone: A Case Report.

Hydatid cysts, caused by the Echinococcus granulosus parasite, predominantly affect the liver and lungs, but can also impact other organs such as the kidneys, brain, and muscles. Infection occurs when individuals ingest eggs from contaminated food or water, leading to cyst formation primarily in the liver. While hydatid cysts are commonly found in various endemic regions, muscular involvement is rare, particularly in the psoas muscle. This report presents a case of a muscular hydatid cyst, describes its management, and emphasizes the need for awareness and prompt intervention. A 50-year-old man presented with abdominal and left lower limb pain, along with weakness over several days. He was febrile, and a physical examination revealed pain during leg movement. Routine laboratory tests were normal. Ultrasound and computed tomography scans identified a solid cystic mass in the left lower quadrant, extending to the left lumbar muscle. After 28 days of preoperative albendazole therapy, the patient underwent surgery through a Rocky Davis incision, where a large hydatid cyst containing daughter cysts in the psoas muscle was discovered. The cyst was unroofed, and its contents were evacuated, followed by irrigation with hypertonic saline. Postoperative recovery was uneventful. He also received standard medication therapy with albendazole, and during monthly visits, no complications were observed during the one-year follow-up. This case contributes to the limited literature on muscular hydatid disease and highlights the importance of awareness among healthcare providers to ensure timely diagnosis and management.

The effects of intercalary fragments at the posterior malleolus on ankle joint pressure distribution - a biomechanical cadaveric study.

With the increased use of computed tomography scans in cases with trimalleolar ankle fractures, bone fragments between the posterior malleolus and the rest of the articular surface tibial plafond surface - described as intercalary fragments (ICFs) - can be recognized. The aim of this study was to determine the ICF size threshold for a significant change in the pressure distribution at the ankle joint, having a considerable impact on the remaining cartilage of the joint. Eight human cadaveric lower legs were used, and a posterior malleolus Bartoniček/Rammelt II fracture was created with sequential 2 mm, 4 mm, 6 mm, and 8 mm ICFs. The posterior malleolus was fixed with a 3.5 mm one-third tube buttress plate and each specimen was mounted in a custom-made frame for axial loading under 700 N in neutral position, 30° plantar flexion, and 30° dorsiflexion of the foot. Using electronic foil sensors, pressure measurements were performed to define the contact area, centre of force, and peak pressure at the ankle joint in loaded condition. Compared to the situation without ICF, contact area decreased significantly after 4 mm, 6 mm and 8 mm ICFs. Anteroposterior center of force shift was significant after 6 mm and 8 mm ICFs. Mediolateral center of force shift was significant after 2 mm, 4 mm, 6 mm and 8 mm ICFs. Posterolateral defects of the tibial plafond alter ankle joint pressure characteristics. Regardless of the direction of ankle joint flexion, increasing the ICF defect size results in decreased contact area, increased mediolateral center of force migration and higher peak joint forces. Malreduction or removal of ICFs larger than 2 mm should be avoided to preserve physiological ankle pressure characteristics.

Response to letter to editor: “Retromalleolar groove morphology of the tibialis posterior tendon (TPT) in patients without TPT pathology evaluated by axial computed tomography scans”

Response to letter to editor: “Retromalleolar groove morphology of the tibialis posterior tendon (TPT) in patients without TPT pathology evaluated by axial computed tomography scans”