Computed Tomography Research Articles

Preliminary results of the non-invasive cardiac radioablation for ventricular tachycardia study; an in silico dosimetric comparison of photon vs proton radiotherapy for ventricular arrhythmias

Abstract Background Stereotactic arrhythmia radio-ablation (STAR) has been proposed as an alternative treatment for refractory ventricular arrhythmias (VA) in patients who are unsuitable or refractory to standard catheter ablation (CA). It consists in the application of external beam radiotherapy in a single dose of 25 Gy to the target areas. Most of the STAR treatments performed so far used photon radiotherapy. As compared to photons, particle therapy with protons, based on its finite penetration depth in tissue, might have the potential to reduce the dose to surrounding healthy tissues thus lowering the risk of side effects. Purpose The purpose of this in silico simulation study was to evaluate the feasibility of STAR with protons in patients with VA and to compare the doses of the organs at risk (OARs) in photon and proton treatment plans. Methods 14 patients (11 males) candidates to standard CA for VA were enrolled. ECG gated CT scans in expiratory breath-hold, and standard electroanatomical mapping were performed in each patients to reconstruct a 3D bipolar voltage map and identify the ablation target. Based on the information obtained by the contouring of the ablation target three treatment plans were simulated: one with photons, and two with protons - with and without cardiac gating- to assess the doses at the OARs. Results The median age was 68.5 (63.25-71.5), all patients had a history of recurrent VA and the indication for treatment with CA. 7 patients had an ischemic cardiomyopathy, 4 an idiopathic cardiomyopathy and 3 ventricular ectopic beats without structural heart disease. The mean left ventricular ejection fraction was 40±11% and 8 out of 14 patients were ICD carriers. Both photons and protons treatment plans reached the goals for target coverage (25 Gy on 98% of the target volume). A statistically significant reduction in the mean maximum dose (Dmax) to some OARs was observed in proton compared to photon plans (see table 1). Specifically, the Dmax delivered to the mitral valve, vena cava, descending aorta, esophagus and to the lungs have been largely reduced with the proton plans. However, in some specific cases, a higher maximum dose was observed for protons in structures close or overlapping with the target, mainly due to the need of an additional margin in the treatment plan to account for proton range uncertainty. The use of cardiac gating did not show a significant dose reduction to OARs compared to the non-gated proton plan. Conclusion The preliminary results of our in silico simulation study suggest that STAR therapy with the use of protons might be associated with a significant dose reduction to the surrounding organs. Nevertheless, the choice of the best treatment should be evaluated on a case by-case strategy since some specific cases may be better suitable for photon treatment.Table 1

CCTA and CTP imaging for detecting clinically suspected in-stent restenosis: a meta-analysis

Abstract Background The evaluation of coronary artery stents via Coronary Computed Tomography Angiography (CCTA) can be compromised by artefacts, potentially undermining its diagnostic accuracy. The integration of CT Perfusion (CTP) with CCTA (CCTA+CTP) has been proposed to enhance the diagnostic yield in detecting in-stent restenosis (ISR). Purpose This meta-analysis aims to assess the diagnostic performance of CCTA and combined CCTA+CTP in detecting ISR. Methods A comprehensive literature search of studies from 2005 to 2022 identified 13,747 articles. Inclusion criteria comprised the utilization of multidetector CT scanners with ≥64 slices and invasive coronary angiography as the reference standard. Studies that systematically evaluated stent patency in asymptomatic patients as part of their protocol were excluded. Results After removing duplicates, screening titles and abstracts, and conducting full-text reviews, 20 studies met the inclusion criteria (17 CCTA, 3 CCTA+CTP). Data on 2,674 CCTA-assessed stents and 752 CCTA+CTP-assessed stents were analyzed. The meta-analysis revealed that CCTA alone achieved a sensitivity of 90% (95% CI; 84-94%) and a specificity of 89% (95% CI; 86-92%)(Figure 1). CCTA+CTP exhibited comparable diagnostic performance, with a per-stent sensitivity of 88% (95% CI; 80-94%) and a specificity of 88% (95% CI; 84-93%) (Figure 2). The summary Receiver Operating Characteristic (sROC) Area Under the Curve (AUC) was 0.96 (95% CI; 0.94-0.97) for CCTA and 0.96 (95% CI; 0.89-1.00) for CCTA+CTP, indicating a high overall performance for both diagnostic modalities. Conclusion Utilizing contemporary imaging hardware, both CCTA and CCTA+CTP demonstrate high diagnostic performance in evaluating ISR. The findings suggest that the presence of coronary artery stents should not preclude the use of these non-invasive diagnostic tests in clinical practice.Figure 1Figure 2

Characteristics of fatal COVID-19 among pregnant women admitted to hospitals in Kazakhstan

Abstract Background The factors contributing to the fatal outcome of COVID-19 in pregnant women remain not entirely clear. We compared the prevalence rates of comorbidities and laboratory test results in pregnant survivors and non-survivors. Methods This retrospective study relied on clinical and laboratory data obtained from medical records of pregnant women with COVID-19 admitted to three hospitals of the Republic of Kazakhstan from 16.07.2021 to 31.01.2022. Overall, we obtained data on 157 pregnant women with COVID-19, of whom 95.9 % survived and 4.1 % died in the hospitals. Results Arterial hypertension was present in 50% of non-survivors vs. 7.9% of survivors (P = 0.001), diabetes mellitus was diagnosed in 16.7% of non-survivors vs. 2.3% of survivors (P = 0.044), and the rate of hyperglycemia was 40% and 7.2%, respectively (P = 0.009). Heart rhythm disturbance was present in 50% of non-survivors vs. 6.4% of survivors (P < 0.001), and already at the time of admission to the hospital, the non-survivors had significantly higher heart and respiratory rates. Laboratory tests showed that non-survivors had higher erythrocytes sedimentation rate, C-reactive protein, leukocyte count, and D-dimer levels (P = 0.001, P < 0.001, P = 0.038, P = 0.014, respectively). The creatinine level was within the normal range in both study groups, but it was relatively higher in the deceased pregnant women (71.3; IQR: 66-251.75) vs. 52; IQR: 43-63; P = 0.001). Finally, a higher proportion of those who died presented with abnormal chest CT as compared with the survivors (33.3% vs. 4.2%, P < 0.001). Conclusions The deceased had a higher rate of comorbidities. Given the vulnerability of pregnant women to COVID-19, it is essential to plan a prospective study to provide insights into the factors that contribute to severe COVID-19 outcomes in pregnant women. Key messages • Determining risk factors for fatal COVID-19 is crucial for effective medical care of pregnant women. • Identifying potential risk factors of fatal COVID-19 among pregnant women could help inform public health policies and clinical guidelines.

Living with a chronic disease: tertiary prevention tools in asbestos-exposed patients

Abstract Background The main asbestos-related pathology is asbestosis, frequently associated with pleural plaques. The spirometric pattern is mainly restrictive, with reduction in all lung volumes (FEV1, FVC, TLC). Also a reduction in alveolus-capillary diffusion of carbon monoxide (DLCO) may be added, related to the fibrotic process. The aim of the study is to analyze the health surveillance data, correlating the spirometric finding and its variation over time with the clinical and radiological picture. Methods The study is conducted on 372 patients with asbestosis from occupational exposure diagnosed in the period 2017-2023, as part of the Tuscany Region’s program for former asbestos exposures (DGR 396/2016). The investigation is at the second level of surveillance, which includes chest CT and Respiratory Functionality Testing (RFT). Data are obtained from patients’ medical records and processed through a database. Results Out of 372 patients with asbestosis, 213 had pleural plaques (57.25%). Out of those, there is a progressive worsening of RFTs in a restrictive direction (TLC <80%, FEV1/FVC >70%) in 71 patients (33.3%), with a mean TLC loss of 8.7 ± 5.9 mL over subsequent follow-ups on a yearly basis. The FEV1/FVC ratio also declines, with a mean reduction of 5 ± 2.4%. Out of those 71 patients, 14 (19.7%) also show a mean reduction in DLCO of 6.7 ± 5 mL/min/mmHg. The negative trend in RFTs correlates with the worsening clinical and radiological picture attributable to the occurrence of plaques on a fibrotic framework. Conclusions The health surveillance protocol that we adopted has as objective the ascertainment of pulmonary pleura-parenchymal alterations correlated with occupational exposure, investigating their evolution over time through the analysis of spirometric data, and to optimize the management of the functional disability, with a view to the tertiary prevention of patients with asbestos-related disease. Key messages • The negative trend in asbestosis PFRs correlates with the worsening of the clinical and radiological picture attributable to the appearance of pleural plaques on an interstitial fibrosis. • Health surveillance is essential in order to optimize the management of functional disability, with a view to tertiary prevention of patients with asbestos-related disease.

Computed tomography-derived myocardial extracellular volume: a diagnostic marker for cardiac amyloidosis in transcatheter aortic valve implantation patients with biopsy confirmation

Abstract Background Transthyretin cardiac amyloidosis (ATTR-CA) appears to be prevalent in aortic stenosis (AS). The coexistence of ATTR-CA and severe AS is associated with an increased risk of hospitalization for heart failure after transcatheter aortic valve implantation (TAVI). The identification of ATTR-CA is of great clinical importance. In this study, we investigated the diagnostic value of computed tomography-derived myocardial extracellular volume (CT-ECV) for the diagnosis of biopsy-proven ATTR-CA. Methods From December 2022 to January 2024, we enrolled patients who underwent both TAVI and myocardial biopsy. CT-ECV was measured as part of routine CT imaging before TAVI and myocardial biopsy for definitive diagnosis of CA. Results Of 131 TAVI patients, 101 patients underwent myocardial biopsy. Eight patients (7.9%) were diagnosed with ATTR-CA. There were no significant differences in electrocardiographic parameters. On echocardiography, left ventricular ejection fraction (64 ± 16% vs. 65 ± 14%, p = 0.84) was similar between the 2 groups, whereas intraventricular septum and left ventricular posterior wall in diastole were thicker in the ATTR-CA group (15 ± 3mm vs. 13 ± 2mm, p = 0.04 and 14 ± 3mm vs. 12 ± 2mm, p <0.01, respectively). Significantly higher CT-ECV values were found in the ATTR-CA group than in the non-ATTR-CA group (32.6 ± 3.7% vs. 28.1 ± 3.7%, p = 0.001). Conclusions Patients with biopsy-proven ATTR-CA had high CT-ECV values. Routine CT-ECV evaluation before TAVI may be useful for the diagnosis of ATTR-CA.

Study on the impact of bowtie filter on photon-counting CT imaging

Objective.The aim of this study was to investigate the impact of the bowtie filter on the image quality of the photon-counting detector (PCD) based CT imaging.Approach.Numerical simulations were conducted to investigate the impact of bowtie filters on image uniformity using two water phantoms, with tube potentials ranging from 60 to 140 kVp with a step of 5 kVp. Subsequently, benchtop PCD-CT imaging experiments were performed to verify the observations from the numerical simulations. Additionally, various correction methods were validated through these experiments.Main results.It was found that the use of a bowtie filter significantly alters the uniformity of PCD-CT images, depending on the size of the object and the x-ray spectrum. Two notable effects were observed: the capping effect and the flattening effect. Furthermore, it was demonstrated that the conventional beam hardening correction method could effectively mitigate such non-uniformity in PCD-CT images, provided that dedicated calibration parameters were used.Significance.It was demonstrated that the incorporation of a bowtie filter results in varied image artifacts in PCD-CT imaging under different conditions. Certain image correction methods can effectively mitigate and reduce these artifacts, thereby enhancing the overall quality of PCD-CT images.

Impact of ultra-high-resolution on cardiac CT assessment of coronary artery stenoses, plaque burden/composition, and pericoronary adipose tissue attenuation

Abstract Background Conventional coronary computed tomography angiography (CCTA) overestimates stenoses within stents and calcified arteries due to "blooming" artifacts. Ultra-high-resolution coronary CT (UHR-CT) may overcome this limitation because of higher spatial resolution. Purpose To investigate differences in coronary arterial lumen volume, stenosis severity, and plaque composition, between CCTA and UHRCT in patients with stents and/or high coronary calcium scores. Methods As part of a prospective pilot study, 14 patients referred for invasive coronary angiography for evaluation of obstructive CAD underwent UHRCT (Canon Precision, 160 x 0.25mm slices) prior to catheterization. Images of identical cardiac phases were reconstructed in two badges for comparison: 1) Ultra-high resolution using a 1,024 x 1,024 matrix, 0.25 mm, and 2) conventional resolution with a 524 x 524 matrix, 0.5 mm. All images were reconstructed using iterative reconstruction algorithm (AIDR 3D) and a sharp kernel (FC05). For the left main and three coronary arteries, an automated contour analysis using a dedicated software (QAngioCT RE 3.2, Medis, Netherlands) was performed to compare conventional CCTA vs. UHR-CT resolution images across common vascular and plaque metrics, including lumen and vessel volume, plaque burden/volume, plaque composition based upon predefined fixed intensity cut-off values of CT attenuation, minimal and maximal plaque thickness, pericoronary adipose tissue attenuation (PCAT), minimal lumen area and diameter, and diameter stenosis. All lumen and vessel contours were generated by the software, without manual editing. The segment model proposed by the SCCT was used as reference and the lesions classified as greater than 25% stenosis by visual assessment were recorded. The quality of the images was subjectively assessed using a 5-point Likert scale. Vessel segments with scores 1 (severe artifacts) and 2 (pronounced artifacts) were not included in the analysis. Results The mean patient age was 68.5 years (±6.8), 2 were female (14.3%), 6 patients had stents (11 stented segments) and the mean Agatston score was 947.6 (±449) among the 8 non-stented patients. A total of 56 vessels, 133 segments, and 57 lesions were analyzed. Eight segments (6%) were excluded from the analysis due to poor quality. Results on a per segment and per lesion basis were summarized in the table. The mean PCAT value was significantly lower for the UHRCT images compared to NR reconstruction in both segment (p<0.001) and lesion based (p=0.002) analyses. Plaque differentiation varied by UHRCT resulted in a lower fibrous plaque volumes but higher necrotic (low attenuation) plaque volumes. Conclusions Ultra-high-resolution CT image analysis results in significantly different coronary artery plaque volume and PCAT assessment vs. conventional resolution CCTA. These findings have implications for evaluating high-risk plaque features and perivascular inflammation in patients.Table 1

Fully automated detection of anomalous aortic origin of the coronary arteries in coronary CT images: a novel artificial intelligence-based screening tool

Abstract Background Anomalous Aortic Origin of the Coronary Artery (AAOCA) is a rare congenital disease that can be easily overlooked during contrast-enhanced Coronary Computed Tomography Angiography (CCTA) image analysis. Objective In this study, we aimed to develop a novel artificial intelligence-based screening tool to automate the detection of AAOCA in CCTA images. Method We enrolled 127 patients from the coronary artery anomaly registry from two centers with AAOCA diagnosis based on CCTA as well as 413 normal cases. A deep learning model was developed to automatically segment the aorta and the left ventricle (LV), after which the images were automatically cropped to the aortic root and LV intersection with a box size of 6 cm3. The images were then clipped to Hounsfield Units ranging from -400 to 750 and normalized to -1 to1. These cropped regions were fed into different residual convolutional neural networks (ResNet, with different depths 10, 18, 34 and 50) to detect AAOCA. Model development (parameter and hyperparameters optimization) was performed on the training and validation sets (70/10%), and finally, it was tested on the 20% untouched test set. Various classification metrics were reported for the detection of AAOCA. Results ResNet-10 achieved an AUC of 0.91 (sensitivity: 0.89, specificity: 0.86), while ResNet-18 showed improved performance with an AUC of 0.95 (sensitivity: 0.89, specificity: 0.95). ResNet-34 achieved an AUC of 0.94 (sensitivity: 0.83, specificity: 0.96), and ResNet-50 excelled with the highest AUC of 0.96 (sensitivity: 0.89, specificity: 0.95), indicating its superior capability in accurately identifying AAOCA. Conclusion We developed a high-performance AI tool for the fully automated detection of AAOCA using CCTA images. This tool can be used to evaluate large patient cohorts and detect AAOCA in extensive databases. Moreover, it can operate seamlessly alongside clinical assessments of CCTA scans, providing real-time alerts to medical personnel about potential AAOCA findings. This enhances diagnostic efficiency and supports early intervention in cardiovascular care.

Application of resistance exercise training combined with CT image evaluation in postoperative functional rehabilitation and fracture risk prediction of elderly femurs

ObjectiveTo evaluate the overall functional recovery of femoral patients, improve recovery ability, and prevent fractures in the elderly. MethodsA group of elderly femoral postoperative participants were selected and randomly divided into resistance exercise training and routine rehabilitation training. Simultaneously, a control group (without a history of fractures) and a fracture group (with a history of fractures) were designed to predict fracture risk. Finally, computerized tomography was used to evaluate the functional rehabilitation status. ResultsThe resistance exercise training group showed significantly better performance in functional rehabilitation and fracture risk prediction than the control group, and the decrease in Barthel index at 12 weeks after surgery in this group was 6.25 (P > 0.001). The age, gender, and volumetric bone density between the control group and the fracture group showed P > 0.001, and the differences were statistically significant. The average age of the control group was significantly higher than that of the fracture group, and the proportion of males in the fracture group was significantly higher than that of the control group. The intramuscular fat content of the iliopsoas muscle in the fracture group was significantly lower than that in the control group, P = 0.004. This indicated that lower intramuscular fat content of the iliopsoas muscle was associated with higher fracture risk, as participants with lower intramuscular fat content of the iliopsoas muscle had less bone protection, resulting in an increased risk of fracture. The difference in body mass index between the two groups was not statistically significant, P = 0.737, indicating that the impact of this parameter on fracture risk was not significant in this study. ConclusionResistance exercise training combined with CT image evaluation is an effective rehabilitation strategy with high clinical application value. This study provides reliable empirical evidence for the application of resistance exercise training and the combination of CT image evaluation, and provides guidance for the optimization of clinical rehabilitation strategies.

Interscan reproducibility of computed tomography derived coronary plaque volume measurements using a semi-automated analysis software

Abstract Background Coronary computed tomography angiography (CCTA) enables detailed quantification and characterization of coronary atherosclerotic plaque, offering diagnostic and prognostic value. Despite the growing demand for accurate plaque analysis, studies on interscan reproducibility of automated plaque quantification are limited in number and size. Moreover, impact of clinical and technical factors on the reproducibility of plaque assessment tools are scarce. Purpose The objective of this study was to assess the interscan reproducibility of CCTA-derived plaque volume measurements and the implications of clinical and technical characteristics on interscan reproducibility. Methods A total of 101 patients with known coronary artery disease underwent two CCTA scans within hour interval using identical CT acquisition protocol. Coronary plaque volume measurements were quantified on a per-patient level using a contemporary semi-automated plaque analysis software. Results There was no statistically significant difference in median plaque volumes between the first and second scan. The direct correlation was excellent for volumes of non-calcified plaque (NCP), calcified plaque (CP), and total plaque (TP) across all analyses (Pearson’s coefficient 0.96 to 0.99), while moderate for low-density non-calcified plaque (LD-NCP) volumes (Pearson’s coefficient 0.77). Bland Altman analyses demonstrated high interscan agreement with narrow absolute and relative limits of agreement (LoA) across plaque subtypes, except for LD-NCP volumes (Table 1). Interscan reproducibility on CP volumes was affected by CT image quality with narrower LoA in scans with the highest image quality score (p = 0.003), or lowest image reconstructive iteration level (p <0.001). Limits of agreement were significantly narrower for NCP, CP, and TP volumes in lesions located in LAD compared to non-LAD lesions (p <0.001). However, no significant difference in LoA was present when comparing patients according to BMI (<27 and ≥27 kg/m2), heart rate (<65 and ≥65 beats per minute), or Agatston score (<193 and ≥193). Conclusions This comprehensive interscan reproducibility study revealed good agreement in the measurement of plaque subtypes. Adding new insight to existing literature, we have demonstrated that factors such as image quality, image reconstructive algorithms, and lesion location affect the reproducibility of plaque volume measurements. CT-derived plaque quantification using a semi-automated plaque analysis software holds potential for monitoring disease progression or regression in patients with CAD, provided high CCTA image quality.

A clinical comparison of a digital versus conventional design methodology for transtibial prosthetic interfaces

A transtibial prosthetic interface typically comprises a compliant liner and an outer rigid socket. The preponderance of today’s conventional liners are mass produced in standard sizes, and conventional socket design is labor-intensive and artisanal, lacking clear scientific rationale. This work tests the clinical efficacy of a novel, physics-based digital design framework to create custom prosthetic liner-socket interfaces. In this investigation, we hypothesize that the novel digital approach will improve comfort outcomes compared to a conventional method of liner-socket design. The digital design framework generates custom transtibial prosthetic interfaces starting from MRI or CT image scans of the residual limb. The interface design employs FEA to simulate limb deformation under load. Interfaces are fabricated for 9 limbs from 8 amputees (1 bilateral). Testing compares novel and conventional interfaces across four assessments: 5-min walking trial, thermal imaging, 90-s standing pressure trial, and an evaluation questionnaire. Outcome measures include antalgic gait criterion, skin surface pressures, skin temperature changes, and direct questionnaire feedback. Antalgic gait is compared via a repeated measures linear mixed model while the other assessments are compared via a non-parametric Wilcoxon sign-rank test. A statistically significant (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P=0.032$$\\end{document}) decrease in pain is demonstrated when walking on the novel interfaces compared to the conventional. Standing pressure data show a significant decrease in pressure on novel interfaces at the anterior distal tibia (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$P = 0.012$$\\end{document}), with no significant difference at other measured locations. Thermal results show no statistically significant difference related to skin temperature. Questionnaire feedback shows improved comfort on novel interfaces on posterior and medial sides while standing and the medial side while walking. Study results support the hypothesis that the novel digital approach improves comfort outcomes compared to the evaluated conventional method. The digital interface design methodology also has the potential to provide benefits in design time, repeatability, and cost.

Prospective evaluation of transcatheter aortic valve implantation (TAVI) with coronary alignment and impact on coronary access

Abstract Introduction Transcatheter aortic valve implantation (TAVI) with optimised coronary alignment aims to reduce coronary-commissural overlap (CCO) to facilitate future coronary intervention and reduce the risk of coronary obstruction after re-do TAVI, however, in-vivo data are lacking. Aims To determine the feasibility of TAVI with coronary alignment assessed by post-TAVI CT. Secondary endpoints included the incidence of adverse anatomical features which could impede coronary access (severe CCO and ostia below valve skirt) and their association with coronary engagement during invasive angiography. Methods 30 patients underwent TAVI with optimised coronary alignment with either ACURATE neo2 or Evolut Pro+ and invasive coronary angiography and cardiac CT performed after valve deployment. Results 15 patients received ACURATE neo2 (50%) and 26 patients (86.7%) underwent CT after TAVI. The mean inter-coronary angle was 140 (19.5)° and the median observed angular deviation from perfect alignment (0°) was 0.8° (IQR -4.5 to +10) ° with perfect alignment (±15°) observed in 21/26 cases (80.8%) and ≤mild misalignment (±30°) in 24/26 of cases (92.3%). The remaining two cases had moderate misalignment (30-45°) with no cases of severe misalignment. The angle between the coronary ostia and the nearest TAVI commissure was 46 (40 - 57) ° for the RCA and 50.5 (43 - 54) ° for the LCA which did not differ significantly from the native situation (both p>0.2), with 1 (3.8%) case of severe overlap. 46/55 (83.6%) coronary engagements were selective, 7/55 (12.7%) semi-selective and 2/55 (3.6%) unable to intubate. Non-selective engagement/unable to engage affected the RCA more than the LCA (6/27 [22.2%] vs. 3/28 [10.7%]) and was three-fold more common with the Evolut (7/29 [24.1%]) than the Acurate (2/26 [7.7%]. Coronary>commissural angle in those with unselective engagement was 43° (IQR 37 to 51°). Conclusions TAVI with optimised coronary alignment is technically feasible, safe and reduces coronary-commissural overlap which is important for future re-do TAVI procedures. Difficult coronary access was encountered more frequently following Evolut Pro+ and when engaging the RCA, but was unrelated to angular distance to nearest commissure.

Case report: The first known case of male retroperitoneal mesonephric-like adenocarcinoma

AimWe aimed to analyze the clinico-pathological and molecular features of mesonephric-like adenocarcinoma (MLA) to enhance understanding of this tumor type.MethodsThis is the first case of MLA occurring in the retroperitoneum of a male patient. Clinico-pathological and molecular characteristics were analyzed, and the relevant literature was reviewed.ResultsA 65-year-old elderly male was admitted to the hospital with mild bilateral dull pain in the lumbar region for more than 1 month, accompanied by a feeling of dysuria. CT tomography revealed a retroperitoneal tumor. While tumor immuno-histochemistry was positive for CK, CK7, Vimentin, PAX-8, CD10, GATA-3, EMA, and CR to varying degrees, it was negative for P53, WT-1, HMB45, MelanA, CD117, DOG-1, CD34, S-100, ER, PR, AR, CEA, α-inhibin and TTF-1. Ki67 index was <10% in most areas and was approximately 30% in the hotspot areas in the glandular ductal region. Molecular detection (Next-generation sequencing method, 425-gene panel from NanjingShihe Gene Biotechnology Co., Ltd. for targeted DNA enrichment): No clinically significant variants detected. The final pathological diagnosis was a retroperitoneal malignant tumor consistent with a well-moderately differentiated MLA.ConclusionMLA in the retroperitoneum of men has not been reported yet. The diverse morphology and unclear molecular characteristics of this tumor mandate careful diagnosis for good clinical outcomes.

Clinical characteristics and distinguishing factors of patients with COVID-19 complicated with active pulmonary tuberculosis.

The current study was conducted aimed at exploring the clinical characteristics and distinguishing factors of patients with the novel coronavirus pneumonia (COVID-19) complicated with active pulmonary tuberculosis. A total of 354 patients with COVID-19 in our hospital from November 2022 to February 2023 were included in the present study, of whom 87 patients were also combined with active pulmonary tuberculosis. Significant differences were found in fever, fatigue, nasal congestion, nasal discharge, sore throat, expectoration, and weight loss between the two groups (p < 0.05). There were significant differences in the levels of leukocyte, neutrophil, lymphocyte count, monocyte, hemoglobin, C-reactive protein, and CD4/CD8 between the two groups (p < 0.05). There were significant differences in pulmonary consolidation, multifocal ground-glass opacities in both lungs and infiltrating shadows, "cavity" by CT imaging between the two groups (p < 0.05). The independent variables were set as the indicators with different results of clinical characteristics and CT imaging, including fever, fatigue, nasal congestion, nasal discharge, sore throat, expectoration, weight loss, leukocytes, count neutrophils and lymphocytes, monocytes, hemoglobin, C-reactive protein, CD4/CD8, pulmonary consolidation, multifocal ground-glass opacities in both lungs and infiltration shadows. Our findings have revealed that fever, fatigue, expectoration, leukocytes, neutrophils, monocytes, hemoglobin, C-reactive protein, lymphocytes, CD4/CD8, pulmonary consolidation, multifocal ground-glass opacities in both lungs, and infiltration shadows were the risk factors responsible for the patients with COVID-19 complicated with active pulmonary tuberculosis.

Semantic Segmentation of the Prostate Based on Onefold and Joint Multimodal Medical Images Using YOLOv4 and U-Net

Magnetic Resonance Imaging is increasing in importance in prostate cancer diagnosis due to the high accuracy and quality of the examination procedure. However, this process requires a time-consuming analysis of the results. Currently, machine vision is widely used in many areas. It enables automation and support in radiological studies. Successful detection of primary prostate tumors depends on the effective segmentation of the prostate itself. At times, a CT scan may be performed; alternatively, MRI may be the selected option. The data always reach a bottleneck stage. This paper presents the effective training of deep learning models to segment the prostate based on onefold and multimodal medical images. This approach supports the computer-aided diagnosis (CAD) system for radiologists as the first step in cancer exams. A comparison of two approaches designed for prostate segmentation is described. The first combines YOLOv4, the object detection neural network, and U-Net for a semantic segmentation based on onefold modality MRI images. The second presents the same method trained on multimodal images—a CT and MRI mixed dataset. The learning process was carried out in a cloud environment using GPU cards. The experiments are based on data from 120 patients who have undergone MRI and CT examinations. Several metrics evaluated the trained models. In the prostate semantic segmentation process, better results were achieved by mixed MRI with CT datasets. The best model achieved the value of 0.9685 for the Sørensen–Dice coefficient for the threshold value of 0.6.

Influence of Temperature and Bedding Planes on the Mode I Fracture Toughness and Fracture Energy of Oil Shale Under Real-Time High-Temperature Conditions

The anisotropic fracture characteristics of oil shale are crucial in determining reservoir modification parameters and pyrolysis efficiency during in situ oil shale pyrolysis. Therefore, understanding the mechanisms through which temperature and bedding planes influence the fracture behavior of oil shale is vital for advancing the industrialization of in situ pyrolysis technology. In this study, scanning electron microscopy (SEM), CT scanning, and a real-time high-temperature rock fracture toughness testing system were utilized to investigate the spatiotemporal evolution of pores and fractures in oil shale across a temperature range of 20–600 °C, as well as the corresponding evolution of fracture behavior. The results revealed the following: (1) At ambient temperature, oil shale primarily contains inorganic pores and fractures, with sizes ranging from 50 to 140 nm. In the low-temperature range (20–200 °C), heating primarily causes the inward closure of inorganic pores and the expansion of inorganic fractures along bedding planes. In the medium-temperature range (200–400 °C), organic pores and fractures begin to form at around 300 °C, and after 400 °C, the number of organic fractures increases significantly, predominantly along bedding planes. In the high-temperature range (400–600 °C), the number, size, and connectivity of matrix pores and fractures increase markedly with rising temperature, and clay minerals exhibit adhesion, forming vesicle-like structures. (2) At room temperature, fracture toughness is highest in the Arrester direction (KIC-Arr), followed by the Divider direction (KIC-Div), and lowest in the Short-Transverse direction (KIC-Shor). As the temperature increases from 20 °C to 600 °C, both KIC-Arr and KIC-Div initially decrease before increasing, reaching their minimum values at 400 °C and 500 °C, respectively, while KIC-Shor decreases continuously as the temperature increases. (3) The energy required for prefabricated cracks to propagate to failure in all three directions reaches a minimum at 100 °C. Beyond 100 °C, the absorbed energy for crack propagation along the Divider and Short-Transverse directions continues to increase, whereas for cracks propagating in the Arrester direction, the absorbed energy exhibits a ‘W-shaped’ pattern, with troughs at 100 °C and 400 °C. These findings provide essential data for reservoir modification during in situ oil shale pyrolysis.

Electromagnetic navigation system for computed tomography-guided synchronous percutaneous lung biopsy and microwave ablation of pulmonary nodules: a prospective, single-center, single-arm clinical study

Background The purpose of this study was to clinically evaluate the safety and effectiveness of the electromagnetic navigation (EMN) system designed for computed tomography (CT)-guided synchronous percutaneous lung biopsy and microwave ablation (MWA) of pulmonary nodules. Methods This prospective, single-center, single-arm clinical cohort study was conducted in Beijing Hospital from March 2023 to May 2023. Patients who underwent CT-guided synchronous percutaneous lung biopsy and MWA via the EMN system were prospectively enrolled in our study. All the interventional procedures were performed by the same interventional radiologist. The technical success rate, the technical efficacy rates of biopsy and MWA were assessed as the primary outcomes. Preoperative, intraoperative, and postoperative variables were also recorded and analyzed for each patient. Results A total of 48 patients were enrolled in the study. The technical success rate was 100%. The technical efficacy rate of biopsy was 95.8% (46/48), and the technical efficacy rate of WMA was 100% (48/48) with no recurrence during follow-up. The total and subpleural needle trajectory length and distance error were 8.3 ± 2.6 cm, 3.6 ± 1.6 cm, and 1.84 ± 1.08 mm, respectively. The median numbers of needle adjustments and CT acquisitions were 1 (range 1–3) and 3 (range 3–5), respectively. The time to reach the target and procedure time were 4.4 ± 1.7 and 19.7 ± 5.2 min, respectively. The dose length product was 748.8 ± 221.8 mGy*cm. The median postoperative hospital stay was 1 (range 1–7) days. No major complications (grade ≥3) occurred and only seven minor complications (14.6%) occurred, including six cases of pneumothorax and one case of hemoptysis. The radiologists achieved high satisfaction scores after surgery. Conclusion The EMN system is feasible, safe and effective for CT-guided synchronous percutaneous lung biopsy and MWA of pulmonary nodules.

TB or Not TB, That is the Question?

A 26-year-old female presented with a 3-month history of dry cough, unintentional weight loss, night sweats and fatigue. Her background history was significant for ulcerative colitis, managed with Adalimumab for almost 2 years. Clinical examination was unremarkable, apart from some mild pallor. Abnormal chest x-ray findings prompted a computerised tomography (CT) thorax which demonstrated multifocal peri-bronchial consolidation. The differential diagnosis was multifocal organising pneumonia and tuberculosis (TB). Extensive investigations, including invasive bronchial imaging and biopsy, ultimately ruled out TB. This paper reports a case of Adalimumab-induced organising pneumonia and discusses its clinical implications.

Artificial Intelligence in Head and Neck Cancer Diagnosis: A Comprehensive Review with Emphasis on Radiomics, Histopathological, and Molecular Applications

The present review discusses the transformative role of AI in the diagnosis and management of head and neck cancers (HNCs). Methods: It explores how AI technologies, including ML, DL, and CNNs, are applied in various diagnostic tasks, such as medical imaging, molecular profiling, and predictive modeling. Results: This review highlights AI’s ability to improve diagnostic accuracy and efficiency, particularly in analyzing medical images like CT, MRI, and PET scans, where AI sometimes outperforms human radiologists. This paper also emphasizes AI’s application in histopathology, where algorithms assist in whole-slide image (WSI) analysis, tumor-infiltrating lymphocytes (TILs) quantification, and tumor segmentation. AI shows promise in identifying subtle or rare histopathological patterns and enhancing the precision of tumor grading and treatment planning. Furthermore, the integration of AI with molecular and genomic data aids in mutation analysis, prognosis, and personalized treatment strategies. Conclusions: Despite these advancements, the review identifies challenges in AI adoption, such as data standardization and model interpretability, and calls for further research to fully integrate AI into clinical practice for improved patient outcomes.

Metabolic profile of acute ischemic stroke patients in a tertiary care hospital

Background: When the blood supply to a portion of the brain is blocked or diminished, brain tissue cannot get oxygen and nutrients, resulting in an ischemic stroke. This study aimed to investigate the prevalence of hyperglycemia and dyslipidemia among patients with acute stroke in a tertiary healthcare setting in Bangladesh. Methods: This cross-sectional study was conducted from January 2022 to December 2022 at a tertiary healthcare facility in Bangladesh, focusing on patients with acute ischemic stroke. Data was collected through a face-to-face interview, and medical records were reviewed. The study included 40 patients with acute stroke, evidenced by clinical findings and a CT scan of the Brain. Written informed consent was obtained after proper explanation, and participants were free to refuse or withdraw at any point. Confidentiality and privacy were maintained. Results: The majority of participants (37.5%) were aged 60-69, with more males (57.5%) than females (42.5%). Most (70%) lived in urban areas. Among the participants, 82.5% had hypertension, and 52.5% had diabetes mellitus. The mean of HbA1c was 7.6% and of triglyceride was 205.0 mg/dl. Of the participants with acute stroke, 47.5% had extracranial carotid stenosis. Conclusions: Nearly half of those who had an acute stroke also had diabetes, and four out of five had a history of hypertension. Among the patient hyperglycemia and dyslipidemia was common. Nearly half of those who suffered an acute stroke also experienced carotid stenosis. Consideration should be given to managing hypertension, DM, dyslipidemia, and carotid stenosis among patients with acute stroke. J Shaheed Suhrawardy Med Coll 2023; 15(1): 50-54