Contrast-enhanced Computed Tomography Scan Research Articles

Tension pneumothorax mimicking giant bullae associated with tuberculosis: a case report

Cough, dyspnea, and chest pain are some of the clinical signs of giant bullae, while in some cases it may be asymptomatic. A pneumothorax can be difficult to identify from giant bullae. A middle-aged patient who had a persistent cough and increasing dyspnea with exertion arrived to the emergency room (ED). A right tension pneumothorax was anticipated based on clinical examination findings, however chest radiography, followed by a contrast-enhanced CT (CECT) scan of the chest showed that the right and left hemithorax were both occupied with giant bullae. Pulmonary tuberculosis (PTB) was diagnosed with sputum for acid-fast bacilli analysis and cartridge based nucleic acid amplification testing (CBNAAT). He was started on antituberculous therapy (ATT) and bullectomy was scheduled for TB-related giant pulmonary bullae.

Machine learning for differentiation of lipid-poor adrenal adenoma and subclinical pheochromocytoma based on multiphase CT imaging radiomics

BackgroundThere is a paucity of research investigating the application of machine learning techniques for distinguishing between lipid-poor adrenal adenoma (LPA) and subclinical pheochromocytoma (sPHEO) based on radiomic features extracted from non-contrast and dynamic contrast-enhanced computed tomography (CT) scans of the abdomen.MethodsWe conducted a retrospective analysis of multiphase spiral CT scans, including non-contrast, arterial, venous, and delayed phases, as well as thin- and thick-thickness images from 134 patients with surgically and pathologically confirmed. A total of 52 patients with LPA and 44 patients with sPHEO were randomly assigned to training/testing sets in a 7:3 ratio. Additionally, a validation set was comprised of 22 LPA cases and 16 sPHEO cases from two other hospitals. We used 3D Slicer and PyRadiomics to segment tumors and extract radiomic features, respectively. We then applied T-test and least absolute shrinkage and selection operator (LASSO) to select features. Six binary classifiers, including K-nearest neighbor (KNN), logistic regression (LR), decision tree (DT), random forest (RF), support vector machine (SVM), and multi-layer perceptron (MLP), were employed to differentiate LPA from sPHEO. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values were compared using DeLong’s method.ResultsAll six classifiers showed good diagnostic performance for each phase and slice thickness, as well as for the entire CT data, with AUC values ranging from 0.706 to 1. Non-contrast CT densities of LPA were significantly lower than those of sPHEO (P < 0.001). However, using the optimal threshold for non-contrast CT density, sensitivity was only 0.743, specificity 0.744, and AUC 0.828. Delayed phase CT density yielded a sensitivity of 0.971, specificity of 0.641, and AUC of 0.814. In radiomics, AUC values for the testing set using non-contrast CT images were: KNN 0.919, LR 0.979, DT 0.835, RF 0.967, SVM 0.979, and MLP 0.981. In the validation set, AUC values were: KNN 0.891, LR 0.974, DT 0.891, RF 0.964, SVM 0.949, and MLP 0.979.ConclusionsThe machine learning model based on CT radiomics can accurately differentiate LPA from sPHEO, even using non-contrast CT data alone, making contrast-enhanced CT unnecessary for diagnosing LPA and sPHEO.

Stereotactic biopsy for brain lesions: Doing more with less.

Stereotactic biopsy (STB) is a potential diagnostic tool considering its minimal invasiveness, high diagnostic yield, and minimal associated complications. Over the years, various frame-based instrument systems and frameless stereotactic biopsy systems have emerged to be employed in clinical use. With this study, we intend to get more by doing less in the form of STB for the patients of doubtful intracranial lesions treated over the past 5 years. We also want to highlight the technique of performing the procedure under scalp block, which can be used as a versatile tool in many clinical scenarios. Stereotactic biopsies may be planned even in rural district-level health facilities. One-time investment to procure instruments and avail existing imaging can lead to establishing definitive diagnoses in many doubtful cases. This will result in lesser cost and early establishment of treatment. Independent risk factors determining the outcome, such as deep-seated lesions, associated edema, and intraoperative hypertension, were studied. Establishing the diagnosis helped in prognosticating the disease, explaining the natural progression of symptoms, and starting adjuvant therapy. This tissue biopsy would also help secure samples for research and molecular analysis. Twenty patients underwent STBs at our institution between January 2018 and December 2022. We retrospectively analyzed patient characteristics, tumor pathology, surgical procedures, and outcomes, including the diagnostic value and surgery-related complications. These patients were followed up, and their progression-free and overall survival were analyzed. The need for adjuvant treatment was noted and analyzed. All procedures were performed using Cosman Roberts Wells® stereotactic frame. Pre-procedure magnetic resonance scans were performed at the time of admission. Contrast-enhanced computerized tomography (CT) scan after frame application was performed to identify targets and calculate the coordinates. A post-procedure CT scan was done to confirm the accessibility of the targeted lesion. The most common location of the tumor was a deep-seated thalamic lesion. A definitive diagnosis was established in 19 patients (95%) at the first STB. The diagnoses were glioma in 55% of cases, primary central nervous system lymphoma, tuberculosis, and demyelinating disorders in 10% of each, and a metastatic brain tumor in 1 (5%). The post-operative complications were all transient except in one patient with deterioration of motor weakness. The follow-up was noted, and modes of adjuvant treatment needed in these patients were recorded. Stereotactic biopsy is a useful and effective method for achieving a definitive diagnosis and aiding in treating multifocal or small deep-seated lesions in or around eloquent regions.

Beyond radiologist-level liver lesion detection on multi-phase contrast-enhanced CT images by deep learning

Accurate detection of liver lesions from multi-phase contrast-enhanced CT (CECT) scans is a fundamental step for precise liver diagnosis and treatment. However, the analysis of multi-phase contexts is heavily challenged by the misalignment caused by respiration coupled with the movement of organs. Here, we proposed an AI system for multi-phase liver lesion segmentation (named MULLET) for precise and fully automatic segmentation of real-patient CECT images. MULLET enables effectively embedding the important ROIs of CECT images and exploring multi-phase contexts by introducing a transformer-based attention mechanism. Evaluated on 1,229 CECT scans from 1,197 patients, MULLET demonstrated significant performance gains in terms of Dice, Recall, and F2 score, which are 5.80%, 6.57%, and 5.87% higher than state of the arts, respectively. MULLET has been successfully deployed in real-world settings. The deployed AI web server provides a powerful system to boost clinical workflows of liver lesion diagnosis and could be straightforwardly extended to general CECT analyses.

Computed Tomography-Based Radiomics Using Tumor and Vessel Features to Assess Resectability in Cancer of the Pancreatic Head.

The preoperative prediction of resectability pancreatic ductal adenocarcinoma (PDAC) is challenging. This retrospective single-center study examined tumor and vessel radiomics to predict the resectability of PDAC in chemo-naïve patients. The tumor and adjacent arteries and veins were segmented in the portal-venous phase of contrast-enhanced CT scans, and radiomic features were extracted. Features were selected via stability and collinearity testing, and least absolute shrinkage and selection operator application (LASSO). Three models, using tumor features, vessel features, and a combination of both, were trained with the training set (N = 86) to predict resectability. The results were validated with the test set (N = 15) and compared to the multidisciplinary team's (MDT) performance. The vessel-features-only model performed best, with an AUC of 0.92 and sensitivity and specificity of 97% and 73%, respectively. Test set validation showed a sensitivity and specificity of 100% and 88%, respectively. The combined model was as good as the vessel model (AUC = 0.91), whereas the tumor model showed poor performance (AUC = 0.76). The MDT's prediction reached a sensitivity and specificity of 97% and 84% for the training set and 88% and 100% for the test set, respectively. Our clinician-independent vessel-based radiomics model can aid in predicting resectability and shows performance comparable to that of the MDT. With these encouraging results, improved, automated, and generalizable models can be developed that reduce workload and can be applied in non-expert hospitals.

Early Clinical Outcomes in Patients of Carcinoma Cervix Treated With Volumetric Modulated Arc Therapy.

Objective Carcinoma cervix is one of the major cancers affecting Indian women. Concurrent chemo-radiotherapy is the standard of care in the treatment of carcinoma cervix. We aimed to study the outcomes and toxicity profile of volumetric modulated arc therapy (VMAT), an advanced modality of radiation delivery when used to treat patients with carcinoma cervix. Materials and methods Patients of carcinoma cervix belonging to FIGO (The International Federation of Gynecology and Obstetrics) stages IB2- IVA were recruited into the study. The patients were treated with VMAT to an EBRT (External Beam Radiation Therapy) dose of 50.4Gy in 28 fractions, which was followed by a brachytherapy schedule of 8Gy for each fraction to point A for three fractions. Toxicities were monitored weekly during the course of treatment and thereafter at every follow-up visit. A response assessment CECT (Contrast Enhanced Computed Tomography) scan was done three months after treatment and the response was recorded using RECIST (Response Evaluation Criteria In Solid Tumors) criteria. Results Sixty-four patients were available for analysis and most of the patients belonged to stage IIB (50.3%) followed by stage IIIB (28.5%). The complete response rate was 90.6% at three months and at a median follow-up of 12 months, the overall survival was 100% and disease-free survival was 89.1%. An analysis of clinically significant toxicities (grade 2 or worse) showed that diarrhea was the most common (20.3%) followed by proctitis (14%) and anemia (9.3%). Conclusion The results of the study established that volumetric modulated arc therapy is an acceptable modality of treatment of carcinoma cervix with an attractive toxicity profile. However, longer follow-ups will provide valuable information regarding the long-term disease control and late toxicities of the treatment.

Patient Experience during Contrast-Enhanced Computed Tomography Examination: Anxiety, Feelings, and Safety

Introductions: Computed tomography is one of the biggest breakthroughs in diagnostic imaging. In order to more accurately assess structures and pathological changes during the examination, it is necessary to administer a contrast agent. Patients presenting for the examination, very often only find out during the examination that a contrast agent is required. This increases patients’ uncertainty when giving written consent for contrast administration, as well as anxiety about the examination. The aim of this study was to explore the experiences of patients who have contrast-enhanced CT scans, focusing primarily on anxiety, feelings, and safety. Methods: The cross-sectional study was conducted in diagnostic imaging offices in Pomeranian Voivodeship in 2019–2020. The survey was aimed at patients presenting for CT examinations with intravenous contrast injection. In total, 172 patients participated in the survey. A proprietary survey questionnaire was used to conduct the study. Results and Conclusions: During a CT scan, intravenous contrast agent administration is often necessary. Although there are few studies on patients’ experiences with this examination, the authors observe that some patients experience anxiety. The results of our study showed the following: (1) 30.8% of patients experience anxiety before a CT scan with intravenous contrast injection; (2) variables such as gender, previous experience, and searching for information about the examination influence the occurrence of anxiety; (3) the most common feelings experienced by patients during intravenous contrast injection are a sensation of warmth spreading throughout the body; (4) the most common source of information about the study used among patients was the Internet; (5) most patients feel safe during a CT scan.

SAT141 A Case Of Non-islet Cell Tumor Hypoglycemia Which Was Ameliorated By Pazopanib Treatment

Abstract Disclosure: N. Yamamoto: None. M. Yamamoto: None. N. Kiyota: None. Y. Inaba: None. K. Kanie: None. S. Urai: None. M. Suzuki: None. Y. Sasaki: None. Y. Oi: None. Y. Tsujimoto: None. Y. Motomura: None. Y. Ohmachi: None. H. Bando: None. G. Iguchi: None. M. Nagao: None. I. Fukuda: None. H. Fukuoka: None. W. Ogawa: None. Introduction: Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome caused by insulin-like growth factor II (IGF-II) hypersecretion from the tumors. It is characterized by incompletely processed big IGF-II with potent insulin-like activity. We present a case of NICTH complicated with solitary fibrous tumor (SFT) which was ameliorated with the administration of pazopanib, a multi-targeted tyrosine kinase inhibitor. Clinical Case: A 57-year-old man went into a coma and was hospitalized. His plasma glucose levels were 26 mg/dL, and he regained consciousness after glucose administration, leading to a diagnosis of hypoglycemic coma. Moreover, a contrast-enhanced CT scan showed multiple tumors in his liver and right kidney. He was referred to our hospital for further management. After 5 hours of fasting, he had a cold sweat, and his plasma glucose levels dropped to 32 mg/dL with suppressed serum insulin levels of 0.2 U/mL. Serum 3-hydroxybutyrate levels were as low as 21 μmol/L, and plasma glucose levels increased to 83 mg/dL after glucagon administration, suggesting an agent mimicking insulin. Percutaneous liver biopsy was performed, and the tumors were diagnosed with SFT. Immunoblotting for his serum showed big IGF-II, leading to a diagnosis of NICTH, and hypoglycemia due to hypersecretion of IGF-II. Due to multiple metastases, surgery was not indicated and pazopanib was administered. Hypoglycemia during the night was prevented by glucose infusion through the central venous port, and he was discharged. Three months later, when he was re-hospitalized for thrombophlebitis of the right jugular vein, hypoglycemia did not occur even after 10 hours of fasting and CT scan showed the necrotic change of the tumor. Two weeks later of pazopanib discontinuation due to the thrombogenic adverse effect, hypoglycemia recurred accompanied by the tumor enlargement. When the anticoagulation therapy regressed the thrombosis and pazopanib was re-administered, hypoglycemia improved reproducibly and remained stable for more than 2 years although the tumor showed gradual progression. Conclusion: This is the first case in which pazopanib was effective in suppressing NICTH associated with SFT. Presentation: Saturday, June 17, 2023

SAT597 Pituitary Abscess Growing Serratia Marcescens With Associated Clivus Osteomyelitis

Abstract Disclosure: S. Brown: None. J. Milosavljevic: None. J. Chai: None. B.Y. Wong: None. Background: Pituitary abscesses are a rare etiology for pituitary lesions (0.2%-1.1%). Up to 60% of abscesses do not have an obvious source of infection. Pituitary abscesses can develop from the spread of local infection (usually the sphenoid sinus or cavernous sinus). Commonly isolated organisms of pituitary abscesses are gram positive cocci (Staphylococcus and Streptococcus) or gram negative bacilli (E. coli, Neisseria, and Corynebacterium). We present a case of a pituitary abscess growing Serratia marcescens with associated clivus osteomyelitis. Clinical Case: A 26-year-old woman with a history of recurrent left ear infections presented with right eye pain, sixth cranial nerve palsy and headaches. Brain MRI revealed 1.2 x 0.9 x 1.2 cm septated, cystic-appearing, rim-enhancing lesion originating from the sella, exerting mild pressure on the optic chiasm and infiltrating the right cavernous sinus. Contrast-enhanced CT scan revealed sclerotic and erosive changes concerning for clivus osteomyelitis and petrous apicitis. Hormonal evaluation demonstrated panhypopituitarism with undetectable cortisol (&amp;lt;1.0 µg/dL, n = 4-20 µg/dL), low ACTH (2.8 pg/mL, n = 7.2-63.3pg/mL), low-normal FT4 (0.6 ng/dL, n = 0.6-1.5ng/dL), low-normal TSH (0.32 µU/mL, n = 0.3-4.2µU/mL), undetectable estradiol (&amp;lt;25 pg/mL, n = 10-400pg/mL), low FSH (4.1 mIU/mL, n = &amp;lt;20 mIU/mL), low LH (0.5 mIU/mL, n = &amp;lt;10 mIU/mL), elevated prolactin (79 ng/mL, n&amp;lt;25ng/mL), and normal IGF-1 (192 ng/mL, n = 63-373ng/mL). Blood cultures, HIV testing, hepatitis serologies, Aspergillus galactomannan and cryptococcal antigen were negative. Replacement with hydrocortisone and levothyroxine was initiated, as well as empiric treatment with ceftriaxone, vancomycin, and metronidazole. Patient then underwent trans-sphenoidal evacuation of the sellar abscess. Specimen cultures grew Serratia marcescens. Post-operatively, she developed arginine vasopressin (AVP) deficiency and was started on desmopressin. Her symptoms and sixth nerve palsy resolved after surgery, and she was discharged with hormone replacements and a 6-week course of ceftriaxone. Conclusion: While other Enterobacteriaceae have previously been isolated from pituitary abscesses (including E. coli, Citrobacter, Salmonella, Proteus and Klebsiella), our case demonstrates, to the best of our knowledge, the first case of Serratia isolated from a pituitary abscess. Serratia is considered to be an opportunistic pathogen, although this patient had no identifiable risk factors for immunosuppression. Also, pituitary abscesses commonly spread from local infections. However, the source of infection in this case is likely the clivus osteomyelitis, which to the best of our knowledge, also has never been reported. In summary, this case differs from other reported cases due to the pituitary abscess growing Serratia with a potential source from the clivus osteomyelitis. Presentation: Saturday, June 17, 2023

MDM-U-Net: A novel network for renal cancer structure segmentation.

Accurate segmentation of the renal cancer structure, including the kidney, renal tumors, veins, and arteries, has great clinical significance, which can assist clinicians in diagnosing and treating renal cancer. For accurate segmentation of the renal cancer structure in contrast-enhanced computed tomography (CT) images, we proposed a novel encoder-decoder structure segmentation network named MDM-U-Net comprising a multi-scale anisotropic convolution block, dual activation attention block, and multi-scale deep supervision mechanism. The multi-scale anisotropic convolution block was used to improve the feature extraction ability of the network, the dual activation attention block as a channel-wise mechanism was used to guide the network to exploit important information, and the multi-scale deep supervision mechanism was used to supervise the layers of the decoder part for improving segmentation performance. In this study, we developed a feasible and generalizable MDM-U-Net model for renal cancer structure segmentation, trained the model from the public KiPA22 dataset, and tested it on the KiPA22 dataset and an in-house dataset. For the KiPA22 dataset, our method ranked first in renal cancer structure segmentation, achieving state-of-the-art (SOTA) performance in terms of 6 of 12 evaluation metrics (3 metrics per structure). For the in-house dataset, our method achieves SOTA performance in terms of 9 of 12 evaluation metrics (3 metrics per structure), demonstrating its superiority and generalization ability over the compared networks in renal structure segmentation from contrast-enhanced CT scans.

Prediction of high Ki-67 proliferation index of gastrointestinal stromal tumors based on CT at non-contrast-enhanced and different contrast-enhanced phases

ObjectivesTo evaluate and analyze radiomics models based on non-contrast-enhanced computed tomography (CT) and different phases of contrast-enhanced CT in predicting Ki-67 proliferation index (PI) among patients with pathologically confirmed gastrointestinal stromal tumors (GISTs).MethodsA total of 383 patients with pathologically proven GIST were divided into a training set (n = 218, vendor 1) and 2 validation sets (n = 96, vendor 2; n = 69, vendors 3–5). Radiomics features extracted from the most recent non-contrast-enhanced and three contrast-enhanced CT scan prior to pathological examination. Random forest models were trained for each phase to predict tumors with high Ki-67 proliferation index (Ki-67>10%) and were evaluated using the area under the receiver operating characteristic curve (AUC) and other metrics on the validation sets.ResultsOut of 107 radiomics features extracted from each phase of CT images, four were selected for analysis. The model trained using the non-contrast-enhanced phase achieved an AUC of 0.792 in the training set and 0.822 and 0.711 in the two validation sets, similar to models trained on different contrast-enhanced phases (p > 0.05). Several relevant features, including NGTDM Busyness and tumor size, remained predictive in non-contrast-enhanced and different contrast-enhanced images.ConclusionThe results of this study indicate that a radiomics model based on non-contrast-enhanced CT matches that of models based on different phases of contrast-enhanced CT in predicting the Ki-67 PI of GIST. GIST may exhibit similar radiological patterns irrespective of the use of contrast agent, and such radiomics features may help quantify these patterns to predict Ki-67 PI of GISTs.Clinical relevance statementGIST may exhibit similar radiomics patterns irrespective of contrast agent; thus, radiomics models based on non-contrast-enhanced CT could be an alternative for risk stratification in GIST patients with contraindication to contrast agent.Key Points• Performance of radiomics models in predicting Ki-67 proliferation based on different CT phases is evaluated.• Non-contrast-enhanced CT–based radiomics models performed similarly to contrast-enhanced CT in risk stratification in GIST patients.• NGTDM Busyness remains stable to contrast agents in GISTs in radiomics models.

Multi-Specialty Physician Performance in Predicting Radiographic Extranodal Extension in Nodal Metastases of Oropharyngeal Squamous Carcinoma

The presence of extranodal extension (ENE) in oropharyngeal (OPC) cancer patients is an important prognostic factor and can be used to determine the optimal course of treatment; however, currently, the gold standard method for ENE assessment is performed pathologically, which can only be done in a post-hoc fashion after surgical treatment has already been performed. Anatomic imaging features are being explored as a possible method for the pre-therapeutic determination of ENE, but there is currently no objective standard for the assessment of ENE from radiographic images. In this study we recruited expert clinicians, including surgeons, radiation oncologists, and radiologists, across multiple institutions to individually evaluate the presence of ENE from CT scans in order to assess the performance of radiographic ENE evaluation in human experts across different specialties. Pre-therapy contrast-enhanced CT scans were collected from 25 OPC patients with lymph node metastasis that were pathologically evaluated for ENE after surgical resection. 5 scans were randomly chosen to be duplicated and left/right inverted, resulting in a total of 30 scans of which 21 had pathologically-confirmed ENE. To hide the inversion, all images were cropped to only show the oropharynx region. 34 expert head and neck cancer physicians, comprised of 12 surgeons, 11 radiation oncologists, and 11 radiologists, then separately evaluated the 30 CT scans using 3D Slicer for ENE presence or absence with their prediction confidence. For each physician, discriminative performance metrics were measured by calculating the accuracy, sensitivity, specificity, area under the receiver-operating characteristic curve (AUC), and Brier score, a measure of the probabilistic prediction accuracy calculated from their confidence where a lower Brier score is better. Statistical tests were performed using the Mann Whitney U test. The median (interquartile) study results are shown in Table 1. There was no statistically significant difference among groups for accuracy or AUC, but significant differences among groups for Brier score, sensitivity, and specificity. In this study we provide evidence that expert physicians, regardless of specialty, show poor performance in assessing the presence of ENE from CT scans in OPC patients. These results agree with conclusions from previous literature, and suggest the need for further research in the automated analysis of radiographic ENE.

Delta-radiomics features for predicting the major pathological response to neoadjuvant chemoimmunotherapy in non-small cell lung cancer.

To investigate if delta-radiomics features have the potential to predict the major pathological response (MPR) to neoadjuvant chemoimmunotherapy in non-small cell lung cancer (NSCLC) patients. Two hundred six stage IIA-IIIB NSCLC patients from three institutions (Database1 = 164; Database2 = 21; Database3 = 21) who received neoadjuvant chemoimmunotherapy and surgery were included. Patients in Database1 were randomly assigned to the training dataset and test dataset, with a ratio of 0.7:0.3. Patients in Database2 and Database3 were used as two independent external validation datasets. Contrast-enhanced CT scans were obtained at baseline and before surgery. The delta-radiomics features were defined as the relative net change of radiomics features between baseline and preoperative. The delta-radiomics model and pre-treatment radiomics model were established. The performance of Immune-Related Response Evaluation Criteria in Solid Tumors (iRECIST) for predicting MPR was also evaluated. Half of the patients (106/206, 51.5%) showed MPR after neoadjuvant chemoimmunotherapy. For predicting MPR, the delta-radiomics model achieved a satisfying area under the curves (AUCs) values of 0.768, 0.732, 0.833, and 0.716 in the training, test, and two external validation databases, respectively, which showed a superior predictive performance than the pre-treatment radiomics model (0.644, 0.616, 0.475, and 0.608). Compared with iRECIST criteria (0.624, 0.572, 0.650, and 0.466), a mixed model that combines delta-radiomics features and iRECIST had higher AUC values for MPR prediction of 0.777, 0.761, 0.850, and 0.670 in four sets. The delta-radiomics model demonstrated superior diagnostic performance compared to pre-treatment radiomics model and iRECIST criteria in predicting MPR preoperatively in neoadjuvant chemoimmunotherapy for stage II-III NSCLC. Delta-radiomics features based on the relative net change of radiomics features between baseline and preoperative CT scans serve a vital support tool in accurately identifying responses to neoadjuvant chemoimmunotherapy, which can help physicians make more appropriate treatment decisions. •The performances of pre-treatment radiomics model and iRECIST model in predicting major pathological response of neoadjuvant chemoimmunotherapy were unsatisfactory. •The delta-radiomics features based on relative net change of radiomics features between baseline and preoperative CT scans may be used as a noninvasive biomarker for predicting major pathological response of neoadjuvant chemoimmunotherapy. •Combining delta-radiomics features and iRECIST can further improve the predictive performance of responses to neoadjuvant chemoimmunotherapy.

A novel method of carotid artery wall imaging: black-blood CT

ObjectivesTo evaluate the application of black-blood CT (BBCT) in carotid artery wall imaging and its accuracy in disclosing stenosis rate and plaque burden of carotid artery.MethodsA total of 110 patients underwent contrast-enhanced CT scan with two phases, and BBCT images were obtained using contrast-enhancement (CE)-boost technology. Two radiologists independently scored subjective image quality on black-blood computerized tomography (BBCT) images using a 4-point scale and then further analyzed plaque types. The artery stenosis rate on BBCT was measured and compared with CTA. The plaque burden on BBCT was compared with that on high-resolution intracranial vessel wall MR imaging (VW-MR imaging). The kappa value and intraclass correlation coefficient (ICC) were used for consistency analysis. The diagnostic accuracy of BBCT for stenosis rate and plaque burden greater than 50% was evaluated by AUC.ResultsThe subjective image quality scores of BBCT had good consistency between the two readers (ICC = 0.836, p < 0.001). BBCT and CTA had a good consistency in the identification of stenosis rate (p < 0.001). There was good consistency between BBCT and VW-MR in diagnosis of plaque burden (p < 0.001). As for plaque burden over 50%, BBCT had good sensitivity (93.10%) and specificity (73.33%), with an AUC of 0.950 (95%CI 0.838–0.993). Compared with CTA, BBCT had higher consistency with VW-MR in disclosing low-density plaques and mixed plaques (ICC = 0.931 vs 0.858, p < 0.001).ConclusionsBBCT can not only display the carotid artery wall clearly but also accurately diagnose the stenosis rate and plaque burden of carotid artery.Clinical relevance statementBlack-blood CT, as a novel imaging technology, can assist clinicians and radiologists in better visualizing the structure of the vessel wall and plaques, especially for patients with contraindication to MRI.Key Points• Black-blood CT can clearly visualize the carotid artery wall and plaque burden.• Black-blood CT is superior to conventional CTA with more accurate diagnosis of the carotid stenosis rate and plaque burden features.

Blunt abdominal trauma: watch and wait.

This review examines recent advancements in nonoperative management (NOM) of hemodynamically stable blunt abdominal trauma, focusing on expanding patient selection for observation-first strategies, particularly for high-grade solid organ injuries. Advances include a more deliberate nonoperative approach, allowing for broader patient inclusion in diagnostic and interventional angiography. Strict clinical monitoring and appropriate follow-up strategies are crucial to identify early signs of clinical progression and complications. Repeated contrast-enhanced CT (CECT) scan can be used for close observation of high-risk injuries, while the repetition of CECTs may be avoided for lower-risk cases, such as specific high-grade kidney injuries. The role of contrast-enhanced ultrasound (CEUS) in detecting sequelae of nonoperative approaches is still debated and has lot of potential, with ongoing trials exploring possible advantages. Multidisciplinary trauma teams play a crucial role in nonoperative management, particularly for high-grade injuries. A careful selection of patients is essential to minimize failure rates. Complications of nonoperative and angiographic approaches should be managed according to local expertise.

KTP-532 Laser Assisted Excision of a Rare Laryngeal Angiolipoma: A Case Report with Review of Literature.

Angiolipoma is a benign mesenchymal tumor and its occurrence in head and neck region is very rare. Only 2 cases of Laryngeal angiolipomas have been reported in the medical literature. We present one such rare case in a 32-year-old male who presented with complaints of change in voice and foreign body sensation in the throat since past 9months along with features suggestive of obstructive sleep apnoea and dysphagia. Contrast enhanced CT scan of the neck showed a cystic lesion arising from right ventricle extending superiorlytill the vallecula, partially obstructing the airway. Suspecting a supraglottic cyst, trans-oral microlaryngoscopic KTP-532 laser assisted excision was planned, intraoperatively a solid tumor was encountered. We discuss herein the clinical presentation and management of this rare neoplasm with review of literature.

Assessment of effectiveness and safety of thrombolytic therapy to pulmonary emboli by endobronchial ultrasound-guided transbronchial needle injection

ObjectiveEndobronchial ultrasound–guided transbronchial needle injection (EBUS-TBNI) may effectively treat acute pulmonary embolisms (PEs). Here, we assessed the effectiveness of clot dissolution and safety of tissue plasminogen activator (t-PA) injection using EBUS-TBNI in a 1-week survival study of a porcine PE model. MethodsSix pigs with bilateral PEs were used: 3 for t-PA injection using EBUS-TBNI (TBNI group) and 3 for systemic administration of t-PA (systemic group). Once bilateral PEs were created, each 25 mg of t-PA injection using EBUS-TBNI for bilateral PEs (a total of 50 mg t-PA) and 100 mg of t-PA systemic administration was performed on day 1. Hemodynamic parameters, blood tests, and contrast-enhanced computed tomography scans were carried out at several time points. On day 7, pigs were humanely killed to evaluate the residual clot volume in the pulmonary arteries. ResultsThe average of percent change of residual clot volumes was significantly lower in the TBNI group than in the systemic group (%: systemic group 36.6 ± 22.6 vs TBNI group 9.6 ± 6.1, P < .01) on day 3. Considering the elapsed time, the average decrease of clot volume per hour at pre-t-PA to post t-PA was significantly greater in the TBNI group than in the systemic group (mm3/hour: systemic 68.1 ± 68.1 vs TBNI 256.8 ± 148.1, P < .05). No hemorrhage was observed intracranially, intrathoracically, or intraperitoneally on any contrast-enhanced computed tomography images. ConclusionsThis study revealed that t-PA injection using EBUS-TBNI is an effective and safe way to dissolve clots.

Pulmonary Invasive Fungal Disease: Ultrasound and Computed Tomography Scan Findings.

The importance of ultrasound in diagnosing pulmonary invasive fungal diseases (IFD) has yet to be assessed. Thus, this study aimed to evaluate the frequency of sonographic findings in patients suspected of an invasive pulmonary fungal infection. This prospective longitudinal study examined all patients with lung lesions in imaging modalities and suspected IFDs referred to Dr. Sheikh and Akbar pediatric hospitals from 2019 to 2022. Considered variables were the halo sign in the computed tomography (CT) scan; the target sign in the ultrasound and contrast-enhanced CT scan; the cavity; wedge-shaped consoli- dation; and pleuritis and extrapulmonary invasion to the chest wall or subdiaphragmatic invasion in both modalities. All patients who underwent lung CT scans and ultrasounds until the final diagnosis were followed up. The degree of agreement between ultrasound and CT scan findings and the sensitivity, specificity, and diagnostic accuracy of these signs were assessed. This study involved 40 patients with an average age of 7.16 ± 4.23 years. Acute leukemia was the commonest underlying dis- ease detected in 17 (42.5%) cases. The target sign in ultrasound (61.9%) and the halo sign in CT scan (71.4%) had the highest frequency among the variables in patients with IFD. Cohen's kappa coefficient agreement in both modalities was 0.5 for the cavity, with significant relation (P = .02). The Cohen's kappa was less than .17 for other findings (P > .05). The diagnostic criteria in the simultaneous examina- tion of the fungus target in ultrasound and halo in CT scan showed a sensitivity of 82.4% and specificity of 76.5%, respectively. Combining the characteristic findings of ultrasound and CT-scan provides a higher value in diagnosing pulmonary invasive fungal disease.

Gastrogastric intussusception and acute pancreatitis caused by a large pyloric gland adenoma treated with endoscopic submucosal dissection

Video 1Gastrogastric intussusception and acute pancreatitis caused by a large pyloric gland adenoma treated with endoscopic submucosal dissection: A 75-year-old woman with a several-week history of intermittent postprandial nausea and vomiting presented to the emergency room after experiencing syncope, following several hours of persistent abdominal pain, nausea, and vomiting. A contrast-enhanced CT scan of the abdomen and pelvis was arranged. Axial images show gastrogastric intussusception with the intussusceptum, indicated by the dashed lines, telescoping into the intussuscipiens indicated by the arrowheads. There is a lobulated mass indicated by the asterisk, serving as the lead point for the intussusception, and there is also a small volume of fluid indicated by the arrow, which delineates the mass from the duodenum. In the coronal images, we can again see a long-segment intussusception indicated by the dashed line with a lobulated mass indicated by the asterisk serving as the lead point and extending into the proximal duodenum. Then the lobulated mass occupying and expanding the duodenal lumen can be seen, indicated by the asterisk. Upon entry into the stomach through endoscopy, the gastrogastric intussusception can be seen. The lobulated mass serving as the lead point can be seen being pulled distally. With air insufflation, the intussusception spontaneously resolved. With continued insufflation, within a few minutes, the native confirmation of the polyp was established. It was located in the proximal body along the greater curve with a lobulated appearance with a Paris 1sp morphology. In addition, there was panatrophy in the background mucosa, which was consistent with autoimmune atrophic gastritis that was subsequently confirmed on histopathology and positive anti-parietal cell antibiotics. An EUS was performed and did not show any evidence of T2 disease. Doppler showed large central feeding vessel. A plan was made for endoscopic submucosal dissection (ESD). The strategy for the ESD was an initial circumferential incision and trimming with subsequent application of multipoint traction. After a circumferential incision, a rich vascular supply is seen. After completion of the incision and trimming, the snare was advanced over the scope and the clip advanced through the instrument channel. Multiple clips were then used to secure the snare to the distal end of the lesion. With traction applied, access to the submucosa became much easier and the ESD proceeded easily. For the final remnant of submucosa, it was more easily dissected in a forward view. Chess is one of the merits of multipoint traction in that traction can be applied both proximally and distally to the lesion. The lesion was resected en bloc. The specimen was retrieved using the attached snare, but unfortunately, some of the friable head was fragmented because of its large size, yet the base remained intact. Final pathology demonstrated PGD+HGD with clear margins vertically and laterally along the base. This case of gastrogastric intussusception, causing gastric outlet obstruction and acute pancreatitis secondary to a large pyloric gland adenoma, highlights several rare clinical entities. First, gastrogastric intussusception in adults is an exceptionally rare phenomenon, with only a few documented cases reported in the literature. Second, in the case of large gastric neoplasms causing intussusception, rarely the neoplasm may extend down into the duodenum and obstruct the ampulla of Vater causing acute pancreatitis. Furthermore, pyloric gland adenomas are rare gastric neoplasms that tend to be polypoid in morphology and are associated with autoimmune gastritis, predominantly occurring in female patients, as in this case. Lastly, the traditional management for lesions causing gastroduodenal intussusception is surgical because of the risk of malignancy. However, in this case, the patient underwent successful curative and therapeutic endoscopic resection with ESD.

A Radiomic-Based Machine Learning Model Predicts Endometrial Cancer Recurrence Using Preoperative CT Radiomic Features: A Pilot Study.

Current prognostic models lack the use of pre-operative CT images to predict recurrence in endometrial cancer (EC) patients. Our study aimed to investigate the potential of radiomic features extracted from pre-surgical CT scans to accurately predict disease-free survival (DFS) among EC patients. Contrast-Enhanced CT (CE-CT) scans from 81 EC cases were used to extract the radiomic features from semi-automatically contoured volumes of interest. We employed a 10-fold cross-validation approach with a 6:4 training to test set and utilized data augmentation and balancing techniques. Univariate analysis was applied for feature reduction leading to the development of three distinct machine learning (ML) models for the prediction of DFS: LASSO-Cox, CoxBoost and Random Forest (RFsrc). In the training set, the ML models demonstrated AUCs ranging from 0.92 to 0.93, sensitivities from 0.96 to 1.00 and specificities from 0.77 to 0.89. In the test set, AUCs ranged from 0.86 to 0.90, sensitivities from 0.89 to 1.00 and specificities from 0.73 to 0.90. Patients classified as having a high recurrence risk prediction by ML models exhibited significantly worse DSF (p-value < 0.001) across all models. Our findings demonstrate the potential of radiomics in predicting EC recurrence. While further validation studies are needed, our results underscore the promising role of radiomics in forecasting EC outcomes.