Contrast-enhanced Computed Tomography Scan Research Articles

Spatial Attention-Guided Generative Adversarial Network for Synthesizing Contrast-enhanced Computed Tomography Images.

Compared to non-contrast computed tomography (NC-CT) scans, contrast-enhanced (CE) CT scans provide more abundant information about focal liver lesions (FLLs), which play a crucial role in the FLLs diagnosis. However, CE-CT scans require patient to inject contrast agent into the body, which increase the physical and economic burden of the patient. In this paper, we propose a spatial attention-guided generative adversarial network (SAG-GAN), which can directly obtain corresponding CE-CT images from the patient's NC-CT images. In the SAG-GAN, we devise a spatial attention-guided generator, which utilize a lightweight spatial attention module to highlight synthesis task-related areas in NC-CT image and neglect unrelated areas. To assess the performance of our approach, we test it on two tasks: synthesizing CE-CT images in arterial phase and portal venous phase. Both qualitative and quantitative results demonstrate that SAG-GAN is superior to existing GANs-based image synthesis methods.

A CT-based Deep Learning Radiomics Nomogram for the Prediction of EGFR Mutation Status in Head and Neck Squamous Cell Carcinoma

Accurately assessing epidermal growth factor receptor (EGFR) mutation status in head and neck squamous cell carcinoma (HNSCC) patients is crucial for prognosis and treatment selection. This study aimed to construct and validate a contrast-enhanced computed tomography (CECT)-based deep learning radiomics nomogram (DLRN) to predict EGFR mutation status of HNSCC. A total of 300 HNSCC patients who underwent CECT scans were enrolled in this study. Participants from two hospitals were separated into a training set (n=200, 56 EGFR-negative and 144 EGFR-positive) from one hospital and an external test set from the other hospital (n=100, 37 EGFR-negative and 63 EGFR-positive). The least absolute shrinkage and selection operator method was used to select the key features from CECT-based manually extracted radiomics (MER) features and features automatically extracted using a deep learning model (DL, extracted using a GoogLeNet model). The selected independent clinical factors, MER features, and DL features were then combined to construct a DLRN. The DLRN's performance was evaluated using receiver operating characteristics curves. Five MER and six DL features were finally chosen. The DLRN, which includes "gender" and "necrotic areas," along with the selected features, predicted EGFR mutation status of HNSCC (EGFR-negative vs. positive) well in both the training (area under the curve [AUC], 0.901) and test (AUC, 0.875) sets. A DLRN using CECT was built to predict EGFR mutation in HNSCC. The model showed high predictive ability and may aid in treatment selection and patient prognosis.

Virtual Non-Contrast Spectral CT in Renal Masses: Is It Time to Discard Conventional Unenhanced Phase?

Dual-layer Dual-Energy CT (dl-DECT) allows one to create virtual non-contrast (VNC) reconstructions from contrast-enhanced CT scans, with a consequent decrease of the radiation dose. This study aims to assess the reliability of VNC for the diagnostic evaluation of renal masses in comparison with true non-contrast (TNC) images. The study cohort included 100 renal masses in 40 patients who underwent dl-DECT between June and December 2021. Attenuation values and standard deviations were assessed through the drawing of regions of interest on TNC and VNC images reconstructed from corticomedullary and nephrographic phases. A Wilcoxon signed-rank test was performed in order to assess equivalence of data and Spearman's Rho correlation coefficient to evaluate correlations between each parameter. The diagnostic accuracy of VNC was estimated through the performance of receiver operating characteristic (ROC) curve analysis. Differences between attenuation values were, respectively, 74%, 18%, 5% and 3% (TNC-VNCcort), and 74%, 15%, 9% and 2% (TNC-VNCneph). The Wilcoxon signed-rank test demonstrated the equivalence of attenuation values between the TNC and VNC images. The diagnostic performance of VNC images in the depiction of kidney simple cysts remains high compared to TNC (VNCcort-AUC: 0.896; VNCneph-AUC: 0.901, TNC-AUC: 0.903). In conclusion, quantitative analysis of attenuation values showed a strong agreement between VNC and TNC images in the evaluation of renal masses.

Anemia detection and quantification in contrast-enhanced CT scans on a novel photon-counting detector CT: A prospective proof-of-concept study

PurposeTo correlate CT values of the blood pool on VNC series with serum hemoglobin values for the detection of anemia in oncologic patients undergoing contrast-enhanced PCD-CT scans. MethodsThis prospective study (NCT04989192) included consecutive oncologic patients undergoing contrast-enhanced CT on a novel PCD-CT system between 08/2021 and 01/2022. The interval between complete blood count (CBC) and CT scan acquisition had to be no more than seven days. CT-values of the blood pool were measured on 70 keV VMI series (CT-values(BP)70keV) and on VNC series (CT-values(BP)VNC) at five anatomic positions (left atrium, left ventricle, main pulmonary artery, ascending and descending aorta) and averaged per patient. Pearson correlation analyses and ROC analyses were performed to identify relations between CT-values(BP)VNC, CBC parameters, and degrees of anemia as defined by the WHO (no anemia, mild, moderate, severe anemia). ResultsA total of 329 patients (age 68 ± 12 years; 200 men) were included. CT-values(BP)VNC showed a strong linear correlation to serum hemoglobin (r2 = 0.80, p <.001) and hematocrit (r2 = 0.76, p <.001) and were significantly different between anemia subgroups in both women and men (ΔHU: 3.5–11.4; all p <.01). ROC analyses yielded high diagnostic performance for the identification of patients without anemia, patients without and with mild anemia, and patients with severe anemia using gender-specific cutoffs for CT-value(BP)VNC (all AUC’s > 0.90). ConclusionsThe spectral information inherent in PCD-CT acquisitions allows the detection and quantification of anemia in contrast-enhanced CT acquisitions of oncologic patients with high diagnostic accuracy.

Correlations between contrast-enhanced CT-measured extracellular volume fraction, histopathological features, and MYCN amplification status in abdominal neuroblastoma: a retrospective study.

To retrospectively investigate the correlations between contrast-enhanced CT (CECT)-measured extracellular volume fraction (fECV) and histopathological features, as well as MYCN amplification status, in abdominal neuroblastoma. One hundred and forty-one patients with abdominal neuroblastoma who underwent CECT scanning were retrospectively enrolled. Calculation of fECV involved the measurement of CT values within regions of interest located within the neuroblastoma and aorta on both non-contrast-enhanced CT and equilibrium CECT. The correlations between fECV and various factors, including pathological subtype, mitosis karyorrhexis index (MKI), Shimada classification, MYCN amplification status, International Neuroblastoma Risk Group (INRG) stage, and risk group were analyzed using either the Mann-Whitney U test or Kruskal-Wallis test. Neuroblastoma and ganglioneuroblastoma exhibited fECV values of 0.349 (0.252, 0.424) and 0.438 (0.327, 0.508), respectively, indicating a statistically significant difference (Z = 2.200, P = 0.028). Additionally, the fECV decreased significantly in neuroblastoma with high MKI (H = 8.314, P = 0.016) or unfavorable histology (Z = 3.880, P < 0.001), as well as in those with MYCN amplification (Z = 5.486, P < 0.001). Notably, a significant variation in fECV was observed among different INRG stages (H = 16.881, P <0.001) and risk groups (H = 29.014, P < 0.001). CECT-derived fECV is associated with histopathological features, MYCN amplification status, INRG stage, and risk stratification of abdominal neuroblastoma, reflecting a potential correlation between the extracellular matrix and the biological behavior of neuroblastoma.

Emphysematous pyelonephritis and sepsis in a diabetic female patient caused by extended-spectrum beta-lactamase-producing Escherichia coli – case report

Emphysematous pyelonephritis (EPN) is a rare, severe, spontaneous gas-forming infection of renal parenchyma and its surrounding areas. EPN was detected in diabetic patients. A 49-year-old female with type I diabetes mellitus presented with severe thrombocytopenia, acute kidney injury (AKI) and was in need of haemodialysis treatment. She had impaired liver function tests, with active urine sediment, indicating severe upper urinary tract infection with suspected sepsis. The contrast enhanced CT scan of the abdomen showed multiple areas of air density in renal parenchyma and perirenal regions, suggestive of left-side EPN. The blood and urine cultures reported growth of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli. The final diagnosis of emphysematous pyelonephritis complicated with severe sepsis and AKI was established. The patient was managed conservatively with wide-spectrum antibiotics, fluid resuscitation, consistent blood sugar control, and haemodialysis treatment. Percutaneous drainage techniques (PCD) and nephrectomy were postponed because of the initial clinical response to the antibiotics treatment. However, the patient experienced sudden clinical deterioration and died only a few hours after the established diagnosis. An autopsy was not performed upon the patient’s family’s request. EPN should be highly suspected in poorly controlled diabetic patients with urinary tract infection and should be promptly recognized and aggressively treated. The patients with multiple risk factors had high mortality, even with timely diagnosis and combined (conservative and surgical) treatment.

Dynamic contrast-enhanced CT and clinical features of sarcomatoid hepatocellular carcinoma

PurposeTo investigate the dynamic contrast-enhanced computed tomography (CECT) features and clinical characteristics of sarcomatoid hepatocellular carcinoma (S-HCC).MethodsWe retrospectively reviewed the CECT data and clinical findings of 13 patients (11 male and 2 female, with an average age of 58.6 ± 11.2 years) with pathologically proven S-HCC, including 9 patients with surgical resection and 4 patients with biopsy examination. All patients underwent CECT scans. Two radiologists reviewed and evaluated general features, CECT features and extratumoral features of each lesions based on a consensus.ResultsAmong the thirteen tumors, a mean size of 66.7 mm was observed, ranging in diameter from 30 to 146 mm. Seven of thirteen patients had hepatitis B virus (HBV) infection and an elevation of alpha-fetoprotein (AFP) level. Most of cases located in the right lobe of liver (84.6%, 11/13). Nine of thirteen tumors showed lobulated or wavy contours and infiltrative morphology, while eight tumors presented with unclear margin. The tumor textures were mainly heterogeneous for ischemia or necrosis, with solid components dominantly in all cases. Eight of thirteen tumors exhibited “slow-in and and slow-out” dynamic enhancement pattern in CECT, with a enhancement peak in the portal venous phase. Portal vein or hepatic thrombus, adjacent organs invasion and lymph node metastasis were observed in two patients, respectively. Four of thirteen lesions occurred intrahepatic metastasis and hepatic surface retraction respectively.ConclusionS-HCC gengerally seen in elderly male with HBV infection and elevated AFP level. The CT manifestations including: large diameter, frequently hepatic right lobe involvement, lobular or wavy contours, ill-defined margins, infiltrative morphology, obvious heterogeneity and dynamic enhancement pattern of “slow-in and and slow-out” , contributed to the diagnosis of S-HCC. These tumors usually occurred hepatic surface retraction and intrahepatic metastasis.

Transformer-based 3D U-Net for pulmonary vessel segmentation and artery-vein separation from CT images.

Transformer-based methods have led to the revolutionizing of multiple computer vision tasks. Inspired by this, we propose a transformer-based network with a channel-enhanced attention module to explore contextual and spatial information in non-contrast (NC) and contrast-enhanced (CE) computed tomography (CT) images for pulmonary vessel segmentation and artery-vein separation. Our proposed network employs a 3D contextual transformer module in the encoder and decoder part and a double attention module in skip connection to effectively finish high-quality vessel and artery-vein segmentation. Extensive experiments are conducted on the in-house dataset and the ISICDM2021 challenge dataset. The in-house dataset includes 56 NC CT scans with vessel annotations and the challenge dataset consists of 14 NC and 14 CE CT scans with vessel and artery-vein annotations. For vessel segmentation, Dice is 0.840 for CE CT and 0.867 for NC CT. For artery-vein separation, the proposed method achieves a Dice of 0.758 of CE images and 0.602 of NC images. Quantitative and qualitative results demonstrated that the proposed method achieved high accuracy for pulmonary vessel segmentation and artery-vein separation. It provides useful support for further research associated with the vascular system in CT images. The code is available at https://github.com/wuyanan513/Pulmonary-Vessel-Segmentation-and-Artery-vein-Separation .

Use of the Endoleak-to-Aortic Density Ratio to Distinguish Direct Endoleaks from Indirect Endoleaks after Endovascular Aortic Aneurysm Repair

PurposeTo define criteria to distinguish direct (type 1 or 3) from indirect endoleaks (type 2) in the arterial phase of contrast-enhanced computed tomography (CT) scans in patients with abdominal aortic aneurysms treated with endovascular aortic repair. Materials and MethodsThis retrospective study was conducted from January 2009 to October 2020 and included consecutive patients treated endovascularly for a direct endoleak or an indirect endoleak associated with an enlarging aneurysm. The following characteristics were evaluated using contrast-enhanced CT: location, size, contact with the endograft, density, morphologic criteria, collateral artery enhancement, and endoleak-to-aortic density ratio. Statistical analysis included the Mann–Whitney U test, Pearson χ2 test, Fisher exact test, receiver operating characteristic curve analysis, and multivariable logistic regression. ResultsContrast-enhanced CT scans from 71 patients (87% men), who presented with 87 endoleaks (44 indirect and 43 direct endoleaks), treated by endovascular techniques were analyzed. Using visual criteria, 56% of the endoleaks were not characterizable as direct or indirect. An endoleak-to-aortic density ratio of >0.77 could properly distinguish direct from indirect endoleaks, with a theoretical accuracy of 98% (area under the receiver operating characteristic curve, 0.99), sensitivity of 95%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 96%. ConclusionAn endoleak-to-aortic density ratio of >0.77 in the arterial phase of contrast-enhanced CT could be a strong discriminant of a direct-type endoleak.

MIS for enucleation of leiomyoma of the oesophagus-strategic approach and experience of 19 cases.

Leiomyoma of the oesophagus, although rare, is the most common benign tumour to occur in the organ. Surgical approaches have evolved over time from an open thoracotomy or laparotomy to video-assisted thoracoscopic or laparoscopic and now robotic enucleation. We report a series of 19 cases of leiomyoma of the middle- and lower-third oesophagus treated by minimally invasive surgery. A retrospective analysis of 19 cases operated at a single tertiary care centre in India was performed. After the diagnosis of a benign oesophageal neoplasm on computed tomography (CT) and endosonography, laparoscopic transhiatal enucleation of the tumour for lower third ( n = 16) and right-sided video-assisted thoracoscopic excision for middle-third tumours ( n = 3) were performed. Dor fundoplication was done after the excision of leiomyomas from the lower oesophagus. The most common symptom at presentation was retrosternal burning in lower oesophageal tumours, while tumours in the middle third of the oesophagus were asymptomatic and incidentally detected. The size of the tumour ranged from 3 cm to 8 cm in the largest dimension on contrast-enhanced CT scan. The mean operative time was 93 min ranging from 61 to 137 min. The average blood loss was 53 ml. No patient had an iatrogenic oesophageal mucosal injury. There were no conversions to open surgery or major complications including post-operative leak or death. Post-operative recovery was uneventful. The transhiatal approach to lower oesophageal leiomyomas is strategic to avoid complications of thoracoscopy, minimally invasive, cost-effective as compared to robotic surgery, suitable for adequate exposure and safe in the hands of an experienced laparoscopic surgeon.

I saw Medusa's head sign and turned to stone

Developmental venous anomalies (DVAs) are characterized by many radially oriented medullary veins surrounding a central draining vessel. When the imaging plane is perpendicular to the central vessel, these medullary veins resemble Medusa's head of snakes. Medusa's head sign, or caput medusae, can be appreciated on contrast enhanced CT scans and MRIs of the brain and is highly indicative of a DVA.

Tobacco Smoking Is a Strong Predictor of Failure of Conservative Treatment in Hinchey IIa and IIb Acute Diverticulitis-A Retrospective Single-Center Cohort Study.

Background and Objectives: Therapeutic management of patients with complicated acute diverticulitis remains debatable. The primary objective of this study is to identify predictive factors for the failure of conservative treatment of Hinchey IIa and IIb diverticular abscesses. Materials and Methods: This is a retrospective cohort study that included patients hospitalized from 1 January 2014 to 31 December 2022 at the Emergency Surgery Department of the Cagliari University Hospital (Italy), diagnosed with acute diverticulitis complicated by Hinchey grade IIa and IIb abscesses. The collected variables included the patient's baseline characteristics, clinical variables on hospital admission, abscess characteristics at the contrast-enhanced CT scan, clinical outcomes of the conservative therapy, and follow-up results. Univariable and multivariable logistic regression models were used to identify prognostic factors of conservative treatment failure and success. Results: Two hundred and fifty-two patients diagnosed with acute diverticulitis were identified from the database search, and once the selection criteria were applied, 71 patients were considered eligible. Conservative treatment failed in 25 cases (35.2%). Univariable analysis showed that tobacco smoking was the most significant predictor of failure of conservative treatment (p = 0.007, OR 7.33, 95%CI 1.55; 34.70). Age (p = 0.056, MD 6.96, 95%CI -0.18; 0.99), alcohol drinking (p = 0.071, OR 4.770, 95%CI 0.79; 28.70), platelets level (p = 0.087, MD -32.11, 95%CI -0.93; 0.06), Hinchey stage IIa/IIb (p = 0.081, OR 0.376, 95%CI 0.12; 1.11), the presence of retroperitoneal air bubbles (p = 0.025, OR 13.300, 95%CI 1.61; 291.0), and the presence of extraluminal free air at a distance (p = 0.043, OR 4.480, 95%CI 1.96; 20.91) were the other variables possibly associated with the risk of failure. In the multivariable logistic regression analysis, only tobacco smoking was confirmed to be an independent predictor of conservative treatment failure (p = 0.006; adjusted OR 32.693; 95%CI 2.69; 397.27). Conclusion: The role of tobacco smoking as a predictor of failure of conservative therapy of diverticular abscess scenarios highlights the importance of prevention and the necessity to reduce exposure to modifiable risk factors.

Automatic Contrast Generation from Contrastless Computed Tomography.

The use of contrast-enhanced computed tomography (CTCA) for detection of coronary artery disease (CAD) exposes patients to the risks of iodine contrast-agents and excessive radiation, increases scanning time and healthcare costs. Deep learning generative models have the potential to artificially create a pseudo-enhanced image from non-contrast computed tomography (CT) scans.In this work, two specific models of generative adversarial networks (GANs) - the Pix2Pix-GAN and the Cycle-GAN - were tested with paired non-contrasted CT and CTCA scans from a private and public dataset. Furthermore, an exploratory analysis of the trade-off of using 2D and 3D inputs and architectures was performed. Using only the Structural Similarity Index Measure (SSIM) and the Peak Signal-to-Noise Ratio (PSNR), it could be concluded that the Pix2Pix-GAN using 2D data reached better results with 0.492 SSIM and 16.375 dB PSNR. However, visual analysis of the output shows significant blur in the generated images, which is not the case for the Cycle-GAN models. This behavior can be captured by the evaluation of the Fréchet Inception Distance (FID), that represents a fundamental performance metric that is usually not considered by related works in the literature.Clinical relevance- Contrast-enhanced computed tomography is the first line imaging modality to detect CAD resulting in unnecessary exposition to the risk of iodine contrast and radiation in particularly in young patients with no disease. This algorithm has the potential of being translated into clinical practice as a screening method for CAD in asymptomatic subjects or quick rule-out method of CAD in the acute setting or centres with no CTCA service. This strategy can eventually represent a reduction in the need for CTCA reducing its burden and associated costs.

Impact of immune checkpoint inhibitors on atherosclerosis progression in patients with lung cancer

BackgroundPatients with lung cancer face a heightened risk of atherosclerosis-related cardiovascular events. Despite the strong scientific rationale, there is currently a lack of clinical evidence examining the impact of immune...

Isolated Superior Mesenteric Artery Dissection following Blunt Trauma: A Case Report

AbstractIsolated superior mesenteric artery dissection (ISMAD) is rare, with symptoms ranging from asymptomatic to acute intestinal ischemia. Risk factors for ISMAD include hypertension, atherosclerosis, abnormal elastic fibers, and pregnancy. In the present case, blunt trauma, which has not been previously reported, was suggested as a risk factor. A 46-year-old man was brought to the emergency room after he was found unconscious after a motor vehicle collision. At presentation, he had no abdominal symptoms; however, on the fourth day of admission, he presented with severe abdominal pain and vomiting. A contrast-enhanced computed tomography scan revealed an ISMAD with associated intestinal ischemia and necrosis; hence, emergency surgery was performed. Herein, we report a case of ISMAD caused by blunt abdominal trauma.

A Study of Management of Adverse Reaction to Iodinated Contrast Media used in Computed Tomography at UCMS-TH

INTRODUCTION: Iodinated contrast media is used in computed tomography imaging to enhance the visibility of blood vessels and tissues. They have distinct clinical effectiveness and toxicity profiles. Although low osmolar contrast media have made iodinated contrast media safer in recent years, adverse reactions can sometimes occur. The management of adverse reactions to iodinated contrast media is an important aspect of patient care during computed tomography examinations. The purpose of this study was to evaluate the management of adverse reactions to iodinated contrast media during contrast-enhanced computed tomography examinations at Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal. MATERIALS AND METHODS: A prospective, observational study was conducted on 323 patients at Department of Radiodiagnosis and Medical Imaging, Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal, from December 15, 2022 to May 15, 2023. All data was obtained from the Department of Radiodiagnosis and Medical Imaging, as per the study inclusion criteria. The data were analyzed with statistical package for the social sciences version 20. RESULTS: The mean age of study participants was 48.49±19.78 years. There were 34.67% male and 65.33% female patients involved in this study. Universal College of Medical Sciences and Teaching Hospital favoured a more strict approach, to determine the normal renal function and withhold metformin before iodinated contrast media exposure. 36.84% of patients had a history of previous adverse reactions, before undergoing contrast-enhanced computed tomography scans. Following iodinated contrast media administration, 94.74% experienced nausea and vomiting which was followed by mild urticarial (88.54%) and dyspnea (19.81%). Premedication protocol was predominantly implemented with antihistamine, pheniramine (73.1%), and corticosteroid, hydrocortisone (26.9%). Mild urticaria was treated with pheniramine (87.1%), nausea and vomiting was treated with metoclopramide (83.01%), dyspnea was treated by epinephrine, hydrocortisone and oxygen (9.38%). CONCLUSIONS: Universal College of Medical Sciences and Teaching Hospital has established a standard protocol for the management of adverse reactions experienced by patients during iodinated contrast media administration. Premedication with antihistamines and corticosteroids was recommended for highrisk patients.

Robotic-assisted partial nephrectomy nightmare: poor clamping and tumor rupture

An 82-year-old Caucasian male patient was referred to our center because of the incidental finding of a nodule in the middle third of the right kidney during a screening abdominal ultrasound. No local or systemic symptom could be associated with the renal mass on initial evaluation. The patient underwent an abdominal contrastenhanced CT scan, which revealed a mass in the outer middle third of the right kidney measuring 4.5 × 3.5 cm, predominantly exophytic, with contact to the collecting system and an enhancement pattern suspicious for primary renal malignancy. Tumor complexity was classified as PADUA score 9 and Renal Score 9x. Clinical stage was cT1bN0M0. Total procedure time was 130 min. Estimated blood loss was 800 mL and warm ischemia time was 24 min. Intraoperative complications were tumor rupture and increased bleeding. The postoperative course was uneventful. Meticulous preoperative planning including contrast enhanced CT with 1 mm thick slices and 3D reconstruction imaging is critical. Comprehensive dissection of the renal hilum must be performed to access the exact number of vessels vascularizing the kidney and to provide adequate ischemia of the renal parenchyma for clean visualization during tumor resection to avoid nightmares such as positive margins and tumor rupture.

Percutaneous Vertebral Reconstruction (PVR) Technique of Pathological Compression Fractures: An Innovative Combined Treatment of Microwave Ablation, Bilateral Expandable Titanium SpineJack Implants Followed by Vertebroplasty.

(1) Background: to retrospectively evaluate safety and efficacy of combined microwave ablation (MWA) and bilateral expandable titanium SpineJack (SJ) implants followed by vertebroplasty (VP) for the treatment of painful thoracolumbar pathological vertebral compression fracture. (2) Methods: from July 2017 to October 2022, twenty-eight patients (13 women and 15 men; mean age 68 ± 11 years) with a history of primary neoplasm and thirty-six painful vertebral metastases with vertebral compression fracture underwent combined MWA and bilateral expandable titanium SpineJack implants with vertebroplasty. We analyzed safety through complications rate, and efficacy through vertebral height restoration and pain decrease, evaluated using a visual analogue scale (VAS), and Functional Mobility Scale (FMS), and local tumor control. Contrast-enhanced CT scans were performed at 1, 3, and 6 months and a contrast-enhanced spine MRI at 6 months after the procedure. (3) Results: Technical success rate was 100%. No procedure-related major complications or death occurred. Vertebral height restoration was observed in 22 levels (58%), with a mean anterior height restoration of 2.6 mm ± 0.6 and a mean middle height restoration of 4.4 mm ± 0.6 (p < 0.001). Mean VAS score of pain evaluation on the day before treatment was 6.3 ± 1.5 (range 4-9). At the 6-month evaluation, the median VAS score for pain was 0.4 ± 0.6 (range 0-2) with a mean reduction of 93.65% (6.8 ± 0.7 vs. 0.4 ± 0.6; p < 0.000) compared with baseline evaluation. Contrast-enhanced CT scans were performed at 1, 3, and 6 months and a contrast-enhanced spine MRI was performed at 6 months after the procedure, showing no local recurrence, implant displacement, or new fractures in the treated site. (4) Conclusions: combined microwave ablation and bilateral expandable titanium SpineJack implants with vertebroplasty is a safe and effective procedure for the treatment of pathological compressive vertebral fractures. The vertebral stabilization achieved early and persistent pain relief, increasing patient mobility, improving recovery of walking capacity, and providing local tumor control.

Diagnostic Accuracy of 16 Slice Contrast Enhanced CT Scan for Detection of Malignancy in Patients with Complex Adnexal Masses on Ultrasonography (Taking Histopathology as Gold Standard)

Objective: To determine the diagnostic accuracy of a 16-slice contrast-enhanced CT scan (CECT) for the detection of malignancy in patients with complex adnexal masses on Ultrasonography (USG) (taking histopathology as the gold standard).&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Pakistan Naval Ship Shifa Hospital, Karachi Pakistan, from Jul to Dec 2020.&#x0D; Methodology: Seventy-five patients with adnexal masses were included. All patients had 16-slice contrast-enhanced CT scans. All the patients then had exploratory laparotomy, followed by histopathology as the gold standard. The diagnostic accuracy of CECT (contrast-enhanced computed tomography) was detected by determining sensitivity, specificity and diagnostic accuracy.&#x0D; Results: 16-slice contrast-enhanced computed tomography showed a sensitivity of 92.2%, specificity of 93.4%, and diagnostic accuracy of 93.1%.for correctly diagnosing adnexal malignancy.&#x0D; Conclusion: Due to its high sensitivity, specificity and diagnostic accuracy, 16 slice contrast-enhanced CT scan is a reliable test for diagnosing malignancy among patients with unexplained adnexal masses on USG.

Use of a new non-contrast-enhanced BOOST cardiac MR sequence before electrical cardioversion or ablation of atrial fibrillation-a pilot study.

Left atrial appendage (LAA) thrombus is the most common source of embolization in atrial fibrillation (AF). Transesophageal echocardiography (TEE) is the gold standard method for LAA thrombus exclusion. Our pilot study aimed to compare the efficacy of a new non-contrast-enhanced cardiac magnetic resonance (CMR) sequence (BOOST) with TEE for the detection of LAA thrombus and to evaluate the usefulness of BOOST images for planning radiofrequency catheter ablation (RFCA) compared with left atrial (LA) contrast-enhanced computed tomography (CT). We also attempted to assess the patients' subjective experiences with TEE and CMR. Patients with AF undergoing either electrical cardioversion or RFCA were enrolled. Participants underwent pre-procedural TEE and CMR scans to evaluate LAA thrombus status and pulmonary vein anatomy. Patient experiences with TEE and CMR were assessed using a questionnaire developed by our team. Some patients scheduled for RFCA also had pre-procedural LA contrast-enhanced CT. In such cases, the operating physician was asked to subjectively define the quality of the CT and CMR scan on a scale of 1-10 (1 = worst, 10 = best) and comment on CMR's usefulness in RFCA planning. Seventy-one patients were enrolled. In 94.4%, both TEE and CMR excluded, and in 1 patient, both modalities reported the presence of LAA thrombus. In 1 patient, TEE was inconclusive, but CMR excluded LAA thrombus. In 2 patients, CMR could not exclude the presence of thrombus, but in 1 of those cases, TEE was also indecisive. During TEE, 67%, during CMR, only 1.9% of patients reported pain (p < 0.0001), and 89% would prefer CMR in case of a repeat examination. The quality of the left atrial contrast-enhanced CT scans was better compared with the image quality of the CMR BOOST sequence [8 (7-9) vs. 6 (5-7), p < 0.0001]. Still, the CMR images were useful for procedural planning in 91% of cases. The new CMR BOOST sequence provides appropriate image quality for ablation planning. The sequence might be useful for excluding larger LAA thrombi; however, its accuracy in detecting smaller thrombi is limited. Most patients preferred CMR over TEE in this indication.