Contrast-enhanced Computed Tomography Scan Research Articles

Preoperative radiomic signature based on CT images for noninvasive evaluation of localized nephroblastoma in pediatric patients.

Nephron sparing nephrectomy may not reduce the prognosis of nephroblastoma in the absence of involvement of the renal capsule, sinus vessels, and lymph nodes, However, there is no accurate preoperative noninvasive evaluation method at present. 105 nephroblastoma patients underwent contrast-enhanced CT scan between 2013 and 2020 in our hospital were retrospectively collected, including 59 cases with localized stage and 46 cases with non-localized stage, and then were divided into training cohort (n= 73) and validation cohort (n= 32) according to the order of CT scanning time. After lesion segmentation and data preprocessing, radiomic features were extracted from each volume of interest. The multi-step procedure including Pearson correlation analysis and sequential forward floating selection was performed to produce radiomic signature. Prediction model was constructed using the radiomic signature and Logistic Regression classifier for predicting the localized nephroblastoma in the training cohort. Finally, the model performance was validated in the validation cohort. A total of 1652 radiomic features have been extracted, from which TOP 10 features were selected as the radiomic signature. The area under the receiver operating characteristic curve, accuracy, sensitivity and specificity of the prediction model were 0.796, 0.795, 0.732 and 0.875 for the training cohort respectively, and 0.710, 0.719, 0.611 and 0.857 for the validation cohort respectively. The result comparison with prediction models composed of different machine learning classifiers and different parameters also manifest the effectiveness of our radiomic model. A logistic regression model based on radiomic features extracted from preoperative CT images had good ability to noninvasively predict nephroblastoma without renal capsule, sinus vessel, and lymph node involvement.

Oral Sodium Chloride in the Prevention of Contrast-Associated Acute Kidney Injury in Elderly Outpatients: The PNIC-Na Randomized Non-Inferiority Trial.

We aimed to test the non-inferiority of oral versus intravenous hydration in the incidence of contrast-associated acute kidney injury (CA-AKI) in elderly outpatients undergoing a contrast-enhanced computed tomography (CE-CT) scan. PNIC-Na (NCT03476460) is a phase-2, single-center, randomized, open-label, non-inferiority trial. We included outpatients undergoing a CE-CT scan, >65 years having at least one risk factor for CA-AKI, such as diabetes, heart failure, or an estimated glomerular filtration rate (eGFR) of 30-59 mL/min/1.73 m². Participants were randomized (1:1) to oral sodium-chloride capsules or intravenous hydration. The primary outcome was an increase in serum creatinine >0.3 mg/dL or a reduction in eGFR >25% within 48 h. The non-inferiority margin was set at 5%. A total of 271 subjects (mean age 74 years, 66% male) were randomized, and 252 were considered for the main analysis (per-protocol). A total of 123 received oral hydration and 129 intravenous. CA-AKI occurred in 9 (3.6%) of 252 patients and 5/123 (4.1%) in the oral-hydration group vs. 4/129 (3.1%) in the intravenous-hydration group. The absolute difference between the groups was 1.0% (95% CI -4.8% to 7.0%), and the upper limit of the 95% CI exceeded the pre-established non-inferiority margin. No major safety concerns were observed. The incidence of CA-AKI was lower than expected. Although both regimens showed similar incidences of CA-AKI, the non-inferiority was not shown.

Laparoscopic management of hydatid cysts using long ribbon gauze: An initial experience of 37 consecutive cases

ObjectiveThe laparoscopic approach is becoming the standard of care for many surgical disorders. However, in the case of hydatid cysts, laparoscopic management is challenging due to the risk of spillage of hydatid fluid, which can cause an anaphylactic reaction and recurrence. Here, we report our initial experience with laparoscopic partial pericystectomy of hydatid cysts using long ribbon gauze to decrease intra-operative spillage. MethodThis was a retrospective study (between January 2010 and December 2021) in the Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Science, a tertiary care referral center in northern India. Here, we have included 37 consecutive patients with hydatid cysts of the liver and spleen. Diagnosis was made by laboratory and imaging findings (abdominal sonography or contrast enhanced CT scans). All patients were managed with laparoscopic partial pericystectomy. Intraoperatively, a betadine-soaked long ribbon gauze, high-pressure suction canula, and an endo-bag were used in all patients. The collected data included patient demography, location, size, and number of cysts, WHO type, operative time, blood loss, postoperative complications, hospital stay and follow-up. ResultIn our series, the mean age was 38.4 ± 13.6 years, 15 (40.5%) were men and 22 (59.5%) were women. The right lobe of the liver was the most commonly affected site (21, 56.8%). The mean operative time was 80.0 ± 32.0 min, and intraoperative blood loss was 23.6 ± 11.5 mL. Bile leak was present in 6 (16.2%) patients. There was no mortality. The hospital stay was 5 (3, 9) days, and no recurrence was observed at a median follow-up of 36 months. ConclusionLaparoscopic partial pericystectomy using this technique is safe in the management of hydatid cysts. Simply, proper packing and safe removal of soaked gauzes can minimize the incidence of postoperative complications and recurrence.

Multi-View Radiomics Feature Fusion Reveals Distinct Immuno-Oncological Characteristics and Clinical Prognoses in Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is one of the most prevalent malignancies worldwide, and the pronounced intra- and inter-tumor heterogeneity restricts clinical benefits. Dissecting molecular heterogeneity in HCC is commonly explored by endoscopic biopsy or surgical forceps, but invasive tissue sampling and possible complications limit the broadeer adoption. The radiomics framework is a promising non-invasive strategy for tumor heterogeneity decoding, and the linkage between radiomics and immuno-oncological characteristics is worth further in-depth study. In this study, we extracted multi-view imaging features from contrast-enhanced CT (CE-CT) scans of HCC patients, followed by developing a fused imaging feature subtyping (FIFS) model to identify two distinct radiomics subtypes. We observed two subtypes of patients with distinct texture-dominated radiomics profiles and prognostic outcomes, and the radiomics subtype identified by FIFS model was an independent prognostic factor. The heterogeneity was mainly attributed to inflammatory pathway activity and the tumor immune microenvironment. The predominant radiogenomics association was identified between texture-related features and immune-related pathways by integrating network analysis, and was validated in two independent cohorts. Collectively, this work described the close connections between multi-view radiomics features and immuno-oncological characteristics in HCC, and our integrative radiogenomics analysis strategy may provide clues to non-invasive inflammation-based risk stratification.

A comparison of suprarenal and infrarenal fixation and renal volumetric analysis after endovascular aneurysm repair

ObjectiveClinical and experimental studies of the stent-graft fixation impact on the renal volume after endovascular abdominal aortic aneurysm repair have focused on glomerular filtration rate, and the results were controversial. The aim of this study was to analyze and compare the impact of the suprarenal (SRF group) and infrarenal (IRF group) stent-graft fixation on the renal volume. MethodsBetween December 2016 and December 2019, all patients treated with endovascular aneurysm repair were retrospectively analyzed. Patients with atrophic or multicystic kidney, renal transplantation, ultrasound examination, or incomplete follow-up were excluded. The renal volume in both groups was extracted with a semiautomatic segmentation from contrast-enhanced computed tomography scan performed before the procedure, at 1 month, and at 12 months of follow-up. A subgroup analysis of the SRF group was performed in order to study the impact of the stent strut position relative to the renal arteries. ResultsA total of 63 patients were analyzed (SRF: 32 and IRF: 31). Demographic and anatomic characteristics were similar between the groups. The procedure contrast volume was higher in the IRF group (P = .01). At 12 months, we observed a decrease in the renal volume of 1.4% in the SRF group and 2.3% in the IRF group (P = .86). The SRF subgroup analysis showed only two patients with no stent struts crossing the renal arteries. In the remaining cases, struts crossed one renal artery in 60% of cases (19 patients) and two renal arteries in 34% of cases (11 patients). The renal volume decrease was not correlated with the presence of stent wire struts, crossing a renal artery. ConclusionsStent graft with suprarenal fixation seems not to be correlated with renal volume deterioration. A randomized clinical trial with a higher effective and longer follow-up is needed to assess the impact of SRF on renal function.

Washout-Computed Tomography Discriminates Pulmonary "Fat-poor" Hamartomas From Neuroendocrine Neoplasms: A Simple Method in the Radiomics Era.

Pulmonary hamartomas (HAs) and neuroendocrine neoplasms (NENs) are often impossible to discriminate using high-resolution computed tomography (CT) as they share morphologic features. This challenge makes differential diagnosis crucial as HAs are invariably benign, whereas NENs must be considered malignant, thus requiring them to be evaluated for surgical excision.Our aim was, therefore, to develop a simple method to discriminate between pulmonary "fat-poor" HAs and NENs using contrast-enhanced CT (CECT). Between September 2015 and December 2021, 95 patients with a histologically proven diagnosis of lung NENs (74) and HAs (21) and who underwent a preoperative CECT scan were initially identified through a review of our pathologic and radiologic databases. Among these, 55 cases (18 HAs and 37 NENs), which have been studied with biphasic CECT, were ultimately selected and reviewed by 3 radiologists with different levels of experience, analyzing their morphologic and enhancement features.The enhancement analysis was performed by placing a region of interest within the lesion in noncontrast (NCp), postcontrast (PCp, 55 to 65s after intravenous contrast injection), and delayed phases (Dp, 180 to 300s). A subgroup of 35 patients who underwent 18FDG-PET/CT was evaluated in a secondary analysis. HU values were significantly different between NENs and HAs in the PCp ( P <0.001). NCp and Dp attenuation values did not show significant differences in the 2 groups. Differences in values of HUs in PCp and Dp allowed to discriminate between NENs and HAs. Wash-out analysis, ΔHU (PCp-Dp), can perfectly discriminate pulmonary "fat-poor" HAs from NENs.

CARTILAGE AND SUBCHONDRAL BONE CHANGES IN OSTEOARTHRITIS CAN BE DETECTED QUANTITATIVELY USING IN VIVO IMAGING

Cartilage diseases have a significant impact on the patient's quality of life and are a heavy burden for the healthcare system. Better understanding, early detection and proper follow-up could improve quality of life and reduce healthcare related costs. Therefore, the aim of this study was to evaluate if difference between osteoarthritic (OA) and non-osteoarthritic (non-OA) knees can be detected quantitatively on cartilage and subchondral bone levels with advanced but clinical available imaging techniques.Two OA (mean age = 88.3 years) and three non-OA (mean age = 51.0 years) human cadaveric knees were scanned two times. A high-resolution peripheral quantitative computed tomography (HR-pQCT) scan (XtremeCT, Scanco Medical AG, Switzerland) was performed to quantify the bone microstructure. A contrast-enhanced clinical CT scan (GE Revolution Evo, GE Medical Systems AG, Switzerland) was acquired with the contrast agent Visipaque 320 (60 ml) to measure cartilage. Subregions dividing the condyle in four parts were identified semi-automatically and the images were segmented using adaptive thresholding. Microstructural parameters of subchondral bone and cartilage thickness were quantified.The overall cartilage thickness was reduced by 0.27 mm between the OA and non-OA knees and the subchondral bone quality decreased accordingly (reduction of 33.52 % in BV/TV in the layer from 3 to 8 mm below the cartilage) for the femoral medial condyle. The largest differences were observed at the medial part of the femoral medial condyle both for cartilage and for bone parameters, corresponding to clinical observations.Subchondral bone microstructural parameters and cartilage thickness were quantified using in vivo available imaging and apparent differences between the OA and non-OA knees were detected. Those results may improve OA follow-up and diagnosis and could lead to a better understanding of OA. However, further in vivo studies are needed to validate these methods in clinical practice.

Changes in renal function over time in outpatients with eGFR ≥ 30 mL/min/1.73 m2: implication for timing of renal function testing before contrast-enhanced CT imaging

PurposeTo evaluate the associations between comorbidities and kidney function decline at 6-month and 1-year follow-up in outpatients with initial estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2.Materials and methodsOutpatients aged 18 and older with confirmed diagnosis, who had eGFR ≥ 30 mL/min/1.73 m2 measured between April 2017 and March 2019, were included in this retrospective observational study. Of them, 30,595 included outpatients had 6-month eGFR test and 27,698 included outpatients had 1-year eGFR test. The outpatients were further divided into two groups based on initial eGFR: between 30 and 59 and ≥ 60 mL/min/1.73 m2. Impaired renal function was defined as eGFR declined to below 30 mL/min/1.73 m2. The comorbidities with P values less than 0.1 identified in univariable logistic regression models were entered into the multivariable analysis with backward selection, thereby identifying comorbidities that increased the risk of eGFR decline at 6-month and 1-year follow-up.ResultsOutpatients with initial eGFR between 30 and 59 mL/min/1.73 m2 were 175.94 times more likely to have eGFR decline at 6 months, and were 94.10 times more likely to have eGFR decline at 1 year, compared with their corresponding initial eGFR ≥ 60 counterparts. Multivariable logistic regression analyses disclosed that chronic kidney disease, hypertension, and heart failure were independent risk factors for eGFR decline in outpatients with initial eGFR between 30 and 59 mL/min/1.73 m2.ConclusionsOutpatients with initial eGFR ≥ 60 mL/min/1.73 m2 might not need routine eGFR test prior to contrast-enhanced CT scan for 1 year. In addition, chronic kidney disease, hypertension, and heart failure increased the risk of declined renal function, particularly, in outpatients with initial eGFR between 30 and 59 mL/min/1.73 m2.

Abstract 34: A clinically-relevant orthotopic endometrial carcinosarcoma mouse model using human patient-derived organoids

Abstract Uterine carcinosarcoma (CS) is a rare but aggressive endometrial malignancy. Like the other subtypes of endometrial cancer, the incidence of CS has been increasing and it is projected to continue to rise. Additionally, there is racial disparity seen in African American women diagnosed with CS. African American women have an increased incidence of CS compared to other racial/ethnic groups. They also have an overall increased mortality related to endometrial cancer. Compared to other histologic subtypes of endometrial cancer, CS remains rare and understudied on a molecular and cellular basis. It remains under-represented in clinical trials. Therefore, the current therapies available for CS are extrapolated from those treatments used in the other subtypes of endometrial cancer. There is a paucity of data surrounding targeted therapies for CS resulting in worse outcomes for patients who are diagnosed with this aggressive and lethal cancer. We have developed a clinically relevant, orthotopic CS murine injection model by injecting human CS patient-derived organoids (PDO) from diverse ancestries into the endometrium of immunocompromised mice. Tumor progression in the mice was monitored with physical examination, PET/CT scan, contrast enhanced CT scan, and ultrasound. The tumor was established after three months and was visualized using various imaging techniques. The mice were sacrificed and the diagnosis of invasive CS was confirmed by macroscopic, histologic and genomic analyses. Our orthotopic CS PDO transplantation model has many potential applications for studying tumor biology and the response to treatment for CS in the pre-clinical setting. This may help identify targeted therapy for CS and potentially advance to Phase 1 human clinical trials. Citation Format: Arielle Katcher, Charlie Chung, Megan Gorman, Brian Yueh, Scott Lyons, Joseph Merrill, Libia Garcia, Marina Frimer, Gary L. Goldberg, Semir Beyaz. A clinically-relevant orthotopic endometrial carcinosarcoma mouse model using human patient-derived organoids [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 34.

Atypical presentation of a case of renal tuberculosis and cardiac muscle bypass

Tuberculosis is an endemic disease in several countries, despite having treatment and cure available. The most common form is pulmonary, but it can also affect any other organ or tissue. A male patient, 43 years old, with important sociodemographic history, as he lives at 3 000 meters above sea level in a rural area of the Ecuadorian Sierra, presents acute weight loss and asthenia. He had two hospital admissions with an interval of 1 month, during which he required intensive care for comprehensive management. During the first hospitalization, he presented abdominal septic shock, acute renal failure, and acute myocardial infarction. Coronary angiography was performed, which revealed a muscular bridge in the anterior descending artery. During the second hospitalization, he presented septic shock with a urinary focus. As the symptoms were similar and no underlying diagnosis was found to trigger instability, a simple and contrast-enhanced CT scan was performed, which showed suggestive images of a renal abscess and bilateral apical nodules with a tree-in-bud pattern in the chest. Therefore, a study was performed to detect tuberculosis

MP26-08 PREDICTORS OF ABDOMINAL ADHESIONS BEFORE ABDOMINAL SURGERY: DEVELOPMENT OF A CLINICAL NOMOGRAM

You have accessJournal of UrologyCME1 Apr 2023MP26-08 PREDICTORS OF ABDOMINAL ADHESIONS BEFORE ABDOMINAL SURGERY: DEVELOPMENT OF A CLINICAL NOMOGRAM Olivia Alessandra Voglino, Giorgio Guarnotta, Elisa Mancini, Carmen Gravina, Riccardo Lombardo, Giorgia Tema, Antonio Francesco Maria Cicione, Giovanni Di Pierro, Giorgio Franco, Costantino Leonardo, Alessandro Sciarra, Stefano Salciccia, Antonio Carbone, Antonio Luigi Pastore, Di Marco Massimiliano, Andrea Tubaro, and Cosimo De Nunzio Olivia Alessandra VoglinoOlivia Alessandra Voglino More articles by this author , Giorgio GuarnottaGiorgio Guarnotta More articles by this author , Elisa ManciniElisa Mancini More articles by this author , Carmen GravinaCarmen Gravina More articles by this author , Riccardo LombardoRiccardo Lombardo More articles by this author , Giorgia TemaGiorgia Tema More articles by this author , Antonio Francesco Maria CicioneAntonio Francesco Maria Cicione More articles by this author , Giovanni Di PierroGiovanni Di Pierro More articles by this author , Giorgio FrancoGiorgio Franco More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , Stefano SalcicciaStefano Salciccia More articles by this author , Antonio CarboneAntonio Carbone More articles by this author , Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , Di Marco MassimilianoDi Marco Massimiliano More articles by this author , Andrea TubaroAndrea Tubaro More articles by this author , and Cosimo De NunzioCosimo De Nunzio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003254.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intraabdominal adhesions are nonspecific complications related to prior abdominal surgery. Aim of our study was to evaluate the possible preoperative predictors of abdominal adhesions. METHODS: A consecutive series of patients undergoing abdominal surgery were prospectively enrolled from January 2021 to October 2022. Patients were preoperatively evaluated with clinical history and physical examination. A contrast enhanced CT scan was performed before the procedure and on the portal phase intrabdominal adhesions were recorded. Intraoperative adhesions were graded according to the peritoneal carcinomatosis index. Predictors of intraoperative adhesions were evaluated using logistic regression analysis. A nomogram was developed based on the logistic regression model. RESULTS: Overall, 104 patients with a median age of 69 (64/73) were enrolled. On abdominal CT 58/104 ( 56%) presented signs of abdominal adhesions and 46/104 (44%) presented adhesions intraoperatively. Median PCI was 5 (3/7). Patients with intraoperative abdominal adhesions presented more frequently Metabolic Syndrome (37/46: 82% vs 30/58: 51%, p<0,05), previous abdominal surgery (32/46:69% vs 21/58: 37%, p<0,01), ischemic heart disease (IHD) (16/46:36 % vs 9/58: 16 %, p<0,05) and signs of adhesions on abdominal CT (40/46: 87% vs 18/58:31%; p<0,05). On univariate analysis, metabolic syndrome, IHD, prior abdominal surgery and CT adhesions were predictors of intraoperative adhesions. On multivariate analysis, metabolic syndrome, abdominal surgery and CT adhesions were predictors of intraoperative adhesions. We developed a clinical nomogram to predict adhesions with an AUC of 0,85 and a clinical net benefit in the range of probabilities between 20 and 80%. CONCLUSIONS: Metabolic syndrome, prior abdominal surgery and CT adhesions are predictors of intraoperative adhesions. The present nomogram may be used after external validation to counsel patients on the presence of adhesions before abdominal surgery. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e355 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Olivia Alessandra Voglino More articles by this author Giorgio Guarnotta More articles by this author Elisa Mancini More articles by this author Carmen Gravina More articles by this author Riccardo Lombardo More articles by this author Giorgia Tema More articles by this author Antonio Francesco Maria Cicione More articles by this author Giovanni Di Pierro More articles by this author Giorgio Franco More articles by this author Costantino Leonardo More articles by this author Alessandro Sciarra More articles by this author Stefano Salciccia More articles by this author Antonio Carbone More articles by this author Antonio Luigi Pastore More articles by this author Di Marco Massimiliano More articles by this author Andrea Tubaro More articles by this author Cosimo De Nunzio More articles by this author Expand All Advertisement PDF downloadLoading ...

Small Bowel Cystic Lymphangioma: An Uncommon Finding During Single-Balloon Enteroscopy

CASE REPORT Cystic lymphangiomas are rare, congenital, nonmalignant lesions, extremely rare in the gastrointestinal tract.1 We report the case of a 76-year-old man referred to our unit for abdominal pain and anemia. Colonoscopy showed hepatic flexure adenocarcinoma confirmed by a contrast-enhanced computed tomography scan, which also revealed a hypodense and intraluminal mass located in the distal jejunum. Therefore, single-balloon-assisted enteroscopy with an antegrade approach was performed. In the distal jejunum, a yellow, glossy, and polylobate polypoid lesion of 30 mm in diameter was found. The lesion showed a tender, smooth, and squeezable surface: Bite-on-bite biopsies were performed, and a large amount of chylous/purulent fluid leaked from the lesion, which gradually deflated (Video 1). Histopathological report was consistent with cystic lymphangioma. Afterward, the patient underwent right hemicolectomy and jejunal resection. Cystic lymphangiomas result from the failure of lymphatic channels to communicate with the main lymphatic system.1 Cysts may contain serous, chylous, bloody, or purulent fluid. Intra-abdominal lymphangiomas mostly occur in the mesentery, followed by the omentum, mesocolon, and retroperitoneum.2 Involvement of solid or cave organs is extremely rare.3 Lymphangiomas are generally asymptomatic or responsible for nonspecific symptoms, including abdominal pain, diarrhea, and bleeding; volvulus typically occurs in mesenteric small bowel lymphangiomas, requiring urgent surgery.2 Enteroscopy, colonoscopy, and endoscopic ultrasonography are useful tools for the diagnosis and management of abdominal lymphangiomas. For symptomatic cystic lesions or tumors larger than 20 mm, surgical resection is the treatment of choice.4 In selected patients, endoscopic resection is a feasible option.4 Lymphangiomas comprise 3% of benign small bowel tumors5; however, it is expected that the frequency of their detection will increase in the coming years given the augmented diffusion of both video capsule and enteroscopy. Therefore, it is important for small bowel endoscopists to be able to recognize these lesions to offer the best therapeutic options to their patients. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1","caption":"Jejunal cystic lympangioma finding during single-balloon enteroscopy.","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_4vtc2xhf"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} DISCLOSURES Author contributions: S. Cocca, G. Pontillo and G. Grande involved in drafting of the manuscript. G. Grande and G. Pontillo performed enteroscopy. S. Cocca, H. Bertani, S. Russo, A. Mussetto and R. Conigliaro performed critical revision of the manuscript. S. Cocca is the article guarantor. Financial disclosure: None to report. Informed consent was obtained for this case report.

Fibrin-associated large B-cell lymphoma around vascular prosthesis mimicking recurrent abdominal aortic aneurysm

Fibrin-associated large B-cell lymphoma around vascular prosthesis mimicking recurrent abdominal aortic aneurysm

Neuroendocrine carcinoma of the minor papilla with pancreas divisum: a case report and review of the literature

BackgroundNeuroendocrine tumors of the minor papilla are very rare, and only 20 cases have been reported in the literature. Neuroendocrine carcinoma of the minor papilla with pancreas divisum has not been reported previously, making this the first reported case. Neuroendocrine tumors of the minor papilla have been reported in association with pancreas divisum in about 50% of cases reported in the literature. We herein present our case of neuroendocrine carcinoma of the minor papilla with pancreas divisum in a 75-year-old male with a systematic literature review of the previous 20 reports of neuroendocrine tumors of the minor papilla.Case presentationA 75-year-old Asian man was referred to our hospital for evaluation of dilation of the main pancreatic duct noted on abdominal ultrasonography. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography showed a dilated dorsal pancreatic duct, which was not connected to the ventral pancreatic duct; however, it opened to the minor papilla, indicating pancreas divisum. The common bile duct had no communication with the pancreatic main duct and opened to the ampulla of Vater. A contrast-enhanced computed tomography scan showed a 12-mm hypervascular mass near the ampulla of Vater. Endoscopic ultrasonography showed a defined hypoechoic mass in the minor papilla with no invasion. The biopsies performed at the previous hospital found adenocarcinoma. The patient underwent a subtotal stomach-preserving pancreaticoduodenectomy. The pathological diagnosis was neuroendocrine carcinoma. At the 15-year follow-up visit, the patient was doing well with no evidence of tumor recurrence.ConclusionIn our case, because the tumor was discovered during a medical check-up relatively early in the course of disease, the patient was doing well at the 15-year follow-up visit, with no evidence of tumor recurrence. Diagnosing a tumor of the minor papilla is very difficult because of the relatively small size and submucosal location. Carcinoids and endocrine cell micronests in the minor papilla occur more frequently than generally thought. It is very important to include neuroendocrine tumors of the minor papilla in the differential diagnosis of patients with recurrent pancreatitis or pancreatitis of unknown cause, especially for patients with pancreas divisum.

A quality-checked and physics-constrained deep learning method to estimate material basis images from single-kV contrast-enhanced chest CT scans.

Single-kV CT imaging is one of the primary imaging methods in radiology practices. However, it does not provide material basis images for some subtle lesion characterization tasks in clinical diagnosis. To develop a quality-checked and physics-constrained deep learning (DL) method to estimate material basis images from single-kV CT data without resorting to dual-energy CT acquisition schemes. Single-kV CT images are decomposed into two material basis images using a deep neural network. The role of this network is to generate a feature space with 64 template features with the same matrix dimensions of the input single-kV CT image. These 64 template image features are then combined to generate the desired material basis images with different sets of combination coefficients, one for each material basis image. Dual-energy CT image acquisitions with two separate kVs were curated to generate paired training data between a single-kV CT image and the corresponding two material basis images. To ensure the obtained two material basis images are consistent with the encoded spectral information in the actual projection data, two physics constraints, that is, (1) effective energy of each measured projection datum that characterizes the beam hardening in data acquisitions and (2) physical factors of scanners such as detector and tube characteristics, are incorporated into the end-to-end training. The entire architecture is referred to as Deep-En-Chroma in this paper. In the application stage, the generated material basis images are sent to a deep quality check (Deep-QC) network to assess the quality of estimated images and to report the pixel-wise estimation errors for users. The models were developed using 5592 training and validation pairs generated from 48 clinical cases. Additional 1526 CT images from another 13 patients were used to evaluate the quantitative accuracy of water and iodine basis images estimated by Deep-En-Chroma. For the iodine basis images estimated by Deep-En-Chroma, the mean difference with respect to dual-energy CT is -0.25 mg/mL, and the agreement limits are [-0.75 mg/mL, +0.24 mg/mL]. For the water basis images estimated by Deep-En-Chroma, the mean difference with respect to dual-energy CT is 0.0 g/mL, and the agreement limits are [-0.01 g/mL, 0.01 g/mL]. Across the test cohort, the median [25th, 75th percentiles] root mean square errors between the Deep-En-Chroma and dual-energy material images are 14 [12, 16] mg/mL for the water images and 0.73 [0.64, 0.80] mg/mL for the iodine images. When significant errors are present in the estimated material basis images, Deep-QC can capture these errors and provide pixel-wise error maps to inform users whether the DL results aretrustworthy. The Deep-En-Chroma network provides a new pathway to estimating the clinically relevant material basis images from single-kV CT data and the Deep-QC module to inform end-users of the accuracy of the DL material basis images inpractice.

Esophageal anthracosis occurred after treatment of esophageal tuberculosis secondary to mediastinal tuberculous lymphadenitis: a rare case report

BackgroundAnthracosis is a disease generally considered to be in the lungs resulting from exposure to industrial dust in the workplace. Esophageal anthracosis is a fairly rare phenomenon and shows a strong correlation with tuberculosis. Moreover, esophageal involvement in tuberculosis is also rare. We here present an extremely rare case in which follow-up gastroesophageal endoscopy revealed a mass with a sunken, black area in the center and raised ring-like pattern in the surrounding mucosa resembling malignant melanoma. Uncovering the patient’s tuberculosis history finally avoided a misdiagnosis or overtreatment.Case presentationA 67-year-old male patient was admitted to the hospital due to “repeated chest pain for 1 month”. Endoscopic ultrasonography and contrast-enhanced CT scans revealed a mass adjacent to the esophageal wall with unclear boundaries. Aspiration biopsy confirmed that esophageal tuberculosis was caused by nearby mediastinal tuberculous lymphadenitis. After a standard anti-tuberculosis treatment regimen, the patient achieved a favorable prognosis. The follow-up gastroesophageal endoscopy showed a sunken black lesion with elevated peripheral mucosa replacing the original tuberculous mass, which was thought to be anthracosis, a disease that rarely occurs in the esophagus.ConclusionThe diagnosis of tuberculosis should be taken into consideration when a submucosal mass appears in the middle part of the esophagus. Endoscopic ultrasonography can effectively contribute to a definite diagnosis. Moreover, this is the first case of esophageal anthracosis observed only 1 year after the treatment of tuberculosis, indicating esophageal anthracosis can be a short-term disease. The traction of the reduction of tubercular mediastinal lymph nodes after anti-tuberculosis treatment may create a circumstance for pigmentation or dust deposition.

Computed tomography texture analysis combined with preoperative clinical factors serve as a predictor of early efficacy of transcatheter arterial chemoembolization in hepatocellular carcinoma.

To investigate a pre-therapeutic radiomics nomogram to accurately predict hepatocellular carcinoma (HCC) lesion responses to transcatheter arterial chemoembolization (TACE). This retrospective study from January 2012 to 2022 included 92 TACE-treated patients who underwent liver contrast-enhanced CT scan 7days before treatment, having complete clinical information. We extracted quantitative texture parameters and clinical factors for the largest tumors on the baseline arterial and portal venous phase CT images. An adaptive least absolute shrinkage and selection operator (LASSO)-penalized logistic regression identified independent predictors of tumor activity after TACE. We fitted an adaptive LASSO regression model to narrow down the texture features and clinical risk factors of the tumor activity status. The selected texture features were used to construct radiomic scores (RadScore), which demonstrated superior performance in predicting tumor activity on both the training (area under the curve (AUC): 0.881, 95% CI: 0.799-0.963) and testing sets (AUC: 0.88, 95% CI: 0.726-1). A logistic regression-based nomogram was developed using RadScore and four selected clinical features. In the testing set, nomogram total points were significant predictors (P = 0.034), and the training set showed no departure from perfect fit (P = 0.833). Internal validation of the nomogram was obtained for the training (AUC: 0.91, 95% CI: 0.837-0.984) and testing (AUC: 0.889, 95% CI: 0.746-1) sets. We propose a nomogram to predict the early response of HCC lesions to TACE treatment with high accuracy, which may serve as an additional criterion in multidisciplinary decision-making treatment.

Torted Wondering Spleen

Background: Wandering spleen was first mentioned by Van Horne in 1667. Wandering spleen (floating, ectopic, ptotic, hypermobile or splenoptosis) may float anchored only by its vascular pedicle with no hooking to the nearby structuresand it is induced by the lengthening of the spleen’s holding ligaments. Although it is rare (less than 0.2%) but it affects mostly children and female adults of active reproductive age. It features as a mass in the abdomen without clinical signs or with intermittent abdominal discomfort due to torsion and spontaneous detorsion of the spleen. Case Report: A 34-year-old male presented to the emergency department with complaints of abdominal pain, distension of the abdomen and vomiting with constipation for two days. There was no past history of any surgery. On general examination, patient was afebrile (temperature of 37°c), pulse rate of 80 bpm and blood pressure of 110/70 mmHg. An abdominal examination revealed mild abdominal distension with mild diffuse abdominal tenderness and guarding. A tender lump sizing 10 × 9 cm with smooth surface, well defined margins and firm consistency was found. Digital rectal examination was normal. Laboratory parameters showed hemoglobin 14.5 gm/dl and white blood cells 12000/mm3. The platelet count was normal. Ultrasonography (USG) showed a solid mass and the absence of the spleen from its normal location. A computed tomography (CT) scan of the abdomen showed large torted spleen at mid abdomen with partial or no enhancement of splenic shape mass on contrast-enhanced CT scan and the patient was scheduled for an exploratory laparotomy for surgical acute abdomen. During laparotomy, a mass measuring 11 × 9 × 3 cm and weighing approximately 280 g was found. The mass was identified as the spleen by visualizing its notch and the absence of the spleen from its normal position. All splenic ligamentous attachments were completely absent. The spleen was found to be partly infarcted due to twisting of the spleen .....

Deep Learning to Detect Pancreatic Cystic Lesions on Abdominal Computed Tomography Scans: Development and Validation Study.

Pancreatic cystic lesions (PCLs) are frequent and underreported incidental findings on computed tomography (CT) scans and can evolve to pancreatic cancer-the most lethal cancer, with less than 5 months of life expectancy. The aim of this study was to develop and validate an artificial deep neural network (attention gate U-Net, also named "AGNet") for automated detection of PCLs. This kind of technology can help radiologists to cope with an increasing demand of cross-sectional imaging tests and increase the number of PCLs incidentally detected, thus increasing the early detection of pancreatic cancer. We adapted and evaluated an algorithm based on an attention gate U-Net architecture for automated detection of PCL on CTs. A total of 335 abdominal CTs with PCLs and control cases were manually segmented in 3D by 2 radiologists with over 10 years of experience in consensus with a board-certified radiologist specialized in abdominal radiology. This information was used to train a neural network for segmentation followed by a postprocessing pipeline that filtered the results of the network and applied some physical constraints, such as the expected position of the pancreas, to minimize the number of false positives. Of 335 studies included in this study, 297 had a PCL, including serous cystadenoma, intraductal pseudopapillary mucinous neoplasia, mucinous cystic neoplasm, and pseudocysts . The Shannon Index of the chosen data set was 0.991 with an evenness of 0.902. The mean sensitivity obtained in the detection of these lesions was 93.1% (SD 0.1%), and the specificity was 81.8% (SD 0.1%). This study shows a good performance of an automated artificial deep neural network in the detection of PCL on both noncontrast- and contrast-enhanced abdominal CT scans.

Transarterial Embolization of Ruptured Pancreaticoduodenal Artery Pseudoaneurysm Related to Chronic Pancreatitis

We presented a 67-year-old woman with lightheadedness, diaphoresis, and acute epigastric and right hypochondrium pain, with a past medical history including stage 2 essential hypertension, chronic ischemic cardiomyopathy, and class 1 obesity. An abdominal contrast-enhanced CT scan showed an extensive hematoma (3 × 4 cm2 in size) located intra-abdominally, adjacent to the duodenojejunal area, with hyperdensity around the duodenum, positioned inferior to the pancreas (30-59 HU). Moreover, the CT scan also revealed an enhancing lesion as a pseudoaneurysm of the inferior pancreaticoduodenal artery, measuring 5 × 8 × 8 mm3 with active bleeding and associated hematoma. Following these investigations of the abdominal area, a decision was made to proceed with an endovascular intervention within the interventional radiology department. With the patient under conscious sedation, via a right common femoral artery approach, the superior mesenteric artery was catheterized. While injecting the contrast agent to obtain a better working projection, the pseudoaneurysm ruptured, and acute extravasation of the contrast agent was noted, followed by injection of a mixture of 1 mL Glubran 2 with 2 mL Lipiodol until complete obliteration of the pseudoaneurysm was obtained. The patient was hemodynamically stable at the end of the procedure and was discharged 6 days later in a good condition without active bleeding signs.