Contrast-enhanced Contrast-enhanced Computed Tomography Scan Research Articles

Evaluating aortomesenteric parameters in a tertiary center of Nepal for superior mesenteric artery syndrome diagnosis and risk factors: cross-sectional study.

This study examines aortomesenteric angle (AMA) and distance (AMD), which are critical in superior mesenteric artery (SMA) syndrome. Addressing the scarcity of SMA cases, the research explores potential links with lower BMI and aims to establish normative data for diagnostic and predictive purposes, using contrast-enhanced computed tomography (CT) scans across various BMI and sex categories. A retrospective quantitative cross-sectional study was conducted on 189 patients undergoing abdominal contrast-enhanced CT scans between December 2019 and December 2020. Ethical clearance was obtained, and participants provided informed consent. Exclusion criteria targeted specific medical histories. Patient demographics, BMI categories, and imaging data were recorded. Helical 128-slice CT scans were employed, with sagittal-oblique multiplanar reconstructions for parameter assessments. Statistical analysis utilized SPSS 26.0, including Pearson correlation coefficients and mean calculations. The study reveals a mean AMA of 54.07°±8.53° and a mean distance of 16.25±3.44 mm. Elevated BMI is found to positively correlate with AMA and distance, indicating that higher BMI values may augment these parameters, with an additional positive correlation observed between AMA and distance. No significant correlations are found with patient age or sex. The study concludes that decreased BMI may pose a potential risk for SMA syndrome, as evidenced by the observed correlations with aortomesenteric parameters. Understanding these normal values in the Nepalese population is critical for accurate diagnoses and predictions using CT scans. The research highlights the impact of demographic factors on these parameters and emphasizes their significance in clinical assessments related to SMA syndrome.

The Influence of Computed Tomography Contrast Agent on Radiation-Induced Gene Expression and Double-Strand Breaks.

After nuclear scenarios, combined injuries of acute radiation syndrome (ARS) with, e.g., abdominal trauma, will occur and may require contrast-enhanced computed tomography (CT) scans for diagnostic purposes. Here, we investigated the effect of iodinated contrast agents on radiation-induced gene expression (GE) changes used for biodosimetry (AEN, BAX, CDKN1A, EDA2R, APOBEC3H) and for hematologic ARS severity prediction (FDXR, DDB2, WNT3, POU2AF1), and on the induction of double-strand breaks (DSBs) used for biodosimetry. Whole blood samples from 10 healthy donors (5 males, 5 females, mean age: 28 ± 2 years) were irradiated with X rays (0, 1 and 4 Gy) with and without the addition of iodinated contrast agent (0.016 ml contrast agent/ml blood) to the blood prior to the exposure. The amount of contrast agent was set to be equivalent to the blood concentration of an average patient (80 kg) during a contrast-enhanced CT scan. After irradiation, blood samples were incubated at 37°C for 20 min (DSB) and 8 h (GE, DSB). GE was measured employing quantitative real-time polymerase chain reaction. DSB foci were revealed by γH2AX + 53BP1 immunostaining and quantified automatically in >927 cells/sample. Radiation-induced differential gene expression (DGE) and DSB foci were calculated using the respective unexposed sample without supplementation of contrast agent as the reference. Neither the GE nor the number of DSB foci was significantly (P = 0.07-0.94) altered by the contrast agent application. However, for some GE and DSB comparisons with/without contrast agent, there were weakly significant differences (P = 0.03-0.04) without an inherent logic and thus are likely due to inter-individual variation. In nuclear events, the diagnostics of combined injuries can require the use of an iodinated contrast agent, which, according to our results, does not alter or influence radiation-induced GE changes and the quantity of DSB foci. Therefore, the gene expression and γH2AX focus assay can still be applied for biodosimetry and/or hematologic ARS severity prediction in such scenarios.

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.

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.

Evaluating the Performance of a Commercially Available Artificial Intelligence Algorithm for Automated Detection of Pulmonary Embolism on Contrast-Enhanced Computed Tomography and Computed Tomography Pulmonary Angiography in Patients With Coronavirus Disease 2019.

To investigate the performance of a commercially available artificial intelligence (AI) algorithm for the detection of pulmonary embolism (PE) on contrast-enhanced computed tomography (CT) scans in patients hospitalized for coronavirus disease 2019 (COVID-19). Retrospective analysis was performed of all contrast-enhanced chest CT scans of patients admitted for COVID-19 between March 1, 2020 and December 31, 2021. Based on the original radiology reports, all PE-positive examinations were included (n=527). Using a reversed-flow single-gate diagnostic accuracy case-control model, a randomly selected cohort of PE-negative examinations (n=977) was included. Pulmonary parenchymal disease severity was assessed for all the included studies using a semiquantitative system, the total severity score. All included CT scans were sent for interpretation by the commercially available AI algorithm, Aidoc. Discrepancies between AI and original radiology reports were resolved by 3 blinded radiologists, who rendered a final determination of indeterminate, positive, or negative. A total of 78 studies were found to be discrepant, of which 13 (16.6%) were deemed indeterminate by readers and were excluded. The sensitivity and specificity of AI were 93.2% (95% CI, 90.6%-95.2%) and 99.6% (95% CI, 98.9%-99.9%), respectively. The accuracy of AI for all total severity score groups (mild, moderate, and severe) was high (98.4%, 96.7%, and 97.2%, respectively). Artificial intelligence was more accurate in PE detection on CT pulmonary angiography scans than on contrast-enhanced CT scans (P<.001), with an optimal Hounsfield unit of 362 (P=.048). The AI algorithm demonstrated high sensitivity, specificity, and accuracy for PE on contrast-enhanced CT scans in patients with COVID-19 regardless of parenchymal disease. Accuracy was significantly affected by the mean attenuation of the pulmonary vasculature. How this affects the legitimacy of the binary outcomes reported by AI is not yet known.

Using computed tomography to evaluate proper chest compression depth for cardiopulmonary resuscitation in Thai population: A retrospective cross-sectional study.

The effectiveness of cardiopulmonary resuscitation is determined by appropriate chest compression depth and rate. The American Heart Association recommended CC depth at 5-6 cm to indicate proper cardiac output during cardiac arrest. However, many studies showed the differences in the body builds between Caucasians and Asians. Therefore, this study aimed to determine heart compression fraction (HCF) in the Thai population by using contrast-enhanced computed tomography (CT) scan of the chest and a mathematical model. Consecutive contrast-enhanced CT scans of the chest performed at Ramathibodi Hospital were retrospectively reviewed from January to March 2018 by two independent radiologists. Patients' characteristics, including gender, age, weight, height, and pre-existing diseases, were recorded, and the chest parameters were measured from a CT scan. The heart compression fraction (HCF) was subsequently calculated. Of 306 subjects, there were 139 (45.4%) males, 148 (47.4%) lung diseases and 10 (3.3%) heart diseases. Mean age and BMI were 60.4 years old and 23.8 kg/m2, respectively. Chest diameter, heart diameter, and non-cardiac soft tissue were significantly smaller in females compared to males. Mean (SD) HCF proportional with 50 mm and 60 mm depth were 38.3% (13.3%) and 50% (14.3%), respectively. There were significant differences of HCF proportional by 50 mm and 60 mm depth between men and women (33.2% vs 42.6% and 44% vs 54.9%, respectively (P<0.001)). In addition, a decrease in HCF was significantly observed among higher BMI groups. The CT scan and mathematical model showed that 38% and 50% HCF proportions were generated by 50 mm and 60 mm CC depth. HCF proportions were significantly different between genders and among BMI groups. The recommended depth of 5-6 cm is likely to provide sufficient CC depth in the population of Thailand.

Current Status of Contrast Computed Tomography Examination for Diagnosing Acute Pulmonary Thromboembolism.

The purpose of this study was to identify instances of unnecessary contrast-enhanced computed tomography (CT) scans performed at the time of diagnosis in patients with pulmonary thromboembolism at the emergency department of Saiseikai Kumamoto Hospital in Kumamoto Prefecture, Japan, between April 1, 2015, and March 31, 2020. The decision criteria for unnecessary contrast-enhanced CT scans included a Wells score of low or moderate risk, a D-dimer level <1.0 μg/mL, and no shock symptoms, or a negative finding for pulmonary thromboembolism. Consequently, 27 patients were considered to have undergone unnecessary contrast-enhanced CT scans. This equated to approximately 15.6% of the study population.

The efficacy and safety of continuous intra-arterial infusion neoadjuvant chemotherapy with surgery for locally advanced gastric cancer: a preliminary pilot study.

Neoadjuvant chemotherapy (NAC) followed by R0 resection is regarded as a standard treatment strategy for locally advanced gastric cancer (GC); however, the response to systemic chemotherapy remains unsatisfactory. Continuous intra-arterial infusion chemotherapy (CAIC) is a new method, compared with systematic chemotherapy, it can deliver chemotherapy drugs more accurately, so as to achieve higher surgical conversion rate. This study aimed to explore the efficacy and safety of CAIC in locally advanced GC patients. In this retrospective pilot study, four patients with histologically confirmed locally advanced GC were identified from a tertiary hospital between May 2018 and December 2018. Clinic stage was belonged to T4N1-3M0 in all cases with potential probability for surgery. All cases received three cycles of NAC by CAIC with oxaliplatin (100 mg on day 1) plus oral S-1 (80 mg/m2/day twice daily for 14 days) (SOX). Contrast-enhanced computed tomography (CT) scans and pathological examinations were performed to evaluate chemotherapeutic response based on the tumor regression grade (TRG) and post-neoadjuvant pathological Tumor Node Metastasis (ypTNM) staging. All cases were regularly followed up with face-to-face interviews at outpatient, abdominal enhanced CT scan and serum tumor markers were be requested at 3-month intervals for up to 1 year postoperatively. The obstruction was significantly alleviated after three cycles of CAIC. Contrast-enhanced CT scans showed decreased tumor volume to some extent, along with lymph node shrinkage after treatment. Radical (R0) resection was achieved in all cases. Histopathological analysis showed tumor downstaging in three cases and upstaging in one case. The tumor response to treatment demonstrated TRG1a in one case, TRG1b in one case, and TRG2 in two cases, with an overall tumor regression rate of 100%. No obvious adverse events or perioperative complications were observed during or following treatment. All cases were alive without tumor recurrence or progression after the 1-year postoperative follow-up. Our study may shed light on super-selective CAIC as an effective method for improving the NAC response in locally advanced GC. Future studies with a larger sample sizes and long-term outcomes are required for a final conclusion.

A Complication Hanging by a Thread

Question: A 75-year-old man presented with a 1-month history of mild abdominal pain and cramping, associated with weight loss (3 kg). He denied any nausea, vomiting, chills, diarrhea, or hematochezia. The patient reported no trauma. He had a history of ampullary adenocarcinoma treated with pancreaticoduodenectomy 2 years earlier. The postoperative course was marked by hemorrhagic shock owing to a splenic artery pseudoaneurysm that was successfully treated by trans-arterial embolization. On physical examination, the patient was afebrile and had normal vital signs. He had a slight tender abdomen on palpation. Blood tests revealed a C-reactive protein level of 20.2 mg/L (reference value, <3.5 mg/L) and a white blood cell count of 3670/mm3 with 87% neutrophils. Other laboratory tests were unremarkable. A contrast-enhanced computed tomography (CT) scan showed a status post embolization of the splenic artery with hyperattenuating embolic material (Figure A) and long thin hyperattenuating foreign bodies in the small bowel lumen (Figure B–D; the entire CT scan is provided as supplemental material) that were better assessed on a coronal maximum intensity projection view (Figure E). The small bowel wall was normal. There was no sign of bowel perforation, no fluid collection, and no sign of active or recent bleeding. The colon was normal. The pancreaticojejunal anastomosis was unremarkable. There was no evidence of tumor recurrence. What is the diagnosis? Look on page 55 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. The pancreaticoduodenectomy was complicated with a pseudoaneurysm arising from the splenic artery (Figure F) that was successfully treated with transarterial embolization with steel wire coils. A postembolization CT scan showed complete occlusion of the lesion and the splenic artery (coronal view; Figure G). There was no bleeding recurrence, and the patient was discharged. The patient was regularly followed-up with a CT scan that showed no evidence of tumor recurrence and no modification of the embolization site. A multidisciplinary team recommended conservative management with no invasive procedure to remove the migrated coils. The patient spontaneously and painlessly evacuated the coils in stools 5 weeks after the diagnosis (Figure H). A contrast-enhanced CT scan performed 3 weeks later showed the evacuation of migrated coils, and the persistence of coils in the splenic artery (Figure I). The patient is currently asymptomatic and free from tumor recurrence. Complications of splenic artery embolization include splenic infarction (1%–2%), splenic abscesses, left pleural effusion (10%), or basal atelectasis (30%), and rarely portal thrombosis. Migration of coils is exceptional and has been described after embolization of splenic pseudoaneurysms owing to vascular coil erosion into the gastrointestinal tract.1Shah N.A. Akingboye A. Haldipur N. et al.Embolization coils migrating and being passed per rectum after embolization of a splenic artery pseudoaneurysm, "the migrating coil": a case report.Cardiovasc Intervent Radiol. 2007; 30: 1259-1262Crossref PubMed Scopus (36) Google Scholar, 2Tekola B.D. Arner D.M. Behm B.W. Coil migration after transarterial coil embolization of a splenic artery pseudoaneurysm.Case Rep Gastroenterol. 2013; 7: 487-491Crossref PubMed Scopus (21) Google Scholar, 3Takahashi T. Shimada K. Kobayashi N. et al.Migration of steel-wire coils into the stomach after transcatheter arterial embolization for a bleeding splenic artery pseudoaneurysm: report of a case.Surg Today. 2001; 31: 458-462Crossref PubMed Scopus (46) Google Scholar As previously reported, migration was a delayed complication (3 months to 10 years in the literature). Of note, several cases reported evidence of infection at the erosion site, which was not present here. Management depends on the extent of material migration and symptoms and ranges from conservative treatment to more invasive procedures (endoscopic or surgical retrieval). No evidence suggests that specific coils are more prone to secondary migration. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiIwMDVhZjJiODcwMzAzNjk2ZmI2YWIzMjUzYjdlYWQxOSIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjgwMjM3NDk5fQ.LS386lU7wuNg_A2l4X5T61IP2FppVGq2DNjFd7aTwKDD2CnGpQETIi90YGkob6isNUAcHjGC4yhMDhQNo1DG5HKu1dFwUcd02ku-3-ijbtwufokHYbR9GkgBLJJrKiVWexXPcCmjZ80L7FxHY7cNGxrNvpL2raueVLp6qDpzbURZecPBVy2dgcAXpt6jsm1aasdWat3eZkIIzv_GjPqtCeiF2xd_C5fCUMsrsLpgVJRc4TUlfE7LeeevSOcSauQrdo1mVy7_4gMzUgxnWKEuzCzZQJNc2cgIvMo0DQPGSs8o2SDa7TKbqSjnpikBuxPR43PNpPDaTpv5tnSCsdVXbQ Download .mp4 (6.04 MB) Help with .mp4 files Video

Drug-induced aortitis of the subclavian artery caused by pegfilgrastim: a case report

BackgroundPegfilgrastim is a modified version of granulocyte-colony stimulating factor (G-CSF), with a polyethylene glycol (PEG) that prolongs its half-life in peripheral blood. It is prophylactically administered during chemotherapy to prevent severe febrile neutropenia. G-CSF-related aortitis is a rare side effect but reports of this disease have been increasing in recent years, probably due to PEGylation. Herein, we report a case who developed pegfilgrastim-induced aortitis, localized to the right subclavian artery, during adjuvant chemotherapy. Her condition recovered without the use of steroids.Case presentationA 58-year-old woman was diagnosed with invasive ductal carcinoma of the left breast. She had a medical history of contralateral breast cancer and pyelonephritis. Following curative surgery for her left breast cancer, she received adjuvant chemotherapy. Two days after the first course of dose-dense paclitaxel, pegfilgrastim was used as planned. Eight days after the administration of pegfilgrastim, she developed a high fever of 38 °C and visited the emergency outpatient clinic 3 days after. Blood tests revealed an increased inflammatory response, and contrast-enhanced computed tomography (CT) revealed a wall thickening of the subclavian artery, suggesting aortitis caused by pegfilgrastim. She was hospitalized on day 15 when CRP increased to 21.5 mg/dL and the high fever continued. Blood and urine culture tests were negative throughout. Pegfilgrastim-induced aortitis was suspected and she was observed without the use of steroids. Seven days later, her fever abated. A contrast-enhanced CT scan on day 26 showed the subclavian artery wall thickening had disappeared. The patient continues to be afebrile and is currently on weekly paclitaxel without use of G-CSF.ConclusionsThe onset of this disease is known to usually occur within 2 weeks after the first pegfilgrastim administration. Aortitis localized to the subclavian artery is relatively rare with the most frequent site being the aortic arch. Clinicians should be aware of the timing and location of onset of this disease.

Imaging criteria to predict Shamblin group in carotid body tumors - revisited.

This study aims to compare the imaging findings of carotid body tumors on contrast-enhanced computed tomography (CT) with the intraoperative Shamblin grade and to evolve an imaging-based scoring system that can accurately predict the Shamblin grade. Preoperative contrast-enhanced CT scans of 40 patients who underwent surgical excision of carotid body tumors in our institution between 2004 and 2017 were retrospectively reviewed. The angle of contact with the internal carotid artery (ICA), tumor volume, presence of peritumoral tuft of veins, loss of tumor adventitia interface and distance from the skull base were assessed and compared with the intraoperative Shamblin grades of the tumor. Ordinal logistic regression was used to determine which parameters could be predictors of the Shamblin grades. Receiver operator characteristic (ROC) curves were used to score the tumor volumes. Among the 42 tumors evaluated, 6 (14.3%) were surgically classified as Shamblin I, 15 (35.7%) as Shamblin II, and 21 (50%) as Shamblin III tumors. Pairwise comparison between the three Shamblin groups showed a statistically significant difference for angle of contact with ICA, maximum tumor dimension, presence of peritumoral tuft of veins and loss of tumor adventitia interface (p = 0.001, p = 0.001, p = 0.038 and p = 0.003, respectively). However, tumor volumes and distance from skull base were not significantly different between the Shamblin groups (p = 0.136 and p = 0.682). A scoring system, including four of the above mentioned parameters (angle of contact with ICA, tumor volume, presence of peritumoral tuft of veins, and loss of tumor adventitia interface) was developed with a maximum score of 8 and a minimum of 2. A statistically significant difference was found between the final scores among the three Shamblin groups (p < 0.001). Using ROC curves, a final score of ≥6 was found to separate Shamblin grade III tumors from grade I and II tumors (sensitivity, 95.24%; specificity, 71.43%). All patients with documented intraoperative estimated blood loss of >1000 mL had Shamblin grade III tumors. Postoperative complications like stroke, ICA thrombosis and lower cranial nerve palsies were seen only with Shamblin grade II and III tumors. The simple scoring system we have proposed correlates well with the Shamblin grade and helps in identifying patients who have a higher risk of developing complications.

Automated mapping and N-Staging of thoracic lymph nodes in contrast-enhanced CT scans of the chest using a fully convolutional neural network

PurposeTo develop a deep-learning (DL)-based approach for thoracic lymph node (LN) mapping based on their anatomical location. MethodThe training-and validation-dataset included 89 contrast-enhanced computed tomography (CT) scans of the chest. 4201 LNs were semi-automatically segmented and then assigned to LN levels according to their anatomical location. The LN level classification task was addressed by a multi-class segmentation procedure using a fully convolutional neural network. Mapping was performed by firstly determining potential level affiliation for each voxel and then performing majority voting over all voxels belonging to each LN. Mean classification accuracies on the validation data were calculated separately for each level and overall Top-1, Top-2 and Top-3 scores were determined, where a Top-X score describes how often the annotated class was within the top-X predictions. To demonstrate the clinical applicability of our model, we tested its N-staging capabilities in a simulated clinical use case scenario assuming a patient diseased with lung cancer. ResultsThe artificial intelligence(AI)-based assignment revealed mean classification accuracies of 86.36 % (Top-1), 94.48 % (Top-2) and 96.10 % (Top-3). Best accuracies were achieved for LNs in the subcarinal level 7 (98.31 %) and axillary region (98.74 %). The highest misclassification rates were observed among LNs in adjacent levels. The proof-of-principle application in a simulated clinical use case scenario for automated tumor N-staging showed a mean classification accuracy of up to 96.14 % (Top-1). ConclusionsThe proposed AI approach for automatic classification of LN levels in chest CT as well as the proof-of-principle-experiment for automatic N-staging, revealed promising results, warranting large-scale validation for clinical application.

An adult with episodic retrosternal chest pain: an unusual presentation of congenital pulmonary airway malformation \u2013 case report

BackgroundCongenital pulmonary airway malformation (CPAM) with partial anomalous pulmonary venous connection presenting as episodic retrosternal chest pain on exertion in an adult has not been described.Case presentationA 21-year-old female, non-smoker, presented with a 4-year history of sharp, episodic, retrosternal chest pains brought on with exercise. A contrast-enhanced computed tomography (CT) scan showed a grossly overinflated left lower lobe with partial anomalous pulmonary venous drainage into the left hemi-azygos vein. Lobectomy, the recommended treatment of choice, carried out thoracoscopically, was curative with satisfactory mid-term results. Histology confirmed type-II congenital pulmonary airway malformation.ConclusionsCPAM can present in young adults with unusual symptoms of chest pain on exertion. When suspected a contrast-enhanced CT scan is the gold standard for establishing the diagnosis. An anatomical lung resection is curative with satisfactory medium term results.

Cryptic brain abscess ‐ do not forget hereditary hemorrhagic teleangiectasia!

Cryptic brain abscess ‐ do not forget hereditary hemorrhagic teleangiectasia!

Imaging biomarkers of contrast-enhanced computed tomography predict survival in oesophageal cancer after definitive concurrent chemoradiotherapy

BackgroundThis study aimed to evaluate the predictive potential of contrast-enhanced computed tomography (CT)-based imaging biomarkers (IBMs) for the treatment outcomes of patients with oesophageal squamous cell carcinoma (OSCC) after definitive concurrent chemoradiotherapy (CCRT).MethodsAltogether, 154 patients with OSCC who underwent definitive CCRT were included in this retrospective study. All patients were randomised to the training cohort (n = 99) or the validation cohort (n = 55). Pre-treatment contrast-enhanced CT scans were obtained for all patients and used for the extraction of IBMs. An IBM score, was constructed by using the least absolute shrinkage and selection operator with Cox regression analysis, which was equal to the log-partial hazard of the Cox model in the training cohort and tested in the validation cohort. IBM nomograms were built based on IBM scores for individualised survival estimation. Finally, a decision curve analysis was performed to estimate the clinical usefulness of the nomograms.ResultsAltogether, 96 IBMs were extracted from each contrast-enhanced CT scan. IBM scores were constructed from 11 CT-based IBMs for overall survival (OS) and 8 IBMs for progression-free survival (PFS), using the LASSO-Cox regression method in the training cohort. Multivariate analysis revealed that IBM score was an independent prognostic factor correlated with OS and PFS. In the training cohort, the C-indices of IBM scores were 0.734 (95% CI 0.664–0.804) and 0.658 (95% CI 0.587–0.729) for OS and PFS, respectively. In the validation cohort, C-indices were 0.672 (95% CI 0.578–0.766) and 0.666 (95% CI 0.574–0.758) for OS and PFS, respectively. Kaplan–Meier survival analysis showed a significant difference between risk subgroups in the training and validation cohorts. Decision curve analysis confirmed the clinical usefulness of the IBM score.ConclusionsThe IBM score based on pre-treatment contrast-enhanced CT could predict the OS and PFS for patients with OSCC after definitive CCRT. Further multicentre studies with larger sample sizes are warranted.

Development and Validation of a Contrast-Enhanced CT-Based Radiomics Nomogram for Prediction of Therapeutic Efficacy of Anti-PD-1 Antibodies in Advanced HCC Patients.

BackgroundThere is no study accessible now assessing the prognostic aspect of radiomics for anti-PD-1 therapy for patients with HCC.AimThe aim of this study was to develop and validate a radiomics nomogram by incorporating the pretreatment contrast-enhanced Computed tomography (CT) images and clinical risk factors to estimate the anti-PD-1 treatment efficacy in Hepatocellular Carcinoma (HCC) patients.MethodsA total of 58 patients with advanced HCC who were refractory to the standard first-line of therapy, and received PD-1 inhibitor treatment with Toripalimab, Camrelizumab, or Sintilimab from 1st January 2019 to 31 July 2020 were enrolled and divided into two sets randomly: training set (n = 40) and validation set (n = 18). Radiomics features were extracted from non-enhanced and contrast-enhanced CT scans and selected by using the least absolute shrinkage and selection operator (LASSO) method. Finally, a radiomics nomogram was developed based on by univariate and multivariate logistic regression analysis. The performance of the nomogram was evaluated by discrimination, calibration, and clinical utility.ResultsEight radiomics features from the whole tumor and peritumoral regions were selected and comprised of the Fusion Radiomics score. Together with two clinical factors (tumor embolus and ALBI grade), a radiomics nomogram was developed with an area under the curve (AUC) of 0.894 (95% CI, 0.797–0.991) and 0.883 (95% CI, 0.716–0.998) in the training and validation cohort, respectively. The calibration curve and decision curve analysis (DCA) confirmed that nomogram had good consistency and clinical usefulness.ConclusionsThis study has developed and validated a radiomics nomogram by incorporating the pretreatment CECT images and clinical factors to predict the anti-PD-1 treatment efficacy in patients with advanced HCC.

Segmentectomy Guided by 3-Dimensional Images Reconstructed From Nonenhanced Computed Tomographic Data

Three-dimensional (3D) imaging is an essential tool for performing an accurate segmentectomy. However, data acquired from contrast-enhanced computed tomography (CT) are considered necessary when reconstructing 3D pulmonary vascular images. Therefore, 3D images are currently unavailable for patients who cannot undergo contrast-enhanced CT scans due to patient-related issues such as anaphylaxis to the contrast agent, among others. We present here our experience with atypical segmentectomies guided by 3D images reconstructed from nonenhanced CT data.

Self-healing omental infarction diagnosed and followed-up using contrast-enhanced computed tomography: A case report and review of literature

Introduction: Omental infarction is a relatively rare disease characterized by acute abdomen. Nonsevere cases may be successfully treated without antibiotics. Although adult cases often require surgical treatment, it remains unknown under what circumstances patients may be treated conservatively, including whether antibiotics are necessary. We report a case of self-healing omental infarction with a clinical course confirmed by contrast-enhanced computed tomography (CT). Case Report: A 53-year-old man presented to our emergency department with right lower abdominal pain. Contrast-enhanced CT scan revealed elevated fat density in the greater omentum and we diagnosed omental infarction based on these findings. The symptoms gradually improved with conservative treatment and we confirmed improvement using contrast-enhanced CT and blood tests. Conclusion: Omental infarction is a relatively rare disease characterized by acute abdomen. Nonsevere cases may be successfully treated without antibiotics. We conclude that contrast-enhanced CT is useful for the diagnosis and follow-up of omental infarction that is treated conservatively.

Mycotic aortic aneurysm as a postsurgical complication: report of a case and review of the literature

Mycotic aneurysms are localized and irreversible dilatations of the arteries caused by weakening and damaging the arterial wall by an invasive organism establishing infective arteritis. Mycotic aneurysm of the thoracic aorta is a rare event; however, it can be fatal if not diagnosed early or not treated appropriately. Clinical findings are usually nonspecific; however, contrast-enhanced computed tomography (CT) is a common imaging modality of choice for the detection of mycotic aneurysms. Current management consists of antibiotic therapy and surgical treatment or endovascular interventions as early as possible. Herein, we present a case report of mycotic aneurysm of the thoracic aorta as a postoperative complication in a 60-year-old female with a clinical history of the cardia and esophageal carcinoma who underwent thoracic surgery. The presence of mycotic aneurysm was detected after performing a contrast-enhanced thoracic CT scan

2540 An Exceptionally Rare Cause of Abdominal Pain: Protein C Deficiency-Induced Mesenteric Panniculitis

INTRODUCTION: Mesenteric panniculitis (MP) is a rare benign disorder that affects the intestinal mesentery causing unexplained gastrointestinal complaints. Herein, we present a case of MP-induced by microinfarction due to Protein C deficiency. CASE DESCRIPTION/METHODS: A 46-year-old female patient with a significant medical history of protein C deficiency and recurrent deep vein thrombosis on long term anticoagulation with warfarin presented to the emergency department after a syncopal episode. She suffered from persistent nausea, vomiting, inability to tolerate oral intake, and mild abdominal pain for the last two weeks prior to presentation. Physical examination was mostly unremarkable except for mild periumbilical tenderness and orthostatic hypotension. Laboratory testing revealed a white blood count of 8 K/uL, hemoglobin of 14.9 g/dL, serum sodium of 135 mmol/L, serum potassium of 4.1 mmol/L, blood urea nitrogen of 20 mg/dL, creatinine of 1.0 mg/dL, international normalized ratio (INR) of 1.23, D-Dimer of 1221 ng/mL, C-reactive protein of 20 mg/L, and erythrocyte sedimentation rate of 29 mm/hr. Contrast-enhanced computed tomography (CT) of the chest and abdomen was negative for thromboembolism, however, it showed a hazy, misty appearance of the mesentery with multiple prominent lymph nodes. The patient was treated conservatively; warfarin was resumed with heparin bridging. With clinical improvement, the patient was discharged home. DISCUSSION: MP is a benign fibroinflammatory disorder primarily affecting the adipose tissue of the mesentery with a prevalence range between 0.16-0.6%. It typically occurs in the 6th decade of life with a male to female ratio of 2:1. The underlying etiology of MP remains unclear, history of abdominal surgery and trauma were considered predisposing factors in the majority of the cases, in addition to autoimmune disorders and vasculitis. Clinical presentation varies with most of the cases being typically asymptomatic. Symptomatic patients report nonspecific complaints such as abdominal pain, fever, nausea, and fatigue. Physical examination and laboratory workup are usually nonrevealing but palpable masses have been reported. These factors make the diagnosis even more challenging and usually requires a contrast-enhanced CT scan. Hence, high clinical suspicion is required to diagnose MP while investigating otherwise unexplained abdominal pain.