Cross-sectional Computed Tomography Images Research Articles

Enterobius Vermicularis Unusual Cause of Appendicitis: A Case Report

Abdominal pain is common in children (under 18 years) with a strong female preponderance in those aged over 8 years. Of those presenting with acute abdominal pain requiring inpatient assessment, only 25% have acute appendicitis. Pinworms are the most common helminth infection in the USA and Western Europe, with prevalence rates in some communities of as high as 30-50%. Pinworms generally live in the gastrointestinal tract, and helminth infestations have been noted in over one-quarter of acute appendectomies on histologic examination. Acute appendicitis is one of the most common emergent surgeries. Generally, appendicitis is inflammation of the appendix. The medical procedure for the departure of the reference area is called an appendectomy. Appendectomy can be performed through an open or laparoscopic medical procedure, and it is the most effective way to prevent complications is to remove the inflamed appendix early by open surgery or laparoscopically. This case was a 14 years old female with abdominal pain and acute appendicitis that underwent surgery shows Occiur patch was the cause of her signs and symptoms of acute appendicitis that performed resection of appendix and discharge healthy. The present study presents a classic case of parasitic appendicitis in a teenage girl and discusses the clinical features, treatment and global burden of disease. Atypical presentations may indicate an unusual anatomical placement of the appendix. Preoperative diagnosis using cross-sectional computed tomography imaging and a thorough understanding of these situations frequently result in early diagnosis and expeditious surgical care. EV was seen in 9.8% of pediatric appendectomies in our study. Pruritus anus, normal WBC count, normal neutrophil count, and normal CRP level at presentation could predict EV infection in children who present with right iliac fossa pain. E. vermicularis is responsible for 7% of acute appendicitis. It is responsible for a significantly higher negative appendectomy rate which if predicted may avoid unnecessary appendectomy and associated morbidity. Enterobius vermicularis associated appendicular colic and acute appendicitis are rarely encountered in the United States. The high rate of inflammation on pathology found among our patients with pinworm appendicitis suggests an association with presentation as acute appendicitis. Enterobius vermicularis is known to be associated with appendicitis, however a causal relationship between Enterobius and appendicitis has not been established. The aim of this study was to explore the relationship between appendiceal Enterobius and histologic appendicitis. Enterobius-associated appendicitis cases and compare them with acute appendicitis cases in terms of parameters such as the neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP)-to-lymphocyte ratio (CLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Enterobius vermicularis infections are usually asymptomatic and may only cause anal pruritis, with occasional reported cases of ectopic migration into the appendix or the female genital tract by adult pinworms.

The Clinical Significance of Myosteatosis in Survival Outcomes in Patients with Hepatocellular Carcinoma Treated with Sorafenib.

The role of body composition parameters in sorafenib-treated hepatocellular carcinoma (HCC) patients is still not fully elucidated. Here, we aimed to evaluate the impact of computed tomography (CT)-based body composition parameters on the survival of such patients. In this multicenter study, we analyzed the data of 245 sorafenib-treated HCC patients from January 2008 to December 2019. Sarcopenia, visceral obesity, and myosteatosis were defined by using cross-sectional CT images at the third lumbar vertebra level. The effects of these parameters on overall survival (OS) and progression-free survival (PFS) were evaluated. The median age was 67.0 years (interquartile range: 61.0-78.0 year), and 211 patients (86.1%) were male. The median OS and PFS were 7.9 months and 4.8 months, respectively. Vascular invasion (hazard ratio (HR), 1.727; 95% confidence interval (CI), 1.258-2.371; p = 0.001), extrahepatic metastasis (HR, 1.401; 95% CI, 1.028-1.908; p = 0.033), alpha-fetoprotein level > 200 ng/mL (HR, 1.559; 95% CI, 1.105-2.201; p = 0.012), and myosteatosis (HR, 1.814; 95% CI, 1.112-2.960; p = 0.017) were associated with OS. Patient mortality was significantly higher in the group with two or more risk factors than in the group with fewer risk factors. In conclusion, myosteatosis may be a novel prognostic CT-based radiological biomarker in sorafenib-treated HCC patients.

Predicting Waist Circumference From a Single Computed Tomography Image Using a Mobile App (Measure It): Development and Evaluation Study.

Despite the existing evidence that waist circumference (WC) provides independent and additive information to BMI when predicting morbidity and mortality, this measurement is not routinely obtained in clinical practice. Using computed tomography (CT) scan images, mobile health (mHealth) has the potential to make this abdominal obesity parameter easily available even in retrospective studies. This study aimed to develop a mobile app as a tool for facilitating the measurement of WC based on a cross-sectional CT image. The development process included three stages: determination of the principles of WC measurement from CT images, app prototype design, and validation. We performed a preliminary validity study in which we compared WC measurements obtained both by the conventional method using a tape measurement in a standing position and by the mobile app using the last abdominal CT slice not showing the iliac bone. Pearson correlation, student t tests, and Q-Q and Bland-Altman plots were used for statistical analysis. Moreover, to perform a diagnostic test evaluation, we also analyzed the accuracy of the app in detecting abdominal obesity. We developed a prototype of the app Measure It, which is capable of estimating WC from a single cross-sectional CT image. We used an estimation based on an ellipse formula adjusted to the gender of the patient. The validity study included 20 patients (10 men and 10 women). There was a good correlation between both measurements (Pearson R=0.906). The student t test showed no significant differences between the two measurements (P=.98). Both the Q-Q dispersion plot and Bland-Altman analysis graphs showed good overlap with some dispersion of extreme values. The diagnostic test evaluation showed an accuracy of 83% when using the mobile app to detect abdominal obesity. This app is a simple and accessible mHealth tool to routinely measure WC as a valuable obesity indicator in clinical and research practice. A usability and validity evaluation among medical teams will be the next step before its use in clinical trials and multicentric studies.

Computed tomography-based abdominal sarcopenic indices and bio-impedance analysis-based skeletal muscle mass index in hemodialyzed patients

Information about muscle wasting in hemodialyzed patients evaluated using computed tomography (CT) is limited. The present study aimed to examine the relationships between CT-based abdominal sarcopenic indices and bio-impedance analysis (BIA)-based skeletal muscle mass index (SMMI) in these patients. A total of 100 consecutive maintenance hemodialyzed patients who underwent CT and BIA were included. The psoas muscle index (PMI), paraspinous muscle index (PSMI), and abdominal skeletal muscle index (ASMI) were calculated by adjusting each muscle area to the height square. The psoas muscle thickness per height (PMTH) was measured using a single cross-sectional CT image obtained at the level of the third lumbar vertebra. The relationships between these CT-based sarcopenic indices and the BIA-based SMMI were examined. Moreover, the diagnostic values of these CT-based indices for BIA-defined muscle wasting (defined by the sex-specific SMMI: males, <7.0kg/m2; females, <5.7kg/m2) were investigated. The PMI, PMTH, PSMI, and ASMI were significantly correlated with the SMMI (r=0.678, 0.760, 0.708, and 0.785, respectively; p<0.0001 for all). Twenty-eight patients with reduced muscle mass determined by BIA were identified. After age-sex adjustment, a multivariate logistic regression analysis revealed that the C-statistics of the PMI, PMTH, PSMI, and ASMI for the diagnosis of low muscle mass were 0.863 (p=0.0099), 0.870 (p=0.013), 0.891 (p=0.040), and 0.950 (reference), respectively. CT-based abdominal sarcopenic indices presented here may be useful for evaluating muscle wasting in hemodialyzed patients; the ASMI may be the most recommended sarcopenic index for such evaluations.

Calcium evaluation using coronary computed tomography in combination with optical coherence tomography.

Optical coherence tomography (OCT) can assess calcium thickness, a key factor for predicting good stent expansion; however, it underestimates coronary calcium severity due to its penetration limitation. This study aimed to evaluate computed tomography (CT) and OCT images to assess calcification. We investigated 25 left anterior descending arteries of 25 patients, using coronary CT and OCT, and assessed their calcification. Of the 25 vessels, 1811 pairs of CT and OCT cross-sectional images were co-registered. Of the 1811 cross-sectional CT images, calcification was not detectable in 256 (14.1%) of the corresponding OCT images due to limited penetration. In the 1555 OCT calcium-detectable images, the maximum calcium thickness was not detectable in 763 (49.1%) images compared to the CT images. In CT images of slices corresponding to undetected calcium in OCT images, the angle, thickness, and maximum density of calcium were significantly smaller compared to slices corresponding to detected calcium in OCT. Calcium with an undetectable maximum thickness in the corresponding OCT image had a significantly greater calcium angle, thickness, and density than calcium with a detectable maximum thickness. There was an excellent correlation between CT and OCT with respect to calcium angle ( R= 0.82, P < 0.001). The calcium thickness on the OCT image had a stronger correlation with the maximum density on the corresponding CT image (R = 0.73, P < 0.001) than with the calcium thickness on the CT image (R = 0.61, P < 0.001). Cross-sectional CT imaging allows for pre-procedural assessment of calcium morphology and severity and could complement the lack of information on calcium severity in OCT-guided percutaneous coronary intervention.

The impact of osteosarcopenia in patients with unresectable or recurrent biliary tract cancer receiving palliative chemotherapy.

Osteosarcopenia is a newly described syndrome that has been reported to be associated with worse outcomes in various types of cancer. However, its impact on survival in biliary tract cancer remains unclear. This study evaluated the impact of osteosarcopenia on survival in patients with unresectable or recurrent biliary tract cancer. A total of 306 patients with unresectable or recurrent biliary tract cancer who initiated chemotherapy at our institution between 2015 and 2021 were retrospectively investigated. Skeletal muscle index and bone mineral density were measured using pretreatment cross-sectional computed tomography images. Baseline characteristics and survival outcomes were compared between patients with osteosarcopenia and those without. The Cox proportional hazards regression model was used to identify factors associated with survival. Osteosarcopenia was present in 66 patients (22%) and was associated with older age (74 vs. 69years, P<0.001) and female sex (58 vs. 37%, P=0.003). Patients with osteosarcopenia tended to have worse performance status (P=0.098), higher modified Glasgow prognostic score (P=0.082), higher neutrophil to lymphocyte ratio (P=0.058) and were significantly less likely to receive combination chemotherapy (68 vs. 80%, P=0.044) than those without. Osteosarcopenia was associated with reduced survival (8.9 vs. 14.0months, P<0.001) and was identified as an independent factor predicting shorter survival in multivariate analysis. Osteosarcopenia was associated with poor survival in unresectable or recurrent biliary tract cancer treated with chemotherapy. This study highlights the potential importance of screening for osteosarcopenia in patients with biliary tract cancer.

Filament Structure Analysis of Multifilament MgB2 Wires by Using X-ray CT

We have investigated the filament structure of 18-filament MgB <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> wires by using an X-ray computed tomography (CT). For the structural analysis of MgB <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> filaments and Nb barriers, we adopted two image processing, the adoptive binarization method and the closing technique, to the series of cross-sectional CT images. After the image processing, we successfully eliminated the effect of several artifacts, such as metal artifacts and beam hardening, and extrapolated the area of MgB <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> filaments and Nb barriers. From the images, we made a three-dimensional model of MgB <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> filaments and confirmed whether the breakout of the filaments and sausaging phenomena exist or not. Although the broken filaments were not observed, the Nb barrier's break was confirmed in all six inner filaments of the MgB <sub xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sub> wire after heat treatment. Moreover, from the statistical distribution analysis, sausaging is more significant in the inner filament than in the outer filament. These results indicate that the X-ray CT observation and advanced image processing is effective in understanding the filament structure in non-destructive ways.

Association of sarcopenia and treatment tolerability in older adults with advanced cancer: Secondary analysis of a nationwide NCI Community Oncology Research Program (NCORP) randomized clinical trial.

12038 Background: Sarcopenia (sarc) is defined by reduced muscle function paired with low muscle mass or quality. Sarc is common in older adults, but the relationship between sarc and treatment tolerability in older patients (pts) with cancer has not been established. This secondary analysis of our nationwide University of Rochester NCORP Research Base randomized trial examines whether pre-treatment sarc was associated with treatment toxicity and survival in older pts with advanced cancers. Methods: Pts aged 70 and older with incurable solid tumors and lymphoma initiating a new high-risk systemic treatment were enrolled in GAP70+ (NCT02054741). GAP70+ was a cluster randomized trial evaluating whether a geriatric assessment intervention can reduce cancer treatment toxicity. This secondary analysis included 161 pts with baseline computed tomography (CT) scans and physical function testing. Sarc was defined as low muscle strength (5-time Chair Stand Test &gt; 16.7 seconds) with reduced muscle mass (BMI and sex-specific cutoffs, cm/m2) or low muscle quality (Hounsfield units [HU] average radiodensity thresholds) utilizing validated cross-sectional CT imaging metrics. Sarc was defined as severe in presence of reduced physical performance (Timed-Up-And-Go &gt; 13.5 seconds). We evaluated if the proportion of pts experiencing any grade 3-5 toxicity in the first 3 months of treatment using Common Terminology Criteria for Adverse Events (CTCAE) V4.0 was higher in those with sarc than those without sarc. Multivariate logistic regression was used to further explore this relationship. Multivariate Cox regression analysis was performed to evaluate the association of sarc and severe sarc with 1-year survival. Results: Mean age of the 161 participants included in this cohort was 76.6 years and 60.9% of were male; over half had gastrointestinal (34.8%) or lung cancer (23.6%). Sarc was found in 91 of 161 (56.5%) pts; 54 had severe sarc. Pts with sarc did not experience significantly more grade 3-5 toxicity compared to those without sarc (79.1% vs. 71.4%, p = 0.26). However, pts with sarc experienced more grade 3-5 non-hematologic toxicity (63.7% vs. 44.3%, p = 0.01) on univariate and multivariate analysis (OR 2.2, CI 1.1-4.5, p = 0.02). The association between sarc and worse survival at 1-year was not statistically significant (OR 1.5, CI 0.9-2.4, p = 0.13). Those with severe sarc did demonstrate significantly worse 1-year survival on multivariate analysis (HR 1.8, CI 1.1-2.9, p = 0.02). Conclusions: Older pts with cancer and sarc were more likely to suffer serious non-hematologic toxicity from cancer treatment. Furthermore, those with severe sarc had significantly worse survival. Evaluation for sarc before initiating treatment in older adults could help oncologists identify pts at higher risk of toxicity and poor survival. Clinical trial information: NCT02054741 .

Sarcopenia Is a Prognostic Factor in Patients Undergoing Percutaneous Endoscopic Gastrostomy.

(1) Background: Percutaneous endoscopic gastrostomy (PEG) is a widely used long-term enteral nutrition method, but little is known about the associated prognostic factors in patients with PEG. Sarcopenia, a condition characterized by a loss of skeletal muscle mass, increases the risk of developing various gastrointestinal disorders. Yet, the relationship between sarcopenia and the prognosis after PEG remains unclear. (2) Methods: We conducted a retrospective study of patients who underwent PEG consecutively from March 2008 to April 2020. We analyzed preoperative sarcopenia and the prognosis of patients after PEG. We defined sarcopenia as a skeletal muscle index at the level of the third lumbar vertebra of ≤29.6 cm2/m2 for women and ≤36.2 cm2/m2 for men. Cross-sectional computed tomography images of skeletal muscle at the level of the third lumbar vertebra were evaluated using DICOM image analysis software (OsiriX). The primary outcome was the difference in overall survival after PEG based on the status of sarcopenia. We also performed a covariate balancing propensity score matching analysis. (3) Results: Of 127 patients (99 men, 28 women), 71 (56%) were diagnosed with sarcopenia, and 64 patients died during the observation period. The median follow-up period did not differ between patients with and without sarcopenia (p = 0.5). The median survival time after PEG was 273 days in patients with sarcopenia and 1133 days in those without (p < 0.001). Cox proportional hazard model analyses identified three factors that were significantly associated with overall survival: sarcopenia (adjusted hazard ratio [HR]: 2.9, 95% confidence interval [CI]: 1.6-5.4, p < 0.001), serum albumin level (adjusted HR: 0.34, 95% CI: 0.21-0.55, p < 0.001) and male sex (adjusted HR: 2.0, 95% CI: 1.1-3.7, p = 0.03). Propensity score-matched analysis (n = 37 vs. 37) showed that the survival rate was lower in the sarcopenia group than in the non-sarcopenia group (at 90 days: 77% (95% CI, 59-88) vs. 92% (76-97), at 180 days: 56% (38-71) vs. 92% (76-97), and at one year: 35% (19-51) vs. 81% (63-91), p = 0.0014). (4) Conclusions: Sarcopenia was associated with poor prognosis in patients having undergone PEG.

Calf extra-Fascial compartment area affects calf muscle pumping action: an air plethysmography and computed tomography study

We aimed to elucidate whether lower limb extra-fascial compartment and muscle areas affect the calf muscle pumping action on lower limbs. This study included 90 patients (180 limbs) who underwent preoperative air plethysmography (APG) and preoperative non-contrast computed tomography (CT) of the lower limbs for diagnosis of unilateral or bilateral primary varicose veins. A correlation between cross-sectional CT images and preoperative APG was confirmed. Cross-sectional CT was used to measure the extra-fascial compartment and muscle areas of the calf. The lower limbs were divided into two groups: those that were normal and those with primary varicose veins. The extra-fascial compartment area was significantly correlated with the ejection fraction in normal (r = 0.388, n = 53, p = 0.004) and varicose limbs (r = 0.232, n = 91, p = 0.027). In normal and varicose limbs, evaluation of ejection fraction, an indicator of muscle pumping, requires consideration of the extra-fascial compartment area.

Establishment and validation of reference values for abdominal skeletal muscle compartments in children

Sarcopenia, resulting from skeletal muscle loss, is a serious concern in children, for whom nutrition and physical activity are essential for growth. In sarcopenia research, the skeletal muscle mass is often obtained from computed tomography (CT) cross-sectional images in both adults and children; however, the method of evaluating skeletal muscle using CT, especially the area range to be measured, has not yet been validated in children. The aim of this study is to establish reference values for three compartments of the abdominal skeletal muscle area (aSMA) obtained from cross-sectional CT images, and to validate the differences among them by assessing correlations with physical development. We conducted a single-centre, retrospective, cross-sectional study and included patients aged 1-17 years who underwent abdominal CT at Chiba University Hospital from 2007 to 2020. Patients with chronic diseases such as malignant tumours and inflammatory bowel disease were excluded from the analysis. aSMA was obtained from CT cross-sections at the lumbar L3-L4 intervertebral disc level by dividing it into three compartments: the psoas muscle area (PMA), paraspinal muscle area (PSMA), and total skeletal muscle area (TSMA). Quartile regression curves by sex and muscle compartment were generated using non-crossover and nonparametric regression quantile estimation. The correlation between each compartment of aSMA with height and weight was assessed using Spearman's rank correlation coefficient. We analysed the abdominal CT images of 593 children (male: n=335, female: n=258) and generated curves predictive for the 5th, 25th, 50th, 75th, and 95th percentiles for each compartment of aSMA by sex. In patients aged 13 years and older, boys had significantly larger aSMA areas than girls in all three compartments. Among the three compartments, PSMA had the strongest correlation coefficient with height and weight for both boys and girls. We generated quantile regression curves for three aSMA compartments obtained from cross-sectional CT images and established reference values in children. PSMA values were most strongly correlated with height and weight among the three aSMA compartments.

Mean density of computed tomography for predicting rotational atherectomy during percutaneous coronary intervention

BackgroundMulti-slice computed tomography (CT) allows noninvasive evaluation of the severity of coronary calcification. However, there has yet to be a definitive parameter based on the cross-sectional CT image for predicting the need for rotational atherectomy (RA). Therefore, we aimed to investigate the mean density of cross-sectional CT images to predict the need for RA during percutaneous coronary intervention (PCI). MethodsA total of 154 lesions with moderate to severe calcification detected in coronary angiography were identified in 126 patients who underwent coronary CT prior to PCI for stable angina. PCI with RA was performed for 48 lesions, and the remaining 106 were treated without RA. Multi-slice CT was retrospectively evaluated for its ability to predict the use of RA. We chose the most severely calcified cross-sectional image for each lesion. The mean density within the outer vessel contour, calcium arc quadrant of the cross-sectional CT image, calcium length, calcification remodeling index, and per-lesion coronary artery calcium score was studied. ResultsReceiver-operator characteristic curve analysis revealed 637 Hounsfield units (HU) (area under the curve ​= ​0.98, 95% confidence interval: 0.97–1.00, p ​< ​0.001) as the best mean density cutoff value for predicting RA. Multivariate logistic regression analysis showed that a mean calcium level >637 HU was a strong independent predictor (odds ratio: 32.8, 95% confidence interval: 7.0–153, p ​< ​0.001) for using RA. ConclusionsThe mean density of the cross-sectional CT image, a simple quantitative parameter, was the strongest predictor of the need for RA during PCI.

Low skeletal muscle mass predicts poor prognosis for patients with stage III cervical cancer on concurrent chemoradiotherapy

ObjectivesThe aim of this study was to evaluate whether low skeletal muscle mass before initial treatment is an independent prognostic factor defining overall survival (OS) and progression-free survival (PFS) in patients diagnosed with stage III cervical cancer. MethodsBody composition and clinicopathologic data were collected retrospectively. Information was extracted and analyzed from the medical records of 92 patients with stage III cervical cancer and undergoing concurrent chemoradiotherapy. Skeletal muscle mass in the L3 region was measured using cross-sectional computed tomography images and corrected for body surface area to calculate the skeletal muscle index (SMI). The primary outcome was OS, and the secondary outcome was PFS. Statistical analyses were performed using the Mann–Whitney U test. The Kaplan–Meier method was used to determine OS and PFS. Univariate and multivariate analyses were performed with Cox proportional hazard ratios. ResultsThe optimal cutoff value for predicting 5-y survival was 35.6 cm2/m2, defined based on data derived from 24 patients with a low SMI and 68 patients without a low SMI. A low SMI was significantly associated with shorter OS (hazard ratio [HR], 2.470; 95% confidence interval [CI], 1.208–5.053; P = 0.013), with no significant difference in PFS (HR, 1.651; 95% CI, 0.876–3.110; P = 0.121). Multivariate analysis also identified a low SMI as an independent OS-defining prognostic factor (HR, 2.473; 95% CI, 1.151–5.314; P = 0.020). ConclusionA low pretreatment SMI is an independent prognostic factor for OS in patients diagnosed with stage III cervical cancer and treated with concurrent chemoradiotherapy.

Development of a navigable 3D virtual model of temporal bone anatomy

Background Computed Tomography (CT) scanning offers an accurate structural definition of bones, blood vessels, and soft tissues; however, mental integration of cross-sectional 2D CT images for a 3D understanding of complex anatomical structures becomes difficult when the field of view is confined to the temporal bone. This project tried to provide a feasible solution to this problem by creating a navigable 3D virtual model which may aid in better comprehension of the temporal bone anatomy. Methods A helical-CT scan was used to obtain high-resolution cross-sectional slices of a cadaveric human temporal bone. Using the volume-rendering capabilities of 3D Slicer®, which involves volume data management, cropping of the data set, and threshold painting, detailed anatomical structures were segmented based on the intensity captured from different regions. This volumetric data was converted to an interactive virtual model using Blender®. Results The final product is a web page that allows interaction and navigation with a 3D annotated model of the temporal bone, which can be accessed from any device with a web browser. Conclusion This model can function as a training tool for students, teachers, and practitioners to understand and review the complex anatomy of the temporal bone.

Linear CT-scan measurements of cerebral ventricles in senile Poodle dogs.

Breed traits seem to influence the dimensions of the cerebral ventricles in dogs. The ratios between the ventricles and the brain are crucial diagnostic criteria for suspected canine cognitive dysfunction (CCD). This study aimed to establish linear computed tomography (CT)-scan measurements of the cerebral ventricles in 55 Poodle dogs aged >7 years. To this end, cross-sectional CT images were evaluated. The measurements in the whole sample were: height of the right ventricle, 6.0 ± 1.6 mm; height of the left ventricle, 5.8 ± 1.6 mm; width of the right ventricle, 6.9 ± 1.4 mm; width of the left ventricle, 7.0 ± 1.3 mm; height of the third ventricle, 3.4 ± 0.8 mm; height of the right cerebral hemisphere, 39.5 ± 2.0 mm; and height of the left cerebral hemisphere, 40.2 ± 2.6 mm. The average ventricular measurements were higher in dogs older than 11 years (p < 0.05). However, the average ratio of the ventricle height to the height of the brain did not reveal differences between age groups, sex, or antimeres. In addition, none of the images showed fused lateral ventricles. Thus, these data can assist in interpreting ventricle size in senile Poodle dogs (aged >7 years).

Impact of body composition and genotype on haemodynamics during surgery for pheochromocytoma and paraganglioma.

Maintaining intraoperative haemodynamic stability can reduce cardiovascular complications during surgery for pheochromocytoma and paraganglioma (PPGL). Risk factors such as tumour size and catecholamine levels are reported to predict haemodynamic responses during surgery for PPGL. We hypothesized that additional factors including body composition and genetic information could further improve prediction. Consecutive patients with PPGL confirmed by surgical pathology between June 2010 and June 2019 were retrospectively included. Cross-sectional computed tomography images at the L3 level were used to assess body composition parameters including skeletal muscle area and visceral fat area. Next-generation sequencing was performed using a panel containing susceptibility genes of PPGL. Differences in clinical-genetic characteristics and body composition parameters were analysed and compared in patients with and without intraoperative haemodynamic instability (HDI). We included 221 patients with PPGL (median age 47 [38-56] years, and 52% male). Among them, 49.8% had Cluster 2 mutations (related to kinase signalling pathways), 44.8% had sarcopenia, and 52.9% experienced intraoperative HDI. Compared with patients without HDI, more patients with HDI had Cluster 2 mutations (59.8% vs. 38.5%, P=0.002) and less had sarcopenia (35.9% vs. 54.8%, P=0.005). Multivariate analysis showed that urine vanillylmandelic acid≥58μmol/day (adjusted odds ratio [OR]=1.840, 95% confidence interval [CI]=1.012-3.347, P=0.046), tumour size≥4cm (adjusted OR=2.278, 95% CI=1.242-4.180, P=0.008), and Cluster 2 mutations (adjusted OR=2.199, 95% CI=1.128-4.285, P=0.021) were independent risk factors for intraoperative HDI, while sarcopenia (adjusted OR=0.475, 95% CI=0.266-0.846, P=0.012) decreased the risk. Body composition and genotype were associated with intraoperative haemodynamics in patients with PPGL. Our results indicated that inclusion of body composition and genotype in the overall assessment of patients with PPGL helped to predict HDI during surgery, which could assist in implementing preoperative and intraoperative measures to reduce perioperative complications.

Hidden appendix: A case report and literature review of perforated acute appendicitis masquerading as acute cholecystitis.

IntroductionAcute appendicitis of the subhepatic appendix is uncommon, and a preoperative diagnosis is difficult without a thorough understanding of the various anatomical locations. Cross-sectional imaging is indispensable for prompt diagnosis and subsequent treatment. Surgery is the standard treatment for perforated appendicitis in the subhepatic region. In this study, we present a case of subhepatic appendicitis with an unusual presentation.Case presentationA 28-year-old man presented to our emergency department with a 3-day history of diffuse right abdominal discomfort, diarrhea, fever, and vomiting. Physical examination revealed rebound soreness and guarding in the right upper and lower quadrants. Laboratory tests revealed high levels of C-reactive protein and serum bilirubin and neutrophilic leukocytosis. Abdominal computed tomography revealed an undescended cecum and a subhepatic appendix with an intraluminal appendicolith, fat stranding, and peri-appendiceal fluid. The patient underwent open exploration and appendicectomy, during which the subhepatic perforated appendix was excised. The patient's recovery was uneventful.DiscussionAtypical presentations may indicate an unusual anatomical placement of the appendix. Preoperative diagnosis using cross-sectional computed tomography imaging and a thorough understanding of these situations frequently result in early diagnosis and expeditious surgical care.ConclusionSurgical crises resulting from aberrant anatomical variations of the appendix constitute a distinct diagnostic challenge. A strong index of suspicion for this uncommon presentation permits early surgical intervention and prevents delay-induced morbidity/mortality.

One‐Year Comparison of Body Composition in a Cohort of Patients with Multiple Myeloma

ObjectiveTo examine whether there are changes in body fat composition and skeletal muscle density over a one‐year period in a cohort of patients with multiple myeloma.HypothesisWe hypothesized that there are differences in specific body fat composition and skeletal muscle indices in a one‐year follow‐up for patients with multiple myeloma. These changes may predict the progression of disease more accurately and offer opportunities to improve outcomes with clinical intervention.MethodsThis is a retrospective cohort study examining preexisting CT scans of multiple myeloma (MM) patients from a midwestern healthcare system. Demographic information including age, sex, race, and BMI was gathered (Table 1). The body fat and skeletal muscle measurements were performed by one investigator using Aquarius iNtuition software version 4.4.12. To standardize the CT scan measurements, slices were taken at the third lumbar vertebra where both transverse processes were visible. Measurements were confirmed using tissue‐specific Hounsfield unit (HU) ranges of ‐190 to ‐30 for adipose tissue and ‐20 to 150 for skeletal muscle. All scans were measured in a light‐controlled radiological reading room and investigator training was performed under the supervision of a board‐certified radiologist who specializes in abdominal imaging.ResultsA total of 22 unique patients (14 women and 8 men) with MM were identified as having had two whole body low‐dose CT scans one year apart during the study period. In women, the mean visceral adipose tissue (VAT) area (cm2) and the subcutaneous adipose tissue (SQAT) area (cm2) decreased slightly from baseline to the one‐year follow‐up (Figure 1). The mean skeletal muscle density showed a small increase from baseline to follow‐up. Men also showed a small decrease visceral adipose tissue (VAT) area (cm2) and the subcutaneous adipose tissue (SQAT) area (cm2) from baseline to one‐year follow‐up. In contrast to women, they showed a small decrease from baseline to follow‐up. All changes were non‐significant.ConclusionsWe performed a retrospective analysis of changes in body fat composition and skeletal muscle density in multiple myeloma patients over a one‐year period. Previous studies have shown that higher SQAT is associated with worse overall survival. However, we found no changes in any of our parameters over the course of one year that would indicate a trend towards disease progression. Further follow‐up may be needed over a longer time period. Additionally, a larger sample with more complete imaging records is needed to make stronger conclusions. More reliable prognostic biomarkers would help determine current disease burden.1. Gomez‐Perez SL, Haus JM, Sheean P, et al. Measuring abdominal circumference and skeletal muscle from a single cross‐sectional computed tomography image: A step‐by‐step guide for clinicians using National Institutes of Health ImageJ. J Parenter Enter Nutr. 2016;40(3):308‐318. doi:10.1177/01486071156041492. Da Cunha, Ademar Dantas, et al. “Adipose Tissue Radiodensity: A New Prognostic Biomarker in People with Multiple Myeloma.” Nutrition, vol. 86, 2021, p. 111141., https://doi.org/10.1016/j.nut.2021.111141.

Predictive Statistical Model of Early Cranial Development.

We present a data-driven method to build a spatiotemporal statistical shape model predictive of normal cranial growth from birth to the age of 2 years. The model was constructed using a normative cross-sectional computed tomography image dataset of 278 subjects. First, we propose a new standard representation of the calvaria using spherical maps to establish anatomical correspondences between subjects at the cranial sutures - the main areas of cranial bone expansion. Then, we model the cranial bone shape as a bilinear function of two factors: inter-subject anatomical variability and temporal growth. We estimate these factors using principal component analysis on the spatial and temporal dimensions, using a novel coarse-to-fine temporal multi-resolution approach to mitigate the lack of longitudinal images of the same patient. Our model achieved an accuracy of 1.54 ± 1.05 mm predicting development on an independent longitudinal dataset. We also used the model to calculate the cranial volume, cephalic index and cranial bone surface changes during the first two years of age, which were in agreement with clinical observations. To our knowledge, this is the first data-driven and personalized predictive model of cranial bone shape development during infancy and it can serve as a baseline to study abnormal growth patterns in the population.

Abstract 9903: CT Number Predicts Calcium Thickness in Optical Coherence Tomography Guided Percutaneous Coronary Intervention

Introduction: Optical coherence tomography (OCT) can assess calcium thickness, which is the key factor for predicting good stent expansion in calcified lesions. However, OCT can underestimate coronary calcium severity due to its penetration limitation and lipid accumulation while multi-slice computed tomography (CT) allows for a noninvasive assessment of coronary calcification. This study aimed to compare cross-sectional CT and OCT images for the assessment of calcification. Methods and Results: We investigated 33 lesions using coronary CT and OCT for the assessment of calcification. Of the 33 lesions, 211 regions of interest were set every 30 degrees in both the CT and OCT cross-sectional images. In 88 (41.7%) regions of interest with CT-detected calcium, the thickness of calcium was not detectable in the corresponding OCT image due to limited penetration, lipid attenuation, and guidewire artifact. There was an excellent correlation between CT number and thickness of calcium in the corresponding OCT image (R=0.797, P&lt;0.001). Receiver-operator curve analysis also showed fair discrimination between calcium thickness less than 500 μm and 500 μm or higher at a CT number of 1021 HU. Conclusions: Cross-sectional CT imaging could complement the underestimation of calcium severity in OCT-guided PCI, predicting the calcium thickness by CT number.