Cross-sectional Imaging Studies Research Articles

Improvement of quality of life in women ≤ 25-years-old with chronic pelvic pain following stenting of nonthrombotic iliac vein compression.

Stenting of nonthrombotic iliac vein compression for chronic pelvic pain (CPP) is controversial, especially in young populations. The current study evaluated the effects of iliac vein stenting on CPP through the assessment of quality-of-life (QoL) and pain scores in female patients ≤25-year-old. A retrospective single site cohort study was conducted for 30 female patients who were treated with left common iliac vein (LCIV) stenting for CPP. QoL was assessed before and after stenting using the following assessments: International Pelvic Pain Society (IPPS), Pelvic Congestion Syndrome (PCS), Pelvic Pain and Urinary Urgency Frequency (PUF), Rome III IBS, ancillary symptoms assessment, and pain scores. Secondary evaluation of the accuracy of radiologic interpretations of iliac vein compression on CT and MRI was also performed. Finally, commonly associated comorbidities within this population were assessed. Patient reported outcomes in 30 iliac vein stent patients demonstrated improvements in QoL post-stenting as demonstrated through significant reductions in IPPS, PCS, and pain scores (p = .0103, .0156, and .0092, respectively). Many of the cross-sectional imaging studies that were read by the interpreting radiologist as normal or mild compression were later identified as moderate or severe by the interventional radiologist clinically evaluating the patient. These patients went on to show significant compression on venography and intravascular ultrasound with associated clinical improvement after stenting. Significant improvements in QoL were identified in young women with CPP after LCIV stenting. Similarities in the clinical presentation of common comorbidities and misinterpretation of cross-sectional imaging studies may make the identification of pelvic venous disease more challenging. Our findings endorse the need for further research on stenting in young women with venous origin CPP through comparative outcomes studies and blinded randomized controlled trials.

Spleen anomalies and lesions in CT and MRI: essentials for radiologists and clinicians-a pictorial review.

The precise evaluation of splenic lesions using cross-sectional imaging presents a complex challenge due to the overlapping imaging characteristics of most splenic diseases and the absence of specific symptoms, complicating the diagnosis process. This pictorial review highlights the essential elements that should be included in a radiology report to interpret cross-sectional imaging studies of splenic lesions. To augment the diagnostic accuracy, we propose the implementation of a stepwise algorithmic approach. This approach offers a comprehensive analysis of splenic anomalies and lesions, providing an invaluable tool for radiologists and clinicians.

Study design features increase replicability in cross-sectional and longitudinal brain-wide association studies.

Brain-wide association studies (BWAS) are a fundamental tool in discovering brain-behavior associations. Several recent studies showed that thousands of study participants are required for good replicability of BWAS because the standardized effect sizes (ESs) are much smaller than the reported standardized ESs in smaller studies. Here, we perform analyses and meta-analyses of a robust effect size index using 63 longitudinal and cross-sectional magnetic resonance imaging studies from the Lifespan Brain Chart Consortium (77,695 total scans) to demonstrate that optimizing study design is critical for increasing standardized ESs and replicability in BWAS. A meta-analysis of brain volume associations with age indicates that BWAS with larger variability in covariate have larger reported standardized ES. In addition, the longitudinal studies we examined reported systematically larger standardized ES than cross-sectional studies. Analyzing age effects on global and regional brain measures from the United Kingdom Biobank and the Alzheimer's Disease Neuroimaging Initiative, we show that modifying longitudinal study design through sampling schemes improves the standardized ESs and replicability. Sampling schemes that improve standardized ESs and replicability include increasing between-subject age variability in the sample and adding a single additional longitudinal measurement per subject. To ensure that our results are generalizable, we further evaluate these longitudinal sampling schemes on cognitive, psychopathology, and demographic associations with structural and functional brain outcome measures in the Adolescent Brain and Cognitive Development dataset. We demonstrate that commonly used longitudinal models can, counterintuitively, reduce standardized ESs and replicability. The benefit of conducting longitudinal studies depends on the strengths of the between- versus within-subject associations of the brain and non-brain measures. Explicitly modeling between- versus within-subject effects avoids averaging the effects and allows optimizing the standardized ESs for each separately. Together, these results provide guidance for study designs that improve the replicability of BWAS.

Literature Review on the Association between Cerebral Large Artery Disease and Cerebral Microbleeds

CMBs are small areas of hemorrhage in the brain, often seen on neuroimaging studies, that have been associated with various cerebrovascular pathologies. Large-artery atherosclerosis and resulting vascular stenosis are major contributors to ischemic stroke. Given the structural continuity between intracranial large and small vessels, their susceptibility to hemodynamic influences, and their shared risk factors, they may coexist in the same individual. This article reviews recent advances in understanding the interplay between large artery atherosclerosis (LAA) and cerebral microbleeds (CMB). Methods: A comprehensive search of electronic databases including PubMed, MEDLINE, and Google Scholar was conducted using relevant keywords such as "cerebral large artery disease," "cerebral microbleeds," "arterial stenosis," and "atherosclerosis." Articles published in English between [2010] and [2024] were considered for inclusion. Studies investigating the relationship between LAA and CMBs through neuroimaging, pathological examination, or clinical correlations were selected for review. Results: The review identified a range of studies exploring the association between LAA and CMBs. Several cross-sectional imaging studies have demonstrated a significant correlation between LAA severity and the presence, number, and distribution of CMBs. Histopathological investigations have revealed microvascular alterations in regions affected by LAA, potentially contributing to CMB formation. The evidence indicates a correlation between cerebrovascular microbleeds (CMBs) and large artery diseases, impacting the prognosis of individuals with cerebral infarction resulting from large artery atherosclerosis (LAA). Keywords: Cerebral infarction; Large-artery atherosclerosis; Cerebral microbleeds.

Portuguese observational cross-sectional clinical imaging study protocol to investigate central dopaminergic mechanisms of successful weight loss through bariatric surgery

IntroductionBariatric surgery (BS) is the treatment of choice for refractory obesity. Although weight loss (WL) reduces the prevalence of obesity-related comorbidities, not all patients maintain it. It has been suggested...

Comparative Analysis of Tomographic Indicators Forecasting Decompensation in Fuchs Endothelial Corneal Dystrophy.

To compare the performance of 3 commercially available tomographers (the Pentacam Scheimpflug camera, the swept-source optical coherence tomography Casia, and the blue light slit-scanning tomographer Precisio) in the identification of patterns associated with Fuchs endothelial corneal dystrophy (FECD) decompensation. This was a clinic-based cross-sectional imaging study. Pachymetry maps and posterior surface elevation maps were acquired with the 3 devices from 61 eyes affected by FECD. The maps were graded according to the evidence of tomographic patterns predictive of FECD decompensation (loss of parallel isopachs, displacement of the thinnest point, and focal posterior depression) by 2 blind cornea specialists. The loss of parallel isopachs was significantly less frequently evident in Pentacam pachymetry maps [8%, 95% confidence interval (CI) (3%, 18%)] compared with both the Casia [31%, 95% CI (20%, 44%), P = 0.01] and Precisio devices [24%, 95% CI (15%, 37%), P = 0.05]. The displacement of the thinnest point was graded as most evident in a significantly higher proportion of Precisio pachymetry maps [43%, 95% CI (31%, 55%)] compared with both the Pentacam [13%, 95% CI (6%, 24%), P = 0.001] and Casia devices [21%, 95% CI (12%, 33%), P = 0.03]. There were no significant differences in the identification of focal posterior depression on posterior elevation maps across the 3 devices. Identification of patterns predictive of FECD prognosis on pachymetry and posterior elevation maps is possible with different devices. However, their evidence varies across tomographers, and the results from different devices are not interchangeable.

Retrospective study of the morphology of third maxillary molars among the population of Lower Silesia based on analysis of cone beam computed tomography.

Understanding the anatomy of root canal systems and being aware of their variations is crucial for successful endodontic treatment. Specifically, the intricate and diverse nature of the root anatomy in maxillary third molars poses a significant challenge for dental clinicians. The study analyzed the morphology of the root canal system in maxillary third molars among residents of the Lower Silesia region in Poland using cone beam computed tomography (CBCT). This retrospective cross-sectional imaging study was conducted at the X-Ray Diagnostics Laboratory of the Academic Dental Polyclinic of Wroclaw Medical University, Poland. The study evaluated 316 CBCT scans and included 196 maxillary third molars. They were obtained from 118 females and 78 males over the age of 18, in the period from January to April 2022 (three consecutive months). The number of roots, root canals, and root canal configurations according to Vertucci's classification were analyzed. Three-rooted maxillary molars were found most often (64.29%), followed by single-rooted (24.49%), two-rooted (7.65%), and four-rooted (3.57%) teeth. Among all the roots examined, Vertucci Type I root canals were the most prevalent. Our research found that single-rooted forms (40 teeth, 33.89% vs. 8 teeth, 10.26%, p = 0.0013) of maxillary third molars were significantly more common in females than in males. However, three-rooted forms (62 teeth, 79.49% vs. 64 teeth, 54.24%, p = 0.0013) of maxillary third molars were significantly more common in males than in females. In the Lower Silesia region, the typical maxillary third molar in the Polish population has a three-rooted structure with Vertucci Type I root canal configuration. We noted a sex-dependent correlation in maxillary third molar morphology, with single-rooted forms more prevalent in women and three-rooted forms in men.

Intrapancreatic fat deposition is unrelated to liver steatosis in metabolic dysfunction-associated steatotic liver disease

Individuals with obesity may develop intrapancreatic fat deposition (IPFD) and fatty pancreas disease (FPD). Whether this causes inflammation and fibrosis and leads to pancreatic dysfunction is less established than for liver damage in metabolic dysfunction-associated steatotic liver disease (MASLD). Moreover, the interrelations of FPD and MASLD are poorly understood. Therefore, we aimed to assess IPFD and fibro-inflammation in relation to pancreatic function and liver disease severity in individuals with MASLD. Seventy-six participants from the Amsterdam MASLD-MASH cohort (ANCHOR) study underwent liver biopsy and multiparametric MRI of the liver and pancreas, consisting of proton-density fat fraction sequences, T1 mapping and intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI). The prevalence of FPD was 37.3%. There was a clear correlation between pancreatic T1 relaxation time, which indicates fibro-inflammation, and parameters of glycemic dysregulation, namely HbA1c (R= 0.59; p <0.001), fasting glucose (R= 0.51; p <0.001) and the presence of type 2 diabetes (mean 802.0ms vs. 733.6ms; p <0.05). In contrast, there was no relation between IPFD and hepatic fat content (R= 0.03; p=0.80). Pancreatic IVIM diffusion (IVIM-D) was lower in advanced liver fibrosis (p <0.05) and pancreatic perfusion (IVIM-f), reflecting vessel density, inversely correlated to histological MASLD activity (p <0.05). Consistent relations exist between pancreatic fibro-inflammation on MRI and endocrine function in individuals with MASLD. However, despite shared dysmetabolic drivers, our study suggests IPFD is a separate pathophysiological process from MASLD. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and 68% of people with type 2 diabetes have MASLD. However, fat infiltration and inflammation in the pancreas are understudied in individuals with MASLD. In this cross-sectional MRI study, we found no relationship between fat accumulation in the pancreas and liver in a cohort of patients with MASLD. However, our results show that inflammatory and fibrotic processes in the pancreas may be interrelated to features of type 2 diabetes and to the severity of liver disease in patients with MASLD. Overall, the results suggest that pancreatic endocrine dysfunction in individuals with MASLD may be more related to glucotoxicity than to lipotoxicity. NTR7191 (Dutch Trial Register).

Imaging Approaches in Dementia: A Retrospective Cohort Study of Cross-sectional Imaging in the Indian Population

Introduction: Dementia is a broad medical term that describes the progressive cognitive decline of brain function due to disease or impairment, resulting in interference with daily activities. Magnetic Resonance Imaging (MRI) is commonly used for the clinical diagnosis of dementia by identifying cerebral atrophy and structural alterations. Furthermore, Magnetic Resonance Spectroscopy (MRS) can detect biochemical abnormalities in dementia patients, which may be beneficial for early diagnosis and treatment. Aim: To provide a comprehensive protocol and a guidance tool for radiologists to effectively diagnose dementia and its subtypes {Alzheimer’s Disease (AD), frontotemporal lobe dementia, etc.} based on radiological findings coupled with volumetry, spectroscopy, and Arterial Spin Labelling (ASL) findings. Materials and Methods: A retrospective observational study was conducted in the Department of Radiology, Nanavati Max Superspeciality Hospital, Mumbai, Maharashtra, India, between June 2022 and June 2023. A total of 125 patients were analysed to observe the correlation between whole brain volume, Intracranial Volume (ICV) of different cortical regions, hippocampal atrophy, and MRS findings. Descriptive statistics were used, and results were expressed as means and standard deviations for continuous variables, and as frequencies and percentages for categorical variables. Results: Out of 125 patients, 71 (56.8%) were males, and 54 (43.2%) were females, with ages ranging from 41 to 96 years. The majority presented with Mild Cognitive Impairment (MCI) 36 patients (28.8%) and Vascular Dementia (VaD) (18 patients - 14.4%). Some clinical features and imaging findings overlapped, resulting in some cases being a combination of different types of dementia. MRI, MRS, and Medial Temporal Atrophy (MTA) played a crucial role in allowing clinicians to perform a differential diagnosis. Conclusion: The use of MR volumetry and spectroscopy aids in classifying the type of dementia, which, in turn, gives treating clinicians a better perspective for further treatment and its outcomes.

Serotonin transporter density in isolated rapid eye movement sleep behavioral disorder.

The serotoninergic nervous system is known to play a role in the maintenance of rapid eye movement (REM) sleep. Serotoninergic projections are known to be vulnerable in synucleinopathies. To date, positron emission tomography (PET) studies using serotonin-specific tracers have not been reported in isolated REM sleep behavior disorder (iRBD). We conducted a cross-sectional imaging study using serotonin transporter (SERT) 11C-3-amino-4-(2-dimethylaminomethyl-phenylsulfaryl)-benzonitrile (DASB) PET to identify differences in serotonin system integrity between 11 participants with iRBD and 16 older healthy controls. Participants with iRBD showed lower DASB distribution volume ratios (DVRs) in the total neocortical mantle [1.13 (SD: 0.07) vs. 1.19 (SD: 0.06); t = 2.33, p = 0.028)], putamen [2.07 (SD: 0.19) vs. 2.25 (SD: 0.18); t = 2.55, p = 0.017], and insula [1.26 (SD: 0.11) vs. 1.39 (SD: 0.09); t = 3.58, p = 0.001]. Paradoxical increases relative to controls were seen in cerebellar hemispheres [0.98 (SD: 0.04) vs. 0.95 (SD: 0.02); t = 2.93, p = 0.007)]. No intergroup differences were seen in caudate, substantia nigra, or other brainstem regions with the exception of the dorsal mesencephalic raphe [3.08 (SD: 0.53) vs. 3.47 (SD: 0.48); t = 2.00, p = 0.056] that showed a non-significant trend toward lower values in iRBD. Insular, neocortical, and striatal serotoninergic terminal loss may be common in prodromal synucleinopathies before the onset of parkinsonism or dementia. Given our small sample size, these results should be interpreted as hypothesis-generating/exploratory in nature.

HPB P52 Castleman Disease in Hepato-pancreaticobiliary Surgery: Friend or Foe?

Abstract Background Castleman disease is a rare lymphoproliferative disorder with low malignant potential. It is associated with risk of lymphoma &amp; follicular dendritic cell tumours. The disease is poorly understood and is well noted in literature, the difficulty in reaching to a diagnosis. While the systemic form of the disease is a subject of Hematological work up, the unifocal disease usually consists of radiologically detected retro-peritoneal or mesenteric masses posing diagnostic challenge to hepato-pancreatico-biliary surgeons. Methods Over a period of 12 years, from 2011 till 2023, in our institution we have identified 4 cases of Castleman disease. Median age of is 60 yo with equal incidence in both sexes. In our series, in all four cases, the diagnosis was incidental while they were being worked up for other conditions. In fact, in 1 case the diagnosis was unexpected after surgery for other reason. Extensive work up including cross-sectional imaging studies failed to reach a diagnosis, therefore, the latter was established by excision. Results All four patients underwent resection that accomplished diagnosis.Three patients underwent surgery for primary excision of the tumour located in various sites of upper abdomen; one para-duodenal, one retro-hepatic and one aorto-caval. In one case, the nodule was a FDG-PET avid mesenteric mass resected in the context of planned Whipple’s procedure for cancer. The Histopathological examination confirmed diagnosis in all cases. Haematology follow-up was recommended in two cases one of which progressed to follicular dendritic cell tumor. All patients were HIV negative and HHV-8 negative. The longest follow-up is 12 years with no evidence of recurrence. Conclusions Castleman’s disease is a rare entity with very low malignant potential. Cases with unifocal disease in upper abdomen are referred to Hepato-pancreato-biliary surgeons and resection is the treatment of choice. The latter allows histopathological analysis establishing the diagnosis. This case series is useful to all HPB surgeons who may come across this diagnostic challenge for this poorly understood pathology.

Lack of reproducibility of resting-state functional MRI findings in migraine with aura.

Several studies have applied resting-state functional MRI to examine whether functional brain connectivity is altered in migraine with aura patients. These studies had multiple limitations, including small sample sizes, and reported conflicting results. Here, we performed a large, cross-sectional brain imaging study to reproduce previous findings. We recruited women aged 30-60 years from the nationwide Danish Twin Registry. Resting-state functional MRI of women with migraine with aura, their co-twins, and unrelated migraine-free twins was performed at a single centre. We carried out an extensive series of brain connectivity data analyses. Patients were compared to migraine-free controls and to co-twins. Comparisons were based on data from 160 patients, 30 co-twins, and 136 controls. Patients were similar to controls with regard to age, and several lifestyle characteristics. We replicated clear effects of age on resting-state networks. In contrast, we failed to detect any differences, and to replicate previously reported differences, in functional connectivity between migraine patients with aura and non-migraine controls or their co-twins in any of the analyses. Given the large sample size and the unbiased population-based design of our study, we conclude that women with migraine with aura have normal resting-state brain connectivity outside of migraine attacks.

A Pilot Study: Free Flap Atrophy in Tongue Reconstruction Using 3D Volumetric Analysis.

To identify factors influencing volume change in non-osseous oral free flap reconstruction using postoperative cross-sectional imaging and 3-dimensional segmentation of the free flap's muscular and adipose tissue content. Oral tongue free flap reconstruction cases (2014-2019) were reviewed with inclusion of patients with 3 postoperative, cross-sectional imaging studies with 1 within 6 months, 1 within 1 year, and 1 that spanned 2 years post-reconstruction. Exclusion criteria included recurrence, significant dental artifact, bony reconstruction, and flap failure. Demographics, risk factors, and surgical/clinical treatments were identified. Flap volumes were measured using Materialise MIMICS. Twenty-two patients met strict inclusion criteria. Four flaps were anterolateral thighs and 18 radial forearms. Median percent volume loss greater than 2 years post-reconstruction was 53.2% overall, 58.1% for radial forearms, and 45.4% for ALTs (21.4% for adipose tissue and 57.4% for muscular tissue). Univariate analysis revealed glossectomy amount was associated with percent volume loss (P = .0417). Each successive postoperative month, the flap decreased by 1.54% (P < .0001). Checking for the interaction effect, the percent of flap loss across time was different for glossectomy amount (P = .0093), obesity status (P = .0431), and base of tongue involvement (P = .0472). Glossectomy type, and thus flap size, is a positive predictor for flap atrophy. Obesity and base of tongue involvement are negative predictors for flap atrophy. The amount of tissue loss may differ from classical teachings with median atrophy 53.2% greater than 2 years post-reconstruction.

TCT-552 Calcified Nodule Is Common at the Edge of a Previously Placed Stent and Is Associated With Severe Lesion Calcium: A Cross-sectional OCT Imaging Study

TCT-552 Calcified Nodule Is Common at the Edge of a Previously Placed Stent and Is Associated With Severe Lesion Calcium: A Cross-sectional OCT Imaging Study

Brain network structural connectome abnormalities among youth with attention-deficit/hyperactivity disorder at varying risk for bipolar I disorder: a cross-sectional graph-based magnetic resonance imaging study.

Attention-deficit/hyperactivity disorder (ADHD) is highly prevalent among youth with or at familial risk for bipolar-I disorder (BD-I), and ADHD symptoms commonly precede and may increase the risk for BD-I; however, associated neuropathophysiological mechanisms are not known. In this cross-sectional study, we sought to investigate brain structural network topology among youth with ADHD, with and without familial risk of BD-I. We recruited 3 groups of psychostimulant-free youth (aged 10-18 yr), namely youth with ADHD and at least 1 biological parent or sibling with BD-I (high-risk group), youth with ADHD who did not have a first- or second-degree relative with a mood or psychotic disorder (low-risk group) and healthy controls. We used graph-based network analysis of structural magnetic resonance imaging data to investigate topological properties of brain networks. We also evaluated relationships between topological metrics and mood and ADHD symptom ratings. A total of 149 youth were included in the analysis (49 healthy controls, 50 low-risk youth, 50 high-risk youth). Low-risk and high-risk ADHD groups exhibited similar differences from healthy controls, mainly in the default mode network and central executive network. We found topological alterations in the salience network of the high-risk group, relative to both low-risk and control groups. We found significant abnormalities in global network properties in the high-risk group only, compared with healthy controls. Among both low-risk and high-risk ADHD groups, nodal metrics in the right triangular inferior frontal gyrus correlated positively with ADHD total and hyperactivity/impulsivity subscale scores. The cross-sectional design of this study could not determine the relevance of these findings to BD-I risk progression. Youth with ADHD, with and without familial risk for BD-I, exhibit common regional abnormalities in the brain connectome compared with healthy youth, whereas alterations in the salience network distinguish these groups and may represent a prodromal feature relevant to BD-I risk.

An alarming rise in COVID-19-related acute macular neuroretinopathy in China: a cross-sectional multimodal imaging study.

COVID-19-related acute macular neuroretinopathy rapidly increased in the pandemic surge in China in December 2022. Possible risk factors and pathophysiological mechanisms including inflammatory responses, vascular factors, and sex hormones have been discussed. Multimodal imaging revealed structural damage and vascular deficits in the retina and choroid, which warrants continuous observation.

Crural and Plantar Fasciae Changes in Chronic Charcot Diabetic Foot: A Cross-Sectional Ultrasound Imaging Study-An Evidence of Fascial Continuity.

Crural fascia (CF) and plantar fascia (PF) are biomechanically crucial in the gait and in the proprioception, particularly in the propulsion phase of the foot during the gait cycle and in the dissipation of forces during weight-bearing activities. Recent studies have revealed an association between increases in PF thickness and diabetes. The purpose of this study was to measure and compare by ultrasound (US) imaging the thickness of the CF and PF at different regions/levels in chronic Charcot diabetic foot patients (group 1) and in healthy volunteers (group 2). A cross-sectional study was performed using US imaging to measure the CF with Pirri et al.'s protocol and PF with a new protocol in a sample of 31 subjects (15 patients and 16 healthy participants). The findings for CF and PF revealed statistically significant differences in the poster region of CF (Post 1: group 1 vs. group 2: p = 0.03; Post 2: group 1 vs. group 2: p = 0.03) and in PF at two different levels (PF level 1: group 1 vs. group 2: p < 0.0001; PF level 2: group 1 vs. group 2: p < 0.0001). These findings suggest that chronic Charcot diabetic foot patients have CF and PF thicker compared to healthy volunteers. The US examination suggests that fascial thicknesses behavior in these patients points out altered fascial remodeling due to diabetes pathology and biomechanical changes.

Imaging of Small Bowel Tumors and Mimics

AbstractSmall bowel tumors are rare with nonspecific and protean clinical presentation. Early diagnosis of small bowel tumors is desirable as they can be associated with significant morbidity. In malignant small bowel tumors, delayed diagnosis may result in dissemination and metastasis leading to poor clinical outcomes. Imaging evaluation of small bowel can be challenging due to unpredictable luminal distension, peristalsis, and motion. In addition, the lack of distinction between the intraluminal lesions and intraluminal contents can be difficult at times. Computed tomography (CT) and magnetic resonance (MR) enterography are the most common imaging techniques for the evaluation of small bowel tumors. While these techniques may not be able to detect small tumors, they provide comprehensive evaluation of lumen, wall, and extramural structures in tumors more than 2 cm. Acquaintance of imaging appearance of common benign and malignant small bowel tumors may allow improved detection during evaluation of CT and MR enterography studies. In this review, we discuss the imaging appearances, approach, and differential diagnosis of small bowel tumors on cross-sectional imaging studies.

Increased risk for incisional hernia following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

The incidence of incisional hernias (IH) after midline laparotomy varies from 11% to 20%. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is potentially prone to hernias because a Xiphoid to pubis laparotomy incision performed on patients who have undergone previous abdominal surgeries with the addition of chemotherapy and its related adverse effects. We performed a retrospective analysis on a prospectively maintained single institution database from March 2015 to July 2020. The inclusion criteria were patients who underwent CRS-HIPEC and had at least 6 months postoperative follow-up with post-operative cross-sectional imaging study. Two hundred and one patients were included in the study. All patients underwent CRS-HIPEC with resection of previous scar and umbilectomy. Fifty-four patients were diagnosed with IH (26.9%). The major risk factors for IH in multivariate analysis were higher American society of Anesthesiologists score (ASA) (OR 3.9, P = 0.012), increasing age (OR 1.06, P = 0.004) and increasing BMI (OR 1.1, P = 0.006). Most of the hernia sites were median (n = 43, 79.6%). Eleven (20.4%) patients had lateral hernias due to stoma incisions or drain sites. Most of the median hernias were at the level of the resected umbilicus 58.9% (n = 23). Five (9.3%) of the patients with IH necessitated an urgent surgical repair. We have demonstrated that more than a quarter of the patients after CRS-HIPEC suffer from IH and up to 10% of them may require surgical intervention. More research is needed to find the appropriate intraoperative interventions to minimize this sequela.

Patterns of pseudoprogression across different cancer entities treated with immune checkpoint inhibitors

BackgroundPseudoprogression (PsPD) is a rare response pattern to immune checkpoint inhibitor (ICI) therapy in oncology. This study aims to reveal imaging features of PsPD, and their association to other relevant findings.MethodsPatients with PsPD who had at least three consecutive cross-sectional imaging studies at our comprehensive cancer center were retrospectively analyzed. Treatment response was assessed according to immune Response Evaluation Criteria in Solid Tumors (iRECIST). PsPD was defined as the occurrence of immune unconfirmed progressive disease (iUPD) without follow-up confirmation. Target lesions (TL), non-target lesions (NTL), new lesions (NL) were analyzed over time. Tumor markers and immune-related adverse events (irAE) were correlated.ResultsThirty-two patients were included (mean age: 66.7 ± 13.6 years, 21.9% female) with mean baseline STL of 69.7 mm ± 55.6 mm. PsPD was observed in twenty-six patients (81.3%) at FU1, and no cases occurred after FU4. Patients with iUPD exhibited the following: TL increase in twelve patients, (37.5%), NTL increase in seven patients (21.9%), NL appearance in six patients (18.8%), and combinations thereof in four patients (12.5%). The mean and maximum increase for first iUPD in sum of TL was 19.8 and 96.8 mm (+ 700.8%). The mean and maximum decrease in sum of TL between iUPD and consecutive follow-up was − 19.1 mm and − 114.8 mm (-60.9%) respectively. The mean and maximum sum of new TL at first iUPD timepoint were 7.6 and 82.0 mm respectively. In two patients (10.5%), tumor-specific serologic markers were elevated at first iUPD, while the rest were stable or decreased among the other PsPD cases (89.5%). In fourteen patients (43.8%), irAE were observed.ConclusionsPsPD occurred most frequently at FU1 after initiation of ICI treatment. The two most prevalent reasons for PsPD were TL und NTL progression, with an increase in TL diameter commonly below + 100%. In few cases, PsPD was observed even if tumor markers were rising compared to baseline. Our findings also suggest a correlation between PsPD and irAE. These findings may guide decision-making of ICI continuation in suspected PsPD.