Plain CT Scan Research Articles

Whole-Brain Volume CT Angiography can Effectively Detect Early Ischemic Cerebrovascular Diseases.

To investigate the role of whole-brain volume computed tomography (CT) perfusion in assessing early ischemic cerebrovascular diseases. Seventy-two patients with early ischemic cerebrovascular diseases who had undergone routine CT scan and 320-row volume CT whole-brain perfusion imaging within 8 h after admission were retrospectively enrolled in this one-center case-sectional study. The perfusion parameters of cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and dynamic CT angiogram (4D-CTA) were obtained and analyzed. Among 72 patients, 29 cases with 37 cerebral ischemic lesions were found in plain CT scan, whereas 51 cases with 76 lesions were found in whole-brain CT perfusion, with 30.6% more patients being detected. The CBF value was significantly lower in the abnormal than normal corresponding perfusion area in the healthy hemisphere (P<0.05), while the MTT and TTP values were significantly higher in the abnormal than the normal corresponding area (P<0.05). 4D-CTA image suggested that 59 cases had different degrees of stenosis or occlusion, including 11 mild, 18 moderate, 21 severe, and 9 occlusive cases. Four-D-CTA imaging could detect significantly (P<0.05) more patients with abnormal perfusion in severe cerebral vascular stenosis or occlusion than those with no, mild or moderate stenosis (93.33% vs. 16.67%) (P<0.05). The stenosis of intracranial and carotid arteries was positively correlated with MTT and TTP values (P<0.05). Whole-brain volume CT angiography can comprehensively display early cerebral ischemic lesions, cerebral blood perfusion status, and cerebral vascular stenosis, providing valuable information for early detection of ischemic cerebral diseases and appropriate treatment planning.

ISANET: Non-small cell lung cancer classification and detection based on CNN and attention mechanism

Lung cancer is one of the malignant tumors with high morbidity and mortality worldwide. Among them, non-small cell lung cancer accounts for about 85% of all lung cancers. In the existing chest CT plain scan or enhanced scan, non-small cell lung cancer images may overlap significantly in imaging features, leading to misdiagnosis and the inability to give an accurate histological classification. Among the existing relevant non-small cell lung cancer classification models, few studies on the precise classification of non-small cell lung cancer types. A multi-category classification model based on CNN is proposed to tackle these problems. The proposed model ISANET embeds channel attention and spatial attention mechanisms to focus on pathological areas based on InceptionV3. The three-category lung cancer dataset provided by the Affiliated Hospital of Hebei University is used, including lung squamous cell carcinoma, lung adenocarcinoma, and normal. Comparative experiments are done between ISANET and the traditional models AlexNet, VGG16, InceptionV3, MobilenetV2, and ResNet18. Results of experiments on two public datasets verify the effectiveness of ISANET, reaching 95.24% and 98.14% respectively, which indicates that ISANET has obtained superior accuracy in classifying non-small cell lung cancer.

The role of cross-link augmentation on fusion rate and patient satisfaction among patients with traumatic thoracolumbar spinal fracture: A randomized clinical trial.

Most of the studies evaluating the effect of cross links on spinal stability are performed in vitro on porcine or human spine segments and there is limited data regarding clinical benefits of cross link augmentation in traumatic injuries. In this study we aimed to evaluate the effects of cross-links insertion between rods on the fusion rates and post-surgical patients' satisfaction among patients with traumatic thoracolumbar fractures who underwent posterior spinal fixation with pedicle screws. This study was conducted as a randomized clinical trial on 60 patients suffering from traumatic thoracolumbar vertebrae fractures. Patients were randomized into three groups: A (without any cross-link), B (One cross-link insertion) and C (two cross-links insertion). Six months after surgery outcomes were evaluated: fusion rates (plain X-ray and CT scan), Back pain (Visual Analog Scale) and patient satisfaction (fair, good, excellent). In group A 13 (65%) patients had structured bone fusion, but in 7 (35%) patients bone fusion was not observed. In both groups B and C, 19 patients (95%) had bone fusion, but only in 1 patient (5%) fusion failed (p=0.009). In group A, fair satisfaction has the highest rate (8 patients (40%)) compared to the other groups. The highest reported severity of back pain was observed in group A while the lowest reported intensity of back pain was related to group B (p=0.001). Adding cross link to posterior spinal fixations of patients with traumatic thoracolumbar fractures can be associated with better final fusion results and patients' satisfaction. However it is necessary to design studies with greater sample sizes to confirm this theory. IRCT20120527009878N3.

The role of cross-link augmentation on fusion rate and patient satisfaction among patients with traumatic thoracolumbar spinal fracture: A randomized clinical trial

Introduction and objectivesMost of the studies evaluating the effect of cross links on spinal stability are performed in vitro on porcine or human spine segments and there is limited data regarding clinical benefits of cross link augmentation in traumatic injuries. In this study we aimed to evaluate the effects of cross-links insertion between rods on the fusion rates and post-surgical patients’ satisfaction among patients with traumatic thoracolumbar fractures who underwent posterior spinal fixation with pedicle screws. Materials and methodsThis study was conducted as a randomized clinical trial on 60 patients suffering from traumatic thoracolumbar vertebrae fractures. Patients were randomized into three groups: A (without any cross-link), B (One cross-link insertion) and C (two cross-links insertion). Six months after surgery outcomes were evaluated: fusion rates (plain X-ray and CT scan), Back pain (Visual Analog Scale) and patient satisfaction (fair, good, excellent). ResultsIn group A 13 (65%) patients had structured bone fusion, but in 7 (35%) patients bone fusion was not observed. In both groups B and C, 19 patients (95%) had bone fusion, but only in 1 patient (5%) fusion failed (p=0.009). In group A, fair satisfaction has the highest rate (8 patients (40%)) compared to the other groups. The highest reported severity of back pain was observed in group A while the lowest reported intensity of back pain was related to group B (p=0.001). ConclusionsAdding cross link to posterior spinal fixations of patients with traumatic thoracolumbar fractures can be associated with better final fusion results and patients’ satisfaction. However it is necessary to design studies with greater sample sizes to confirm this theory.Trial registration number: IRCT20120527009878N3.

ROLE OF POCUS IN DETECTION OF EMPHYSEMATOUS PYELONEPHRITIS IN COVID WARDS: OUR INSTITUTIONAL EXPERIENCE

introduction: Our institution has been at the forefront in the management of COVID 19 cases since the beginning of the pandemic. With more than 2000 dedicated covid beds at the peak of 2nd wave and a daily inpatient admission of 350 and outpatient census of 1000, resource availability was at its lowest,necessitating judicious use. With an increased incidence of emphysematous pyelonephritis in covid patients, we present our experience with use of point of care ultrasound(POCUS) in screening and management of emphysematous pyelonephritis Materials And Methods: Abdominal pain is a symptoms in upto 15% of covid 19 patients . A wide variety of diseases can present with abdominal pain, ruling out urological emergencies takes precedence. We used POCUS in screening of 97 patients with loin pain, fever who were on O2 support. Patients were screened for signs of parenchymal irregularities(including dirty echoes), hydronephrosis, renal abscess, perinephric collection. Patients with no major changes were followed up with conservative management. Patients with clear parenchymal changes and highly suspicious signs were only suggested plain CT scans to conrm changes.POCUS was also used to insert a Percutaneous nephrostomy in patients as a bedside procedure Results: Of the 97 patients screened using POCUS, only 28 had lesions suspicious of infection and parenchymal changes and only 13 had suspicion of gas or obstructive features in kidney. CT scan was prescribed to 25 patients which revealed 11 cases of emphysematous pyelonephritis. 3 patients were conservatively managed , 7 needed percutaneous drainage which was done as a bedside procedure and 1 patient with bilateral disease was taken up for emergency stenting Conclusion: While ultrasound has a poor sensitivity compared to computed tomography in detecting parenchymal changes, easy availability,portability,no radiation risk make ultrasound a RELIABLE tool in times of the pandemic.

Diagnostic Dilemma: A Case Report of Isolated Foot Drop

The Foot drop in which the patient is unable to or has difficulty performing dorsiflexion of the ankle joint. The causes of this condition are Lower motor neuron disease or Upper motor neuron disease with the former being much more common than the latter. We hereby present a case of a 41- year- old male who presented to the Outpatient Department with complaints of difficulty in walking and weakness of the left foot since the past 4 months. Neurological examination found 1/5 power of the left ankle dorsiflexors along with the presence of ankle clonus.”Radiological investigations of the spine did not show any abnormality. Nerve conduction study of the lower limbs was also found to be normal. A plain CT scan of the brain showed the presence of a hyperdense lobulated mass on the right parietal lobe. Patient was referred to Neurosurgery after diagnosis was made where he underwent surgery for removal of the lesion. Patient’s ankle dorsiflexion power improved to 4/5 three weeks post surgery.

Classification and Segmentation Algorithm in Benign and Malignant Pulmonary Nodules under Different CT Reconstruction.

Methods The imaging data of 55 patients with chest CT plain scan in the Xuancheng People's Hospital were collected retrospectively. The data of each patient included lung window reconstruction, mediastinum reconstruction, and bone window reconstruction. The depth neural network and 3D convolution neural network were used to construct the model and train the classification and segmentation algorithm. The pathological results were the gold standard for benign and malignant pulmonary nodules. The classification and segmentation algorithms under three CT reconstruction algorithms were compared and analyzed by analysis of variance. Results Under the three CT reconstruction algorithms, the classification accuracy of pulmonary nodule density types was 98.2%, 96.4%, and 94.5%, respectively. The Dice coefficients of all nodule segmentation were 80.32% ± 5.91%, 79.83% ± 6.12%, and 80.17% ± 5.89%, respectively. The diagnostic accuracy between benign and malignant pulmonary nodules under different reconstruction algorithms was 98.2%, 96.4%, and 94.5%, respectively. There was no significant difference in the classification accuracy, Dice coefficients, and diagnostic accuracy of pulmonary nodules under three different reconstruction algorithms (all P > 0.05). Conclusion The depth neural network algorithm combined with 3D convolution neural network has a good efficiency in identifying benign and malignant pulmonary nodules under different CT reconstruction classification and segmentation algorithms.

The Experience of CT Plain Scanning Texture Analysis Imaging in the Diagnosis and Differentiation of Renal Clear Cell Carcinoma

The Experience of CT Plain Scanning Texture Analysis Imaging in the Diagnosis and Differentiation of Renal Clear Cell Carcinoma

Phenotypic variability of syndromic craniosynostosis caused by c.833G > T in FGFR2: Clinical and genetic evaluation of eight patients from a five-generation family.

ObjectiveCraniosynostosis is the result of the early fusion of cranial sutures. Syndromic craniosynostosis includes but not limited by Crouzon syndrome and Pfeiffer syndrome. Considerable phenotypic overlap exists among these syndromes and mutations in FGFR2 may cause different syndromes. This study aims to investigate the explanation of the phenotypic variability via clinical and genetic evaluation for eight patients in a large pedigree.MethodsFor each patient, comprehensive physical examination, cranial plain CT scan with three‐dimensional CT reconstruction (3D‐CT), and eye examinations were conducted. Whole exome sequencing was applied for genetic diagnosis of the proband. Variants were analyzed and interpreted following the ACMG/AMP guidelines. Sanger sequencing was performed to reveal genotypes of all the family members.ResultsA pathogenic variant in the FGFR2 gene, c.833G > T (p.C278F), was identified and proved to be co‐segregate with the disease. Some symptoms of head, hearing, vision, mouth, teeth expressed differently by affected individuals. Nonetheless, all the eight patients manifested core symptoms of Crouzon syndrome without abnormality in the limbs, which could exclude diagnosis of Pfeiffer syndrome.ConclusionWe have established clinical and genetic diagnosis of Crouzon syndrome for eight patients in a five‐generation Chinese family. Variability of clinical features among these familial patients was slighter than that in previously reported sporadic cases.

127 Optimum Treatment for Sigmoid Volvulus Remains Elusive but Surgery May Provide Considerable Benefit: Results of a 5-Year Audit

Abstract Background Sigmoid volvulus is a surgical emergency and patients are often elderly with significant comorbidities. Whilst endoscopic decompression is easy and effective in the short-term, recurrence and repeated admissions are common with surgery generally being reserved for non-resolution or complications. Consensus an optimum management is lacking. Method A retrospective audit of all patients admitted with sigmoid volvulus to a DGH General Surgery service between 01/01/2015-20/10/2020 was undertaken. Patient demographics, comorbidities, clinical findings, investigations, and treatment were recorded. Results Sixty-three patients were identified (median age 71.5 years; 58.7% male]. Some 50.8% had more than one previous presentation (range 1–6), 19% presented after 3 days of symptoms and 3.2% presented with perforation. Plain radiography and CT scanning was undertaken in 90.5% and 54%, respectively. Endoscopic detorsion was performed in 77.77% and repeated in the same admission for 33.3% of cases. Flatus tubes and rigid sigmoidoscopy was used in 47.6% with a 59.6% success rate. Seventeen patients (27%) underwent sigmoid resection, 14 having open surgery and 3 laparoscopic. Primary anastomosis was undertaken in 64.7% (11 patients), with only one anastomotic leak; the remaining 6 patients had a colostomy. The re-admission rate was 30.1% (19% non-operated patients, 11.1% operated patients). Conclusions Most patients with sigmoid volvulus are managed non-operatively with endoscopic detorsion which may be associated with a considerable healthcare burden and high readmission rates. Selective resection can be associated with low morbidity and good outcomes. Clinicians could reasonably adopt a lower threshold for surgical intervention, particularly for recurrent volvulus.

Atypical lymphoid proliferation of the orbit.

Objective: Lymphoproliferative disorders are a group of lesions characterized by abnormal proliferation of lymphocytes. In the orbit, they can occur in the ocular adnexae. These neoplasms have defined clinical and pathologic characteristics and account for more than 20% of all orbital tumors. Several types of lymphoproliferative lesions have been described in the orbit. One example is lymphoid hyperplasia, which commonly involves the lacrimal gland. A benign lesion like lymphoid hyperplasia will show a general normal archetype of the tissues-involved lacrimal gland. We expect a polyclonal group of cells with more or less normal architecture of a follicle. On the other hand, lymphoma will show less organized arrangement of cells, and we expect them to be of monoclonal lineage.Methods: This is a case report of a 55-year-old Filipino female who came in for blurring of vision of both eyes. During her assessment, there was an incidental finding of bilateral upper eyelid swelling, and a 30x15 mm palpable firm mass under the right superior orbital rim and a 30x10 mm mass under the left were noted. The right globe was displaced inferiorly, but no proptosis was seen on exophthalmometry. On plain CT scan, we noted a homogenous mass with molding or contouring around the orbital structures. On coronal view, we noted homogenous masses that mold around the globe and recti, and this also confirmed on axial cuts. A section biopsy was done via anterior orbitotomy.Results: Our patient’s histopath had features of both. On scanning magnification, we noted a very cellular round cell tumor. The round cell lesion seemed to be reminiscent of a germinal center of a lymph node. Around it we noticed the glandular structures, which were expected, since this specimen was from the lacrimal gland. A closer view of the lesion on high power showed these lymphocytes within a germinal center. These are large macrophages that actively phagocytose apoptotic lymphoid cells in germinal centers. We expect to see a lot of them in benign hyperplasia, but only a few will be present in malignancies. In summary, our patient had both benign and malignant features, resulting in a histopath result of atypical lymphoid proliferation.Conclusion: Atypical lymphoid proliferation is a rare orbital tumor with benign and malignant features. There is no standard protocol for treatment, and proper multi-specialty coordination is important. External beam radiation therapy with linear accelerator (LINAC) appears to be an effective treatment, with no recurrence in our patient after 5 months.

Application Values of 2D and 3D Radiomics Models Based on CT Plain Scan in Differentiating Benign from Malignant Ovarian Tumors.

Background Accurate identification of ovarian tumors as benign or malignant is highly crucial. Radiomics is a new branch of imaging that has emerged in recent years to replace the traditional naked eye qualitative diagnosis. Objective This study is aimed at exploring the difference in the application potential of two- (2D) and three-dimensional (3D) radiomics models based on CT plain scan in differentiating benign from malignant ovarian tumors. Method A retrospective analysis was performed on 140 patients with ovarian tumors confirmed by surgery and pathology in our hospital from July 2017 to August 2020. These 140 patients were divided into benign group and malignant group according to the pathological results. The ITK-SNAP software was used to outline the regions-of-interest (ROI) of 2D or 3D tumors on the CT plain scan image of each patient; the texture features were extracted through analysis kit (AK), and the cases were randomly divided into training groups (n = 99) and validation group (n = 41) in a ratio of 7 : 3. The least absolute shrinkage and selection operator (LASSO) algorithm was used to perform dimensionality reduction, followed by the construction of the radiomics nomogram model using the logistic regression method. The receiver operating characteristic (ROC) curve was drawn, and the calibration curve and decision curve analysis (DCA) were used to evaluate and verify the results of the radiomics nomogram and compare the differences between 2D and 3D diagnostic performance. Results There were 396 quantitative radiomics feature parameters extracted from 2D group and the 3D group, respectively. The area under the curve (AUC) of the radiomics nomogram of the 2D training group and the validation group were 0.96 and 0.97, respectively. The accuracy, specificity, and sensitivity of the training set were 92.9%, 88.9%, and 96.3%, respectively, and those of the validation set were 90.2%, 82.6%, and 100.0%, respectively. The AUCs of the radiomics nomogram of the 3D training group and validation group were 0.96% and 0.99%, respectively. The accuracy, sensitivity, and specificity of the training set were 92.9%, 96.3%, and 88.9%, respectively, and those of the validation set were 97.6%, 95.7%, and 100.0%, respectively. DeLong's test indicated that there was no statistical significance between the two sets (P > 0.05). Conclusions For the differential diagnosis of benign and malignant ovarian tumors, the 2D and 3D radiomics nomogram models exhibited comparable diagnostic performance. Considering that the 2D model was cost-effective and time-efficient, it was more recommended to use 2D features in future research.

A study on evaluation of knee osteoarthritis with MRI and comparing it with CT scan, high resolution USG and conventional radiography

Background: Knee osteo-arthritis is widely prevalent in the elderly population in our society and associated with significant morbidity and poor quality of life. Early diagnosis of the condition can enable timely and proper care for the patients. Magnetic Resonance Imaging, CT Scan, Ultrasonography and plain radiography are the different modalities of imaging that are commonly used for detection and diagnosis of knee osteo-arthritis. Aims and Objectives: To find out the early osteoarthritic changes of knee by Magnetic Resonance Imaging and compare those findings with conventional radiography, high frequency USG and CT scan findings. Materials and Methods: Patients suffering from knee osteoarthritis (OA) as per American College of Rheumatology guideline criteria (n=56) underwent imaging of the knee using plain radiography, ultrasonography, CT scan and MRI. The imaging findings studied in the patients were joint space narrowing (JSN), meniscal abnormality, Baker’s cyst, cruciate ligament abnormality, knee effusion, subchondral cyst, and loose bodies. A comparison between radiography, CT scan and USG was done for the imaging findings with MRI as the reference standard. Z-test of proportionality was used to find statistically significant difference for the three imaging modalities. A P&lt;0.05 was deemed statistically significant. Results: The mean age of the patients was 61 years (38 males). The tibiofemoral compartment was most commonly affected. CT scan was more sensitive than radiography in detecting sub-chondral cyst (P=0.018) and loose bodies (P=0.004). USG and MRI were equally sensitive in detecting knee effusion (P=0.22) and synovial thickening (P=0.10). CT scan and MRI were equally sensitive in detecting subchondral cyst (P=1.00) and loose bodies (P=0.22). Conclusion: While CT imaging was more sensitive for detection of subchondral cysts and loose bodies than conventional radiography, it was as sensitive as MRI in detecting these findings in the study group. Additional study is warranted to assess diagnostic performance of CT scan and MRI in the diagnosis and progression of knee OA.

Synovial facet joint cysts after lumbar posterior decompression surgery.

Numerous studies have reported on synovial facet joint cysts of the spine as a primary lesion. The exact pathogenesis of those cysts is still controversial, but degeneration and destabilization seem to be underlying mechanisms. However, only a few reports have thus far investigated synovial cysts of the spine as postoperative complications of decompression surgery. In this retrospective clinical study, the authors focused on synovial cysts of the lumbar facet joints as complications after lumbar decompression surgery, with the aim of elucidating their pathophysiology. A total of 326 patients with 384 segments treated with posterior decompression surgery without fusion were included in the study. Of these segments, 107 were surgically decompressed unilaterally and 277 were decompressed bilaterally. After surgery, 18 of the 384 segments developed a complication of symptomatic facet synovial cyst. The anatomical and morphological evaluations of these segments were performed using functional plain radiographs, CT scans, and MR images. All of the 18 segments with postoperative lumbar facet synovial cyst were treated with bilateral lumbar posterior decompression. There was no significant radiological lumbar spinal instability in any segments, although 17 of 18 segments demonstrated facet articular spondylotic changes. Moreover, 12 of 18 patients demonstrated lumbar retrolisthesis in the neutral position. Based on the authors' results, they propose that patients with lumbar degenerative disease who have a potential biomechanical lumbar instability such as disruption of the facet articular surface and hydrarthrosis or lumbar facet tropism might have a high risk for formation of lumbar facet synovial cyst after bilateral posterior decompression surgery.

EFFECT OF AUTOGENOUS, NON-VASCULARIZED PERIOSTEUM TRANSPLANTATION ON ALLOGRAFT BONE GRAFTING FOR LARGE CORTICAL LOAD-BEARING BONE DEFECT – A RABBIT MODEL

Segmental bone allografts are widely used in managing large cortical bone defects. To improve host-graft union, the effect of allograft on a large cortical tibial bone defect augmented with a non-vascularized periosteal flap was studied. Twelve mature Australian white rabbits (Oryctolagus cuniculus) were divided into intervention groups and a control group. Bone defects in the intervention groups were treated with segmental allografts wrapped with a non-vascularized periosteal flap. The control group was treated with allograft transplantation alone. Healing was evaluated at the end of the 2nd, 4th, and 6th weeks with plain radiographs, CT scan, and histology. In the intervention groups, the bony union was achieved at both ends of the allografts at the 4th to 6th weeks. Solid callus encasing the whole allograft segments at the end of the 6th week. In the control group, the union did not occur at both ends of the allograft segments even up to the end of the 6th week. No callus formation surrounding the allograft segments. Fragmentation and telescoping of the allograft segment into the medullary cavity of the host were observed. The use of autogenous, non-vascularized periosteal flap modified the healing process of allograft and maintained the integrity of the allograft.

Lateral subtalar dislocation associated with a lateral malleolus and a nutcracker cuboid fracture: Case report of a rare pattern of lesion.

Introduction and importanceCombined fracture of the lateral malleolus and cuboid due to a lateral subtalar dislocation is an uncommon injury. Literature is scarce on this trauma association. To the best of our knowledge, this represents a new lesion pattern. Hereby we describe its mechanism, management and outcomes.Case presentationWe report a case of a 58-year-old woman, who fell from the stairs and presented with pain and an acute deformity of the left foot and ankle. Plain radiographs and CT scan revealed a lateral subtalar dislocation with a lateral malleolus and cuboid fractures. After a failed closed reduction, the patient underwent an open reduction and fixation of the talonavicular joint. An external fixator was applied to address the cuboid fracture. The lateral malleolus was treated conservatively with 5.5 weeks of immobilization. At 38 months of follow-up, the patient scored 87% on the AOFAS ankle-hindfoot scale and returned to normal daily activity. Radiographs demonstrate signs of posttraumatic arthritis at the subtalar and talonavicular joints.Clinical discussionAfter reduction of the lateral subtalar dislocation, addressing the nutcracker cuboid fracture was essential, since it can contribute to a flatfoot deformity. Although the patient progressed to posttraumatic arthritis, the sequelae are usually well tolerated and a good outcome was achieved.ConclusionThe rarity of this pattern of lesion is related to the necessary multidirectional forces. Correct management of the associated fractures is essential.Our study demonstrates a new lesion pattern of lateral subtalar dislocations, its mechanism, management and outcomes.

Differentiating mass-like tuberculosis from lung cancer based on radiomics and CT features.

BackgroundThe number of TB subtypes with irregular masses are increasing year by year, which can easily be confused with lung cancer. This study aimed to explore the value of CT radiomics analysis in differentiating mass-like tuberculosis (TB) from peripheral lung cancer.MethodsA retrospective analysis of 37 cases with mass-like TB and 41 cases with peripheral lung cancer confirmed by pathology was performed. The performance of conventional CT (7 quantitative and 13 qualitative detection) was analyzed, and 828 texture features extracted by plain CT scan were subjected to dimensionality reduction using the minimal absolute contraction and logistic least absolute shrinkage and selection operator regression. The results were tested according to data distribution types, with differences between the TB and lung cancer groups analyzed by independent-samples t-test, Mann-Whitney test, Pearson chi-square test, or Fisher’s exact test. Logistic regression was used to establish a texture feature model, a morphology model and a combined prediction model. The models’ diagnostic efficacy was evaluated using receiver operating characteristic (ROC) curves.ResultsThe comparative analysis between the two groups revealed significant differences in 7 texture parameters (kurtosis, median, skewness, gray-level co-occurrence matrix, gray-level length matrix, gray-level area size matrix, and regional percentage), 4 quantitative parameters [plain scan CT value, arterial phase (AP) CT value, venous phase (VP) CT value, and the difference in CT value between the VP and plain scan], and 8 qualitative CT manifestations (lobular sign, long burr sign, exudation, pleura, necrosis, trachea, vessels, calcifications, and satellite lesions) (P<0.05); logistic regression analysis revealed the area under the ROC curve values of the texture feature, morphology, and combined prediction models to be 0.856, 0.950, and 0.982, respectively (P<0.05).ConclusionsCombining morphological and radiomics models can effectively and noninvasively improve the efficiency of differentiating mass-like TB from peripheral lung cancer, which is conducive to selecting the appropriate therapy.

THROMBECTOMY FOR ACUTE EMBOLIC STROKE FOLLOWING HEART SURGERY

Introduction Acute ischaemic stroke occurs in approximately 1-10% of patients undergoing cardiac surgery and can markedly impair recovery (1). Thrombolysis carries an unacceptably high risk of haemorrhage in the early postoperative period after heart surgery. Mechanical thrombectomy is becoming an increasingly preferred alternative to treat ischaemic strokes, and unlike thrombolysis, is not contraindicated in the early postoperative period. We report a patient who had witnessed onset of ischaemic stroke in the early postoperative period after aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) surgery and was treated with mechanical thrombectomy. Discussion An 81-year-old male patient underwent elective tissue AVR and CABG (internal mammary to left anterior descending coronary artery) surgery. Surgery was uncomplicated and following weaning from mechanical ventilation, the patient's trachea was extubated on the evening of surgery. His recovery progressed uneventfully and on the day after surgery, he was moved to a high dependency unit. On the morning of the second post-operative day, the patient had a witnessed rapid deterioration in conscious level, becoming unresponsive with a divergent gaze. Urgent plain CT scan of the brain showed hyperattenuation of the left middle cerebral artery (MCA) territory consistent with acute thrombosis. The patient was granted emergency funding for a mechanical thrombectomy and was transported to the regional neurology hospital. A mechanical thrombectomy was performed successfully, with digital subtraction angiography (DSA) confirming complete occlusion of the left MCA with poor collateral cross flow. The patient failed to recover neurological function and died approximately 24 hours later. Mechanical thrombectomy is now a well-established treatment for acute ischaemic stroke. There are clear advantages with regard to functional outcome for patients undergoing mechanical thrombectomy versus best available medical therapies such as thrombolysis (2). A recent systematic review of acute ischaemic stroke post cardiac surgery showed that 50% of patients who underwent endovascular mechanical thrombectomy had a full or good neurological recovery, 36% had moderate recovery and 14% had little improvement (1). Factors that may have led to a poor outcome in this patient's case included the delay in hospital transfer, the poor cerebral cross blood flow noted on DSA and extensive comorbidities. In conclusion, although there are many reports of mechanical thrombectomy being associated with a good neurological outcome from acute ischaemic stroke associated with cardiac surgery, outcome may not be improved if there is underlying cerebrovascular disease and intervention is delayed.

Comparison of lateral neck X-ray to neck CT in patients with suspicious bone impaction: “Old habits die hard”

ObjectiveBone impaction (BI) is a common cause for emergency room visits. Among foreign bodies, fish bone is considered the most common. The sensitivity of symptoms in predicting BI is relatively low, making imaging a central tool to aid diagnosis. Current imaging practices include both neck plain film radiography and none-contrast CT scans of the neck. We evaluated the accuracy of neck plain film radiography and CT scans of the neck for the diagnosis of BI. MethodsRetrospective review of all patients who presented to the emergency room between 2009 and 2016 with a suspicious history of BI whom underwent plain film neck radiography or CT. All Images were reviewed by two neuro-radiologist blinded to the clinical symptoms and findings. Symptoms, clinical findings and images results were compared to the final diagnosis. Results89 patients (30.7%), out of 290 patients who presented with complaints of BI, were diagnosed with BI. Mean age was 44.7 years old. Plain film neck radiography failed to predict BI (sen. 14.4%, spe 89.8% accuracy 63.2%), neck CT has an improved accuracy and sensitivity in locating BI (sen. 83.3%, spe. 94.1% accuracy 92.5%). Interobserver agreement between the two neuro-radiologists was moderate (0.46) and substantial (0.77) in neck radiography and CT images, respectively. Neck radiography missed 60 (out of 61) oropharyngeal BI's. ConclusionNeck radiography has high inter-observer variability and low sensitivity for the diagnosis of BI. Neck CT should be the first imaging modality in patients with suspicious complaints for BI and negative physical exam.

Finite element analysis of the lumbar spine in adolescent idiopathic scoliosis subjected to different loads

To explore the biomechanical changes of the lumbar spine segment of idiopathic scoliosis under different loads by simulating six kinds of lumbar spine motions based on a three-dimensional finite element (FE) model. Methods According to the plain CT scan data of L1-L5 segment of an AIS patient, a three-dimensional FE model was established to simulate the biomechanics of lumbar scoliosis under different loads. The lumbar model was reconstructed using Mimics20.0, smoothed in Geomagic2013, assembled in Solidworks 2020, with FE analysis performed using Workbench19.0. Results The completed model had a total of 119029 C3D4 solid elements, 223805 nodes, including finely reconstructed tissue structures. In patients with AIS, the range of motion (ROM) is reduced under all loads. Under flexion loads, the vertebral concave stress distribution is greater; under extension lateral bending, and rotation load at the posterior side of the vertebral body, the stress is concentrated in the L3 vertebral arch. The buffering effect of intervertebral disc on the rotational load is the weakest. Different loads of AIS cause corresponding changes in the force and displacement of different positions of the vertebral body or intervertebral discs. Conclusions The change in physiological shape of the lumbar vertebrae limits the ROM of the lumbar vertebrae. The stress showed a trend of local concentration which located in the concave side of the scoliosis. The stress on the lumbar vertebrae comprising the greatest curvature is the most excessive. The stress in the intervertebral disc under the rotating load is greater than that under other kinds of loads, and the intervertebral disc is more likely to be injured because of the rotating load.