CT Scan In Diagnosis Research Articles

Is intravenous iodinated contrast medium administration really harmful in hospitalized acute kidney injury patients: a propensity score-matched study.

To evaluate the effects of intravenous iodinated contrast medium (ICM) administration on the deterioration of renal function (DRF), new renal replacement therapy (RRT) induction and mortality of hospitalized acute kidney injury (AKI) patients. Adult hospitalized patients undergoing a contrast-enhanced or unenhanced CT scan within 7 days after AKI diagnosis from January 2015 to December 2019 were identified in this retrospective study. Propensity score matching was performed. Outcomes in 7 and 30 days after CT scan were compared between the contrast and non-contrast groups. Additional analyses were also performed in patients stratified by SCr levels at AKI diagnosis, times and time of CT scan, and in patients without chronic kidney disease or RRT requirement prior to CT scan. In total, 1172 pairs were generated after 1:1 propensity score matching from 1336 cases exposed to ICM and 2724 unexposed. No significant differences were found in the outcomes between the two groups: DRF, 7.8% vs 9.0% (odds ratio (OR) 0.83, 95% confidence interval (CI) 0.62-1.11) in 7 days, 5.1% vs 5.4% (OR 0.93, 95%CI 0.64-1.34) in 30 days; new RRT induction, 2.3% vs 3.3% (OR 0.72,95%CI 0.43-1.18) in 7 days, 4.2% vs 4.5% (OR 0.95,95%CI 0.64-1.41) in 30 days; and mortality, 3.9% vs 4.8% (OR 0.83,95%CI 0.56-1.22) in 7 days, 9.0% vs 10.2% (OR 0.88,95%CI 0.68-1.15) in 30 days. Subset analyses showed similar results. Intravenous ICM administration during AKI duration did not increase the risks of DRF, new RRT induction, and mortality in 7 and 30 days after CT scan. • Intravenous ICM administration in hospitalized AKI patients does not increase the risks of deterioration of renal function, RRT induction, and mortality in 7 and 30 days after CT scan. • The effects of intravenous ICM on adverse outcomes are minimal even in AKI patients with high level of SCr values or multiple CT scans.

Multidetector Computed Tomography (MDCT) Evaluation of Traumatic Brain Injury in Head Trauma Patients in Tertiary Hospital of Eastern Region of Nepal

Introduction: Traumatic brain injury (TBI) in patients with head trauma is common cause for emergency visits to hospital affecting all age groups. It is one of important leading cause of death and disability worldwide besides leading to neurological disease burden. Noncontrast enhanced Multidetector computed tomography (MDCT) is imaging modality of choice for detection of various intracranial lesions.
 Objectives: This study was done to analyse various imaging findings on MDCT in traumatic head injury patients along with association of CT findings with clinical manifestation and mechanism of injury.
 Methodology: In this ethically approved prospective study, CT scan was done in 224 consecutive patients with head injury from November 2020 to February 2021. The various imaging findings seen in CT scan were documented in proforma. The data collected was analyzed with appropriate statistical test and statistical significance was calculated.
 Results: Total of 224 patients with diagnosis of head injury were included in the study. The male to female ratio was 2.86 and most common age group involved was between 20-40years (41.1%). The most common mode of injury was road traffic accidents (57.6%) and most of the patients presented with history of altered sensorium (35.7%). About 47.3% patients showed abnormal findings on CT scan with scalp lesion was most common findings (82%) followed by skull fractures (54.7%) and cerebral contusions (43.4%). Patients with history of RTA had more abnormal CT scan (62%) than fall injury and physical assault. Statistically significant association seen between CT scan findings with Glasgow Coma Scale and RTA (P<0.05).
 Conclusion: The present study showed well documented role of CT scan in diagnosis of TBI besides detection of spectrum of intracranial lesions in patients with head trauma. Road traffic accident is most common mode of head injury with most of the victims are young middle age active male.

Use of Zinc Oxide Solution as an Alternate Contrast Medium for Computed Tomography Imaging of Rabbit’s Heart, Kidney, and Liver

Introduction: A new chemical compound of zinc oxide (ZnO) solution was used as a suitable an alternativecontrast agent in computed tomography scan (CT-Scan). The choosing of ZnO solution has distinct inelectrochemical study in the blood electrolyte. Results: From the results ZnO molecules in the blood mediaacts as an anti-oxidizing reagent that cyclic voltammogram result has reduction current peak at potential of-0.75 volt, while the using in routine contrast media in CT-scan is iodine compound; they have an anodicpeak in the blood medium at +1 volt. Additionally, iodine compounds have many problems through using forthe patients, but the current using in CT-Scan diagnosis are Iodine compounds for this purpose. Conclusions:the good alternative contrast medium using in the CT-Scan without any side effects and high resolution ofimaging which increased the Hounsfield unit (HU) values for rabbit’s organs (heart, kidney, and liver),compared with other cases through using the routine Iodine contrast media in the same doses.

Usefulness of CT Scan in Diagnosis of Cervical Spine Injury

Traumatic injuries account for more than 3.2 million deaths and more than 312 million injured annually worldwide. The present study was conducted to assess role of CT in diagnosis of cervical spine injury. 85 patients with cervical spine injury of both genders were selected and CT scan was obtained. Frankel grading was followed. Out of 85 patients, males were 55 and females were 30. The mechanism of trauma was RTA in 40, violence in 20, fall in 15 and sports injury in 10. Grade I was seen in 40, grade II in 25, grade III in 16, grade IV in 4 and grade E in none. The difference was significant (P< 0.05). CT scan found to be effective in assessing traumatic injuries to cervical spine.

Role of HRCT Imaging in Diagnosis And Prognosis of Novel Corona (Covid-19) Pneumonia, Radiologists Experience in Dhaka Medical College Hospital Correlated with Rt-PCR.

Background: High resolution computed tomography scan can be used as a effective modality for corona virus disease 2019(COVID -19) being a useful alternative to RT-PCR specially in hospitalized and RT-PCR negative patients.
 Purpose: To evaluate the efficacy of high resolution CT scan in diagnosis and prognosis of COVID 19 and to see the sensitivity specificity, accuracy, positive and negative predictive value. We also aimed to compare HRCT findings with RT-PCR in COVID 19 patients to find out the severity, prognosis and staging of COVID-19 corona virus disease.
 Materials and Method: This cross sectional prospective observational study was carried out in department of Radiology and imaging, Dhaka Medical College Hospital Dhaka ,Bangladesh in collaboration with department of Virology and COVID unit, Dhaka Medical college Hospital , Bangladesh
 Observations and Results : Total 200 patients were evaluated with HRCT findings and correlated with RT-PCR as gold standard. . Sensitivity was about 96% for chest CT, specificity 66% , PPV 97% accuracy 90% and NPV 62%.
 Conclusion: HRCT scan of chest is a useful modality for COVID -19 patients for the purpose of diagnosis and response to treatment. It is an important indicator for future prognosis . HRCT can be an important alternative of RT-PCR in symptomatic patients when RT-PCR is negative where facilities are available . It is important for the radiologists and clinicians to be familiar with different manifestations on CT . It will help in management planning for these patients .
 J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 110-115

Infection control status of novel coronavirus pneumonia and radiation safety at CT workplace

CT is an important imaging tool for the diagnosis of novel coronavirus pneumonia (COVID-19), therefore, it's necessary to strictly control the disinfection of CT workplace and equipment and biosafety to avoid the place from becoming a potential infection source and to reduce the risk of infection of patients and radiological staff. It is also necessary to reduce the CT scan dose to minimize the radiation hazards on patients under the premise of ensuring the CT image quality and diagnostic efficiency. Based on the survey that novel coronavirus residues after disinfection at some CT workplace in domestic and overseas and the application of low-dose CT scan in diagnosis of COVID-19, as well as the current situation of radiological protection management in emergency hospital, this paper summarizes and proposes suggestions on infection control and radiological protection for CT workplace to strengthen the defense line of COVID-19 prevention and control. Copyright © 2021 by the Chinese Medical Association.

Computed Tomography Evaluation Of Patients With Traumatic Head In Juries

Background and Objectives: - The aim of this study was to evaluate the role of CT scan in evaluation of patients with traumatic head injury, to study the imaging spectrum of traumatic head injury, to study the relative prevalence of different traumatic head injury lesions.Methods: The study was prospective and was carried out between December 2019 and January 2020 at the Department of Radiology, AMC MET Medical College and Sheth L.G. Hospital, Ahmedabad. Total 50 patients having clinical history of traumatic head injury and sent to department of radiodiagnosis and diagnosed having abnormal findings on CT scan were included in the study. Confirmation of diagnosis by CT Scan done prior to data collection. (Only those patients were included who had traumatic head injury confirmed with history correlation and then were confirmed by CT scan.)Results: Out of 50 patients diagnosed by CT scan, the most common traumatic head injury seen in our study were- subarachnoid hemorrhage, subdural hematoma, epidural hematoma, skull fractures, pneumocephalus, scalp injures and focal areas of contusions/laceration. CT scan had an average specificity of 94%, with 100% specificity for common traumatic head injury like subdural hematoma.Conclusion: CT scan is a safe and effective method of detecting traumatic head injury. It aids in defining therapeutic decision quickly and allows predicting outcomes of the patient. High degree of specificity of CT scan diagnosis in the present study confirms the value of CT scan evaluation of traumatic head injury and suggests that it can be effectively used in the routine diagnostic work.

LungSeg-Net: Lung field segmentation using generative adversarial network

Automatic lung segmentation is an essential step towards the Computer-Aided Diagnosis of the lung CT scan. However, in presence of dense abnormalities, existing methods fail in accurate lung segmentation. In this paper, a generative adversarial networks-based approach is proposed for improving the accuracy of lung segmentation. The proposed network effectively segments the lung region from the surrounding chest region hence, named as LungSeg-Net. In the proposed LungSeg-Net, the input lung CT slices are processed through the trail of encoders which encode these slices into a set of feature maps. Further, a multi-scale dense-feature extraction (MSDFE) module is designed for extraction of multi-scale features from the set of encoded feature maps. Finally, the decoders are employed to obtain the lung segmentation map from the multi-scale features. The MSDFE makes the network to learn the relevant features of dense abnormalities whereas the iterative down-sampling followed by the up-sampling makes it invariant to the size of the dense abnormality. The publicly available benchmark ILD dataset is used for the experimental analysis. The qualitative and quantitative analysis has been carried out to compare the performance of the proposed network with the existing state-of-the-art methods for lung segmentation. The experimental analysis show that the performance of the proposed LungSeg-Net is invariant to the presence of dense abnormalities in lung CT scan.

Hybrid clustering algorithm for an efficient brain tumor segmentation

This work describes the data mining methods, techniques and algorithms used for implementation. It is an emerging field of IT industry and research. There are many other fields such as Artificial Intelligence, Machine Learning, Deep Learning, Virtualization, Visualization, Parallel Computing and Image Processing. The human internal Brain can be seen or visualized by the Magnetic Resonance Imaging scan or Computerized Tomography scan. The MRI image is scanned and will be taken as input for processing. The MRI scan is more advantageous and more comfortable than CT scan for diagnosis. MRI scan provides detailed picture of organs. It does not affect the human health and body condition. It doesn't use any radiation. It is purely based on the magnetic field and radio waves. LIPC technique makes the training samples from the patients and arranges them into different group of classes used to construct different dictionaries. Image segmentation is a technique of dividing an image into different multiple portions, which is used to spot out objects and boundaries in images. There are many image segmentation techniques applicable for image processing. No acceptable method is available for solving all kinds of segmentation problem. Every method has merits and demerits. So, choosing good method is the challenging task. The hybrid clustering method is proposed in this work. The k-means algorithm and fuzzy c-means algorithm is proposed for brain tumor segmentation. The algorithm is implemented in synthetic and real time dataset. From the experimental results, this method provides better results in the form of accuracy.

Factors Affecting Traumatic Brain Injury Outcome Among Patients Treated for Head Injury at Surgical Side, in Nekemte Referral Hospital, Oromia, Ethiopia.

Background Traumatic brain injury is an expanding major public health problem and the leading cause of death of the young and productive part of the world’s population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. Only few studies have examined prognostic factors of traumatic brain injury outcome in developing countries including Ethiopia. This study was aimed at defining the peculiar demographic and other associated factors of traumatic brain injury (TBI) outcome among patients treated for head injury at Nekemte Referral Hospital. Objective The main purpose of this study was to describe the magnitude of TBI outcome and assess factors associated with unfavourable outcome of TBI among patients treated for head injury at the surgical side in Nekemte Referral Hospital from July 8, 2016 to July 7, 2018. Methods A retrospective cross-sectional document review was conducted among TBI patients treated for head injury from July 8, 2016 to July 7, 2018 at Nekemte Referral Hospital. Data were collected using a pre-tested data collection format. Data analysis was done using SPSS version 20. Descriptive statistics were computed and association between the dependent and independent variables were assessed by using logistic regression. Odds ratios with 95% confidence interval were computed. Significant association was declared when the p value was <0.05. Results In this study, out of 378 cases 95 (25.1%) were discharged with unfavourable outcome of which 37(9.8%) were neurologic deficits and 58 were deaths giving overall mortality rate of 15.3%. Patient age>60years (AOR: 15.13; 95%CI: 3.575-64.028), time interval from injury to treatment (AOR: 16.054; 95%CI: 5.832-44.194), low GCS (AOR: 18.224; 95%CI: 4.167, 79.695), conservative management (AOR: 20.774; 95%CI: 6.106-70.681), pupils abnormality (AOR: 9.078; 95%CI: AOR: 2.996-27.509) were associated with unfavourable outcome. Conclusions A quarter of patients treated for TBI at Nekemte Referral Hospital are discharged with unfavourable outcomes. Old age, delayed presentation to the hospital, low GCS, conservative management, and pupillary abnormality increase the odds of unfavourable outcome. Timely management of TBI before patients develop secondary brain injury and use of surgical intervention based on CT scan diagnosis will reduce the occurrence of unfavourable outcome.

Role of Computed Tomography Scan in The Evaluation of Cerebral Palsy in Children

Background. Cerebral palsy is one of the common childhood neurological problem which occurs due to defect or lesion in immature brain. The worldwide incidence of cerebral palsy is approximately 2-2.5 per 1000 live births. There have been many works on the role of computed tomography scan in the diagnosis of cerebral palsy.
 Objective: The objective information available from careful review of imaging information such as CT brain scans, is an important adjunct to clinical data.
 Materials and Methods: This cross sectional study was carried out in the department of Radiology and Imaging, BSMMU and department of Paediatric Neurology unit over a period of 12 months from January 2019 to December 2019. We calculated the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT scan in diagnosis of CP in children.
 Results: This cross sectional study was carried out on consecutively selected 94 children below 15 years having clinical evidence of cerebral palsy. Among the study subjects 86.2% were diagnosed as cerebral palsy through CT scan.
 Conclusion: The sensitivity and specificity of CT scan of present study was found to be quite high in children which suggests a CT scan as an effective investigation for the diagnosis of cerebral palsy.
 KYAMC Journal Vol. 11, No.-1, April 2020, Page 3-8

Effectiveness of CT Scan in diagnosis and management of emphysematous pyelonephritis

To the organising secretory, respected sir; kindly find attached research paper over the topic to assess diagnostic accuracy of CTscan in diagnosis and management of EPN, permission has already been obtained by RRC and study has been started. So far, we have 8 cases, we are targeting around 15 cases till November and 20 cases upto January, considering this is not a common entity, approx 15-20 cases should be adequate. Class1: Gas confined to the collecting system Class3A: Perinephric extension of gas/abscess Class4: B/L EPN or EPN in a solitary kidney.

Use of CT Scans for Abdominal Pain in the ED: Factors in Choice

Overutilization of healthcare resources is a threat to long-term healthcare sustainability and patient outcomes. CT is a costly but efficient means of assessing abdominal pain; however, 97 per cent of ED physicians acknowledge its overutilization. This study sought to understand factors that influence ED providers' decision regarding CT use in the evaluation of abdominal pain. After evaluating a patient for acute abdominal pain, ED providers filled in a form in which the primary diagnosis and index of suspicion were recorded. Bivariate and multivariate analyses were used to identify predictors of outcomes. The CT scan utilization rate was 54.82 per cent. Whereas 34.11 per cent of CT scans were normal, 30 per cent yielded an acute abdominal pathology. Tenderness and rebound tenderness were positive predictors of high index of suspicion [odds ratio (OR) 2.09 and 2.54, respectively]. These variables were also predictive of obtaining a CT scan [OR 2.64 and 3.41, respectively]. Compared with whites, the index of suspicion was 26 per cent and 56 per cent less likely to be high when patients were black [OR 0.73] or Hispanic [OR 0.44] respectively. Blacks and Hispanics were less likely to have CT scans performed than whites [OR 0.58 and 0.48, respectively]. Leukocytosis significantly affected the index of suspicion for acute abdominal pathology, obtaining a CT scan and the acuity of CT scan diagnosis on multivariate analysis. Patients aged ≥60 years had 2.03 odds of acute CT finding compared with those aged <60 years. There is a need for committed efforts to optimize CT scan utilization and eliminate socioeconomic disparities in health care.

Ultrasonography after pharmacological stimulation of erection for the diagnosis and therapeutic follow-up of erectile dysfunction due to cavernovenous leakage.

The goal of this work was to demonstrate that Doppler ultrasound (DUS) after pharmacological stimulation of erection (PSE) can be used to evaluate the presence and intensity of a cavernovenous leak (CVL) suspected in erectile dysfunction (ED) patients. The study was built around 50 DUS-PSE exams of penile arteries and veins, which were carried out 3, 5, 10 and 20minutes after pharmacological stimulation. Measured parameters were end diastolic velocity of the cavernous arteries and mean velocity of the deep penile vein and/or penile superficial veins. A score from 0 to 3 was attributed to each according to the recorded velocities. A final score from 0 to 9 was established by adding the three values: patients quoting 0 and 1 were classified as "no leak" (n=8); from 2 to 9 (n=42) as "leaking". Penile computed tomography (CT-scan) under identical pharmacological stimulation identified the cavernovenous leak to be compared with the DUS-PSE results, which were valid in 47 cases (94%), with 97.6% sensitivity and 77.7% specificity. The kappa correlation coefficient for CT-scan diagnosis of suspected CVL was 0.7875 (P<0.001). In addition, we found that end diastolic velocity in the cavernous artery, considered up until now as the gold standard in cases of suspected CVL was insufficient (negative predictive value=47%). In addition to its well-known diagnostic value regarding ED of arterial origin, DUS-PSE is an excellent screening test for CVL, especially in young patients without vascular risk factors who are resistant to medical treatments. For those with well-established CVL, confirmation by CT-scan to discuss possible surgery should be the next step. Moreover, DUS-PSE is useful in postoperative monitoring.

Comparative assessment between Clinical and CT scan diagnosis in the treatment of blunt abdominal trauma

Comparative assessment between Clinical and CT scan diagnosis in the treatment of blunt abdominal trauma

Clinicoepidemiological Presentation of Sinonasal Mass in A Nigerian Tertiary Health Care Centre

Background: Sinonasal masses are common worldwide with clinical entity ranges from simple sinonasal polyps to malignancy. This study aimed at determining the prevalence, Sociodemographic features, clinical characteristics, clinical presentation, and management outcome of sinonasal masses. Materials and Methods: This was a retrospective study of patients with sinonasal masses in ear, nose and throat department of our center over a period of ten years (from November 2008 to October 2018). Data were retrieved from the clinic register and hospital medical record. Information on sociodemographic features, the clinical presentation of presentation, examination findings, CT Scan findings, diagnosis and treatment outcomes were retrieved. Data obtained were collated and analysed by using SPSS version 18.0. Results: The total number of patients seen over the studied period was 4,678 Male accounted for 62.9% with male to female ratio of 1.7:1. Sinonasal masses were bilateral in 44.3%, left-sided in 32.0% and right-sided in 23.7. Multiple grapelike sinonasal masses accounted for 50.5% while single sinonasal masses accounted for 49.5%. Commonest anatomical origin was ethmoid sinuses in 50.5%. Main clinical features were nasal blockage 83.5% and nasal discharge 63.9%. Masses extension was into 52.6% Intranasal/sinuses and 34.0% orbital extension. Main histological diagnosis were ethmoidal (simple) nasal polyps in 49.5%, squamous cell carcinoma in 17.5%, antrochoanal polyp in 9 3% and inverted papilloma in 9.3%. Histological examination showed simple inflammatory nasal polyps in 58.8%, benign tumour in 13.4% and malignant tumour in 23.7%. Patients were managed by 76.3% surgery, 16.5% surgery and radiotherapy and 7.2% chemoradiotherapy. Recurrent masses and death from malignancy were 8.2% and 2.1% respectively. Conclusions: Sinonasal masses are perceived and presented as a simple disorder with nasal obstructions and discharge. It consists of polyps and malignant tumour. Nasal Polyps are commoner than the neoplastic tumour. The commonest origin of the sinonasal masses was ethmoid sinuses which may be because polyps are the most common causes of sinonasal masses as shown in our study. Further evaluation revealed that majority of the unilateral sinonasal masses were neoplastic. They are poorly managed and presented in advanced stage to the otorhinolaryngologist, head and neck surgeon. Late presented patients had palliative treatment with resultant high recurrence and fatality. Thus Health education, serial and early screening are highly recommended.

What’s New in Orthopaedic Trauma

What’s New in Orthopaedic Trauma

Differences in Pain Intensity of Tumors Spread to the Anterior versus Anterolateral/Lateral Portions of the Vertebral Body Based on CT Scans.

We investigated whether the intensity of cancer pain differs for malignant tumors that have spread to anterior or anterolateral/lateral portions of the vertebral body. We hypothesize that tumor spread to the anterolateral/lateral vertebral body elicits more serious pain due to increased irritation of the spinal nerve. The selection criteria were as follows: (1) advanced or metastatic solid tumor; (2) radicular pain without extremity weakness; (3) malignant lesions anteriorly, anterolaterally, or laterally located at the vertebral body either spread locoregionally or over a greater distance via metastasis based on CT scan diagnosis; and (4) patient needs to use opioids for pain relief. Severe spinal pain intensity was defined as spinal pain for which patients required either strong opioids or spinal irradiation for relief. Eighty-six patients were enrolled in the study. Bone lesions were mainly osteolytic. Thirty-nine tumors spread to the vertebral body in the anterior direction, and 47 in the anterolateral/lateral direction. Severe pain intensity related to vertebral body lesions was due to anterolateral/lateral spread, primary sites of nonurothelial carcinoma, metastatic vertebral lesions, multiple lesions within a vertebrum, and location within the cervical-thoracic spine. In conclusion, patients with tumor spread to the anterolateral/lateral portion of vertebrae bodies based on CT scan diagnosis experienced severe cancer pain. These patients needed strong opioids or palliative spinal irradiation for pain relief.

Pilot study of plasma KRAS as a prognostic biomarker in localized pancreas ductal adenocarcinoma (PDAC).

294 Background: Validated predictive and prognostic biomarkers are needed in PDAC. Such biomarkers could predict response and resistance early in treatment. As 95% of PDAC harbor KRAS mutations (mKRAS), plasma mKRAS has utility as a biomarker. We explored the prognostic value of mKRAS in a PDAC cohort at Memorial Sloan Kettering. Methods: 10 mL of whole blood was collected at diagnosis of localized PDAC and early interval CT scan (approx. 8 weeks). DNA was extracted with QIAamp DNA kits (Qiagen, Valencia, CA). Single locus, if tissue KRAS known, or multiplex (G12A, G12C, G12D, G12R, G12S, G12V, G13D) digital droplet PCR (ddPCR) was performed with QX200 (BioRad, Hercules, CA) ddPCR system. Disease status was determined by radiographic, CA19-9 and clinical evaluation. Results: N = 18 enrolled (median age: 65 [range 34-85]). Median time between baseline (B) and interval (I) blood was 2.53 months (range 0.9-6). One had locally recurrent disease, 2 AJCC stage IIa, 1 IIb and 14 III. Three had tissue KRAS G12D mutation, 6 G12V and 9 unknown. Eight had gemcitabine-based treatment, 10 5-FU-based and 5 radiation. See table. mKRAS and CA19-9 at B were not associated with progression free survival (PFS) or overall survival (OS). mKRAS detection at I was associated with shorter PFS/OS (P &lt; 0.01), but CA19-9 was not. mKRAS change from B to I was also associated with PFS/OS. For every 1 copy/mL increase in the change of mKRAS from B to I, the risk of death or progression/death increased by nearly 2 fold after controlling for baseline value (p = 0.01 for OS, p = 0.03 for PFS). Four patients, all undetectable mKRAS at I, went to surgery; 2/4 resected. Conclusions: In this pilot, 59% of localized PDAC patients had detectable mKRAS at B. mKRAS detection at I and change from B to I were associated with PFS/OS supporting that mKRAS early in treatment may be a useful prognostic and predictive marker in localized PDAC. We have initiated a large prospective trial to evaluate the predictive and prognostic potential of plasma mKRAS in advanced PDAC. [Table: see text]

Relevance of early CT scan diagnosis of blunt diaphragmatic injury: A retrospective analysis from the Northern French Alps Emergency Network

Diaphragmatic rupture following blunt trauma occurs rarely. Classically described after high-velocity accidents, ruptures are often associated with multiple organ injuries. The diagnosis is sometimes difficult. The goal of this study was to analyze and to discuss the modalities of early radiologic diagnosis and management of these injuries. This multicenter retrospective study included patients seen between 2009 and 2017 within the Northern Alpine Emergency Network [REseau Nord Alpin des Urgences (RENAU)]. Clinical, radiologic and surgical data from all patients sustaining blunt diaphragmatic rupture were studied. Thirty-one patients (18 men and 13 women), median age 44, were included. The principle mechanism of injury was road or traffic accidents for 22 patients. Diaphragmatic rupture occurred on the left side in 23 patients. Diagnosis was delayed in two patients, at 11 days and three months after the initial accident. Chest X-rays were diagnostic in 18 of 29 patients. CT scan was the reference investigation since it was performed in all patients and confirmed the diagnosis in 26 instances. Repair was surgical via a midline laparotomy in 27 patients, via laparoscopy in three, and via thoracoscopy in one. Three patients died. At urgent surgical exploration in the unstable blunt trauma patient, the surgeon should keep in mind the relatively poor diagnostic performance of chest X-rays. Accurate diagnosis relies on routine inspection of the diaphragmatic cupolas. In the stable trauma victim, contrast-enhanced abdomino-thoracic CT with reconstruction can lead to early diagnosis, which allows for repair under optimal conditions, whether by laparotomy, laparoscopy or thoracoscopy, according to local conditions and expertise.