Diagnostic Imaging Evaluation Research Articles

Transposition of the Great Arteries with Intramural Left Main Coronary Artery—Salient Imaging Findings and Choice of Operative Technique

D-transposition of the great arteries (D-TGA) is a common cyanotic critical congenital heart disease. An arterial switch operation (ASO) with/without a ventricular septal defect (VSD) closure is the preferred surgical approach, with an added challenge when an intramural coronary artery (IMC) is present (1), with a reported increased incidence of postoperative complications and mortality (2,3). We present our recent D-TGA with intramural coronary artery (TGA-IMC) experience, focusing on the salient features identified on echocardiography, computed tomography (CT) angiography, and invasive angiograms, as well as variations in ASO surgical techniques for repair. Diagnostic imaging evaluation allowed for identification of the lesion, as well as planning for and undertaking of two different surgical approaches. While the two patients had differing immediate postoperative courses, both were asymptomatic at discharge, with normal biventricular systolic function. Our experience demonstrates that the suspicion for a coronary anomaly in TGA can be raised prenatally and confirmed postnatally with focused trans-thoracic echocardiography and ECG-gated CT angiogram evaluation while also aiding in operative planning. Moreover, suggesting further exploration of the optimal surgical technique for the repair of TGA-IMC.

Extracranial arteriovenous malformations: a 10-year experience at a German vascular anomaly center and evaluation of diagnostic imaging for endovascular therapy assessment.

Arteriovenous malformations (AVMs) account for <3% of vascular anomalies. This study aims to present the 10-year experience of a German vascular anomaly center (VAC) with AVMs and evaluate diagnostic imaging for treatment-relevant information for minimally invasive therapy planning. A retrospective study including patients from the VAC database with AVMs was conducted. Clinical information from patients' records was evaluated. An additional image reading analysis of the available diagnostic imaging using a 4-point Likert scale, focusing on relevant points for minimally invasive treatment planning, was conducted in 13 patients who had all three magnetic resonance tomography (MRI), computed tomography (CT), and conventional angiography available. Between April 2014 and March 2024, 60 patients (60% female, 40% male; 12% Parkes Weber syndrome) with AVMs presented to the VAC. The median age was 36 years (range: 11-78 years). Referral diagnosis was correct in 73.3% of cases. The mean distance to the VAC was 102.5 km (±111.0). The most common locations involved the hand (32%), lower extremity (22%), and pelvis (22%). The most common symptoms were pain (81%), pulsation (64%), and local hyperthermia (62%). Necrosis was significantly more common when the AVM was located in the hand (p = 0.0129) and growth when located in the pelvis (p = 0.0037). Furthermore, cosmetic issues were significantly more frequent when the AVM was located in the head area (p = 0.0333). Most patients presented with Schobinger stage II (57%). Right heart strain was only documented in one case. A total of 47% had undergone invasive therapies before VAC admission. In 30% of cases, further minimally invasive or invasive therapy was required. In the diagnostic imaging evaluation, conventional angiography had the overall best ratings for image quality (median = 1.00; range: 1.00-2.00), NIDUS evaluation median = 1.00; range: 1.00-2.00), and therapy planning (median = 1.00; range: 1.00-1.33). Our 10-year experience showed that in patients with AVMs, the correct diagnosis is often made before admission to a specialized VAC. Diagnostic imaging is essential for endovascular treatment planning, with conventional angiography showing superior utility in image quality, NIDUS evaluation, and therapy planning compared to other modalities.

Understanding risk factors for revision surgery after cubital tunnel release: Analysis of patient selection, surgeon, and clinical factors

PurposeThe purpose of this study was to identify and characterize factors that may contribute to revision surgery following primary cubital tunnel release (CuTR) surgery. MethodsA retrospective study was performed by reviewing all patients who underwent CuTR at a single institution between 2014 and 2021. Only primary in situ CuTR surgeries were included. Exclusion criteria were any case of primary ulnar nerve transpositions or ulnar nerve decompression surgery related to pathology other than isolated ulnar neuropathy (ie. elbow fracture repair, medial epicondylitis debridement, etc.). Revision surgery was defined as return to the operating room by the index surgeon or another surgeon within the same practice for repeat ulnar nerve decompression and/or transposition. Patient demographics and surgical information was analyzed to determine factors that may be associated with revision surgery following primary in situ ulnar nerve decompression. ResultsA total of 1367 patients met inclusion criteria. Revision rate following primary CuTR was 1.2 ​% (n ​= ​16). Of the factors evaluated, younger age (46.6 vs 57.0 years) and a history of cervical stenosis had a higher correlation with undergoing a revision. Patients who had revision surgery were more likely to have negative electrodiagnostic studies versus those who did not. Otherwise, there was no association between sex, race, tobacco use, medical comorbidities, symptom severity, bilateral symptoms, or concurrent surgery and the subsequent need for revision ulnar nerve decompression. ConclusionsFollowing primary in situ CuTR, younger age or a history of cervical stenosis may be at higher risk of undergoing revision surgery. Additionally, patients without electrodiagnostic evidence of ulnar neuropathy may have less reliable outcomes versus those who have a positive nerve study. Given the unpredictable nature of ulnar nerve surgery, further prospective data including diagnostic imaging and biomechanical evaluation of patients following ulnar nerve release may help provide a deeper understanding of this unique patient population. Level of evidencePrognostic, level IV.

Prevention of Adhesions after Bone Fracture Using a Carboxymethylcellulose and Polyethylene Oxide Composite Gel in Dogs.

The formation of adhesions is a common complication following traumatic injuries and surgical procedures, often resulting in pain, stiffness, and loss of function. This study aimed to evaluate the feasibility and safety of using a composite material comprising of carboxymethylcellulose (CMC), polyethylene oxide (PEO), and calcium chloride, for preventing adhesions between muscle and bone during the healing stage, as well as its effect on the bone healing process. Ten healthy purpose-bred laboratory Beagle dogs were randomly subjected to two consecutive operations with a 6-month interval, alternating between left and right forelimbs. On the left forelimb an osteotomy at the ulna was performed, while on the right forelimb the same procedure was supplemented by the application of the anti-adhesion agent in the osteotomy site prior to closure. Clinical, diagnostic imaging, macroscopic, and histological evaluations were performed at various time points. The results showed no significant differences in surgical site perimeter (p = 0.558), lameness (p = 0.227), and radiographic bone healing (p = 0.379) between the two groups. However, the macroscopic (p = 0.006) and histological assessments revealed significantly lower adhesion scores (p = 0.0049) and better healing (p = 0.0102) in the group that received the anti-adhesion agent. These findings suggest that the CMC/PEO composite material is a safe and potentially effective intervention for preventing post-traumatic and post-surgical adhesions in canine patients without compromising bone healing. Further research is warranted to fully characterize the clinical benefits of this approach.

2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Risk Assessment, Diagnostic Imaging, and Microbiological Evaluation in Adults, Children, and Pregnant People.

As the first part of an update to the clinical practice guideline on the diagnosis and management of complicated intra-abdominal infections in adults, children, and pregnant people, developed by the Infectious Diseases Society of America, the panel presents 21 updated recommendations. These recommendations span risk assessment, diagnostic imaging, and microbiological evaluation. The panel's recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.

2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Diagnostic Imaging of Suspected Acute Appendicitis in Adults, Children, and Pregnant People.

This paper is part of a clinical practice guideline update on the risk assessment, diagnostic imaging, and microbiological evaluation of complicated intra-abdominal infections in adults, children, and pregnant people, developed by the Infectious Diseases Society of America (IDSA). In this paper, the panel provides recommendations for diagnostic imaging of suspected acute appendicitis. The panel's recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Diagnostic Imaging of Suspected Acute Intra-abdominal Abscess in Adults, Children, and Pregnant People.

This article is part of a clinical practice guideline update on the risk assessment, diagnostic imaging, and microbiological evaluation of complicated intra-abdominal infections in adults, children, and pregnant people, developed by the Infectious Diseases Society of America. In this article, the panel provides recommendations for diagnostic imaging of suspected acute intra-abdominal abscess. The panel's recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Utility of Intra-abdominal Fluid Cultures in Adults, Children, and Pregnant People.

This paper is part of a clinical practice guideline update on the risk assessment, diagnostic imaging, and microbiological evaluation of complicated intra-abdominal infections in adults, children, and pregnant people, developed by the Infectious Diseases Society of America. In this paper, the panel provides recommendations for obtaining cultures of intra-abdominal fluid in patients with known or suspected intra-abdominal infection. The panel's recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intraabdominal Infections: Diagnostic Imaging of Suspected Acute Cholecystitis and Acute Cholangitis in Adults, Children, and Pregnant People.

This article is part of a clinical practice guideline update on the risk assessment, diagnostic imaging, and microbiological evaluation of complicated intraabdominal infections in adults, children, and pregnant people, developed by the Infectious Diseases Society of America. In this article, the panel provides recommendations for diagnostic imaging of suspected acute cholecystitis and acute cholangitis. The panel's recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Risk Assessment in Adults and Children.

This paper is part of a clinical practice guideline update on the risk assessment, diagnostic imaging, and microbiological evaluation of complicated intra-abdominal infections in adults, children, and pregnant people, developed by the Infectious Diseases Society of America. In this paper, the panel provides a recommendation for risk stratification according to severity of illness score. The panel's recommendation is based on evidence derived from systematic literature reviews and adheres to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.

2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Utility of Blood Cultures in Adults, Children, and Pregnant People.

This article is part of a clinical practice guideline update on the risk assessment, diagnostic imaging, and microbiological evaluation of complicated intra-abdominal infections in adults, children, and pregnant people, developed by the Infectious Diseases Society of America. In this guideline, the panel provides recommendations for obtaining blood cultures in patients with known or suspected intra-abdominal infection. The panel's recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Diagnostic Imaging of Suspected Acute Diverticulitis in Adults and Pregnant People.

This paper is part of a clinical practice guideline update on the risk assessment, diagnostic imaging, and microbiological evaluation of complicated intra-abdominal infections in adults, children, and pregnant people, developed by the Infectious Diseases Society of America. In this paper, the panel provides recommendations for diagnostic imaging of suspected acute diverticulitis. The panel's recommendations are based on evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

Venous thromboembolism swine model with reflux-induced venous hypertension

ObjectiveThis study describes a novel swine model of venous thromboembolism (VTE) with reflux-induced venous hypertension. MethodsSix pigs underwent disruption of the tricuspid chordae tendineae to create reflux and venous hypertension in the femoral vein. The vein was traumatized 2 to 3 weeks later by repeated withdrawal of a slightly overinflated occlusion balloon across the lumen, followed by balloon occlusion of the outflow. A small amount of thrombin was injected into the traumatized vein segment immediately after outflow occlusion. Thrombosis of the traumatized vein evolved into an organized thrombus seven weeks later. The histological features of the harvested post-thrombotic femoral vein were studied with hematoxylin and eosin and Trichrome stains. ResultsIn all six pigs, initial disruption of the chordae tendineae was successfully performed to create tricuspid reflux and venous hypertension. After two-stage sequential procedures, a thrombus formed in the target femoral vein segment. Histology of the harvested thrombotic vein showed features of an organizing thrombus with collagen formation and fibrosis. ConclusionsThe novel swine VTE model may serve as a platform for developing and testing human-sized therapeutic procedures and devices in translational venous research. Clinical RelevanceThis study describes a swine model of VTE created by incorporating all three elements of Virchow’s triad. The model uniquely incorporates reflux-induced venous hypertension, which may be used in studying venous insufficiency and VTE in those with systemic venous hypertension. Likewise, this model may serve as a platform for development and evaluation of diagnostic imaging or therapeutic procedures and devices in subjects with systemic venous hypertension.

Next Level of Care Protocols in Radiology: Improving Patient Access to Care

ObjectiveTo introduce a novel next level of care (NLC) protocol used in our breast imaging practice to bypass additional imaging and image-guided biopsy orders and to examine the impact of NLC on breast biopsy wait times compared with thyroid biopsy wait times, which do not use NLC. MethodsOur institutional review board deemed this retrospective analysis to be exempt. NLC was implemented for breast imaging in late 2014. Two 6-month periods before and after the COVID-19 shutdown were sampled and compiled. Data were queried from departmental database and electronic health record for all breast and thyroid biopsies during this time. Time to biopsy (TTB) was defined as the number of days from the diagnostic imaging evaluation recommending the biopsy to the completion of the biopsy. To determine the effect of NLC, TTB was compared between breast and thyroid biopsies. ResultsOf the 1,114 breast biopsies and 154 thyroid biopsies included, the mean TTB was 9 days (95% confidence interval 8.4-9.3) for breast and 23 days (95% confidence interval 20.5-25.0) for thyroid. There was a 61% reduction in the mean TTB for patients in the breast group compared with patients in the thyroid group. The effect of the NLC was comparable among different races and ethnicities in the breast group, but a significantly higher mean TTB (24% higher, P = .025) was observed for thyroid biopsies in Black patients compared with thyroid biopsies in Hispanic patients. ConclusionNLC protocol facilitates imaging evaluations and reduces the time interval to image-guided biopsies.

Investigating the suitability of newly developed epoxy-based equivalent tissues for newborn and 5-year-old in paediatric radiology

The varied radiological applications of tissue equivalent (TE) materials encompass quality checks, diagnostic imaging, and dose evaluations. However, the availability of compounds representing paediatric patient tissues for scientific use in lower diagnostic photon energy spectra is limited. In this study, several TE substitutes were developed to replicate the radiographic characteristics of neonatal soft tissue (ESST-NB), neonatal skeletal tissue (ESTB-NB), and equivalent tissues of a 5-year-old child (ESST and ESBT, respectively) within these energy ranges. The ORNL stylized computational model series was utilised as the primary reference for obtaining the desired elemental ratios. The density, effective atomic number, CT numbers, and electron densities obtained for the developed tissue substitutes exhibited a close resemblance to those of the reference phantom system, demonstrating a high level of accuracy and agreement. Furthermore, in order to accommodate constraints related to material selection and production, significant correlations were established between the obtained data and the reference values for mass densities, mass attenuation coefficients, and mass energy-absorption coefficients. In comparison to the ORNL reference samples, the neonates TE substitutions showed maximum discrepancies μ/ρ ranging from +1.6% to −3.01% and μen/ρ from +1.15% to −1.4% throughout an energy range from 47 keV to 66 keV. For the TE materials representing a 5-year-old, the corresponding comparable data ranges were +1.09% to −3.02% and +1.92% to −2.53%. These tissues may then be utilised to produce physical phantoms for neonates and 5-year-old as a result of the great concordance established between the newly built TE materials and the reference data.

Multimodality diagnostic imaging for anomalous pulmonary venous connections: a pictorial essay.

Anomalous pulmonary venous connections represent a heterogeneous group of congenital heart diseases in which a part or all pulmonary venous flow drains directly or indirectly into the right atrium. Clinically, anomalous pulmonary venous connections may be silent or have variable consequences, including neonatal cyanosis, volume overload and pulmonary arterial hypertension due to the left-to-right shunt. Anomalous pulmonary venous connections are frequently associated with other congenital cardiac defects and their accurate diagnosis is crucial for treatment planning. Therefore, multimodality diagnostic imaging, comprising a combination (but not all) of echocardiography, cardiac catheterization, cardiothoracic computed tomography and cardiac magnetic resonance imaging, helps identify potential blind spots relevant to each imaging modality before treatment and achieve optimal management and monitoring. For the same reasons, diagnostic imaging evaluation using a multimodality fashion should be used after treatment. Finally, those interpreting the images should be familiar with the various surgical approaches used to repair anomalous pulmonary venous connections and the common postoperative complications.

Congenital Portosystemic Shunts in Dogs and Cats: Treatment, Complications and Prognosis.

Congenital portosystemic shunts (CPSS) are a common vascular anomaly of the liver in dogs and cats. Clinical signs of CPSS are non-specific and may wax and wane, while laboratory findings can raise the clinical suspicion for CPSS, but they are also not specific. Definitive diagnosis will be established by evaluation of liver function tests and diagnostic imaging. The aim of this article is to review the management, both medical and surgical, complications, and prognosis of CPSS in dogs and cats. Attenuation of the CPSS is the treatment of choice and may be performed by open surgical intervention using ameroid ring constrictors, thin film banding, and partial or complete suture ligation or by percutaneous transvenous coil embolization. There is no strong evidence to recommend one surgical technique over another. Medical treatment strategies include administration of non-absorbable disaccharides (i.e., lactulose), antibiotics, and dietary changes, and are indicated for pre-surgical stabilization or when surgical intervention is not feasible. After CPSS attenuation, short- and long-term post-surgical complications may be seen, such as post-operative seizures and recurrence of clinical signs, respectively. Prognosis after surgical attenuation of CPSS is generally favorable for dogs and fair for cats.

Diagnostic Imaging in Evaluation of Aortic Dissection

Dr. Omar is Chief Resident, Department of Radiology, Detroit Medical Center, 4201 St. Antoine, 3J-2, Detroit, MI 48201, E-mail: [email protected]; and Dr. Abidov is Professor, Department of Radiology, John D. Dingell VA Medical Center, Detroit, Michigan. After participating in this educational activity, the radiologist should be better able to identify risk factors, epidemiology, clinical presentation, imaging characteristics, and pathophysiology of aortic dissection and describe associated complications. Dr. Abidov is a recipient of grant/research funding from Astellas Pharma. Lippincott CME Institute has identified and mitigated all relevant financial relationships regarding this educational activity. The remaining author, faculty, and staff have no relevant financial relationships with any ineligible organizations. The FDA has not approved gadolinium contrast for use in DE-CMR as discussed in this article. Please consult the product labeling for approved information. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed answer form, answering at least seven of the 10 quiz questions correctly. This continuing medical education activity expires on April 14, 2025.

Diagnostic Imaging in Evaluation of Aortic Dissection

Contemporary Diagnostic Radiology 46(8):p 8, April 15, 2023. | DOI: 10.1097/01.CDR.0000923816.93232.ba

Imaging of tubercular mastitis presenting as recurrent breast nodules and abscesses: a rare case report

BackgroundTubercular mastitis could be a rare diagnostic find clinically. It is largely seen in Asian, African and alternative non-developed countries and might occur with coincident primary tuberculosis of the respiratory tract or spine. Primary breast tuberculosis (TB) is even rarer and presents with non-specific clinical signs of continual breast masses, inflammation and sinus tracts. It can be similar to bacterial inflammation/abscess and malignant pathologies on imaging. The key to identification could be a holistic combination of imaging, clinical, biochemical and histopathological analysis.Case presentationWe discuss a case of a 41-year-old lady who conferred at the start with tender breast nodules that progressed to continual, multiple abscesses and sinus tract formation. It had been an unusual and unanticipated presentation in breast followed by uncommon events throughout the course of the treatment forcing us to re-evaluate the primary diagnosis. A sequence of multiple diagnostic imaging and histopathological evaluations confirmed the identification of tubercular mastitis. Following prolonged treatment, there was vital reduction within the range and size of nodules and abscesses.ConclusionsSuch cases imitate bacterial abscess and cancer in their clinical presentation and imaging findings and are imperative to be diagnosed via a myriad of diagnostic tests with histopathology. Such a clinical presentation should warrant a differential of granulomatous inflammation of the breast in cases of non-responders to incision and drainage, prolonged antibiotic medical therapy and prolonged anti-tubercular treatment up to twenty four months after assessment of the individual response.