Follow-up CT Research Articles

The efficacy of flexible ureteroscopy for large volume stones and hazards of ureteral access sheath usage: A prospective randomized study

ABSTRACT Objectives We aimed to assess the stone free rate of flexible ureteroscopy and laser lithotripsy (FURL) in upper urinary tract stones (UUTS) >20 mm and the risk of complications from ureteral access sheath (UAS) usage. Methods This is a prospective randomized clinical trial that included patients with UUTS larger than 20 mm who underwent FURL after randomization into two groups: group A (UAS) and group B (non-UAS). Data were collected for patients’ demographics, stone parameters, operative and postoperative complications, and the outcome of FURL regarding stone-free rate (SFR) and perioperative complications, with a 6-month follow-up. Stone clearance was defined as the absence of fragments or the presence of fragments smaller than 2 mm on follow-up CT scans of the urinary tract (CTUT). Results One hundred and fifty-nine patients were evaluated. The mean stone size was 27.08 ± 6.185 mm. Complete stone-free status was achieved in 84.9% of the patients. No significant difference was detected between both groups regarding operative time or SFR. The ureteric injury was identified in 13 (8.1%) patients (10 in group A and 3 in group B, p: 0.0481). Five of them, from group A, revealed hydronephrosis after stent removal. Postoperative pain and fever were documented in 50 and 22 patients, respectively, without significant differences between both groups. Postoperative sepsis occurred in 7 patients (2 in group A, 5 in group B, p: 0.380) who required supportive care. Conclusion FURL without UAS is a safe and efficient treatment for upper urinary tract stones larger than 20 mm in the form of lower risk of ureteric injury.

Relations between bone density from computed tomography and bone regeneration after reduction mandibuloplasty

BackgroundBone regeneration in the mandibular angle region after reduction mandibuloplasty may compromise the aesthetics of the lower face and thus lead to revision surgery. Bone quality is known to play an important role in osteogenesis. However, no study has evaluated the relationship between mandibular bone quality and bone regeneration volume. MethodsThe bone density of the mandibular angle immediately after surgery (BD) was determined as the grey level in computed tomography (CT) images. Based on the immediate postoperative and long-term follow-up CT images, the volumes of the regenerated angle (VSA) and the regenerated outer cortex (VOC) were measured after model reconstruction, automatic alignment and Boolean operation. Correlation analyses were then performed between VSA and BD, VOC and BD. Results23 patients (46 mandibular angles) were included in this study. The average BD was 907.09 ± 111.89 HU. The mean VSA was 201.66 (131.73–357.24) mm3. Spearman correlation analysis revealed a positive correlation between BD and VSA (r = 0.5449, p < 0.0001). The mean VOC was 236.23 ± 151.35 mm3. Pearson correlation analysis found a negative correlation between BD and VOC (r = -0.3501, p = 0.0171). ConclusionsCT images can provide a quantitative assessment of mandibular bone quality. BD may influence the volumes of bone regeneration in different areas of the mandibular angle portion after reduction mandibuloplasty, in the regenerated angle area positively and in the regenerated outer cortex region negatively. Therefore, slight over-grinding may be a choice to prevent secondary angulation.

EP142 - "Unravelling the Enigma: Navigating the Diagnostic Dilemma of Abdominal Toxoplasmosis"

Abstract Introduction Abdominal toxoplasmosis, an infrequent yet medically significant manifestation of Toxoplasma infection, primarily caused by the protozoan parasite Toxoplasma gondii. Although toxoplasmosis can affect various organs, its occurrence in the abdominal region introduces unique diagnostic complexities, presenting symptoms such as abdominal pain, gastrointestinal disruptions, and systemic complications. Case Report In a notable case, a middle-aged patient presented with perplexing gastrointestinal symptoms, including nausea, vomiting, abdominal pain, and irregular bowel habits. With a history of anaemia and thrombocytopenia necessitating transfusions and yielding inconclusive bone marrow biopsies, the patient underwent OGD and colonoscopy with biopsies during initial management, revealing a hiatus hernia and diverticulosis that did not explain the symptoms. Despite being discharged pending biopsy results, subsequent normal findings failed to clarify. Upon readmission with persistent gastrointestinal complaints, a CTAP revealed two suspicious neoplastic focal areas of small bowel wall thickening and enlarged mesenteric lymph nodes. The MDT discussions ensued to rule out malignancy, leading to a follow-up PET scan suggesting nodal disease, raising concerns about lymphoma, small bowel adenocarcinoma, or carcinoid tumour and recommended an ultrasound-guided lymph node biopsy, 5 HIAA if asymptomatic, and diagnostic laparoscopy if symptomatic or obstructed. Subsequent core biopsy of a neck lymph node unveiled appearances consistent with toxoplasmosis, prompting treatment with anti-parasitic drugs. The patient awaits capsule endoscopy, and a follow-up CT scan displayed a reduction in bowel lesions and lymph nodes. Conclusion This case highlights the swift and precise identification of toxoplasmosis, resulting in an optimal patient outcome. The clinical manifestations of toxoplasmosis are diverse and lack distinct characteristics, making it challenging to definitively diagnose, particularly in immunocompetent individuals.

Nontuberculous mycobacterial pulmonary disease presenting as bronchiolitis pattern on CT without cavity or bronchiectasis

BackgroundThis study aimed to investigate the radiological changes in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) having bronchiolitis patterns on computed tomography (CT).MethodsWe retrospectively reviewed the final diagnosis and radiologic changes of patients suspected of having NTM-PD without cavity or bronchiectasis on CT image, between January 1, 2005 and March 31, 2021. NTM-PD was diagnosed based on the American Thoracic Society and Infectious Diseases Society of America criteria. The initial and final CT findings (bronchiectasis, cellular bronchiolitis, cavity formation, nodules, and consolidation) were compared between patients diagnosed with and without NTM-PD.ResultsThis study included 96 patients and 515 CT images. The median CT follow-up duration was 1510.5 (interquartile range: 862.2–3005) days. NTM-PD was recognized in 43 patients. The clinical variables were not significantly different between patients with and without NTM-PD, except for underlying chronic airway disease (P < 0.001). Nodule and consolidation were more frequently observed on the initial CT scans of patients with NTM-PD compared with those without (P < 0.05). On the final follow-up CT scan, bronchiectasis (P < 0.001), cavity (P < 0.05), nodule (P < 0.05), and consolidation (P < 0.05) were more frequently observed in patients with NTM-PD. Among the 43 patients with NTM-PD, 30 showed a radiological progression on CT, with bronchiectasis (n = 22) being the most common finding. The incidence of bronchiectasis increased over time.ConclusionThe bronchiolitis pattern on CT images of patients with NTM-PD showed frequent radiological progression during the follow-up period.

CLINICAL MANAGEMENT OF CHRONIC ORANGUTAN RESPIRATORY DISEASE SYNDROME IN THREE ADULT MALE BORNEAN ORANGUTANS (PONGO PYGMAEUS).

Orangutan respiratory disease syndrome (ORDS) is a disease unique to orangutans (Pongo sp), characterized by chronic bacterial infection and inflammation of any region or combination of regions of the respiratory tract, including the sinuses, air sacs, cranial bones, airways, and lung parenchyma. Aggressive early intervention during a first episode may prevent progression to chronic disease. However, in the setting of an established chronic disease, intermittent acute exacerbations are associated with worsening symptoms and increased infection and inflammation. ORDS is ultimately fatal due to loss of respiratory function resulting from chronic structural damage. Utilizing potentially lifelong medications to slow the progression of chronic, destructive inflammation in the respiratory tract, chronic treatment is aimed at stabilizing the animals' respiratory function, decreasing the frequency of recurrent exacerbations, and improving their general well-being. Three adult male Bornean orangutans (Pongo pygmaeus) housed at an orangutan rehabilitation and reintroduction center in Indonesia have long histories of recurrent respiratory disease. Each underwent CT scans confirming ORDS with chronic airway disease prior to initiation of a long-term treatment protocol. Based on data-driven medical management of bronchiectasis in humans, the three orangutans have been treated with long-term combination regimens of oral azithromycin, nebulized salbutamol, and nebulized hypertonic saline. Follow-up CT scans in all three animals at least 1 yr following treatment initiation showed improvements throughout their respiratory tracts. The duration of each exacerbation period decreased, and the orangutans have longer symptom-free periods compared to before the start of treatment. At an average of 5 yr into the long-term treatment protocol, all three orangutans are thriving. Chronic medical management of ORDS modeled after human treatment of bronchiectasis has been efficacious in these three orangutans and encourages further study of this approach.

Accuracy of Ultralow-Dose Photon-counting CT in the Detection of Lung Changes after Lung Transplant.

Background Data on the diagnostic accuracy of ultralow-dose (ULD) CT protocols for periodic surveillance in recipients of lung transplant are lacking. Purpose To assess the potential for radiation dose reduction using ULD photon-counting CT (PCT) to detect lung abnormalities in recipients of lung transplant during repeat CT follow-up. Materials and Methods Consecutive adult recipients of lung transplant undergoing same-day standard-of-care low-dose (LD) and ULD PCT from March 2023 to May 2023 were prospectively included. The ULD protocols were performed with two target effective doses comprising 20% (hereafter, ULD1) and 10% (hereafter, ULD2) of the standard LD protocol. The 1-mm reconstructions were reviewed by three readers. Subjective image quality, the visibility of certain anatomic structures (using a five-point Likert scale), and the presence of lung abnormalities were independently assessed. The χ2 or t tests were used to evaluate differences between the ULD1 and ULD2 protocols. Results A total of 82 participants (median age, 64 years [IQR, 54-69 years]; 47 male) were included (41 participants for each ULD protocol). The mean effective doses per protocol were 1.41 mSv ± 0.44 (SD) for LD, 0.26 mSv ± 0.08 for ULD1, and 0.17 mSv ± 0.04 for ULD2. According to three readers, the subjective image quality of the ULD images was deemed diagnostic (Likert score ≥3) in 39-40 (ULD1) and 40-41 (ULD2) participants, and anatomic structures could be adequately visualized (Likert score ≥3) in 33-41 (ULD1) and 34-41 (ULD2) participants. The detection accuracy for individual lung anomalies exceeded 70% for both ULD protocols, except for readers 1 and 3 detecting proximal bronchiectasis and reader 3 detecting bronchial wall thickening and air trapping. No evidence of a statistically significant difference in noise (P = .96), signal-to-noise ratio (P = .77), or reader accuracy (all P ≥ .05) was noted between the ULD protocols. Conclusion ULD PCT was feasible for detecting lung abnormalities following lung transplant, with a tenfold radiation dose reduction. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Ciet in this issue.

Residual Cyst Mimicking an Aggressive Neoplasm—A Life-Threatening Condition

Odontogenic cysts are frequently encountered in clinical practice. However, residual cysts, a specific type of inflammatory odontogenic cyst, are relatively rare. These cysts may slowly expand over time, damaging surrounding soft tissues and bone, typically without posing a threat to life. We report the case of a 67-year-old man with liver failure and a cystic tumor in his right maxilla that had invaded his oral cavity and cheek, causing nasal obstruction and severe bleeding following an incisional biopsy. A computed tomography (CT) scan of the mass was nonspecific, and an initial histopathological analysis of the tissues was inconclusive due to chronic inflammation and hemorrhagic alterations, complicating the diagnostic pathway. The suspicion of a potentially aggressive malignant neoplasm and the need for immediate intervention due to bleeding necessitated a tracheotomy, tumor removal, percutaneous endoscopic gastrostomy, and transfusions of red blood cells. A subsequent histopathological examination revealed features indicative of a residual cyst. The entire lesion was excised through functional endoscopic sinus surgery. The surgical treatment was performed safely and effectively. Follow-up CT confirmed complete removal of the lesion. This case highlights a rare yet possible complication of odontogenic cysts and underscores the necessity of early diagnosis and comprehensive prophylaxis to prevent severe complications.

CT-based multimodal deep learning for non-invasive overall survival prediction in advanced hepatocellular carcinoma patients treated with immunotherapy

ObjectivesTo develop a deep learning model combining CT scans and clinical information to predict overall survival in advanced hepatocellular carcinoma (HCC).MethodsThis retrospective study included immunotherapy-treated advanced HCC patients from 52 multi-national in-house centers between 2018 and 2022. A multi-modal prognostic model using baseline and the first follow-up CT images and 7 clinical variables was proposed. A convolutional-recurrent neural network (CRNN) was developed to extract spatial-temporal information from automatically selected representative 2D CT slices to provide a radiological score, then fused with a Cox-based clinical score to provide the survival risk. The model’s effectiveness was assessed using a time-dependent area under the receiver operating curve (AUC), and risk group stratification using the log-rank test. Prognostic performances of multi-modal inputs were compared to models of missing modality, and the size-based RECIST criteria.ResultsTwo-hundred seven patients (mean age, 61 years ± 12 [SD], 180 men) were included. The multi-modal CRNN model reached the AUC of 0.777 and 0.704 of 1-year overall survival predictions in the validation and test sets. The model achieved significant risk stratification in validation (hazard ratio [HR] = 3.330, p = 0.008), and test sets (HR = 2.024, p = 0.047) based on the median risk score of the training set. Models with missing modalities (the single-modal imaging-based model and the model incorporating only baseline scans) can still achieve favorable risk stratification performance (all p < 0.05, except for one, p = 0.053). Moreover, results proved the superiority of the deep learning-based model to the RECIST criteria.ConclusionDeep learning analysis of CT scans and clinical data can offer significant prognostic insights for patients with advanced HCC.Critical relevance statementThe established model can help monitor patients’ disease statuses and identify those with poor prognosis at the time of first follow-up, helping clinicians make informed treatment decisions, as well as early and timely interventions.Key PointsAn AI-based prognostic model was developed for advanced HCC using multi-national patients.The model extracts spatial-temporal information from CT scans and integrates it with clinical variables to prognosticate.The model demonstrated superior prognostic ability compared to the conventional size-based RECIST method.Graphical

Early temporal changes on CT chest in patients with COVID-19 pneumonia

Introduction: Computed tomography (CT) scan of the chest helps in the evaluation, prognostication, and follow-up of patients with Corona virus disease-19 (COVID-19) pneumonia.Objectives: To study the early temporal evolution of findings on CT chest in patients with COVID-19 pneumonia at 6 weeks follow up.Material and methods: A retrospective analysis was performed on 40 patients with confirmed COVID-19 pneumonia who underwent baseline chest CT scans followed by a repeat scan at six weeks. Patients were quantitatively assessed using an objective CT severity score and qualitatively assessed using imaging parameters like consolidation, ground glass opacities (GGOs), parenchymal bands, septal thickening, nodules and crazy paving pattern.Results: Mean age of our study population was 58.5 ± 10.2 years with 80% being males. The baseline CT scan revealed a total median CT severity score interquartile range (IQR) of 16/25 (range: 14-20) while the follow-up scan after six weeks revealed a median score (IQR) of 14/25 (range: 8-19). This difference was statistically significant (p=0.04). The difference in CT severity scores of bilateral upper lobes was statistically significant (p=0.04 on right side and p=0.009 on left side); however, the difference in scores of bilateral lower lobes was not statistically significant (p&gt;0.05). The common imaging patterns on baseline imaging were GGO (97.5%), con-solidation (85%), septal thickening (85%), parenchymal bands (60%) and nodules (32.5%), which showed an interval resolution in the follow-up CT scan.Conclusion: Most of the patients with COVID-19 pneumonia showed interval resolution of lung findings seen on short-term follow-up CT scan.

Computed tomographic re-evaluation of skeletally immature French bulldogs previously diagnosed with humeral intracondylar fissure: 12 cases (2018-2022).

The objective of this study was to present the follow-up findings obtained through computed tomography in skeletally immature French bulldogs previously diagnosed with humeral intracondylar fissures. Medical records from a surgical referral centre between January 2018 and September 2022 were evaluated for all dogs with a humeral condylar fracture where preoperative CT of both humeri was performed. French bulldogs between the age of 12 weeks and 12 months were identified and evaluated for the presence of contralateral humeral intracondylar fissure. The dogs with follow-up CT were evaluated for humeral intracondylar fissure resolution. A total of 137 humeral condylar fractures were operated on within the study period, 58 of which were in French bulldogs. Twenty-seven French bulldogs had a contralateral humeral intracondylar fissure with 12 dogs matching the inclusion criteria. Follow-up CT demonstrated resolution of the humeral intracondylar fissure in 11 (91.7%) of 12 cases. Contralateral humeral intracondylar fissures are common in skeletally immature French bulldogs sustaining humeral condylar fractures and the majority of these fissures tend to fuse within the follow-up period. Due to the potential for breed variation in ossification of the humeral condyle, follow-up CT may be warranted in skeletally immature French bulldogs before considering prophylactic transcondylar screw placement.

Exploring bone density analysis on routine CT scans as a tool for opportunistic osteoporosis screening

The primary aim of this study was to evaluate computed tomography (CT)-based bone density analysis at the level of thoracic vertebra 12 (Th12) as a screening method for decreased bone density in patients admitted to the intensive care unit (ICU). Interobserver variability was analyzed. Secondary aims were to assess the prevalence of CT-based low bone density upon ICU admission in a cohort of COVID-19 patients and to assess the potential effect of long-term ICU stay on bone density in these patients. Retrospective single-center cohort study. ICU of the Leiden University Medical Center (LUMC), the Netherlands. Patients admitted to the ICU of the LUMC between March 1st, 2020 and February 1st, 2022 with a diagnosis of COVID-19, and a length of ICU stay of ≥ 21 days. In the included patients both baseline chest CT scans (obtained upon ICU admission) and follow-up chest CT scans (obtained ≥ 21 days after ICU admission) were available for analysis. A total of 118 CT scans in 38 patients were analyzed. There was a good interobserver variability, with an overall mean absolute difference (between measurements of three observers) of 9.7 Hounsfield Units (HU) and an intraclass correlation coefficient (ICC) of 0.93 (95% CI 0.88–0.96). The effect of intravenous contrast administration on bone density measurements was small (+ 7.5 HU (95% CI 3.4–11.5 HU)) higher in contrast enhanced CT images compared to non contrast enhanced CT images). Thirty-seven percent of patients had a bone density < 140 HU, suggestive of osteoporosis. No significant difference was found between bone density upon ICU admission and bone density at follow-up (≥ 21 days after ICU admission). Vertebral CT-based bone density analysis using routine CT scans is an easily applicable method to identify ICU patients with decreased bone density, which could enable enrollment in osteoporosis prevention programs. A high prevalence of low bone density was found in our cohort of ICU patients. There were no changes observed in bone density between baseline and follow-up measurements.

A Revolutionary Device for Endovascular Aortic Repair of Abdominal Aortic Aneurysm: A Pilot Study

Background Endovascular repair for abdominal aortic aneurysms (AAA) has been the gold standard since it was established in 1991. Various graft configurations have been developed to overcome the limitations of endovascular aortic repair (EVAR), including contralateral gate cannulation (CGC). We propose a new device and technique intended to simplify endovascular AAA repair, along with reports of its application in six patients. Intervention The Taofan and Kang (T&amp;K) bidirectional endovascular aortic repair (B-EVAR (B-EVAR) device uses a main-body stent graft, two-limb extensions, and bare metal stent. The procedure involved accessing the right and left femoral arteries, followed by standard aortography evaluation using a pigtail catheter through the contralateral femoral access. The main body stent graft is deployed through ipsilateral femoral access using a balloon catheter, while the contralateral gate is cannulated with a hydrophilic coated wire. Both balloons were inflated simultaneously to ensure that the wires were in different lumens. Contralateral and ipsilateral extensions were deployed using a limb extension stent graft. Standard aortography evaluation was repeated. Result T&amp;K B-EVAR pilot procedures proved successful in various cases, from simple to complex anatomy, and even with varied graft stent deployment strategies. None of the patients had complications or prolonged length of stay (LOS). Follow-up CT did not reveal any high-pressure endoleaks. Conclusion T&amp;K B-EVAR has been proven to simplify endovascular AAA repair in six patients with excellent results. It is also reproducible, potentially universally applicable, and can offer operators ease of use, faster procedure times, reduced fluoroscopy times, and reduced contrast usage.

The Impact of Double Pelvic Osteotomy on Dorsolateral Subluxation in 24 Dogs.

The aim of this study was to determine the effect of double pelvic osteotomy (DPO) on dorsolateral subluxation (DLS) of the femoral head in a weight-bearing position. Retrospective observational study with treatment effect analysis. Twenty-four client-owned dogs that underwent DPO due to hip dysplasia. Computed tomography (CT) studies were performed on 24 dogs that underwent a DPO between 2015 and 2021. The patients were positioned with the femora in a weight-bearing position. The DLS score was measured pre-DPO, immediately post-DPO, and at follow-up to determine if DPO resulted in an increase in the DLS score. A total of 21 dogs underwent single-stage bilateral DPO and 3 dogs underwent unilateral DPO resulting in 45 hip joints available for analysis. Follow-up CT was available for 29 of these at a median of 51 days (range: 35-482 days). The mean DLS score was 36.1% ± 14.6 preoperatively, 71.4% ± 12.5 post-DPO, and 70.0% ± 15.3 at follow-up. The increase between the pre- and postoperative measurement was significant (p < 0.001). DPO results in reduced subluxation of the femoral head in a weight-bearing position. The in vivo results suggest that DPO will result in reduced femoral subluxation during weight-bearing.

Evaluating the interaction between hemorrhagic transformation and cerebral edema on functional outcome after ischemic stroke

BackgroundHemorrhagic transformation (HT) and cerebral edema (CED) are both major complications following ischemic stroke, but few studies have evaluated their overlap. We evaluated the frequency and predictors of CED/HT overlap and whether their co-occurrence impacts functional outcome more than each in isolation. Methods892 stroke patients enrolled in a prospective study had follow-up CT imaging evaluated for HT and CED; the latter was quantified using the ratio of hemispheric CSF volumes (with hemispheric CSF ratio < 0.90 used as the CED threshold). The interaction between HT and CED on functional outcome (using modified Rankin Scale at 3 months) was compared to that for each condition separately. ResultsAmong the 275 (31%) who developed HT, 233 (85%) manifested hemispheric CSF ratio < 0.9 (CED/HT), with this overlap group representing half of the 475 with measurable CED. Higher baseline NIHSS scores and larger infarct volumes were observed in the CED/HT group compared with those with CED or HT alone. Functional outcome was worse in those with CED/HT [median mRS 3 (IQR 2-5)] than those with CED [median 2 (IQR 1-4)] or HT alone [median 1 (IQR 0-2), p < 0.0001]. Overlap of CED/HT independently predicted worse outcome [OR 1.89 (95% CI: 1.12-3.18), p = 0.02] while HT did not; however, CED/HT was no longer associated with worse outcome after adjusting for severity of CED [adjusted OR 0.35 (95% CI: 0.23, 0.51) per 0.21 lower hemispheric CSF ratio, p < 0.001]. ConclusionsMost stroke patients with HT also have measurable CED. The co-occurrence of CED and HT occurs in larger and more severe strokes and is associated with worse functional outcome, although this is driven by greater severity of stroke-related edema in those with HT.

A challenging decision for emergency physicians: Routine repeat computed brain tomography of the brain in head trauma in infants and neonates.

Head trauma is a leading cause of death and disability. While standard treatment protocols exist for severe head trauma, no clear follow-up standards are available for mild head trauma with positive imaging findings in infants and newborns. Although routine follow-up brain computed tomography (CT) imaging is not recommended for children with moderate and mild head trauma, the necessity for follow-up imaging in infants and newborns remains uncertain. Our study is a retrospective, observational, and descriptive study. Infants under 1 year old presenting to the emergency department with isolated head trauma were reviewed with the approval of the Ethics Committee of Ankara Etlik City Hospital. Inclusion criteria included presentation to the emergency department, undergoing more than one brain CT scan, and sustaining mild head trauma (Glasgow Coma Scale [GCS] >13). Patients with incomplete follow-up data or multiple traumas were excluded. Age, gender, mechanism of trauma, initial and follow-up brain CT findings, hospital admission, and surgical procedures were recorded and analyzed using the SPSS statistical package. Out of 238 screened patients, 154 were included in the study. Of these, 66.9% were male and the average age was 5.99 months. The most common presenting symptom was swelling at the trauma site, observed in 79.2% of cases. The most common mechanism of injury was falling from a height of less than 90 cm, accounting for 85.1% of cases. Pathological progression on follow-up CT was observed in 5.2% of the patients, and only 1.9% required surgical treatment. A total of 34.4% of the patients required hospitalization. Patients with parenchymal brain pathology had a higher rate of pathological progression on follow-up CT and a longer hospital stay. Follow-up CT scans in infants with mild head trauma do not alter patient outcomes except in cases with brain parenchymal pathology. Study data indicated that repeat imaging is not beneficial for isolated skull fractures. Imaging artifacts often necessitated repeated scans, contributing to increased radiation exposure. Unnecessary repeat imaging escalates radiation exposure and healthcare costs. Only a small percentage of patients exhibited progression of intracranial pathology, justifying follow-up imaging solely in the presence of brain parenchymal injury. Larger prospective studies are necessary to confirm these findings.

Abdominal aneurysm sac thrombus CT density and volume after EVAR: which association with underlying endoleak?

BackgroundOur aim was to analyse abdominal aneurysm sac thrombus density and volume on computed tomography (CT) after endovascular aneurysm repair (EVAR).MethodsPatients who underwent EVAR between January 2005 and December 2010 and had at least four follow-up CT exams available over the first five years of follow-up were included in this retrospective single-centre study. Thrombus density and aneurysm sac volume were calculated on unenhanced CT scans. Linear mixed models were used for data analysis.ResultsOut of 82 patients, 44 (54%) had an endoleak on post-EVAR contrast-enhanced CT. Thrombus density significantly increased over time in both the endoleak and non-endoleak groups, with a slope of 0.159 UH/month (95% confidence interval [CI] 0.115–0.202), p < 0.0001) and 0.052 UH/month (95% CI 0.002–0.102, p = 0.041). In patients without endoleak, a significant decrease in aneurysm sac volume was identified over time (slope -0.891 cc/month, 95% CI -1.200 to -0.581); p < 0.001) compared to patients with endoleak (slope 0.284 cc/month, 95% CI -0.031 to 0.523, p = 0.082). The association between thrombus density and aneurysm sac volume was positive in the endoleak group (slope 1.543 UH/cc, 95% CI 0.948–2.138, p < 0.001) and negative in the non-endoleak group (slope -1.450 UH/cc, 95% CI -2.326 to -0.574, p = 0.001).ConclusionWe observed a progressive increase in thrombus density of the aneurysm sac after EVAR in patients with and without endoleak, more pronounced in patients with endoleak. The association between aneurysm volume and thrombus density was positive in patients with and negative in those without endoleak.Relevance statementA progressive increase in thrombus density and volume of abdominal aortic aneurysm sac on unenhanced CT might suggest underlying endoleak lately after EVAR.Key PointsThrombus density of the aneurysm sac after EVAR increased over time.Progressive increase in thrombus density was significantly associated to the underlying endoleak.The association between aneurysm volume and thrombus density was positive in patients with and negative in those without endoleak.Graphical

Humeral rotation osteotomy is not associated with glenohumeral and scapulohumeral decentering at long-term follow-up

BackgroundWeber rotational osteotomy which increases humeral retrotorsion in patients with anterior shoulder instability has become unpopular because of recurrence of instability and high rates of early onset OA. However, the wear pattern in patients after rotational osteotomy remains unknown. The aim of this study was to determine the influence of surgically increased humerus retrotorsion on glenohumeral and scapulohumeral centering in a long-term follow-up. MethodsThe data of 18 shoulders in 18 patients diagnosed with a unilateral chronic recurrent anterior shoulder instability treated with an internal rotation subcapital humerus osteotomy between 1984 and 1990 were drawn from a previously published cohort and enrolled in the study. All patients had available bilateral CT scans performed after a mean follow-up of 14 (12-18) years. On these CT scans a comparison of the operated and the contralateral healthy side with regards to humerus torsion, glenoid version, glenoid offset, glenohumeral and scapulohumeral subluxation indices, rotator cuff action lines and osteoarthritic changes (OA) was performed. ResultsThe analysis of follow-up CT scans revealed a significantly higher mean humeral retrotorsion in the operated side compared to healthy side (41.6° ± 14.0° vs. 20.7°±8.2°, p<0.001). No differences were found in terms of glenohumeral subluxation index (0.50 ± 0.08 vs 0.51 ± 0.03, p = 0.259), scapulohumeral subluxation index (0.53 ± 0.09 vs 0.54 ± 0.03, p = 0.283), glenoid version (- 3.9° ± 4.6 vs - 4.1° ± 3.7, p = 0.424), glenoid offset (4.0 mm ± 2.8 vs 4.0 mm ± 1.3, p = 0.484), infraspinatus action lines (102.5° ± 4.7 vs 101.2° ± 2.1, p = 0.116) , subscapularis action lines (74.0° ± 6.0 vs 73.1° ± 2.3, p = 0.260) and resultant rotator cuff action lines (87.8° ± 4.9 vs 87.0° ± 1.8, p = 0.231) between operated and healthy shoulders. Osteoarthritic changes were observed in all operated shoulders and in 13 of 18 healthy shoulders. The OA Grade was mild in 5 patients, moderate in 11 and severe in 2 cases for operated shoulders and mild in 13 healthy shoulders at the last follow-up. ConclusionThe surgical increase of humeral retrotorsion by 20-30° did not affect glenohumeral and scapulohumeral centering in patients with a Weber rotational osteotomy after a long-term follow-up compared to the healthy side. While a high degree of early onset OA was observed it remains unclear whether the cause is the surgical interventions performed or the joint instability itself.

Evaluation of Progressive Architectural Distortion in Idiopathic Pulmonary Fibrosis Using Deformable Registration of Sequential CT Images.

Monitoring the progression of idiopathic pulmonary fibrosis (IPF) using CT primarily focuses on assessing the extent of fibrotic lesions, without considering the distortion of lung architecture. To evaluate three-dimensional average displacement (3D-AD) quantification of lung structures using deformable registration of serial CT images as a parameter of local lung architectural distortion and predictor of IPF prognosis. Patients with IPF evaluated between January 2016 and March 2017 who had undergone CT at least twice were retrospectively included (n = 114). The 3D-AD was obtained by deformable registration of baseline and follow-up CT images. A computer-aided quantification software measured the fibrotic lesion volume. Cox regression analysis evaluated these variables to predict mortality. The 3D-AD and the fibrotic lesion volume change were significantly larger in the subpleural lung region (5.2 mm (interquartile range (IQR): 3.6-7.1 mm) and 0.70% (IQR: 0.22-1.60%), respectively) than those in the inner region (4.7 mm (IQR: 3.0-6.4 mm) and 0.21% (IQR: 0.004-1.12%), respectively). Multivariable logistic analysis revealed that subpleural region 3D-AD and fibrotic lesion volume change were independent predictors of mortality (hazard ratio: 1.12 and 1.23; 95% confidence interval: 1.02-1.22 and 1.10-1.38; p = 0.01 and p < 0.001, respectively). The 3D-AD quantification derived from deformable registration of serial CT images serves as a marker of lung architectural distortion and a prognostic predictor in patients with IPF.

Myocardial calcification: case reports and a systematic review.

Myocardial calcification is an unusual condition in which excess calcium is deposited in the myocardium. Herein, we report two cases of myocardial calcification from our clinical experience. Furthermore, we conduct a systematic review to examine the clinical course and associated pathologies of myocardial calcification. This systematic review was registered in PROSPERO (CRD42023463285). PubMed and Scopus were searched according to the following inclusion criteria: (i) case reports or case series describing patients with myocardial calcification; (ii) diagnosis of myocardial calcification by computed tomography (CT); (iii) adequate description of patients, including their chief complaint, medical history, evaluations, and treatments; and (iv) publication in English. Among the 75 patients, 24 had sepsis, 14 had myocarditis, and 37 had other pathologies. The mortality rate was 33% for patients with sepsis, 14% for patients with myocarditis, and 11% for patients with other pathologies. Follow-up CT findings beyond 2 years were reported in six patients, showing that the CT findings of myocardial calcification persisted but subsided over time. Autopsy was performed in seven patients, and extensive interstitial fibrosis and collection of inflammatory cells were observed in patients with myocarditis, sepsis, and ischaemic heart disease. While various medical conditions can cause myocardial calcification, accompanying conditions commonly reported with myocardial calcification were sepsis and myocarditis. The CT findings of myocardial calcification tend to regress over time if the underlying disease can be treated.

Prognostic factors for interstitial lung disease progression in rheumatoid arthritis: May methotrexate protect against progression?

Objective Lung computed tomography (CT) is a valid method for the detection and assessment of the progression of interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients. The objective of this study is to conduct a comparative analysis of the characteristics of individuals with RA-ILD, with and without radiographic progression, determined using lung CT scans. Method In this retrospective observational study, three radiologists re-evaluated CT scans of RA-ILD patients who had at least one follow-up CT. The lungs were divided into upper, middle, and lower zones, with equal slices. Progression was defined as the involvement of more zones in the vertical extent by the same elementary findings or the emergence of more severe findings in the same zones compared to the previous examination. Logistic regression analysis was used to assess the possible factors identified in univariate analysis. Results This study included 104 patients with 215 lung CT scans for analysis. Radiographic progression was seen in 43 patients (41.3%). Male sex, findings compatible with ILD on the last X-ray, age at diagnosis of ILD > 50 years, and presence of ground-glass opacity on CT were more common in the group with progression. In multivariate analysis (adjusted for ILD disease duration), findings consistent with ILD on chest X-ray and male sex were independent risk factors for progression, while taking methotrexate (ever) was an independent protective factor for progression. Conclusion Our findings indicate a negative association between methotrexate use and ILD progression. These results should be confirmed in further studies.