Follow-up CT Scans Research Articles

Butterfly needle tap and suction (BTS) technique: a treatment for recurrent chronic subdural hematoma after burr hole craniostomy.

In this study, we propose a butterfly needle tap and suction (BTS) technique for recurrent chronic subdural hematoma (CSDH) as an alternative to reoperation with burr hole craniostomy (BHC) and investigate its efficacy and safety. The procedure involves percutaneous puncture through the burr hole created during the previous surgery and subsequent hematoma evacuation using a butterfly needle. This retrospective study included patients who underwent BTS for CSDH at Ogaki Municipal Hospital between January 2017 and December 2020. The follow-up CT scans were reviewed after several weeks. We evaluated the number of percutaneous punctures required to resolve CSDH during the BTS technique, the volume of the evacuated hematoma, and procedure-related complications. Twenty-six patients were enrolled in the study, 21 of whom achieved resolution of the hematoma using punctures with the BTS technique alone (mean, 2.2 ± 1.5). Five patients had a recurrence of hematoma after one or more punctures during the BTS technique, and they underwent reoperation with BHC according to the surgeon's decision or patient requests. Among the 55 punctures, 43.0 ± 16.0ml of hematoma was evacuated per puncture. The evacuated hematoma volume was 41.9 ± 16.4ml in the BTS-alone group and 49.4 ± 12.9ml in the reoperation group, with no significant difference (p = 0.25). Three patients complained of a headache during the puncture procedure, and no other complications, including intracranial hemorrhage or infection, were reported therein. The BTS technique is an effective alternative to reoperation with BHC.

Can a Deep Learning Algorithm Improve Detection of Occult Scaphoid Fractures in Plain Radiographs? A Clinical Validation Study.

Occult scaphoid fractures on initial radiographs of an injury are a diagnostic challenge to physicians. Although artificial intelligence models based on the principles of deep convolutional neural networks (CNN) offer a potential method of detection, it is unknown how such models perform in the clinical setting. (1) Does CNN-assisted image interpretation improve interobserver agreement for scaphoid fractures? (2) What is the sensitivity and specificity of image interpretation performed with and without CNN assistance (as stratified by type: normal scaphoid, occult fracture, and apparent fracture)? (3) Does CNN assistance improve time to diagnosis and physician confidence level? This survey-based experiment presented 15 scaphoid radiographs (five normal, five apparent fractures, and five occult fractures) with and without CNN assistance to physicians in a variety of practice settings across the United States and Taiwan. Occult fractures were identified by follow-up CT scans or MRI. Participants met the following criteria: Postgraduate Year 3 or above resident physician in plastic surgery, orthopaedic surgery, or emergency medicine; hand fellows; and attending physicians. Among the 176 invited participants, 120 completed the survey and met the inclusion criteria. Of the participants, 31% (37 of 120) were fellowship-trained hand surgeons, 43% (52 of 120) were plastic surgeons, and 69% (83 of 120) were attending physicians. Most participants (73% [88 of 120]) worked in academic centers, whereas the remainder worked in large, urban private practice hospitals. Recruitment occurred between February 2022 and March 2022. Radiographs with CNN assistance were accompanied by predictions of fracture presence and gradient-weighted class activation mapping of the predicted fracture site. Sensitivity and specificity of the CNN-assisted physician diagnoses were calculated to assess diagnostic performance. We calculated interobserver agreement with the Gwet agreement coefficient (AC1). Physician diagnostic confidence was estimated using a self-assessment Likert scale, and the time to arrive at a diagnosis for each case was measured. Interobserver agreement among physicians for occult scaphoid radiographs was higher with CNN assistance than without (AC1 0.42 [95% CI 0.17 to 0.68] versus 0.06 [95% CI 0.00 to 0.17], respectively). No clinically relevant differences were observed in time to arrive at a diagnosis (18 ± 12 seconds versus 30 ± 27 seconds, mean difference 12 seconds [95% CI 6 to 17]; p < 0.001) or diagnostic confidence levels (7.2 ± 1.7 seconds versus 6.2 ± 1.6 seconds; mean difference 1 second [95% CI 0.5 to 1.3]; p < 0.001) for occult fractures. CNN assistance improves physician diagnostic sensitivity and specificity as well as interobserver agreement for the diagnosis of occult scaphoid fractures. The differences observed in diagnostic speed and confidence is likely not clinically relevant. Despite these improvements in clinical diagnoses of scaphoid fractures with the CNN, it is unknown whether development and implementation of such models is cost effective. Level II, diagnostic study.

Abstract P544: Post-COVID-19: Predictors of Pulmonary Fibrosis

Introduction: From observational studies, it is known that some survivors of COVID-19 pneumonia have developed fibrotic pulmonary remodeling, restrictive lung abnormalities, associated with impaired exercise tolerance and poor quality of life at follow-up. Post-COVID-19 pulmonary fibrosis may be defined as the presence of persistent fibrotic changes identified on follow-up CT scans, such as traction bronchiectasis. It is important to identify the potential risk factors for the occurrence of pulmonary fibrosis in this context, although they have not yet been completely defined. Hypothesis: We hypothesize that lung fibrosis may be also a possible long-term consequence of COVID-19 pneumonia and the risk factors associated with the acute phase that enhance the risk of pulmonary sequelae, such as duration of hospitalization and intensive care stay, of high-flow oxygen support, and need for mechanical ventilation. Methods: We undertook a cohort study of COVID-19 survivors, that required supplemental oxygenation during the acute phase, who had been discharged from hospitals April 2020 to March 2022 in public hospitals of Curitiba/PR (BRAZIL). At 1-month and 6-month follow-up visit, survivors were interviewed with questionnaires symptoms, received a physical examination, sit-to-stand test, laboratory test ant chest CT scan was performed between two visits. The primary outcomes were persistent fibrotic changes, such as traction bronchiectasis, on follow-up chest CT. Multivariable adjusted logistic regression models were used to evaluate the risk factors of CT scan outcomes. Results: We followed 63 COVID-19 survivors with CT scan follow-up. The median age of patients was 52 years (±13.3) and 37 (58.7%) were women. The median CT scan follow-up time was 151 days (38-428). The median hospitalization time during acute phase was 13 (3-48) days. The proportion of patients with persistent dyspnoea, characterized by mMRC score of 1 or more, was 52 (82,5%). The proportion of patients with at least one fibrotic change on CT scan was 35 (55.6%), traction bronchiectasis was identified on 16 (25.4%). Hospitalization time during acute phase was associated with traction bronchiectasis, main persistent fibrotic change on CT scan (OR, 1.19; 95% CI:1.036, 1.207; p=0,004). Conclusion: In a follow-up, the duration of hospitalization COVID-19 acute phase was associated with higher odds of traction bronchiectasis on chest CT follow-up.

Efficacy of less Invasive modified O-arm navigated delta fixation in osteoporotic high-grade spondylolisthesis: "a LIMO delta technique".

In 1994, the technique of transdiscal screws fixation in spondylolisthesis was introduced but did not gained popularity as it failed to address problems with spinal sagittal imbalance, retroverted pelvis, pseudoarthrosis, implant failure and neural injury. Majority of problems were due to lack of clear indications; hence, in this study, with modification of traditional technique and use of O-arm navigation for selected group of patients, we have addressed the above problems and given good to excellent functional outcomes. We did prospective study on 15 patients with osteoporotic high-grade spondylolisthesis Meyerding grade 3 & 4 admitted in period 2020-2021. Intraoperative assessment was done in form of blood loss, incision length, operative time and complications. The preoperative & postoperative assessment was done in the form of clinical and radiological parameters. The average follow-up was of 21.2months (18-24months). There was no significant difference between pre- & postoperative spinopelvic parameters. Intraoperative average blood loss was 100ml (90-120ml) with mean surgical time of 138min (120-150min). Incision length was about 5-6-cms-posterior midline with two paraspinal 1-cm incisions for transdiscal screws. Patients were mobilized on postoperative day-2. There was statistically significant improvement in mean ODI, COMI and VAS for LBP and radicular pain with no intra- or postoperative complication observed till latest follow-up with all patients showing solid monoblock fusion on 1-year follow-up CT scan. LIMO delta technique is a newly modified version of conventional transdiscal screw technique. Minimal incision, decreased blood loss & operative time with in situ 3-column rigid fixation and solid fusion minimizing risk of complications makes this novel technique safer, simpler & effective in osteoporotic HGS.

Advances in Prediction for Perihematomal Edema Growth in Intracerebral Hemorrhage

Perihematomal edema (PHE) has been represented as an important secondary injury after intracerebral hemorrhage (ICH). The evolution of PHE contributed to mass effect, which could induce the increase of intracranial pressure. The volume of PHE increased rapidly in the early stage of ICH and continued to increase for 7 to 11 days after symptom onset, and the edema extension distance (EED) increased rapidly within 24 hours, accounting for 60% of the peak EED [1-2]. For the timepoint of follow-up CT scans was different, the fastest development stage of PHE could also be 48 or 72 hours after symptom onset [3-4]. If patients with ICH could not benefit from early surgical evacuation of the hematoma, anti-edema treatment may bring better therapeutic effect. Thus, the use of anti-edema treatment may need to be considered for reducing PHE volume during the early phase of PHE development. How to appropriately predict PHE growth is important in patients at the early stage of ICH.

Abstract TP107: Utility of routine 24h follow-up CT after thrombolysis

Background: 24h CT is routinely acquired post-thrombolysis. Parenchymal hematoma and brain edema are feared complications. Predicting complications that change management would help reduce unnecessary imaging. Objective: To evaluate the utility of 24h per-protocol CT scan for stroke patients after thrombolysis. Methods: A prospectively collected cohort of consecutive patients presenting with acute ischemic stroke to our hospital from 2013- 2021 who were treated with IV tPA without undergoing endovascular therapy was entered into our IRB-approved stroke registry. Neuroimaging performed within 48h after admission was reviewed. Patients’ demographics, past medical history, admission National Institute of Health Stroke Scale (NIHSS) score, and medical variables were obtained. The primary outcome was significant radiologically findings (parenchymal hematoma or midline shift/herniation) leading to change in management (additional monitoring, emergent procedure, administration of mannitol or alteration in blood pressure goal). Results: From 2013 to 2021, 875 patients (mean age 69) who had IV tPA without undergoing endovascular therapy were identified, of which 472 (47.1%) were female. Median (IQR) NIHSS score was 9 (4-16) on admission. Imaging findings: 339 (38.7%) had expected evolving infarctions; 106(13.3%) developed any type of hemorrhagic transformation, including 66 (7.5%) who had hemorrhagic infarction and 50 (5.7%) parenchymal hematomas; 142(16.2%) developed any kind of mass effect, including 63 (7.2%) who had mild mass effect and 79 (9.0%) midline shift/herniation. There were 124 patients (12.1%) had significant findings (including parenchymal hematoma and midline shift/brain herniation) leading to change in the management. Patients who had significant findings had higher NIHSS score 16 (8-21) than those without 8 (4-15) (p&lt;0.001). NIHSS was the only significant outcome predictor both in univariate and the multivariable analysis. Conclusions and interpretations: Our study showed that patients with high NIHSS score were more likely to have significant findings. 24-hour follow-up CT scan should be based on the risk of developing significant complications.

STUDY OF POST COVID 19 PULMONARY COMPLICATIONS ON CT: A FOLLOW UP STUDY

Introduction: SARS-CoV-2 is a severe acute respiratory syndrome coronavirus with a high pathogenicity to humans. In order to properly diagnose and monitor individuals who have COVID-19 pneumonia, a chest CT scan is essential. In numerous researches, radiographic alterations in the acute course of COVID-19 have been observed. These changes range from mild to severe cases. According to recent studies, 94% of hospitalized patients' discharge CT scans show persisting lung parenchymal abnormalities. With this perspective present study is conducted to evaluate follow up CTndings in Post COVID 19 infection. Aim &amp; Objectives: Aim:To evaluate follow up CTndings in Post COVID 19 infection Objective: 1. To assess clinical prole and CTndings in Post COVID 19 infection patients with brotic changes found on CT 2. To assess clinical prole and CTndings in Post COVID 19 infection patients with no brotic changes 3. To correlate clinical prole and CTndings amongst two groups 4. To assess &amp; correlate CTndings amongst timely performed CTscan at 3 and 6 months after discharge Materials and Methods: 100 COVID-19 patients who had been discharged from the hospital after treatment for COVID-19 were prospectively enrolled at follow up visit. Discharge chest CTscan were reviewed. All 100 patients advised follow-up CTscan of thorax at 3 and 6 months from the Time of discharge. All CT reports were evaluated and patients were categorized into two groups based on presence or absence of traction bronchiectasis, parenchymal bands and/or honeycombing as Group A(Cases with brotic changes) and Group B (Cases without brotic changes). Data are expressed as frequency N (%) or mean ± SD. χ2-test was used to study correlation between variables Observations and Results: Majority had bilateral lung involvement in both groups. Ground glass opacity dominated in CTpattern. Other CTndings were less in proportion in group B (35/71) compared to group A (27/29). Statistically signicant difference found for CT score amongst two groups (P&lt; 0.00001). About 29 (29 %) cases out of total 100 (100 %) showed brotic changes. 22 (22 %) showed Residual GGO/interstitial thickening. 49 (49 %) got complete radiological resolution at the end of 6 months Conclusion: All patients with dyspnoea after SARS-CoV-2 infection should undergo a thorough thin-section CT. Depending on the degree of initial lung involvement and the length of time since infection, certain CT abnormalities are more or less common. According to longitudinal investigations, GGO can be replaced by abnormalities that resemble brosis, and abnormalities may linger in patients who have recognised risk factors.

Osseointegration and Bone Resorption of Scapula Tip Free Flaps in Mandibular Reconstruction.

Bone resorption of more conventional vascularized bone grafts have been well described showing minimal resorption over time. Few studies have evaluated osseous union and bone resorption in scapula tip free flaps (STFF) in the reconstruction of mandibulectomy defects. We aimed to describe our series on STFF with respect to osseous union and bone resorption over time. Retrospective chart review of patients receiving STFF from January 2014-January 2017 (n=25). A neuroradiologist analyzed follow-up CT scans to assess (1) STFF complete, partial, or no osseous union with native mandible and (2) STFF volume change over time in a subset with multiple follow-up scans (n=18). Twenty-three of 25 patients (92%) showed complete or partial STFF osseous union with native mandible either distally or proximally. STFF volume change ranged from +4.8 to -54% (median -0.5%) over median follow-up interval of 23 months. History of chemoradiation therapy, bisphophonate use, sex, age, or smoking history did not correlate with bone resorption. STFFs shows high rates of osseous union and limited bone resorption that is equivalent to, or less than, vascularized fibular and iliac crest flaps. Clinically, this translates into both optimal healing andfunctional and cosmetic outcomes, especiallyin the setting of prior therapies. 4 Laryngoscope, 133:2597-2602, 2023.

Natural progression of persistent pure ground-glass nodules 10mm or smaller: long-term observation and risk factor assessment.

Semi-automatic segmentation was used to investigate the natural progression of pure ground-glass nodules (pGGNs) of 5-10mm in long-term follow-up and to analyze independent risk factors for subsequent growth. A total of 154 pGGNs of 5-10mm from 132 patients with 698 follow-up CT scans were retrospectively identified. Subsequently, enrolled pGGNs were semiautomatically segmented on initial and follow-up CT to obtain diameter, density and volume, thus calculating mass, volume doubling time (VDT), and mass doubling time (MDT). Kaplan‒Meier analysis and multivariate Cox proportional risk regression were performed to explore independent predictors of pGGN growth. We analyzed growth differences among different pathological results of pGGNs confirmed by surgery. The prognosis was analyzed using the total diameter or solid size of the nodules on the last preoperative CT. Among the 85 (55.2%) pGGNs with growth, 5.9%, 51.8%, and 80.0% showed growth within 1, 3, and 5years, respectively. The median VDT and MDT were 1206.4 (range 349.8-5134.4) days and 1161.3 (range 339.4-6630.4) days, respectively. The multivariate Cox risk regression analysis showed that mean CT attenuation (m-CTA) [hazard ratio (HR) = 2.098, p = 0.010] and roundness index (HR = 1.892, p = 0.021) were independent risk factors for pGGN growth. In total, 67.6% of surgically resected and growing pGGNs were invasive non-mucinous adenocarcinoma (IA), including 2 cases of endpoint events, showing a PSN with solid components of 5.6mm and a solid nodule with a diameter of 19.9mm. pGGNs of 5-10mm showed an indolent clinical course. Follow-up CT imaging of pGGNs in the latter half of the first two years should be a rational management strategy. Small pGGNs with a larger overall m-CTA and roundness index on baseline CT are more likely to grow.

CT-based delta radiomics in predicting the prognosis of stage IV gastric cancer to immune checkpoint inhibitors.

To explore the prognostic value of CT-based delta radiomics in predicting the prognosis of patients with stage IV gastric cancer treated with immune checkpoint inhibitors (ICI). Forty-two patients with stage IV gastric cancer, who had received ICI monotherapy, were enrolled in this retrospective study. Baseline and first follow-up CT scans were analyzed. Intratumoral and peritumoral regions of interest (ROI) were contoured, enabling the extraction of 192 features from each ROI. The intraclass correlation coefficients were used to select features with high stability. The least absolute shrinkage and selection operator was used to select features with high weights for predicting patient prognosis. Kaplan-Meier analysis and log-rank test were performed to explore the association between features and progression free survival (PFS). Cox regression analyses were used to identify predictors for PFS. The C-index was used to assess the prediction performance of features. Two radiomics features of ΔVintra_ZV and postVperi_Sphericity were identified from intratumoral and peritumoral regions, respectively. The Kaplan-Meier analysis revealed significant differences in PFS between patients with low and high feature value (ΔVintra_ZV: P=0.000; postVperi_Sphericity: P=0.012), and the multivariable cox analysis demonstrated that ΔVintra_ZV was independent predictor for PFS (HR, 1.911; 95% CI: 1.163-3.142; P=0.011), with C-index of 0.705. Based on CT scans at baseline and first follow-up, the delta radiomics features could efficiently predict the PFS of gastric cancer patients treated with ICI therapy.

Severe COVID-19 pneumonia leads to post-COVID-19 lung abnormalities on follow-up CT scans

PurposeTo investigate the association of the maximal severity of pneumonia on CT scans obtained within 6-week of diagnosis with the subsequent development of post-COVID-19 lung abnormalities (Co-LA). MethodsCOVID-19 patients diagnosed at our hospital between March 2020 and September 2021 were studied retrospectively. The patients were included if they had (1) at least one chest CT scan available within 6-week of diagnosis; and (2) at least one follow-up chest CT scan available ≥ 6 months after diagnosis, which were evaluated by two independent radiologists. Pneumonia Severity Categories were assigned on CT at diagnosis according to the CT patterns of pneumonia and extent as: 1) no pneumonia (Estimated Extent, 0%); 2) non-extensive pneumonia (GGO and OP, <40%); and 3) extensive pneumonia (extensive OP and DAD, >40%). Co-LA on follow-up CT scans, categorized using a 3-point Co-LA Score (0, No Co-LA; 1, Indeterminate Co-LA; and 2, Co-LA). ResultsOut of 132 patients, 42 patients (32%) developed Co-LA on their follow-up CT scans 6–24 months post diagnosis. The severity of COVID-19 pneumonia was associated with Co-LA: In 47 patients with extensive pneumonia, 33 patients (70%) developed Co-LA, of whom 18 (55%) developed fibrotic Co-LA. In 52 with non-extensive pneumonia, 9 (17%) developed Co-LA: In 33 with no pneumonia, none (0%) developed Co-LA. ConclusionsHigher severity of pneumonia at diagnosis was associated with the increased risk of development of Co-LA after 6–24 months of SARS-CoV-2 infection.

Clinical profile and radiological pattern in follow-up study of patients treated for moderate-to-severe COVID-19 pneumonia

The COVID-19 pandemic is the modern-day apocalypse that the world has experienced, with a death toll of 60.1 lakh by 2022. Although many patients recovered from the disease, a major part of the population has been crippled with the sequelae that occurred with the infection. One such complication is the development of pulmonary fibrosis, especially among those who recovered from moderate-to-severe COVID-19 infection that has been reported in several studies. Albeit adequate and early usage of antivirals, antibiotics, and steroids, and the development of lung fibrosis was inevitable in certain patients. Here, we report four cases, who recovered from COVID-19 infection but developed pulmonary fibrosis along the course of illness. They were followed for 6 months, along with treatment with antifibrotics, and were assessed for improvement, both clinically and radiologically. While three among the four patients showed resolution in their follow-up CT scans, one patient's fibrosis worsened with progression to interstitial lung disease.

Difference of mean Hounsfield units (dHU) between follow-up and initial noncontrast CT scan predicts 90-day poor outcome in spontaneous supratentorial acute intracerebral hemorrhage with deep convolutional neural networks

ObjectivesThis study aimed to investigate the usefulness of a new non-contrast CT scan (NCCT) sign called the dHU, which represented the difference in mean Hounsfield unit values between follow-up and the initial NCCT for predicting 90-day poor functional outcomes in acute supratentorial spontaneous intracerebral hemorrhage(sICH) using deep convolutional neural networks. MethodsA total of 377 consecutive patients with sICH from center 1 and 91 patients from center 2 (external validation set) were included. A receiver operating characteristic (ROC) analysis was performed to determine the critical value of dHU for predicting poor outcome at 90 days. Modified Rankin score (mRS) >3 or >2 was defined as the primary and secondary poor outcome, respectively. Two multivariate models were developed to test whether dHU was an independent predictor of the two unfavorable functional outcomes. ResultsThe ROC analysis showed that a dHU >2.5 was a critical value to predict the poor outcomes (mRS >3) in sICH. The sensitivity, specificity, and accuracy of dHU >2.5 for poor outcome prediction were 37.5%, 86.0%, and 70.6%, respectively. In multivariate models developed after adjusting for all elements of the ICH score and hematoma expansion, dHU >2.5 was an independent predictor of both primary and secondary poor outcomes (OR = 2.61, 95% CI [1.32,5.13], P = 0.006; OR = 2.63, 95% CI [1.36,5.10], P = 0.004, respectively). After adjustment for all possible significant predictors (p < 0.05) by univariate analysis, dHU >2.5 had a positive association with primary and secondary poor outcomes (OR = 3.25, 95% CI [1.52,6.98], P = 0.002; OR = 3.42, 95% CI [1.64,7.15], P = 0.001). ConclusionsThe dHU of hematoma based on serial CT scans is independently associated with poor outcomes after acute sICH, which may help predict clinical evolution and guide therapy for sICH patients.

Endovascular aneurysm repair using the Gore Excluder Conformable Abdominal Aortic Aneurysm Endoprosthesis with active control system in octogenarians with highly angulated aneurysm neck: a UK single-centre experience

Objective: Abdominal aortic aneurysm (AAA) with highly angulated neck (&gt;60°) in octogenarians represents a challenge to treatment with endovascular aneurysm repair (EVAR). In such cases, EVAR may be used outside the manufacturer’s Instructions for Use and attendant higher risk of failure. The new device Gore Excluder Conformable AAA Endoprosthesis with active control (CEXC) system has been designed to achieve optimal aortic wall apposition and seal in these more challenging geometries. This study reports the initial results and technical success of this device in octogenarians with highly angulated aneurysm necks (&gt;60°). Methods: All patients aged &gt;80 years who had AAAs treated with the CEXC device at a single UK centre between January 2020 and July 2023 were analysed. The primary endpoint was technical success, which was defined as successful introduction and deployment of the device in the absence of surgical conversion or mortality, type I or III endoleaks or graft limb obstruction. The secondary outcomes included 30-day morbidity, mortality, endoleak and re-intervention rates. Results: Twenty patients were included (17 (75%) males) of median age 81 (range 80–84) years. The median AAA diameter was 60 (57–63) mm and the median infrarenal neck angulation was 80 (70–89)°. The active control system was used in six cases. The median procedural time was 277 (254–316) minutes. The immediate technical success rate was 95%, with one type Ia endoleak (5%). In the 30-day postoperative period, four complications were reported. On the 30-day follow-up CT scan, five type II endoleaks were observed and one initial type Ia endoleak had persisted at 30 days. No re-intervention was required during the first 30-day postoperative period. One hospital death occurred during the coronavirus disease 2019 pandemic; however, the death was unrelated to the surgery. Conclusions: EVAR with the CEXC device in octogenarians with hostile aortic neck anatomy is feasible inside the Instructions for Use, and shows satisfactory initial results.

CT Evaluation of Long-Term Changes in Common Bile Duct Diameter after Cholecystectomy.

The present study aimed to investigate the frequency and extent of compensatory common bile duct (CBD) dilatation after cholecystectomy, assess the time between cholecystectomy and CBD dilatation, and identify potentially useful CT findings suggestive of obstructive CBD dilatation. This retrospective study included 121 patients without biliary obstruction who underwent multiple CT scans before and after cholecystectomy at a single center between 2009 and 2011. The maximum short-axis diameters of the CBD and intrahepatic duct (IHD) were measured on each CT scan. In addition, the clinical and CT findings of 11 patients who were initially excluded from the study because of CBD stones or periampullary tumors were examined to identify distinguishing features between obstructive and non-obstructive CBD dilatation after cholecystectomy. The mean (standard deviation) short-axis maximum CBD diameter of 121 patients was 5.6 (± 1.9) mm in the axial plane before cholecystectomy but increased to 7.9 (± 2.6) mm after cholecystectomy (p < 0.001). Of the 106 patients with a pre-cholecystectomy axial CBD diameter of < 8 mm, 39 (36.8%) showed CBD dilatation of ≥ 8 mm after cholecystectomy. Six of the 17 patients with longterm (> 2 years) serial follow-up CT scans (35.3%) eventually showed a significant (> 1.5-fold) increase in the axial CBD diameter, all within two years after cholecystectomy. Of the 121 patients without obstruction or related symptoms, only one patient (0.1%) showed IHD dilatation > 3 mm after cholecystectomy. In contrast, all 11 patients with CBD obstruction had abdominal pain and abnormal laboratory indices, and 81.8% (9/11) had significant dilatation of the IHD and CBD. Compensatory non-obstructive CBD dilatation commonly occurs after cholecystectomy to a similar extent as obstructive dilatation. However, the presence of relevant symptoms, significant IHD dilatation, or further CBD dilatation 2-3 years after cholecystectomy should raise suspicion of CBD obstruction.

Redefining “indeterminate” ground glass opacities in SARS-CoV-2

Background: Isolated ground glass opacities are often seen in the lungs and these are a diagnostic challenge. There are numerous different causes of ground glass opacities in the lungs. The broad list of etiologies are infectious causes, interstitial disease, alveolar disease, neoplastic, and drug toxicity. In the era of SARS Cov-2, it becomes very difficult to differentiate the ground glass opacities due to inflammatory bronchiolitis and other viral pneumonitis from those which are due to SARS CoV-2. Aims and Objectives: We aim to look for vascular signs seen in association with ground glass opacities which increase our level of confidence to call them ground glass opacities due to SARS-CoV-2 as an etiology. Materials and Methods: We present an observational study on 34 patients who presented with only patchy focal ground glass opacities in the lungs. All these patients were also subjected to nasopharyngeal swab test. The vascular signs seen on CT scan were of help to establish definite diagnosis of SARS-CoV-2 only on the basis of ground glass opacities. Results: Out of 31 patients showing CT scan finding of prominent intralesional vessel, 27 were positive for COVID-19 on reverse transcription-polymerase chain reaction (RT-PCR) test. Four patients showing prominent intralesional vessel on CT scan were negative for COVID-19 infection on RT-PCR test. These four patients who were tested negative on RT-PCR were treated symptomaticaly for inflammatory bronchiolitis. Follow-up CT scan of two such patients were done after 4 days, which showed resolution of the focal ground glass opacities. Conclusion: The parenchymal imaging findings of SARS-Cov-2 are well described as ground glass opacities associated with septal thickening and consolidation. However, in some cases, only few focal isolated ground glass opacities are seen without any other typical features. In such cases, the vascular signs are of help to increase our level of diagnostic confidence.

Evaluation of Follow-Up CT Scans in Patients with Severe Initial Pulmonary Involvement by COVID-19.

To investigate the predictive factors of residual pulmonary opacity on midterm follow-up CT scans in patients hospitalized with COVID-19 pneumonia. This prospective study was conducted in a tertiary referral university hospital in Iran, from March 2020 to December 2020. Patients hospitalized due to novel coronavirus pneumonia with bilateral pulmonary involvement in the first CT scan were included and underwent an 8-week follow-up CT scan. Pulmonary involvement (PI) severity was assessed using a 25-scale semiquantitative scoring system. Density of opacities was recorded using the Hounsfield unit (HU). The chest CT scans of 50 participants (mean age = 54.4 ± 14.2 years, 72% male) were reviewed, among whom 8 (16%) had residual findings on follow-up CT scans. The most common residual findings were faint ground-glass opacities (GGOs) (14%); fibrotic-like changes were observed in 2 (4%) patients. Demographic findings, underlying disease, and laboratory findings did not show significant association with remaining pulmonary opacities. The total PI score was significantly higher in participants with remaining parenchymal involvement (14.5 ± 6.5 versus 10.2 ± 3.7; P=0.02). On admission, the HU of patients with remaining opacities was significantly higher (-239.8 ± 107.6 versus -344.0 ± 157.4; P=0.01). Remaining pulmonary findings were more frequently detected in patients who had received antivirals, steroid pulse, or IVIG treatments (P=0.02, 0.02, and 0.001, respectively). Only the PI score remained statistically significant in multivariate logistic regression with 88.1% accuracy (OR = 1.2 [1.01-1.53]; P=0.03). Pulmonary opacities are more likely to persist in midterm follow-up CT scans in patients with severe initial pulmonary involvement.

Role of radiotherapy in the treatment of locally advanced penile cancer

Penile cancer is a rare but aggressive tumor, most commonly squamous cell carcinoma. Treatment modalities depend on the stage of the disease, but the backbone of treatment is surgical resection of the primary tumor and regional lymph nodes with the use of neoadjuvant/adjuvant chemotherapy and radiotherapy. Our case report is about a 59-year-old patient which was presented with bilateral inguinal lymphadenitis, scrotal and penile edema. A biopsy of the change in the penis confirmed squamous cell carcinoma. Partial amputation of the penis and an excisional biopsy of the inguinal lymph nodes was performed, which confirmed the metastasis to the lymph nodes. Diagnostic imaging revealed bilateral enlarged inguinal lymph nodes which were later surgically removed. Postoperative CT scan showed three suspected lung metastases. The patient was then treated with polychemotherapy. Follow-up CT scan showed complete regression of metastatic changes in the lungs but also showed local recurrence in the area of the penile root. Radiotherapy with concomitant administration of cisplatin was conducted. Penile cancer is an aggressive disease that can be cured at an early stage if adequate treatment is applied. We highlight the importance of a multimodal and multidisciplinary approach consisting of polychemotherapy, surgical treatment, and radiotherapy.

Anteroposterior Ethmoidectomy in the Endoscopic Reduction of Medial Orbital Wall Fractures: Does It Really Reduce Stability?

The surgical treatment of isolated medial orbital wall fractures is still a much-debated topic in the literature due to the choice of many surgical accesses. The main options are represented by transcutaneous versus endonasal endoscopic approaches. Our study aims to clarify the role of ethmoidectomy in the pure endoscopic endonasal reduction of medial orbital wall fractures, evaluating the immediate postoperative outcome and its long-term stability. A total of 31 patients affected by isolated medial orbital wall fracture, treated only by endoscopic approach, were included in the study and divided in two groups: (A) 14 patients treated by endoscopic reduction and anterior ethmoidectomy; (B) 17 patients treated by endoscopic reduction and anteroposterior ethmoidectomy. Perioperative and 6-month postoperative follow-up CT scans were performed. With the use of 3D medical software, we evaluated the comparison between the treated orbit and the mirrored contralateral orbit in the two groups, in order to observe the reduction of the fracture. Furthermore, to check the stability of reduction and to evaluate any medial orbital wall changes, we provided a comparison between the 3D CT scan orbital images of immediate postoperative CT and 6-month follow-up. Data obtained showed that the intraoperative surgical reduction was successful in all 31 cases, but it was better in Group B. Stability of the reduction at 6 months was observed in both groups without significant discrepancies. In our opinion, the endonasal endoscopic approach with ethmoidectomy represents a valid and useful technique by which to treat medial orbital wall fractures. The anatomical detail of the buttressing structures of the medial orbital wall, as the second portion of the middle turbinate, grants long-term stability of the surgical outcome.

Prospective evaluation of low-dose multiphase hepatic computed tomography for detecting and characterizing hepatocellular carcinoma in patients with chronic liver disease

BackgroundKnowing the lowest acceptable radiation dose of multiphase hepatic CT may allow us to reduce the radiation dose for detecting HCC.PurposeTo prospectively assess the image quality and diagnostic performance of low-dose and ultra-low-dose multiphase hepatic computed tomography using a dual-source CT scanner.MethodsThree reconstructed different dose scan images (standard-dose, low-dose, and ultra-low-dose) of hepatic multiphase CT were obtained from 67 patients with a dual-source CT scanner. The image quality and the diagnostic performance of the three radiation dose CT scans of the hepatic focal lesion (≥ 0.5 cm) were analyzed by two independent readers using the Liver Imaging Reporting and Data System.ResultsQualitative image quality and signal-to-noise ratio were significantly different among the radiation doses (p < 0.001). In total, 154 lesions comprising 32 hepatocellular carcinomas (HCC) and 122 non-HCC were included. The sensitivities of SDCT, LDCT, and ULDCT were 90.6%(29/32), 81.3%(26/32), and 56.2%(18/32), respectively. The accuracies of SDCT, LDCT, and ULDCT were 98.1%(151/154), 96.1%(148/154), and 89.6%(138/154), respectively. On per-lesion analysis, SDCT and LDCT did not show significantly different sensitivity and accuracy in diagnosing HCC (p = 0.250 and 0.250).ConclusionsThe diagnostic performance of dynamic hepatic LDCT with 33% reduced radiation dose in comparison to SDCT would be acceptable even though its image quality was qualitatively and quantitatively inferior. However, few HCCs could be overlooked. Therefore, with caution, radiation dose reduction by one-third could be implemented for follow-up CT scans for patients suspected of having HCC with caution and further studies are needed in the future.