Follow-up CT Scans Research Articles

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 & 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 & 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< 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.

Registry of Aortic Diseases to Model Adverse Events and Progression (ROADMAP) in Uncomplicated Type B Aortic Dissection: Study Design and Rationale.

To describe the design and methodological approach of a multicenter, retrospective study to externally validate a clinical and imaging-based model for predicting the risk of late adverse events in patients with initially uncomplicated type B aortic dissection (uTBAD). The Registry of Aortic Diseases to Model Adverse Events and Progression (ROADMAP) is a collaboration between 10 academic aortic centers in North America and Europe. Two centers have previously developed and internally validated a recently developed risk prediction model. Clinical and imaging data from eight ROADMAP centers will be used for external validation. Patients with uTBAD who survived the initial hospitalization between January 1, 2001, and December 31, 2013, with follow-up until 2020, will be retrospectively identified. Clinical and imaging data from the index hospitalization and all follow-up encounters will be collected at each center and transferred to the coordinating center for analysis. Baseline and follow-up CT scans will be evaluated by cardiovascular imaging experts using a standardized technique. The primary end point is the occurrence of late adverse events, defined as aneurysm formation (≥6 cm), rapid expansion of the aorta (≥1 cm/y), fatal or nonfatal aortic rupture, new refractory pain, uncontrollable hypertension, and organ or limb malperfusion. The previously derived multivariable model will be externally validated by using Cox proportional hazards regression modeling. This study will show whether a recent clinical and imaging-based risk prediction model for patients with uTBAD can be generalized to a larger population, which is an important step toward individualized risk stratification and therapy.Keywords: CT Angiography, Vascular, Aorta, Dissection, Outcomes Analysis, Aortic Dissection, MRI, TEVAR© RSNA, 2022See also the commentary by Rajiah in this issue.

Abstract 15424: The Toxic Tango: Tyrosine Kinase Inhibitors (TKI) and Immune Checkpoint Inhibitors (ICI) Toxicities

Introduction: ICI and TKI have several cardiotoxicity side effects. We present a case of TKI-ICI toxicity resulting in multiorgan inflammatory syndrome with myocarditis and thrombotic STEMI that was treated with high-dose steroids and PCI. Case Presentation: 72-year-old man presented with acute SOB and inferior STEMI. He complains of severe DOE for the past 3 months, chronic diarrhea, and altered mental status. PMH of renal cell carcinoma (RCC) limited to kidney s/p nephrectomy. Follow-up CT scan with 4cm inferior left adrenal gland mass avid for FDG-PET and IR-biopsy positive for RCC. He was started on Pembrolizumab 200mg IV q3 weeks and axitinib 5mg PO q12h for the past 5 months. Investigation: LHC showed a thrombotic lesion in RCA with normal rest of coronaries without evidence of atherosclerosis or bystander plaque with successful PCI-DES. TTE with inferior wall hypokinesis and moderate pericardial effusion with organized material. Elevated CRP/ESR. Despite PCI, he is unable to walk 200ft due to DOE and needs supplemental O2. VQ scan low % for PE, PFT mild obstructive disease with severe reduction DLCO, and HRCT moderate emphysema, bronchial/ septal thickening, and normal hemodynamics in RHC. CMR demonstrated moderate pericardial effusion with internal debris, LVEF 38%, myocardial edema, and delayed gadolinium enhancement from base to apical inferior wall. Treatment: Empirical trial of IV-methylprednisolone 500mg IV q12 was started with drastic improvement of shortness of breath, resolution of AMS, ESR/CRP, and discontinuation of oxygen. Follow-up TTE with normal LVEF and resolution of pericardial effusion. Conclusions: ICI-Myocarditis is a severe irAE. The diagnosis requires clinical suspicion and exclusion of other cardiac conditions due to the high fatality rate. Early recognition and prompt treatment are needed to improve mortality. TKI-related arterial-thromboembolic events is not common but if present different therapy options should be offered.

3D planning and patient specific instrumentation for intraarticular corrective osteotomy of trapeziometacarpal-, metacarpal and finger joints

BackgroundIntra-articular malunions of the finger can lead to deformity and loss of function and can be treated with intra-articular corrective osteotomies. The aim of this study was to evaluate radiographic joint congruency, feasibility and functional outcome of three-dimensional (3D) printed patient-specific instrumentation (PSI) for corrective osteotomies at the trapeziometacarpal and finger joints.MethodsComputer-tomography (CT) scans were acquired preoperatively for standard 3D planning, which was followed by calculation of cutting planes and the design of individualized bone surface contact drilling, sawing and reposition guides. Follow-up CT scans and clinical examinations (range of motion, grip strength) were performed. Postoperative complications were documented and patient-reported outcome measurements were assessed (Single Assessment Numeric Evaluation (SANE) score, brief Michigan Hand Questionnaire (MHQ)).ResultsTen patients (mean age 28.4 ± 12.8,range 13.8–51.3) years) were included with a mean follow-up of 21 ± 18 (3–59) months including seven osteotomies at the trapeziometacarpal or metacarpophalangeal joints and three at the proximal interphalangeal joint (PIP). All radiographic follow-up examinations showed the planned correction with good joint congruency and regular osseous consolidation. At the latest follow-up, the range of motion (ROM) increased and the average grip strength recovered to the level of the contralateral side. No postoperative complication was detected. The mean SANE score improved from 44 ± 23 (0–70) to 82 ± 12 (60–90) after a mean of 72 ± 20 (44–114) months. The mean postoperative brief MHQ was 92 ± 8 (71–98).ConclusionThe use of 3D PSI in treating intra-articular malunions at the trapeziometacarpal and finger joints restored articular congruency accurately. ROM and grip strength improved postoperatively comparable to the healthy contralateral side and patient-reported outcome measures improved after medium-term follow-up.

Abstract 10736: Statistical Shape Modeling Reveals Anatomic Shape Features Associated With the Outcome of Optimal Medical Therapy in Uncomplicated Type B Aortic Dissection

Introduction: Currently, Type B aortic dissection (TBAD) without the presence of either organ malperfusion or aortic rupture is managed with optimal medical therapy (OMT) consisting of an aggressive anti-hypertensive medical regimen and surveillance imaging. Although OMT achieves excellent early survival, the long-term outcomes with OMT alone remain poor. In this study, we identified anatomic shape features that correlate with OMT failure and aortic growth rates in uncomplicated TBAD via statistical shape modeling (SSM). Methods: Contrast CT scans of patients with acute uncomplicated TBAD were analyzed from 25 patients who were initially treated with OMT. OMT failure was defined as aortic intervention (surgical or endovascular repair, n = 8). Statistical shape models were constructed using principal component analysis (PCA) and partial least square regression (PLSR) to extract anatomic shape features from the aorta and flap geometries. For 14 of the 25 patients, additional follow-up CT scans (5 to 117 months) were used to quantify the rate of aortic expansion. Results: Four PCA (feature 5: p = 0.048, 12: p = 0.005, 14: p = 0.047, 24: p = 0.038) and two PLSR (feature 1: p = 0.000, 2: p = 0.004) shape features were effective at separating OMT failure patients and patients who were adequately treated with OMT. Two PCA features were moderately correlated with aortic growth rate (correlation coefficient, feature 11; r = 0.579, 21: r = 0.503). A PLSR feature was correlated with the growth rate (r = 0.867). Representative shape features are shown in Figure 1. Conclusions: Anatomic shape features extracted from SSM were correlated with the outcomes of OMT and aortic growth rate. SSM shape features may provide additional anatomic risk factors in addition to aortic diameter that predicts aneurysmal degeneration and the need for surgical intervention. Future investigations will incorporate the SSM shape features to determine the risk of OMT failure in uncomplicated TBAD patients.

PSAT286 A Rare Case of Papillary Thyroid Cancer of the Thyroglossal Duct Cyst with Benign Thyroid

Abstract Introduction While the thyroglossal duct cyst (TGDC) is the most commonly seen midline neck mass, thyroglossal duct cyst carcinoma is rare (1-2%) with only a few hundred cases published in the literature. The disease can be challenging to diagnose and treat because most TGDC carcinoma are diagnosed post-operatively and data is limited regarding the extent of surgical resection, adjuvant therapy and long-term outcomes. We report a case of papillary thyroid carcinoma arising from TGDC without any evidence of disease in the thyroid gland. Case Report A 31-year-old male presented with complaints of progressively worsening dysphagia and weight loss for 4 months. An initial CT neck with contrast revealed a soft tissue mass along the anterior aspect of the thyroid cartilage measuring 3.4×2.0×2.2 cm that extended anteriorly from the base of the tongue, favoring a thyroglossal duct cyst. The thyroid gland appeared normal on this imaging. He was given a 2-week course of antibiotics and pantoprazole with no improvement in his symptoms. He underwent a thyroid ultrasound, which showed a large hypoechoic mass, partially cystic, anterior to thyroid. FNA of the TGDC was suspicious for papillary thyroid cancer. Follow-up CT scan redemonstrated known TGDC with increased size of adjacent lymph nodes, concerning for metastasis. Given FNA results, regional lymph node involvement, and the patient's symptoms, he underwent successful Sistrunk procedure for TGDC removal. He declined to wait for intraoperative frozen pathology and opted to discuss pathology and next steps after surgery. Pathology of the TGDC confirmed papillary thyroid cancer (conventional type) with uninvolved margins and metastasis to one of four lymph nodes with the largest lymph node being 7 mm. At the tumor board conference, it was recommended he further undergo a total thyroidectomy with possible post-operative radioactive iodine (RAI) treatment. He underwent a total thyroidectomy, and pathology showed benign thyroid gland with a few colloid cysts. Post-operatively, he was started on levothyroxine. He did not have any improvement in dysphagia following both surgeries. After extensive discussion of the risks and benefits of RAI, the patient chose to defer RAI treatment until further evaluation of his dysphagia was completed. Ultimately, the decision was made to monitor with serial ultrasounds and thyroglobulin levels. Conclusion Optimal treatment of TGDC carcinoma is debatable. A Sistrunk procedure involving resection of cyst plus mid-portion of hyoid bone is universally recommended for adequate excision of the cyst. However, no clear consensus guidelines exist for further management with total thyroidectomy and/or post-operative RAI. Total thyroidectomy permits excision of unsuspected thyroid carcinomas and enables a better follow-up. However, decisions can vary based on extent of disease, tumor characteristics, demographics, and patient preferences. Management decisions should be made on an individualized basis, using a multidisciplinary and shared decision-making approach. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Local Recurrence Risk Score to Predict Relapse after Stereotactic Body Radiation Therapy for Lung Tumors.

After stereotactic body radiation therapy (SBRT) for lung tumors, follow-up CT scans remain a pitfall. The early detection of local relapse is essential to propose a new treatment. We aim to create a local recurrence predictive score using pre- and post-therapeutic imaging criteria and test it on a validation cohort. Between February 2011 and July 2016, lung tumors treated by SBRT with available pretreatment fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) and follow-up CT scans were retrospectively analyzed. The risk factors associated with relapse were identified by univariate logistic regression on a train cohort. The score was created using these factors, merging clinical and imaging criteria associated with local relapse, and then tested on an independent validation cohort. Overall and local relapse-free survival at 1 and 3 years were recorded. Twenty-eight patients were included in the train cohort and ten in the derivation cohort (male 74%, median age 70 ± 12 years). Five variables significantly associated with local recurrence (female gender; sequential enlargement; craniocaudal growing; bulging margins; standardized uptake value (SUVmax &gt; 5.5)) were combined to create the score on five points. With the threshold &gt;2.5/5, the sensitivity and specificity of the score on the validation cohort were 100% and 88%, respectively. Overall survival and local relapse-free survival at 1 and 3 years were 89% and 42%, and 89% and 63%, respectively. The local recurrence risk score created has high sensitivity (100%) and specificity (88%), upon independent validation cohort, to detect local relapse. This score is easy to use in daily clinical practice.