Follow-up Scans Research Articles

An extremely rare case of thymic squamous cell carcinoma complicated with B3 thymoma and myasthenia gravis: a case report

BackgroundThymomas complicated with myasthenia gravis are conventionally treated during thoracic surgery. Particularly, invasive thymomas are resected alongside the surrounding organs. Here, we present a case where surgical and perioperative management was performed under the presumption of thymoma with myasthenia gravis. However, definitive pathology revealed the co-occurrence of B3 thymoma and thymic squamous cell carcinoma. This case highlights the unique presentation and exceptional rarity of thymomas that are complicated by myasthenia gravis and thymic carcinoma. Case presentationA 65-year-old female presented with eyelid ptosis at our hospital. Following a comprehensive examination, the patient was diagnosed with myasthenia gravis. Her computed tomography (CT) scan revealed an anterior mediastinal tumor suggestive of a thymoma, prompting a referral to the Department of Thoracic Surgery. Moreover, preoperative assessment could not definitively exclude pericardial invasion. She subsequently underwent an extended thymectomy via a longitudinal sternal incision. The tumor exhibited partial invasion of the pericardium, necessitating resection and reconstruction. Definitive pathological examination confirmed the co-occurrence of B3 thymoma and thymic squamous cell carcinoma. Positive lymph node metastasis classified the patient as stage IVa according to the Union for International Cancer Control (UICC) TNM Classification of Malignant Tumors, 8th Edition, and she was started on adjuvant radiotherapy postoperatively. Currently, the patient remains under observation, with follow-up CT scans showing no signs of recurrence.ConclusionsThis report describes an extremely rare case of thymoma complicated with myasthenia gravis and thymic squamous cell carcinoma.

Stepwise Corrected Attention Registration Network for Preoperative and Follow-Up Magnetic Resonance Imaging of Glioma Patients.

The registration of preoperative and follow-up brain MRI, which is crucial in illustrating patients' responses to treatments and providing guidance for postoperative therapy, presents significant challenges. These challenges stem from the considerable deformation of brain tissue and the areas of non-correspondence due to surgical intervention and postoperative changes. We propose a stepwise corrected attention registration network grounded in convolutional neural networks (CNNs). This methodology leverages preoperative and follow-up MRI scans as fixed images and moving images, respectively, and employs a multi-level registration strategy that establishes a precise and holistic correspondence between images, from coarse to fine. Furthermore, our model introduces a corrected attention module into the multi-level registration network that can generate an attention map at the local level through the deformation fields of the upper-level registration network and pathological areas of preoperative images segmented by a mature algorithm in BraTS, serving to strengthen the registration accuracy of non-correspondence areas. A comparison between our scheme and the leading approach identified in the MICCAI's BraTS-Reg challenge indicates a 7.5% enhancement in the target registration error (TRE) metric and improved visualization of non-correspondence areas. These results illustrate the better performance of our stepwise corrected attention registration network in not only enhancing the registration accuracy but also achieving a more logical representation of non-correspondence areas. Thus, this work contributes significantly to the optimization of the registration of brain MRI between preoperative and follow-up scans.

Exploring 3D Printed Implants With Anti-Dropout Function to Overcome Time Constraints in Acute Orbital Fractures for Patient-Specific Implants.

Orbital wall reconstruction and implant insertion are crucial procedures for temporarily replacing the orbital walls in cases of significant fractures. Traditional methods using planar orbital implants have faced challenges owing to their flat shape, which increases the risk of dislocation from improper cuts and necessitates the use of screws in the orbital rim. This study aims to improve outcomes by employing customized 3-dimensional implants, thereby reducing complications and risk of dislocation resulting from external shock or implant weight postinsertion. This prospective study included 12 Korean individuals diagnosed with facial fractures (orbital wall injuries). Surgeries were performed on 12 patients, and follow-up CT scans were conducted on 10 of them. Therefore, the authors could only address the results for the 10 patients. The authors used bioactive glass ceramics and medical-grade poly-e-caprolactone to 3D print personalized implants, completing the manufacturing process in an average of 4.6 days. Computed tomography scans guided measurements of orbital volumes and exophthalmos. After surgery, we found that the difference values for bone orbital volumes (<0.1mL) and exophthalmos (<1mm except one) decreased compared with presurgery values. Independent t tests and Pearson correlation analysis revealed no significant changes between normal and affected sides in both phases. However, R-values increased in the postsurgery phase. Patients monitored postsurgery at 2 weeks, 3 months, and 6 months showed no complications. The 3D-printed patient-specific implants, customized to individual fracture shapes and featuring distinct implants and locking parts with notches, effectively restore bony orbital volumes and reduce exophthalmos. They have been proven feasible and applicable for reconstructing acute orbital wall fractures.

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.

A case of basal cell carcinoma of skin with bone metastasis: a case report

BackgroundBasal cell carcinoma is the most prevalent skin cancer, most characterized by local aggressiveness but with low metastatic potential, and bone metastasis is quite heterogeneous, thus the incidence profile is variable size from 0.0028% to 0.5%. We have this patient with an unusual example of basal cell carcinoma with bone metastases to add to the scarce report on this matter.Case descriptionHere we document a 48-year-old Persian man with a background of being exposed to the sun for a long time. He was diagnosed with an ulcer on the cheek, which was clinically characterized and further confirmed by biopsy as morpheaform basal cell carcinoma. Following the first round of excision, multiple relapses eventually metastasized to the bone. The latter was found on follow-up radiologic scans. This case is characterized by the aggressive nature of the disease and the heterogeneity of basal cell carcinoma growth, thus challenging the conventional view of basal cell carcinoma behavior. Treatment included surgical excision of the primary lesion, which was treated with radiotherapy afterward. However, the skeleton improved slowly during follow-up, and palliative care was eventually pursued to control symptoms and improve quality of life.ConclusionsThis was a rare case of basal cell carcinoma metastasis to non-bone organs, which reminded us to consider basal cell carcinoma metastasis, especially in the case of atypical basal cell carcinoma. Therefore, risk-aware patient management is essential. Moreover, these findings highlight the role of further research into the mechanisms of basal cell carcinoma metastasis, leading to improved therapeutic strategies that may lead to potential improvements in patient outcomes.

The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT trial.

Early ischemic changes on baseline imaging are commonly evaluated for acute stroke decision-making and prognostication. We assess the association of early ischemic changes on clinical outcomes and whether it differs between intravenous tenecteplase and Alteplase. Data are from the phase 3, Alteplase compared to Tenecteplase (AcT) trial. Subjects with anterior circulation stroke were included. Early ischemic changes were assessed using the Alberta Stroke Program Early CT score (ASPECTS). Efficacy outcomes included modified Rankin scale (mRS) 0-1, mRS 0-2, and ordinal mRS at 90 days. Safety outcomes included 24-h symptomatic intracerebral hemorrhage (sICH), any hemorrhage on follow-up scan, and 90-day mortality rate. Mixed-effects logistic regression was used to assess the association of ASPECTS (continuous and categorical (0-4 vs 5-7 vs 8-10)) with outcomes and if these associations were modified by thrombolytic type after adjusting for age, sex, and baseline stroke severity. Of the 1577 patients in the trial, 901 patients (56.3%; median age 75 years (IQR 65-84), 50.8% females, median National Institute of Health Stroke Scale (NIHSS) 14 (IQR 17-19)) with anterior circulation stroke were included. mRS 0-1 at 90 days was achieved in 1/14 (0.3%), 43/160 (14.7%), and 252/726 (85.1%) in the ASPECTS 0-4, 5-7, and 8-10 groups respectively. Every one-point decrease in ASPECTS was associated with 2.7% and 1.9% decrease in chances of mRS 0-1 and mRS 0-2 at 90 days, respectively, and 1.9% chances of increase in mortality at 90 days. Subgroup analysis in endovascular thrombectomy (EVT)-treated population showed similar results. Thrombolytic type did not modify this association between ASPECTS and 90-day mRS 0-1 (P-interaction 0.75). There was no significant interaction by thrombolytic type with any other outcomes. Similar to prior studies, we found that every one-point decrease in ASPECTS was associated with poorer clinical and safety outcomes. This effect did not differ between alteplase and tenecteplase. Data shall made available on reasonable request from the PI (BMM).

Evaluation of the thickness of acetabular cartilage by ultrasound in developmental dysplasia of the hip.

It has been reported that the cartilaginous roof of the acetabulum is thicker in infants with developmental dysplasia of the hip (DDH) than in those with healthy hips. However, there is limited research on the changes in the thickness of acetabular cartilage after follow-up or treatment of DDH. This study aims to report the thickness of acetabular cartilage before and after treatment of DDH. In this prospective study, infants with clinical suspicion of DDH were enrolled in the pediatric outpatient service in our hospital from January 2022 to August 2023. The thickness of acetabular cartilage was measured in the standard coronal plane. Borderline hips (Graf IIa type) were monitored with monthly ultrasound examination until they were classified as normal hips (Graf I type), while dysplastic hips (Graf IIb type or worse) were treated with the Pavlik harness until they were also classified as normal hips in the final ultrasound examination. A total of 592 children [median age, 96 days (interquartile range, 70-142 days); 197 boys] were enrolled in the study. The thickness of acetabular cartilage in dysplastic hips (4.3 ± 1.6 mm) was greater than that in normal hips (3.0 ± .39 mm, P < 0.001) and borderline hips (3.1 ± .57 mm, P < 0.001). In borderline hips, the thickness of acetabular cartilage decreased from 3.1 ± .57 mm in the initial evaluation to 2.9 ± .53 mm in the final follow-up scan (P = 0.01). In dysplastic hips, the thickness of acetabular cartilage decreased from 4.3 ± 1.6 mm in the initial evaluation to 3.5 ± .51 mm after treatment (P = 0.003). The thickness of acetabular cartilage in dysplastic hips after treatment remained greater than that in normal hips (P < 0.0001). The thickness of acetabular cartilage decreased after follow-up or treatment of DDH. Further research is required to determine whether cartilage that remain thicker in dysplastic hips than that in normal hips after treatment should be considered an early indicator of residual acetabular dysplasia.

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.

The role of 18FDG-PET imaging in VEXAS syndrome: a multicentric case series and a systematic review of the literature.

VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, and somatic) syndrome is characterized by heterogeneous clinical manifestations. Due to the inflammatory nature of this condition, 18-FDG-PET (18-fluorodeoxyglucose-positron emission tomography) might be used to diagnose and monitor the disease. However, no data are available about the most common findings of PET imaging in this disease. For this reason, we summarised all the available reports of patients with VEXAS who underwent at least one PET scan and described 8 additional patients' PET from our centres. Overall, we described 35 patients' PET findings. All patients were male, with a median age of 70years. The most frequent hypermetabolic sites on PET scans were the bone marrow (77.1%), lymph nodes (35.3%), lungs (28.6%), spleen and large vessels (22.9%), and cartilage (20%). Six patients underwent a PET scan 2.7 ± 1.5years before VEXAS diagnosis, showing nonspecific uptake in the bone marrow. Four patients had a follow-up PET scan, showing a decrease or a disappearance of the previously identified hypermetabolic areas. In conclusion, although no specific uptake site has been found for VEXAS syndrome, PET imaging could help detect inflammatory foci that are not clinically evident. In addition, high metabolic activity in bone marrow might precede the clinical onset of the disease, shedding light on the pathogenesis of VEXAS.

Characterization of neural networks involved in transdiagnostic emotion dysregulation from a pilot randomized controlled trial of a neurostimulation-enhanced behavioral intervention

BackgroundEmotional dysregulation is a serious and impairing mental health problem. We examined functional activity and connectivity of neural networks involved in emotional dysregulation at baseline and following a pilot neurostimulation-enhanced cognitive restructuring intervention in a transdiagnostic clinical adult sample. MethodsNeuroimaging data were analyzed from adults who scored 89 or higher on the Difficulties with Emotion Regulation (DERS) scale and had at least one DSM-5 diagnosis. These participants were part of a pilot randomized, double-blind, placebo-controlled trial combining a single therapeutic session of cognitive restructuring with active or sham transcranial magnetic stimulation over the dorsolateral prefrontal cortex. During the study, participants engaged in an emotional regulation task using personalized autobiographical stressors while undergoing functional magnetic resonance imaging (fMRI) before and after the pilot intervention. The fMRI task required participants to either experience the emotions associated with the memories or apply cognitive restructuring strategies to reduce their distress. ResultsWhole-brain fMRI results during regulation at baseline revealed increased activation in the dorsal frontoparietal network but decreased activation in the supplementary motor area, cingulate cortex, insula, and ventrolateral prefrontal cortex (vlPFC). Emotion dysregulation was associated with greater vmPFC and amygdala activation and functional connectivity between these regions. The strength of functional connectivity between the dlPFC and other frontal regions was also a marker of emotional dysregulation. Preliminary findings from a subset of participants who completed the follow-up fMRI scan showed that active neurostimulation improved behavioral indices of emotion regulation more than sham stimulation. A whole-brain generalized psychophysiological interaction analysis indicated that active neurostimulation selectively increased occipital cortex connectivity with both the insula and the dlPFC. Region-of-interest functional connectivity analyses showed that active neurostimulation selectively increased dlPFC connectivity with the insula and orbitofrontal cortex (OFC). ConclusionInsufficient neural specificity during the emotion regulation process and over-involvement of frontal regions may be a marker of emotional dysregulation across disorders. OFC, vlPFC, insula activity, and connectivity are associated with improved emotion regulation in transdiagnostic adults. In this pilot study, active neurostimulation led to neural changes in the emotion regulation network after a single session; however, the intervention findings are preliminary, given the small sample size. These functional network properties can inform future neuroscience-driven interventions and larger-scale studies.

Outcomes of fenestrated and branched endovascular aneurysm repair with an inverted contralateral limb

ObjectiveTo report technical success and evaluate clinical outcomes of fenestrated and branched endovascular aortic repair (F/B-EVAR) incorporating a contralateral inverted limb. MethodsPatients who underwent F/B-EVAR with a custom-made bifurcated device containing an inverted limb between January 2010 and September 2023 were retrospectively analyzed. Time-to-event data were analyzed using the Kaplan-Meier method. ResultsA total of 32 patients (26 men; mean age 77±6.2 years) were included in the analysis. Technical success was achieved in 28 patients (87.5%). Two technical failures resulted from misplaced contralateral limbs in patients with previous endovascular aortic repair (EVAR), necessitating one open conversion due to a type 3b endoleak, and one femoro-femoral crossover bypass after occlusion of a misplaced contralateral limb. Additionally, two technical failures were attributed to a type 3c endoleak and a type 1c endoleak, originating from a fenestrated device at the level of the left and right renal artery, respectively. One patient (3.1%) died <30 days post-operatively due to a subdural hemorrhage. Estimated patient survival after 1 and 2 years was 92.7%±5.1%, and 74.3%±10.1%, respectively. No aneurysm-related deaths were observed. During the median follow-up of 13 months, one (3.1%) inverted limb occluded, in addition to the occlusion resulting from a misplaced contralateral limb, and was treated with a femoro-femoral crossover bypass. One target vessel (right renal artery) occluded (0.9%), resulting in a permanent, significantly reduced renal function. Freedom from overall reintervention after 1 and 2 years was 73.5%±8.0% and 68.3%±9.0%, respectively. An additional four patients (12.5%) presented with a type 3c endoleak during follow-up scans, three of which originated from fenestrations at the level of the renal stents. There were no junctional problems between the inverted limb device and the main endograft, and no significant correlation was found between the one-sealing-stent inverted limb device design and the onset of type 3 endoleak (log-rank p=.064). ConclusionF/B-EVAR incorporating an inverted limb can be a viable endovascular option to manage complex aneurysms with a short renal artery to bifurcation distance. However, using the inverted limb presents a notable technical challenge and could be associated with a higher need for reintervention. Carefully confirming correct cannulation of the inverted limb is warranted.

695P Assessment of the utility of CT scans in the long-term follow-up of metastatic non-seminomatous germ cell tumours (mNSGCT): The Late CT study

695P Assessment of the utility of CT scans in the long-term follow-up of metastatic non-seminomatous germ cell tumours (mNSGCT): The Late CT study

Changes in the medial prefrontal cortex metabolites after 6 months of medication therapy for patients with bipolar disorder: A 1H-MRS study.

The study aimed to assess brain metabolite differences in the medial prefrontal cortex (mPFC) between acute and euthymic episodes of bipolar disorder (BD) with both mania and depression over a 6-month medication treatment period. We utilized 1H-MRS technology to assess the metabolite levels in 53 individuals with BD (32 in depressive phase, 21 in manic phase) and 34 healthy controls (HCs) at baseline. After 6 months of medication treatment, 40 subjects underwent a follow-up scan in euthymic state. Metabolite levels, including N-acetyl aspartate (NAA), glutamate (Glu), and Glutamine (Gln), were measured in the mPFC. Patients experiencing depressive and manic episodes exhibited a notable reduction in NAA/Cr + PCr ratios at baseline compared to healthy controls (p = 0.004; p = 0.006) in baseline, compared with HCs. Over the 6-month follow-up period, the manic group displayed a significant decrease in Gln/Cr + PCr compared to the initial acute phase (p = 0.03). No significant alterations were found in depressed group between baseline and follow-up. This study suggests that NAA/Cr + PCr ratios and Gln/Cr + PCr ratios in the mPFC may be associated with manic and depressive episodes, implicating that Gln and NAA might be useful biomarkers for distinguishing mood phases in BD and elucidating its mechanisms.

314. TRANSORAL ANTEGRADE T-TUBE INSERTION FOR MANAGEMENT OF OESOPHAGEAL LEAKS FOLLOWING MINIMAL INVASIVE OESOPHAGECTOMY

Abstract Introduction Oesophageal leaks following minimal invasive oesophagectomy (MIE) present significant challenges to upper GI surgeons, with reported rates ranging from 11% to 21%. Management strategies include: conservative, endoscopic, and surgical interventions. These vary based on patient clinical status and institution. Here, we propose a hybrid approach involving thoracoscopic washout coupled with antegrade T-tube insertion via gastroscopy for managing these complex leaks. Methods We describe the case of a 66-year-old male who underwent MIE via the McKeown approach for Siewert 1 Gastro-oesophageal adenocarcinoma. His neoadjuvant chemotherapy had been interrupted by a complex ischiorectal abscess and thus a decision was made to proceed for surgery. The surgery proceeded with a cervical anastomosis using a linear stapled technique and closure with 3.0 PDS. Postoperatively, the patient deteriorated on day 2, necessitating intubation due to decreased oxygen saturation. The chest tube output looked slightly bile stained. A subsequent CT scan revealed mediastinal fluid accumulation, prompting urgent intervention. Results Diagnostic thoracoscopy revealed contamination of the right chest and posterior mediastinum, necessitating extensive washout. A 2cm necrotic patch and perforation were identified on the gastric side of the oesophago-gastric anastomosis. Intraoperative gastroscopy localized the leak with a positive air bubble test. A Maryland forceps was passed through the defect to confirm the defect. Subsequently, a guidewire was passed antegrade into the cavity using the gastroscope. Decision was made to purse-string the defect (around the guidewire) using 3.0 PDS and the T-tube was exchanged transorally via the guidewire into the cavity and exteriorized through a 5mm port to the skin. Existing large-bore chest and Blake drains were retained, and a feeding jejunostomy was established. Conclusion This hybrid management approach, combining endoscopy and thoracoscopic washout with T-tube insertion, offers an alternative for addressing complex anastomotic leaks following MIE. By avoiding resection and diversion, this technique potentially reduces morbidity. Follow-up scans demonstrated resolution of the leak allowing the patient to be discharged. https://1drv.ms/v/s!Aghd8kXfo8oQlX6QyliVLgRDmIu-?e=EGN5YD

Differences in Graft Tear Configurations in Medial and Lateral Meniscal Allograft Transplantation: Objective Evaluations Using Magnetic Resonance Imaging

Background: Few studies have compared the characteristics of meniscal allograft tears between medial and lateral meniscal allograft transplantation (MAT) using bone fixation. Purpose: To investigate the prevalence, location, and patterns of allograft tears after MAT with the bone fixation technique and compare tear patterns between medial and lateral compartments according to the time elapsed after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: The charts of consecutive patients who underwent primary medial or lateral MAT between December 1996 and June 2019 were retrospectively reviewed. The location, pattern, and postoperative periods during which allograft tears occurred were evaluated by reviewing all series of follow-up magnetic resonance imaging (MRI) scans, which were performed at 6 weeks, 3 months, 6 months, and 1 year postoperatively and every 2 years thereafter with the patient's agreement. Postoperative periods for allograft tears were defined as the time between surgery and the follow-up MRI scan in which the meniscal tear was first confirmed. Allograft tears were compared between the medial and lateral MAT groups. Results: A total of 327 consecutive patients who underwent MAT (55 medial, 272 lateral) with a minimum 2-year follow-up were retrospectively reviewed. The incidences of allograft tears after medial and lateral MATs were 32.7% and 30.9%, respectively. The mean times for tears were 80.1 ± 81.1 months and 48.9 ± 46.3 months in the medial and lateral MAT groups, respectively (P = .130). In both the medial and lateral MAT groups, allograft tears were observed mainly in the posterior horn, with complex tears being the most commonly identified tear type. In medial MATs, root tears were the second most common at 27.8%, with a significantly higher proportion than the lateral MATs (P = .014). On the other hand, in lateral MATs, meniscocapsular separation and radial tears were the second most common at 15.5% each, albeit not significantly more common than in medial MATs (P = .123 and P = .454, respectively). All root tears in medial MATs and meniscocapsular separations in lateral MATs were observed within 1 year postoperatively. Conclusion: Significant differences in allograft tear patterns were identified between the medial and lateral MAT groups. The proportion of root tears in medial MATs was higher than that in lateral MATs; conversely, the proportion of meniscocapsular separation was more common in lateral MATs. Such tear patterns, which may require surgical repair or graft resection, were observed only within 1 year of surgery. Therefore, close observation and regular follow-up in the earlier postoperative period are necessary after medial or lateral MATs.

Predicting peritumoral glioblastoma infiltration and subsequent recurrence using deep-learning-based analysis of multi-parametric magnetic resonance imaging.

Glioblastoma (GBM) is the most common and aggressive primary adult brain tumor. The standard treatment approach is surgical resection to target the enhancing tumor mass, followed by adjuvant chemoradiotherapy. However, malignant cells often extend beyond the enhancing tumor boundaries and infiltrate the peritumoral edema. Traditional supervised machine learning techniques hold potential in predicting tumor infiltration extent but are hindered by the extensive resources needed to generate expertly delineated regions of interest (ROIs) for training models on tissue most and least likely to be infiltrated. We developed a method combining expert knowledge and training-based data augmentation to automatically generate numerous training examples, enhancing the accuracy of our model for predicting tumor infiltration through predictive maps. Such maps can be used for targeted supra-total surgical resection and other therapies that might benefit from intensive yet well-targeted treatment of infiltrated tissue. We apply our method to preoperative multi-parametric magnetic resonance imaging (mpMRI) scans from a subset of 229 patients of a multi-institutional consortium (Radiomics Signatures for Precision Diagnostics) and test the model on subsequent scans with pathology-proven recurrence. Leave-one-site-out cross-validation was used to train and evaluate the tumor infiltration prediction model using initial pre-surgical scans, comparing the generated prediction maps with follow-up mpMRI scans confirming recurrence through post-resection tissue analysis. Performance was measured by voxel-wised odds ratios (ORs) across six institutions: University of Pennsylvania (OR: 9.97), Ohio State University (OR: 14.03), Case Western Reserve University (OR: 8.13), New York University (OR: 16.43), Thomas Jefferson University (OR: 8.22), and Rio Hortega (OR: 19.48). The proposed model demonstrates that mpMRI analysis using deep learning can predict infiltration in the peri-tumoral brain region for GBM patients without needing to train a model using expert ROI drawings. Results for each institution demonstrate the model's generalizability and reproducibility.

18F-FDG positron emission tomography as a marker of disease activity and treatment response in ankylosing spondylitis and psoriatic arthritis

The ability of 18F-FDG positron emission tomography (PET) to track disease activity and treatment response in patients with Ankylosing Spondylitis (AS) or Psoriatic Arthritis (PsA) remains unclear. Here, we assessed whether 18F-FDG uptake is a marker of disease activity and treatment response in AS or PsA, and explored the ability of 18F-FDG to predict treatment response. Patients with AS (n = 16) or PsA (n = 8) who were scheduled to initiate treatment with biologics were recruited. Participants underwent a clinical evaluation and an 18F-FDG scan prior to therapy initiation. Eleven participants underwent a follow-up 18F-FDG scan 3 months post-treatment. Images were quantified using a composite measure that describes the inflammatory status of the patient. Clinically involved joints/entheses had higher 18F-FDG uptake compared to unaffected areas (median difference > 0.6, p < 0.01). Among patients with AS, pre-treatment 18F-FDG uptake was strongly associated with disease activity (r = 0.65, p = 0.006). Longitudinal 18F-FDG scans demonstrated that decreases in uptake at 3 months were associated to clinical response (βΔgSUVmax > 8.5, p < 0.001). We found no significant association between pre-treatment 18F-FDG uptake and subsequent clinical response. 18F-FDG PET shows potential as a marker of disease activity in AS and PsA, allowing for monitorization of biological treatment efficacy in these patients.

Metabolic Imaging of Advanced Basal Cell Carcinoma Treated with Sonidegib: A Retrospective Case Series Study.

Background: Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) is a firmly established tool in oncology and is gaining importance in dermato-oncology. However, its use in advanced basal cell carcinoma (BCC) is limited, with only a few case reports and a single study focused on vismodegib. This study evaluates the role of 18F-FDG PET/CT in advanced BCC treated with sonidegib. Methods: We retrospectively assessed the clinical data of patients with advanced BCC who underwent 18F-FDG PET/CT between January 2022 and January 2024. Inclusion criteria included histologically confirmed BCC, FDG-avid lesions on baseline PET/CT, and a minimum follow-up of 6 months. Metabolic response was assessed using the PET Response Criteria in Solid Tumors (PERCIST). Results: Four patients with advanced BCC treated with sonidegib were included, presenting with a total of 10 hypermetabolic lesions at baseline PET/CT. The mean interval between baseline and follow-up scans was 8.7 ± 1.6 months. According to PERCIST, two patients achieved a complete metabolic response (CMR), while the other two had stable metabolic disease (SMD). Low baseline-standardized uptake values (i.e., SUVmax, SUVmean) and reduced total lesion glycolysis (TLG) were associated with CMR. No relapses were observed during follow-up. Conclusions: This study suggests that 18F-FDG PET/CT may help identify advanced BCC patients who are likely to benefit from sonidegib treatment. Further research is needed to fully explore the potential of PET/CT in this specific clinical context.

Diagnosis and management of heterotopic intramural pregnancy after in vitro fertilization: an eight-case series.

To analyze the ultrasound characteristics, clinical management, and pregnancy outcomes of heterotopic intramural pregnancies (HIMPs) after embryo transfer. This was a retrospective observational study of women who were diagnosed with HIMPs. The ultrasound characteristics, clinical treatment, and pregnancy outcomes of patients with HIMPs were evaluated. Eight women with HIMPs were included. Among them, 6 patients were diagnosed by transvaginal sonography, and 2 patients were misdiagnosed with heterotopic interstitial pregnancy. The diagnostic accuracy was 75% (6/8). Five patients with HIMPs were diagnosed at the time of the initial scan (5+6-6+3 weeks). An intramural gestational sac was observed in all 6 patients, and an embryo with cardiac activity was detected in one patient on the follow-up scans. Intrauterine pregnancies (IUPs) were revealed in all 6 patients, and embryo(s) with cardiac activity were observed in 5 patients at the time of the initial diagnosis or later. The patients receiving expectant treatment all presented with bagel signs, while patients with embryos with cardiac activity all underwent surgery. Among the 6 diagnosed women, 1 patient was initially treated medically, 4 were treated expectantly, and 1 was treated surgically. Among the 6 diagnosed patients, the IUPs of 5 patients resulted in live infants. Single ET should be recommended to decrease the possibility of HIMP. An accurate diagnosis of HIMP was reached in most cases by detailed ultrasound early in the first trimester. Most IUPs of HIMPs seem to have good outcomes with timely and proper management. Expectant management might be a possible choice for nonviable intramural pregnancies.

Natural history of spinal cord compression stage AFMS3 in infants with achondroplasia: retrospective cohort study

Background and objectiveForamen magnum stenosis (FMS) is a common, serious complication of achondroplasia in infancy and associated with sudden infant death. The Achondroplasia Foramen Magnum Score (AFMS; 0–4) is used...