Imaging In Clinical Management Research Articles

Development and Validation of Multimodal Models to Predict the 30-Day Mortality of ICU Patients Based on Clinical Parameters and Chest X-Rays.

We aimed to develop and validate multimodal ICU patient prognosis models that combine clinical parameters data and chest X-ray (CXR) images. A total of 3798 subjects with clinical parameters and CXR images were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and an external hospital (the test set). The primary outcome was 30-day mortality after ICU admission. Automated machine learning (AutoML) and convolutional neural networks (CNNs) were used to construct single-modal models based on clinical parameters and CXR separately. An early fusion approach was used to integrate both modalities (clinical parameters and CXR) into a multimodal model named PrismICU. Compared to the single-modal models, i.e., the clinical parameter model (AUC = 0.80, F1-score = 0.43) and the CXR model (AUC = 0.76, F1-score = 0.45) and the scoring system APACHE II (AUC = 0.83, F1-score = 0.77), PrismICU (AUC = 0.95, F1 score = 0.95) showed improved performance in predicting the 30-day mortality in the validation set. In the test set, PrismICU (AUC = 0.82, F1-score = 0.61) was also better than the clinical parameters model (AUC = 0.72, F1-score = 0.50), CXR model (AUC = 0.71, F1-score = 0.36), and APACHE II (AUC = 0.62, F1-score = 0.50). PrismICU, which integrated clinical parameters data and CXR images, performed better than single-modal models and the existing scoring system. It supports the potential of multimodal models based on structured data and imaging in clinical management.

Giant adrenal metastasis of malignant melanoma: impact of 18F-FDG PET/CT in early assessment of dramatic response to immunotherapy: case report

BackgroundThis case represents one of the largest adrenal metastases in the literature and highlights the importance of accurate imaging in clinical management of patients with advanced malignant melanoma.Case presentationA 67-year-old female with an ulcerated malignant melanoma presented with an asymptomatic 18-cm left adrenal mass on 18F-FDG PET/CT staging. After two cycles of combined systemic immunotherapy, an impressive shrinkage of the adrenal metastatic tumor was observed on 18F-FDG PET/CT imaging.ConclusionsThe case emphasizes the potential of 18F-FDG PET/CT as a functional imaging modality for accurate staging and precise early assessment of response to immunotherapy. Overall, this report highlights the importance of accurate imaging for the effective management of adrenal metastases in melanoma patients.

Role of Positron Emission Tomography Cardiac Perfusion Imaging in Clinical Management, Prognosis, and Risk Stratification of Cardiovascular Disease

Coronary artery disease (CAD) is an important cause of morbidity and mortality worldwide. Perfusion abnormalities precede wall motion abnormalities, ECG changes, and angina in the etiology of CAD. myocardial perfusion imaging (MPI) can detect perfusion alterations due to pathology at sites such as the endothelium, microvasculature, and epicardial coronary arteries. Thus, it measures the universal burden of ischemic heart disease (IHD). Nuclear medicine MPI is an important noninvasive imaging modality to evaluate the perfusion of the myocardium. Positron Emission Tomography (PET) and single-photon emission computed tomography (SPECT) with or without computed tomography (CT) are 2 primary modalities. PET is a highly sensitive modality with an inherent ability to quantify absolute myocardial blood flow (MBF) and variations in MBF due to various stress agents. PET has immense potential to change clinical management, prognosticate, and risk stratify patients presenting with clinical or preclinical CAD. Evidence shows that early PET detection of myocardial perfusion abnormalities, followed by aggressive intervention for cardiovascular risk factors, can reinstate myocardial perfusion. This may reduce morbidity and mortality. We shall be reviewing the clinical impact of PET in CAD and preclinical CAD patients.

Significance of aneurysm wall enhancement on high-resolution vessel wall magnetic resonance imaging in clinical management of patients with intracranial aneurysms.

The prevalence of intracranial aneurysms is estimated to be around 3% in the general population. Although these are often incidental findings, they potentially carry the risk of rupture, with all of the devastating consequences of SAH. Several risk factors of aneurysm rupture have been identified, including aneurysm size, irregular shape, and location. Although it is widely accepted that the risk of rupture increases with size, small aneurysms remain the cause of a significant percentage of aneurysmal SAH. Up to 30% of patients with acute aneurysmal SAH have multiple aneurysms. Determining the site of rupture in these patients can be challenging, given that the results of imaging studies and clinical symptoms are sometimes inconclusive. It would be extremely useful to identify new imaging biomarkers of aneurysm instability which could have an impact on patient management and qualification for treatment. High-resolution vessel wall magnetic resonance imaging (HR-VW MRI) opens up new possibilities for improved characterisation of intracranial vasculature. One of the most promising clinical applications of this new imaging tool is the evaluation of intracranial aneurysms. Aneurysm wall enhancement (AWE) on HR-VW MRI is believed to be a marker for wall inflammation and, potentially, for aneurysm instability. In this article, we summarise the published literature on AWE with special emphasis on its use in determining the site of rupture in the setting of acute SAH in patients with multiple aneurysms, as well as its role in identifying unruptured aneurysms which are at the greatest risk of rupture. More and larger studies are needed to definitively establish the role of AWE on HR-VW MRI in the diagnostic workup of patients with intracranial aneurysms.

Stereotactic Brain Biopsy Hemorrhage Risk Factors and Implications for Postoperative Care at a Single Institution: An Argument For Postoperative Imaging

To determine preoperative factors contributing to postoperative hemorrhage after stereotactic brain biopsy (STB), clinical implications of postoperative hemorrhage, and the role of postoperative imaging in clinical management. Retrospective review of STB (2005-2018) across 2 institutions including patients aged >18 years undergoing first STB. Patients with prior craniotomy, open biopsy, or prior STB were excluded. Preoperative variables included age, sex, neurosurgeon seniority, STB method. Postoperative variables included pathology, postoperative hemorrhage on computed tomography, immediate and 30-day postoperative seizure, infection, postoperative hospital stay duration, and 30-day return to operating room (OR). Analysis used the Fisher exact tests for categorical variables. Overall, 410 patients were included. Average age was 56.5 (±16.5) years; 60% (n= 248) were men. The majority of biopsies were performed by senior neurosurgeons (66%, n= 270); frontal lobe (42%, n= 182) and glioblastoma (45%, n= 186) were the most common location and pathology. Postoperative hemorrhage occurred in 28% (114) of patients with 20% <0.05 cm3 and 8% >0.05 cm3. Postoperative hemorrhage of any size was associated with increased rate of postoperative deficit within both 24 hours and 30 days, postoperative seizure, and length of hospital stay when controlling for pathology. Hemorrhages >0.05 cm3 had a 16% higher rate of return to the OR for evacuation, due to clinical deterioration as opposed to radiographic progression. Postbiopsy hemorrhage was associated with higher risk of immediate and delayed postoperative deficit and seizure. Postoperative computed tomography should be used to determine whether STB patients can be discharged same day or admitted for observation; clinical evaluation should determine return to OR for evacuation.

AMBULATORY PLEURODESIS: SUCCESSFUL USE OF TALC WITH INDWELLING PLEURAL CATHETER FOR MANAGEMENT OF BILATERAL MALIGNANT PLEURAL EFFUSIONS

SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Malignant pleural effusions affect more than 750,000 patients each year in Europe and the United States and account for greater than 125,000 hospitalizations and have an estimated cost of $5 billion per year1,2. Treatment for malignant pleural effusions with expandable lung would favor treatment with talc pleurodesis and often requires days of inpatient hospitalization for management and observation3. Placement of indwelling pleural catheters (IPCs) can be used as successful alternative for management of symptoms in an ambulatory setting3,4. Additionally, administration of talc through an IPC shows increased probability of pleurodesis4. We present a patient with bilateral malignant pleural effusions with successful bilateral pleurodesis using talc instilled through bilateral IPCs. CASE PRESENTATION: A 72-year-old man with a past medical history significant for metastatic melanoma presented to the ED with complaints of progressive dyspnea at rest. Imaging revealed large bilateral pleural effusions with symptomatic improvement with therapeutic thoracentesis. Initial studies were consistent with exudative effusion with negative cytology and patient was discharged with follow-up in Pulmonary Clinic. He underwent repeat large-volume thoracentesis with repeat cytology showing metastatic melanoma. Given rapidly re-accumulating fluid and symptoms, a left IPC was placed with significant improvement and a right IPC was placed 2 weeks later with continued improvement and decreased effusions on repeat U/S. At this time, further management with talc pleurodesis was discussed to ideally eliminate the need of IPCs and enhance the patient’s quality of life. Talc was instilled per IPC plus protocol4 with subsequent ultrasound monitoring with <25 cc of output daily. Given good apposition, the left IPC was removed and 2 weeks later, talc was administered to the right IPC with similar results on ultrasound with upcoming removal of right IPC given continued good apposition and decreased drainage. DISCUSSION: We demonstrate a validated alternative treatment strategy in a patient with bilateral malignant pleural effusions. This presents a plausible alternative to patients to decrease hospital days and expenses, while improving quality of life and allowing for pleurodesis in an outpatient setting. We show success using bilateral IPCs with sequential talc pleurodesis and removal of IPCs. No hospitalizations were made during this time period and the patient tolerated all procedures well. CONCLUSIONS: Given continued advancement in techniques, we continue to show patient-centered care in a challenging population with an outpatient centered treatment approach and use of U/S imaging for clinical management. Reference #1: 1. Marel M, Zrustova M, et al. The incidence of pleural effusion in a well-defined region: epidemiology study in Central Bohemia. Chest 1993; 104:1486-9. Reference #2: 2. Taghizadeh N, Fortin M, Tremblay A. US hospitalizations for malignant pleural effusions: data from the 2012 National Inpatient Sample. Chest 2017;151:845–854. Reference #3: 3. Feller-Kopman D, Reddy C, et al. Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guidelines. Am J Respir Crit Care Med. 2018 Oct 1; 198(7):839-849. 4. Bhatnagar R, Keenan E, et al. Outpatient Talc Administration by Indwelling Pleural Catheter for Malignant Effusion. N Engl J Med. 2018 Apr 5;378(14):1313-1322. DISCLOSURES: No relevant relationships by Michael Gonzales, source=Web Response No relevant relationships by Tyson Sjulin, source=Web Response No relevant relationships by John Untisz, source=Web Response

Position of cardiac magnetic resonance imaging in clinical management of cardiomyopathies

Position of cardiac magnetic resonance imaging in clinical management of cardiomyopathies

Giant epithelioid hemangioma of the external auditory canal: Role of imaging in clinical management

Abstract Being uncommon neoplasms of elusive origin, epithelioid hemangiomas are benign vascular tumors found in young adults. 1 These epithelioid hemangiomas are mostly found in the head and neck region, presenting as solitary or multiple lesions, and they vary between 2 and 3 cm in diameter, and morphologically manifest as intradermal papules or subcutaneous nodules. 2 More eloquently termed as angiolymphoid hyperplasia with eosinophilia on pathological basis, these tumors are amenable to surgical excision, though rare instances exist where they might regress on their own. 3 A 23-year-old male, who we report, had a bizarre unusual presentation with an extremely large mushroom shaped mass occluding the left external auditory canal. He had considerable facial disfigurement, pulsatile tinnitus and unilateral deafness. Even though it was clinically thought to be a malignant mass, cross sectional imaging gave clue to its highly vascular yet benign nature. Despite its large size, the tumor did not cause osseous destruction and had simply traveled into adjacent anatomical structures and overlying subcutaneous tissues and skin. The characteristic histologic picture was pathognomonic. This case report highlights the unusually large size and atypical clinical presentation of the tumor.

Erratum to: Persistent Urogenital Sinus: Diagnostic Imaging for Clinical Management. What Does the Radiologist Need to Know?

Background Persistent urogenital sinus (PUGS) is a congenital pathological condition characterized by an abnormal communication between the urethra and vagina. It may be a part of a complex syndrome and can be more often associated with congenital malformations affecting the genitourinary tract system (33%) such as intersex, rectovaginal communication, bladder agenesis, absence of vagina, and hydrocolpos. The correct radiological assessment of PUGS is especially useful for clinicians since the exact anatomical evaluation of this abnormality is a crucial factor for surgical planning. The imaging study modalities, which are essentially based on ultrasonography, voiding cystourethrography, and magnetic resonance imaging, could be misinterpreted if not correctly performed. Aim The aim of this article is to highlight this rare pathological condition and to help general radiologists in achieving the correct technical approach for the diagnosis. Special attention will be paid in discussing the role of different imaging modalities and their contribution to the diagnosis and clinical management of patients.

SP0081 Impact of Imaging in Clinical Management of Inflammatory Back Pain: The Example of MRI in Spondyloarthritis

Magnetic resonance imaging (MRI) is, through its ability to directly visualize inflammatory changes in bone and soft tissues, the most sensitive imaging modality for recognizing early spine and sacroiliac joint...

Mri of sports-related injuries of the foot and ankle: part 1

The ankle is one of the most frequently injured joints in the course of sports activities. MR imaging has become the modality of choice in the evaluation of most of these lesions, especially in competitive athletes. The purpose of this article is: 1) To illustrate the MR imaging features of a great number of sports-related injuries of the ankle, correlating it with lesional mechanisms and clinical findings, and 2) To review the role of MR imaging in clinical management and surgical planning of these injuries, especially in competitive athletes. In order to a better understanding of these lesions, a classification based on the anatomic origin are outlined. The spectrum of injuries has been classified in: 1) osseous lesions, 2) ligamentous injuries, 3) tendinous lesions, 4) impingement impingement, and 5) plantar fascial lesions.

The Role of TI-201 Perfusion Imaging in Clinical Management

Better, Nathan; Parker, J. Anthony; Simons, Michael; Rocco, Tom; Gervino, Ernest Author Information