Imaging Specialists Research Articles

Who publishes imaging articles in non-imaging journals? A large sample data-mining study.

To assess the weight of imaging and imaging specialists (i.e., affiliated to a radiology/nuclear medicine department) in publications in non-imaging journals. All articles indexed in English on the Embase database between 1989 and 2019 were extracted. The number and affiliation of authors were determined. A naive Bayesian classifier algorithm was trained to classify abstracts as "imaging" or "non-imaging." The main outcome was the number and position of imaging specialists in the authorship of imaging articles published in non-imaging journals. Analyses per medical specialties and per journal impact factor (IF) were performed. A total of 15,787,825 articles were included with 968,259 (6%) "imaging" articles. The proportion of imaging articles increased over time (+ 370%), quicker than the overall academic output. The proportion of imaging specialist among authors grew from 0.58% in 1989-1994 to 1.54% in 2015-2019. About 20% of imaging articles had ≥ 1 imaging specialist among authors. The proportion of imaging articles decreased with the IF (7.3% for IF 0-2.5 vs. 5.1% for IF > 10, p < 0.001), but the proportion of imaging specialist authors in imaging papers with ≥ 1 imaging specialist author increased with the IF (40% for IF 0-2.5, 53% for IF > 10, p < 0.001). There was significant variability across medical specialties. The weight of imaging articles and imaging specialist among authors in non-imaging journals has increased over time but remains limited. Most of the authors of imaging publications are not imaging specialists. Imaging specialists among authors in imaging papers are associated with a greater IF. • The proportion of imaging specialist authors in non-imaging journals, though small, has increased significantly. • Marked differences are observed according to medical specialties and the reputation/impact factor of the journal. • Collaboration between imaging specialists and non-specialists is associated with publication in higher impact journals.

Ethics in the professional practice of imaging specialists

Introduction: During professional practice, it is absolutely necessary that ethics and Imaging complement each other as fundamental sciences. Objective: Describe the role of ethics in Imaging for the proper development of professional practice. Methods: In June and July of 2023, an electronic search for publications and systematic literature reviews was conducted using Google Scholar and the electronic databases PubMed, Medline, and SciELO. The following descriptors were used: "ethics and medical ethics", "Imaging", and "ethics and Imaging". A total of 56 sources were reviewed in the databases mentioned above. Out of these, 31 bibliographic references were used.Results: Imaging specialists, like other healthcare professionals, must adhere to ethical duties that include respecting privacy, maintaining privileged communication, confidentiality, and obtaining informed consent. Professionals in the field often face ethical conflicts during their practice. Therefore, it is crucial that they are technically and scientifically prepared to handle such situations. This is especially important when dealing with medical-legal imaging and the ethical dilemmas that may arise. It is essential to pay close attention to the indication of imaging studies, particularly when they do not provide any benefit to the patient. Conclusions: Imaging specialists who are involved in patient care must adhere to ethical standards governing the practice of the profession

Impact of observer experience on multi-detector computed tomography aortic valve morphology assessment and valve size selection for transcatheter aortic valve replacement

Transcatheter aortic valve replacement (TAVR) has become the standard treatment for aortic stenosis in older patients. It increasingly relies on accurate pre-procedural planning using multidetector computed tomography (MDCT). Since little is known about the required competence levels for MDCT analyses, we comprehensively assessed MDCT TAVR planning reproducibility and accuracy with regard to valve selection in various healthcare workers. 20 randomly selected MDCT of TAVR patients were analyzed using dedicated software by healthcare professionals with varying backgrounds and experience (two structural interventionalists, one imaging specialist, one cardiac surgeon, one general physician, and one medical student). Following the analysis, the most appropriate Edwards SAPIEN 3™ and Medtronic CoreValve valve size was selected. Intra- and inter-observer variability were assessed. The first structural interventionalist was considered as reference standard for inter-observer comparison. Excellent intra- and inter-observer variability was found for the entire group in regard to the MDCT measurements. The best intra-observer agreement and reproducibility were found for the structural interventionalist, while the medical student had the lowest reproducibility. The highest inter-observer agreement was between both structural interventionalists, followed by the imaging specialist. As to valve size selection, the structural interventionalist showed the highest intra-observer reproducibility, independent of the brand of valve used. Compared to the reference structural interventionalist, the second structural interventionalist showed the highest inter-observer agreement for valve size selection [ICC 0.984, 95% CI 0.969–0.991] followed by the cardiac surgeon [ICC 0.947, 95%CI 0.900–0.972]. The lowest inter-observer agreement was found for the medical student [ICC 0.507, 95%CI 0.067–0.739]. While current state-of-the-art MDCT analysis software provides excellent reproducibility for anatomical measurements, the highest levels of confidence in terms of valve size selection were achieved by the performing interventional physicians. This was most likely attributable to observer experience.

Pre-pregnancy counselling in patients with Turner syndrome: A multidisciplinary approach

Life-threatening complications may occur during pregnancy in patients with Turner syndrome (TS), such as eclampsia, gestational diabetes, cholestatic hepatitis or aortic dissection (AD). In France, a fatal AD occurred in 2 patients after oocyte donation (OD). Therefore, since 2019, our reference center created, on a quarterly basis, the first national multidisciplinary meeting evaluating the risk of a potential pregnancy in patients with TS. It involves physicians specialized in maternal-fetal medicine, gynaecologists, endocrinologists, imaging and cardiology specialists. Sixty-two cases have been evaluated. The patients’ median age at diagnosis of TS is 11 years (IQR: 8–15) and their median age at evaluation is 33 years (IQR: 29–36.7). Spontaneous menarche was present in 13/62 (21%) women. Primary ovarian insufficiency was present in 51/62 (82%) at a median age of 15 years (IQR: 14–17.2). A 45,X karyotype was observed in 16/62 (26%) of cases. Bicuspid aortic valve (BAV) was present in 16/62 cases (25.8%). The patients’ median aortic index was 16 mm/m2 (IQR: 15–18.9), evaluated with CMR and/or transthoracic echocardiography. A pregnancy has not been contraindicated in 42/62 (67.8%) of cases. The reasons for the refusal were a previous aortic replacement (6/20 patients) or a significant aortic dilatation (14/20 patients). The aortic index was above 25 mm/m2 in one patient. Mean aortic index was significantly higher in the contraindicated patients compared to the other patients: 19.5 mm/m2 (range: 15.6–26.2) vs. 15.6 mm/m2 (range: 11.4–22) (P < 0.001), respectively. Seven live births occurred at a median maternal age of 34.5 (IQR: 32.7–36.7): 3 were natural and 4 after OD. No cardiovascular events, including AD, were observed during pregnancy and in the population evaluated. Our preliminary results suggest that a multidisciplinary team meeting could improve the safety of pregnancy in women with TS.

Perception of final year radiography students towards the proposed six-year Doctor of Radiography/Medical Imaging program

Introduction: Medical imaging or radiography as a profession has evolved considerably. As a result, the radiography/medical imaging program would need to be upgraded to keep up with the changes. The purpose of this study was to find out how final-year radiography students feel about the proposed six-year Doctor of Radiography/Medical Imaging program. Methods: From June to October 2021, a cross-sectional study of final-year radiography students was undertaken at the University of Cape Coast. All students received pilot tested questionnaires through email. There were 29 questions in all, grouped into three sections A, B and C. Data was analyzed statistically with the Statistical Package for Social Sciences (SPSS) version 25. Results: This survey drew a total of 83 students, with 62 males (75%) and 21 females (25%) participating. The mean of all the listed items in section B was 1.78 while C was 1.77. This indicated strong optimistic about the proposed program's ability to generate high-quality, exceptional and diverse imaging specialists. Conclusion: The final year students had a favorable perception toward the proposed six-year Doctor of Radiography/Medical Imaging program. As a result, they are confident that the program would result in more flexible imaging experts than the four-year bachelor's degree.

Sinonasal Anatomy

It is imperative for all imaging specialists to be familiar with detailed multiplanar computed tomography imaging anatomy of the paranasal sinuses and adjacent structures. This article reviews, in brief, the radiologically relevant embryology of the sinonasal region and discusses the imaging anatomy of the nasal cavity and paranasal sinuses. Radiologists should understand the importance and clinical implications of identifying the numerous anatomic variations encountered in this region and prepare a structured report that provides a surgical road map to the referring clinician.

Current status of nuclear cardiology practice in Latin America and the Caribbean, in the era of multimodality cardiac imaging approach: 2022 update.

Cardiovascular diseases (CVDs) are the leading cause of mortality in Latin America and the Caribbean (LAC), with the risk in men being slightly higher than in women. The coronavirus disease 2019 (COVID-19) pandemic caused a significant reduction in the number of cardiac diagnostic procedures globally and in particular in LAC. Nuclear cardiology is available in the region, but there is variability in terms of existing technology, radiopharmaceuticals, and human resources. In the region, there are 2385 single photon emission computed tomography (SPECT) and 315 PET scanners, Argentina and Brazil have the largest number. There is an increasing number of new technologies such as cadmium-zinc-telluride (CZT) cardiac-dedicated gamma cameras, SPECT/computed tomography (CT), and PET/CT. All countries performed myocardial perfusion imaging studies, mainly gated-SPECT; the rest are multi-gated acquisition, mainly for cardiac toxicity; detection of viability; rest gated SPECT in patients with dilated cardiomyopathy, and bone-avid tracer cardiac scintigraphy for transthyretin cardiac amyloidosis diagnosis. Regarding other non-nuclear cardiac imaging modalities, Argentina, Colombia, and Chile have the highest ratio of CT scanners, while Brazil, Argentina, and Chile show the highest ratio of MRI scanners. The development of nuclear cardiology and other advanced imaging modalities is challenged by the high cost of equipment, lack of equipment maintenance and service, insufficient-specific training both for imaging specialists and referring clinicians, and lack of awareness of cardiologists or other referring physicians on the clinical applications of nuclear cardiology. Another important aspect to consider is the necessity of implementing cardiac imaging multimodality training. A joint work of nuclear medicine specialists, radiologists, cardiologists, and clinicians, in general, is mandatory to achieve this goal. National, regional, and international cooperation including support from scientific professional societies such as the American Society of Nuclear Cardiology and Latin American Association of Biology and Nuclear Medicine Societies, cardiological societies, and organizations such as the International Atomic Energy Agency, and Pan American Health Organization, as well as government commitment are key factors in the overall efforts to tackle the burden of cardiovascular diseases in the region.

OC-048 CHRONIC GROIN PAIN. ALGORITHM FOR EVALUATION

Abstract Aim Chronic groin pain is a challenge for surgeons. It is the main symptom in pathologies caused by sports activities (Sportsman's Groin) and is also found as a complication after inguinal hernia repair. Currently multivariable analysis reports that : younger age (≤40 years), small hernias (EHS I: &amp;lt;1.5 cm), and preoperative pain; are risk factors for the appearance of postoperative chronic pain. The Manchester Consensus concluded that general surgeons have límited experience on the topic and the difficulty of making randomized trials with high level of evidence The main objective is to describe a diagnostic algorithm to be used in patients with chronic groin pain and those with small hernia that are going to be repaired. Material &amp; Methods A multidisciplinary team had developed an assessment, diagnosis, and treatment algorithm for CGP. The team is composed of surgeons, physiotherapists, orthopedists, and imaging specialists. We implement this algorithm in young patients (16–30) who consult for chronic groin pain, even those with inguinal hernia diagnosis. Results A total of 5,737 patients were assessed by the multidisciplinary team from June 2009 to June 2021. The most frequent clinical entities registered were tendinopathies: iliopsoas-pectineus- related (42.7%) and adductor-related (39.5%). In those patients with postoperative pain, (45%) reported preoperative pain and (91%) were not related to neuropathies. Conclusions The algorithm has proven to be safe and successful. It has been used in patients who consulted with pre and postoperative chronic groin pain, with a high rate of achievement

Outcomes benefit in asymptomatic patients with moderate aortic valve stenosis followed up in heart valve clinics

Abstract Background The management of patients with asymptomatic moderate aortic stenosis (AS), particularly the follow-up and the choice between early intervention vs watchful waiting, remains debated. A progressively increasing number of patients with valvular heart disease (VHD) were diagnosed and followed in an ambulatory setting with a dedicated cardiologist and cardiac imaging specialist: the Heart Valve Clinics (HVC). However, the number of patients with VHD is that high, that these patients are also followed by routine cardiac care consultations (standard-of-care). Purpose To determine the benefit of a HVC approach and outcomes compared to standard-of-care for patients with moderate asymptomatic AS. Methods From November 2014 a HVC environment was introduced at our Cardiovascular Center, to follow patients with moderate and severe VHD by an imaging and valve specialist. Patients who received at least one visit in the Ambulatory HVC were included in a prospective registry. All consecutive patients with aortic valve velocity max&amp;gt;3 cm/sec diagnosed with 2-D echocardiography according to the ESC Guidelines were included in this study. Exclusion criteria included more than moderate aortic regurgitation and prior aortic valve replacement (AVR). Natural history, need for AVR, and survival of patients with baseline moderate AS were assessed at follow up. Cox proportional hazard model, Kaplan-Meier survival curves and propensity score matching where used to assess the HVC approach effect on the mortality. Results A total of 2130 patients were included (1879 in the standard-of-care group and 251 in the Ambulatory HVC group). 1187 (55.7%) were male, and the mean (SD) age was 77.2±12.2 years. A total of 919 patients (43.1%) had severe AS (aortic valve area &amp;lt;1.0 cm2). Mean clinical follow-up was 1.2±2.4 years. A total of 822 patients (38.6%) died during the follow up and 114 patients (55.6%) underwent AVR during the study period. After using 1:1, nearest neighbour, without replacement propensity score matching, baseline characteristics between the two groups were balanced. The introduction of Ambulatory HVC was associated with a reduction of adjusted all-cause mortality compared to the standard-of-care group (HR=0.53, 95% CI 0.35–0.82, p=0.004) (Figure1). At multivariable analysis, the Ambulatory HVC pathway was a significant predictor of reduced all-cause of death (HR=0.46, 95% CI 0.33–0.65, p&amp;lt;0.001), together with younger age and higher GFR, independently of AVA, tricuspid regurgitation gradient, LVEF and chronic obstructive pulmonary disease. Conclusions Patients with moderate AS followed up in HVC had lower rate of all-cause of death compared to the standard-of-care group. The Ambulatory HVC was a significant predictor of reduced all-cause of death and was associated with more efficient patient management and lower mortality. Dedicated HVC have the potential to improve patient care and clinical outcomes. Funding Acknowledgement Type of funding sources: None.

Thrombophilia in Budd-Chiari syndrome patient

A 27-years old female patient presented with a severe general condition of generalized edema and hypotension. Two months earlier computed tomography imaged thrombosis of the inferior vena cava and the three hepatic veins, or Budd-Chiari syndrome (BCS). Additional findings were thrombosis of the right common iliac vein and thrombosis of the renal veins bilaterally. Genetic testing proved congenital thrombophilia. Anticoagulation therapy did not affect thrombotic occlusions. In another cardiovascular center, an unsuccessful attempt for interventional treatment of the inferior vena cava with a jugular approach was made. The patient was admitted to our hospital for further evaluation and decision on treatment strategy. Laboratory and non-invasive imaging at admission rejected hepatic cirrhosis. An abdominal ultrasound scan demonstrated complete occlusion of the three hepatic veins and post hepatic portal hypertension. When thrombosis of all hepatic veins was detected transjugular intrahepatic portosystemic shunt (TIPS) was an option. An endovascular strategy for inferior vena cava was undertaken and complete revascularization was achieved with the right femoral approach as a bridge to TIPS shunt procedure, since the patient didn&amp;rsquo;t meet the criteria for liver transplantation. In diagnosing disease, the main contributors were the gastroenterologist, diagnostic imaging specialist, and hematologist, while the multidisciplinary team included also cardiologist, interventional cardiologist, and angiologist. In this case the multidisciplinary decisions played a major role in diagnosing and building an appropriate therapeutic strategy for systemic illnesses and conditions for which medical guidance does not yet have clear guidelines.

Imaging standardisation in metastatic colorectal cancer: A joint EORTC-ESOI-ESGAR expert consensus recommendation

BackgroundTreatment monitoring in metastatic colorectal cancer (mCRC) relies on imaging to evaluate the tumour burden. Response Evaluation Criteria in Solid Tumors provide a framework on reporting and interpretation of imaging findings yet offer no guidance on a standardised imaging protocol tailored to patients with mCRC. Imaging protocol heterogeneity remains a challenge for the reproducibility of conventional imaging end-points and is an obstacle for research on novel imaging end-points. Patients and methodsAcknowledging the recently highlighted potential of radiomics and artificial intelligence tools as decision support for patient care in mCRC, a multidisciplinary, international and expert panel of imaging specialists was formed to find consensus on mCRC imaging protocols using the Delphi method. ResultsUnder the guidance of the European Organisation for Research and Treatment of Cancer (EORTC) Imaging and Gastrointestinal Tract Cancer Groups, the European Society of Oncologic Imaging (ESOI) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), the EORTC-ESOI-ESGAR core imaging protocol was identified. ConclusionThis consensus protocol attempts to promote standardisation and to diminish variations in patient preparation, scan acquisition and scan reconstruction. We anticipate that this standardisation will increase reproducibility of radiomics and artificial intelligence studies and serve as a catalyst for future research on imaging end-points. For ongoing and future mCRC trials, we encourage principal investigators to support the dissemination of these imaging standards across recruiting centres.

Integration of ultrasonography training into undergraduate medical education: catch up with professional needs

ObjectiveUltrasonography (US) has become the first-line imaging modality even for physicians who are not imaging specialists. The progress has not yet been sufficiently considered in medical education. The aim was to develop a curriculum that integrates US as a compulsory part into medical education directly from the start, to build up professional competencies toward residency.MethodsDevelopment was based on Kern’s six-step approach to identify problems, specify needs, define goals, outline strategies, and propose methods.ResultsThe proposed curriculum follows a spiral course within which students should pass through four levels of training with increasing complexity. Students will be asked to independently prepare for courses by using learning videos. On the first training level, US should be closely linked to anatomy and physiology courses. Competency-centered courses should be held in small groups. On the second level, in the third year of education, students will apply point-of-care ultrasonography concerning multiple medical disciplines. On the third level, they will select a compulsory course in a specialty of their choice, held at five consecutive dates. From then on, US will be conducted in patients. Finally, during the final year, students are expected to use US under pro-active supervision with a large degree of independence and confidence. Throughout the curriculum, the discipline of radiology combines vertically with foundational sciences and horizontally with other medical specialties.ConclusionThe conceptual proposal for a longitudinal US curriculum presented here has been developed by radiologists to equip students with competencies needed for contemporary patient care.

Reconsidering evidence-based management of endometriosis.

Without an adequate animal model permitting experiments the pathophysiology of endometriosis remains unclear and without a non-invasive diagnosis, information is limited to symptomatic women. Lesions are macroscopically and biochemically variable. Hormonal medical therapy cannot be blinded since recognised by the patient and the evidence of extensive surgery is limited because of the combination of low numbers of interventions of variable difficulty with variable surgical skills. Experience is spread among specialists in imaging, medical therapy, infertility, pain and surgery. In addition, the limitations of traditional statistics and p-values to interpret results and the complementarity of Bayesian inference should be realised. To review and discuss evidence in endometriosis management. A PubMed search for blinded randomised controlled trials in endometriosis. Good-quality evidence is limited in endometriosis. Clinical experience remains undervalued especially for surgery. Evidence-based medicine should integrate traditional statistical analysis and the limitations of P-values, with the complementary Bayesian inference which is predictive and sequential and more like clinical medicine. Since clinical experience is important for grading evidence, specific experience in the different disciplines of endometriosis should be used to judge trial designs and results. Finally, clinical medicine can be considered as a series of experiments controlled by the outcome. Therefore, the clinical opinion of many has more value than an opinion.

Anatomical variants of the uterine artery: 214 angiotomographies

The aim of the work is to know the changes that the uterine artery undergoes with age, the determination of its origin and its possible variants. Cross-sectional, comparative, descriptive, retrospective study Angiotomographies of the abdomen and pelvis of female patients were obtained, reformatted in 3D, analyzing the uterine arteries (thickness, origin and trajectory). Measurements were carried out by two medical specialists in diagnostic imaging. 107 CT angiograms of patients with a mean age of 56.62±16.97 years (range 1890) were included. The average thickness of the uterine arteries was 2.16 mm (±0.38 mm). Divided by laterality and age groups, they were 2.35 mm, 2.19 mm and 2.36 mm on the right side and 2.19 mm, 2.07 mm and 2.15 mm on the left side, respectively. There was no statistically significant difference in thickness between the three groups (p=0.08). Five types of anatomical variants are described with prevalence of 85.1% in type I, 6.75% in type II, 5.4% in type III, 2.02% in type IV and 0.67% in type V, the latter coming directly from the left ovarian artery. There are five diffe– rent anatomical variants in our population, Type I is the most predominant. There are no significant morphological changes with age, except for an increase in vascular lesions, mainly atherosclerosis, in people over 50 years of age.

Intelligent Labeling of Tumor Lesions Based on Positron Emission Tomography/Computed Tomography.

Positron emission tomography/computed tomography (PET/CT) plays a vital role in diagnosing tumors. However, PET/CT imaging relies primarily on manual interpretation and labeling by medical professionals. An enormous workload will affect the training samples’ construction for deep learning. The labeling of tumor lesions in PET/CT images involves the intersection of computer graphics and medicine, such as registration, a fusion of medical images, and labeling of lesions. This paper extends the linear interpolation, enhances it in a specific area of the PET image, and uses the outer frame scaling of the PET/CT image and the least-squares residual affine method. The PET and CT images are subjected to wavelet transformation and then synthesized in proportion to form a PET/CT fusion image. According to the absorption of 18F-FDG (fluoro deoxy glucose) SUV in the PET image, the professionals randomly select a point in the focus area in the fusion image, and the system will automatically select the seed point of the focus area to delineate the tumor focus with the regional growth method. Finally, the focus delineated on the PET and CT fusion images is automatically mapped to CT images in the form of polygons, and rectangular segmentation and labeling are formed. This study took the actual PET/CT of patients with lymphatic cancer as an example. The semiautomatic labeling of the system and the manual labeling of imaging specialists were compared and verified. The recognition rate was 93.35%, and the misjudgment rate was 6.52%.

Joint EANM/SIOPE/RAPNO practice guidelines/SNMMI procedure standards for imaging of paediatric gliomas using PET with radiolabelled amino acids and [18F]FDG: version 1.0

Positron emission tomography (PET) has been widely used in paediatric oncology. 2-Deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is the most commonly used radiopharmaceutical for PET imaging. For oncological brain imaging, different amino acid PET radiopharmaceuticals have been introduced in the last years. The purpose of this document is to provide imaging specialists and clinicians guidelines for indication, acquisition, and interpretation of [18F]FDG and radiolabelled amino acid PET in paediatric patients affected by brain gliomas. There is no high level of evidence for all recommendations suggested in this paper. These recommendations represent instead the consensus opinion of experienced leaders in the field. Further studies are needed to reach evidence-based recommendations for the applications of [18F]FDG and radiolabelled amino acid PET in paediatric neuro-oncology. These recommendations are not intended to be a substitute for national and international legal or regulatory provisions and should be considered in the context of good practice in nuclear medicine. The present guidelines/standards were developed collaboratively by the EANM and SNMMI with the European Society for Paediatric Oncology (SIOPE) Brain Tumour Group and the Response Assessment in Paediatric Neuro-Oncology (RAPNO) working group. They summarize also the views of the Neuroimaging and Oncology and Theranostics Committees of the EANM and reflect recommendations for which the EANM and other societies cannot be held responsible.

\u201cMultidisciplinary management of post- infective osteoarthritis and secondary condylar resorption of temporomandibular joint: a case report in a 9\u2009years-old female patient and a review of literature\u201d

BackgroundOsteoarthritis and condylar resorption of temporomandibular joint (TMJ) has rarely been reported in children as consequence of otologic disease. We describe the management of a case in a 9-year-old female as long-term complication of an otomastoiditis and review the literature currently available on this topic.Case presentationA nine-years-old female patient referred to Emergency Room of Bambino Gesù Children’s Research Hospital, IRCCS (Rome,Italy) for an acute pain in the left preauricular area and reduced mandibular movements. In the medical history an otomastoiditis and periorbital cellulitis was reported at the age of six with complete remission of symptoms after antibiotic treatment. No recent history of facial trauma and no previous orthodontic treatment were reported. She was referred to a pediatric dentist that conducted a clinical examination according to the Diagnostic Criteria of Temporomandibular Disorders (DC/TMD) and was diagnosed with bilateral myalgia of the masticatory muscles and arthralgia at the level of the left TMJ. Then, a complete diagnostic path was performed that included multidisciplinary examinations by a rheumatologist, infectious disease specialist, ear nose and throat (ENT) doctor, a maxillofacial surgeon and a medical imaging specialist. Differential diagnosis included juvenile idiopathic arthritis, idiopathic condylar resorption, trauma, degenerative joint disease, neurological disease. Finally, unilateral post-infective osteoarthritis of the left TMJ with resorption of mandibular condyle was diagnosed. The patient went through a pharmacological therapy with paracetamol associated to counselling, jaw exercises and occlusal bite plate. After 1 month, the patient showed significant reduction of orofacial pain and functional recovery that was confirmed also one-year post-treatment. The novelty of this clinical case lies in the accurate description of the multidisciplinary approach with clinical examination, the differential diagnosis process and the management of TMD with conservative treatment in a growing patient.ConclusionsSeptic arthritis of temporomandibular joint and condylar resorption were described as complications of acute otitis media and/or otomastoiditis in children. We evidenced the importance of long-term follow-up in children with acute media otitis or otomastoiditis due to the onset of TMJ diseases. Furthermore, in the multidisciplinary management of orofacial pain the role of pediatric dentist is crucial for the diagnostic and therapeutic pathway to avoid serious impairment of mandibular function.

MRI and Anatomical Determinants Affecting Neuroforaminal Stenosis Evaluation: A Descriptive Observational Study.

PurposeNeuroforaminal stenosis (NFS), a narrowing of the intervertebral foramen, is a cause of disability in the aging population. Formal magnetic resonance imaging (MRI) classification of NSF has been developed recently and contradictory findings have been reported. This study aims to assess whether in-plane, anatomically conformed two-dimensional (2D) views of the neuroforamen characterize NFS more accurately than traditional axial, coronal, and sagittal views in healthy individuals with and without simulated scoliosis.Patients and methodsThis observational study was approved by the designated institutional review board at our academic tertiary care center. Four volunteers underwent lumbar spine MRI twice, once in the supine position and once with intentionally introduced hip tilt. The latter resulted in lumbar curvature mimicking positioning errors approximating degenerative lumbar scoliosis. Anatomically oriented cuts such as axial with endplate correction and coronally obliqued parasagittals, also called coronal obliques, were performed. Standard sagittal and axial views were also performed in both the supine and rotated groups.ResultsCoronal oblique and anatomically oriented axial views demonstrated the highest correlation with true neuroforaminal caliber. Deviation from anatomical congruence resulted in false measurements of neuroforaminal size. The hip-tilt studies produced MR that were less favorable to characterization of the caliber of neuroforamina. Coronal sections demonstrated reliability only when performed at the mid-pedicular lines. Standard axial views were reliable only when taken at the upper one-third of the neuroforamen. Coronal oblique views demonstrated superiority when evaluating consecutive neuroforamen on one image compared to non-obliqued parasagittal slices.ConclusionTo minimize error in neuroforaminal analysis, imaging specialists should perform anatomically oriented cuts to conform to individual patient anatomy. When this cannot be performed due to a patient’s spine rotation or position, the MRI reader should view oblique, axial, and coronal images simultaneously and dynamically for proper foraminal characterization.

Role of Abdominal and Pelvic CT Scans in Diagnosis of Patients with Immunotherapy-Induced Colitis.

Introduction:Colitis is one of the most common immune-related adverse events in patients receiving immune checkpoint inhibitors. Although radiographic changes on computed tomography (CT), such as mild diffuse bowel thickening, mesenteric fat stranding, and mucosal enhancement, have been reported, the utility of CT in diagnosis of patients with suspected immune-related colitis is not well documented. The aim of this retrospective study was to determine the value of CT scans in diagnosis of immunotherapy-induced colitis.Methods:CT scans of the abdomen and pelvis of 34 patients receiving immunotherapy who had a clinical diagnosis of immunotherapy-induced colitis and 19 patients receiving immunotherapy without clinical symptoms of colitis (controls) were evaluated. Segments of the colon (rectum, sigmoid, descending, transverse, ascending, and cecum) were assessed independently by two abdominal imaging specialists, blinded to the clinical diagnosis. Each segment was assessed for radiographic signs such as mucosal enhancement, wall thickening, distension, and periserosal fat stranding. The presence of any of the signs was considered radiographic evidence of colitis.Results:CT findings suggestive of colitis was seen in 20 of 34 patients with symptoms of colitis and in 5 of 19 patients without symptoms of colitis. The sensitivity, specificity, positive predictive value, and negative predictive value for colitis on CT were 58.8%, 73.7%, 80%, and 50%, respectively.Conclusions:We found that CT had a low sensitivity, specificity, and negative predictive value for the diagnosis of immunotherapy-induced colitis. We therefore conclude that CT has a limited role in the diagnosis of patients with suspected uncomplicated immune-related colitis.

Long Term Follow-Up of Stereotactic Body Radiation Therapy for Refractory Ventricular Tachycardia in Advanced Heart Failure Patients.

BackgroundInitial studies of stereotactic body radiation therapy (SBRT) for refractory ventricular tachycardia (VT) have demonstrated impressive efficacy. Follow-up analyses have found mixed results and the role of SBRT for refractory VT remains unclear. We performed palliative, cardiac radio ablation in patients with ventricular tachycardia refractory to ablation and medical management.MethodsArrhythmogenic regions were targeted by combining computed tomography imaging with electrophysiologic mapping with collaboration from a radiation oncologist, electrophysiologist and cardiac imaging specialist. Patients were treated with a single fraction 25 Gy. Total durations of VT, the quantity of antitachycardia pacing (ATP) and shocks before and after treatment as recorded by implantable cardioverter-defibrillators (ICDs) were analyzed. Follow-up extended until most recent device interrogation unless transplant, death or repeat ablation occurred sooner.ResultsFourteen patients (age 50–78, four females) were treated and had an average of two prior ablations. Nine had ACC/AHA Stage D heart failure and three had left ventricular assist devices (LVAD). Two patients died shortly after SBRT, one received a prompt heart transplant and another had significant VT durations in the following months that were inaccurately recorded by their device. Ten of the 14 patients remained with adequate data post SBRT for analysis with an average follow-up duration of 216 days. Seven of those 10 patients had a decrease in VT post SBRT. Comparing the 90 days before treatment to cumulative follow-up, patients had a 59% reduction in VT, 39% reduction in ATP and a 60% reduction in shocks. Four patients received repeat ablation following SBRT. Pneumonitis was the only complication, occurring in four of the fourteen patients.ConclusionSBRT may have value in advanced heart failure patients with refractory VT acutely but the utility over long-term follow-up appears modest. Prospective randomized data is needed to better clarify the role of SBRT in managing refractory VT.