Segment Involvement Research Articles

A Case of Postpartum Reversible Cerebral Vasoconstriction Syndrome with Extracranial Artery Involvement.

Reversible cerebral vasoconstriction syndrome (RCVS) is generally recognized as an intracranial pathology. Involvement of the extracranial segments of the carotid or vertebral arteries (VAs) is rare. Here, we present a case of postpartum RCVS with extracranial VA involvement. A 31-year-old female developed postpartum thunderclap headaches with neck pain, followed by generalized seizures. The patient had been healthy with an uncomplicated pregnancy and delivery. Head computed tomography showed minimal right frontal convexity subarachnoid hemorrhage. Transcranial color-coded sonography disclosed increased mean flow velocity in multiple arteries, consistent with vasoconstriction, while the extracranial Doppler study revealed an abrupt change in the diameter of the left VA, indicative of dissection or vasospasm. Brain magnetic resonance imaging demonstrated nonenhancing T2/fluid-attenuated inversion recovery hyperintensities involving bilateral occipital, parietal, and frontal regions, with normal diffusion-weighted imaging signals, suggesting vasogenic edema. Magnetic resonance angiography showed multifocal segmental vasoconstriction of cerebral arteries, along with multiple irregular luminal narrowing of bilateral extracranial VAs. T1 fat-suppressed images revealed no features indicative of arterial dissection. The patient was treated with nimodipine as she was diagnosed with postpartum RCVS with extracranial artery involvement and concomitant posterior reversible encephalopathy syndrome. During an outpatient follow-up 1 month after discharge, she reported complete resolution of symptoms. It is crucial to acknowledge that cervical artery vasoconstriction, while rare, remains a possibility in RCVS. In patients having significant multiple extracranial artery vasoconstriction, even when they are the main or even the only arteries involved, RCVS should always be taken into consideration.

Non contiguous dual level spinal injuries - A tertiary care centre institutional experience.

Non contiguous dual level spinal injuries - A tertiary care centre institutional experience.

Diagnostic Accuracy of On-Premise Automated Coronary CT Angiography Analysis Based on Coronary Artery Disease Reporting and Data System 2.0.

Background Chest pain is a leading cause of outpatient and emergency department visits; advancements in artificial intelligence (AI) could improve coronary CT angiography (CCTA) workflows for these patients. Purpose To evaluate the performance of an on-premise AI-based coronary artery calcium scoring (CACS) and CCTA analysis software against expert interpretation based on Coronary Artery Disease Reporting and Data System (CAD-RADS) 2.0. Materials and Methods This retrospective study included consecutive patients undergoing CCTA for coronary analysis at a tertiary academic center between January 2017 and October 2021 across four scanners from three vendors. Patients with stents, bypass grafts, anomalies, or nondiagnostic studies were excluded. On-premise AI output included CACS, CAD-RADS category, and segment involvement score (SIS) within less than 5 minutes. Original CCTA reports were used as the reference, and discrepancies between AI and reports were further adjudicated by two blinded level-III readers with 8 and 5 years of CCTA experience. Agreement among CACS risk categories, CAD-RADS categories, and plaque burden scores was measured with the weighted κ. The area under the receiver operating characteristic curve, positive predictive value, and negative predictive value were used to evaluate diagnostic performance. Bootstrapping was used to estimate 95% CIs. Results A total of 1032 patients (median age, 62 [IQR, 54-69] years; 581 female) with 1041 CCTA images were included: 361 of the 1041 images (35%) were classified as CAD-RADS 0, 274 (26%) as CAD-RADS 1, 186 (18%) as CAD-RADS 2, 101 (10%) as CAD-RADS 3, 95 (9%) as CAD-RADS 4A, 11 (1%) as CAD-RADS 4B, and 13 (1%) as CAD-RADS 5. There was substantial agreement between AI and expert CAD-RADS stenosis severity categories (weighted κ = 0.73). AI demonstrated high performance (per-scan area under the receiver operating characteristic curve, 0.90; 95% CI: 0.87, 0.92) for CAD-RADS greater than or equal to 3 or greater than or equal to 4A and high negative predictive value (98%; 95% CI: 97, 99) but low positive predictive value (39%; 95% CI: 32, 45) for CAD-RADS greater than or equal to 4A. AI-based plaque burden scores derived from CACS reached near-perfect agreement with experts (weighted κ = 0.97), whereas those derived from SIS showed substantial agreement (weighted κ = 0.79). Conclusion On-premise AI accurately ruled out obstructive coronary artery disease at CCTA and achieved substantial to near-perfect agreement with human experts for CAD-RADS 2.0 stenosis severity and plaque burden. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by van Assen and De Cecco in this issue.

Semiquantitative metrics of coronary artery disease burden: Intra-individual comparison between ultrahigh-resolution photon-counting detector CT and energy-integrating detector CT.

Semiquantitative metrics of coronary artery disease burden: Intra-individual comparison between ultrahigh-resolution photon-counting detector CT and energy-integrating detector CT.

Epidemiology and management of massive, sub-massive, and non-massive pediatric pulmonary embolism: a systematic reviews

ObjectiveTo evaluate the current evidence on the diagnosis, management, and outcomes of pediatric pulmonary embolism (PE) across varying severity classifications, including massive, submassive, and non-massive presentations.MethodsA systematic review was conducted following PRISMA guidelines. Searches were performed in PubMed, Scopus, Web of Science, and Cochrane databases up to February 17, 2024. Eligible studies included pediatric and adolescent patients (≤ 21 years) with confirmed PE diagnoses. Risk of bias was assessed using the NIH tool.ResultsSix studies involving 258 pediatric patients with massive, submassive, or non-massive PE were included. Most patients were adolescents, with a mean age of 14.1 years and a predominance of females (62–66%). Risk factors included obesity, oral contraceptive use, thrombophilia, and autoimmune conditions. Computed tomography pulmonary angiography (CTPA) was the most frequently used diagnostic modality, showing varied lobar, segmental, and subsegmental involvement. Management strategies ranged from anticoagulation to catheter-directed thrombolysis and surgical thrombectomy. Outcomes varied by severity, with massive PE cases showing higher mortality and complications compared to submassive and non-massive cases.ConclusionPediatric PE requires tailored risk stratification and management strategies to optimize outcomes. Delays in diagnosis and severe disease presentations contribute to higher morbidity and mortality. Future research should focus on standardized severity classifications, novel diagnostic modalities, and comparative assessments of therapeutic interventions to enhance outcomes in this population.

Juvenile Idiopathic Arthritis with Anterior Uveitis and Vasculitis

Abstract Purpose To report a case of Juvenile Idiopathic Arthritis (JIA) with anterior uveitis and vasculitis. Methods Report of one case. Results A 16-year-old female with a history of refractory JIA for ten years, was diagnosed with concurrent vasculitis on exam and underwent fluorescein angiography (FA). Treatment was changed to adalimumab and methotrexate to resolve ocular inflammation. Conclusion This report demonstrates a rare finding of JIA-associated uveitis with vasculitis. Future studies are needed to evaluate the incidence of posterior segment involvement in patients with JIA uveitis.

The association between the triglyceride–glucose index and vulnerable plaques in patients with type 2 diabetes mellitus: insights from coronary computed tomography angiography

BackgroundThe triglyceride‒glucose index (TyG index) has been verified to be a useful predictor of insulin resistance (IR), and is associated with the occurrence of acute coronary syndrome (ACS). However, the effect of the TyG index on vulnerable plaques (VP), which were identified when at least two high-risk features are present within the same lesion, in type 2 diabetes mellitus (T2DM) patients is not fully understood. This study aimed to explore the association between the TyG index and the presence of VP.MethodsWe retrospectively enrolled 2056 T2DM patients who underwent coronary computed tomography angiography (CCTA) examinations at West China Hospital from February 2017 to February 2022. These patients were divided into four groups on the basis of the quartiles of the TyG index. The high-risk coronary plaque features, vulnerable plaques, plaque type, coronary artery stenosis, segment involvement score (SIS), segment stenosis score (SSS) and multivessel disease (MVD) based on CCTA data were evaluated and compared among the four groups.ResultsPatients with a higher TyG index had more noncalcified and mixed plaques, high-risk plaque features, vulnerable plaques and fewer calcified plaques (P < 0.05 for all). The proportion of patients with high-risk plaque features, including low-attenuation noncalcified plaques, positive remodeling and “napkin ring” sign was associated with the TyG index (P for trend < 0.05 for all). Multivariate analysis revealed that the TyG index was significantly associated with vulnerable plaques in T2DM patients [OR = 1.23 (95% CI 1.00–1.51), P = 0.046]. Subgroup analysis revealed that the association between the TyG index and vulnerable plaques varied with age and the prevalence of cardiovascular (CVD) symptoms, even after controlling for confounding factors (P for interaction < 0.05 for both).ConclusionThe TyG index was independently associated with vulnerable plaques of the coronary artery among patients with T2DM. The TyG index could be regarded as a marker to reduce the incidence of cardiovascular events in the targeted population of T2DM patients.Graphical

ACHADOS DO SEGMENTO POSTERIOR POR DENGUE: UMA REVISÃO SISTEMÁTICA E METANÁLISE DE PREVALÊNCIA.

Introduction: Dengue is a viral disease with symptoms such as fever, headache, muscle pain, retroocular pain, and skin rashes. Ocular complications, more frequent in severe dengue, include macular and retinal hemorrhages, related to low platelet counts and which can lead to conditions such as optic neuritis (PAHO, 2024). Considering its possible effects on ocular health, this study aims to provide a comprehensive and updated analysis on the interference of dengue in the posterior ocular segment. Objective: To assess, through a systematic review and meta-analysis, the prevalence and impact of posterior ocular segment disorders in patients with dengue. Methods: We conducted a systematic review and meta-analysis. The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for articles showing posterior segment disorders and including patients diagnosed with dengue. In addition, studies were considered only if they reported any clinical outcomes of interest. Case reports were excluded. Statistical analysis was performed using RStudio software version 4.3.2. Results: A total of 341 records were identified, of which 34 articles were included, comprising a total of 1501 patients. Maculopathy showed a proportion of 32.24% [95% CI: 14.10% - 58.20%], I² = 95%, P &lt; 0.01. Macular hemorrhage showed a proportion of 16.35% [95% CI: 0.52% - 88.03%], I² = 96%, P &lt; 0.01. Retinal hemorrhage showed a proportion of 29.25% [95% CI: 15.62% - 48.01%], I² = 90%, P &lt; 0.01. Other outcomes such as macular edema, cotton-wool spots, disc edema, vascular sheathing, optic neuropathy, and subhyaloid hemorrhage were also analyzed, showing varying proportions and levels of heterogeneity. Conclusion: In patients with posterior segment involvement due to dengue, the prevalence of ocular involvement was significant. The observation of the outcomes indicates that posterior segment involvement is a common condition among these patients, highlighting the high prevalence of complications such as maculopathy and retinal hemorrhage. The prevalence found underscores the importance of monitoring ocular complications in patients with dengue, highlighting the need for detailed ophthalmological evaluations to better understand and manage these manifestations.

Parcerias público privadas e uso público em unidades de conservação

Despite the recognized benefits associated with visitation in protected areas such as parks, currently, many of these areas coexist with a reality of precariousness and/or lack of support infrastructure for visitation, in addition to the inability to carry out new investments in the face of the growing demand for visitors. As a result, in recent years, there has been a growing number of initiatives led by the State, in different spheres, aimed at establishing partnerships with the private sector and civil society for the management of visitation support services. Inspired by this scenario, the present work aimed to understand the process of conception/modeling of the concession of support services for visitation in the State Park of Ibitipoca (MG) in the light of participation and social control. The methodological procedures involved bibliographical and documental research and the case study, through interviews with territorial agents directly involved in the process. The main results show limitations to participation and social control, especially in relation to the prior definition of the partnership model to be adopted, restricted involvement of segments of society in the process of designing the concession model and low access to information.

A genome-wide association study of imaging-defined atherosclerosis

Imaging-defined atherosclerosis represents an intermediate phenotype of atherosclerotic cardiovascular disease (ASCVD). Genome-wide association studies (GWAS) on directly measured coronary plaques using coronary computed tomography angiography (CCTA) are scarce. In the so far largest population-based cohort with CCTA data, we performed a GWAS on coronary plaque burden as determined by the segment involvement score (SIS) in 24,811 European individuals. We identified 20 significant independent genetic markers for SIS, three of which were found in loci not implicated in ASCVD before. Further GWAS on coronary artery calcification showed similar results to that of SIS, whereas a GWAS on ultrasound-assessed carotid plaques identified both shared and non-shared loci with SIS. In two-sample Mendelian randomization studies using SIS-associated markers in UK Biobank and CARDIoGRAMplusC4D, one extra coronary segment with atherosclerosis corresponded to 1.8-fold increased odds of myocardial infarction. This GWAS data can aid future studies of causal pathways in ASCVD.

Long-Term Treatment Outcomes with a Single 0.19 Mg Fluocinolone Acetonide Implant in Non-Infectious Uveitis – A Real-World Study

ABSTRACT Purpose To evaluate time to first additional treatment following intravitreal 0.19 mg fluocinolone acetonide (FAc) in non-infectious uveitis with posterior segment involvement (NIU-PS) in a real-world setting. Methods Prospective observational study on 37 eyes (30 patients) with chronic or recurrent NIU-PS, treated with FAc after achieving control – indicated by absence of vitreous haze or clearly visible posterior pole. Over a median follow-up of 48.0 ± 0.0 months, we assessed time to and number of additional treatments, inflammatory activity, central subfield macular thickness (CSMT), visual acuity (VA) and intraocular pressure (IOP). Results Restricted mean time to first adjuvant treatment was 31.9 ± 2.97 months, with 52.8% requiring no additional treatment ≥ 48 months. VA remained stable (baseline 0.56 ± 0.44 logMAR, p = 0.86). A negative correlation was found between the number of prior steroid implants (DEX-I) and time to additional treatment (r = −0.44, p = 0.001). For up to 24 months, FAc reduced anterior chamber flare (0.44 ± 0.81 to 0.00 ± 0.00, p < 0.001), vitreous haze (0.28 ± 0.51 to 0.00 ± 0.00, p = 0.01), and CSMT (407.1 ± 135.9 µm at baseline to 324.2 ± 75.7 µm at M24, p = 0.001). Within 48 months, ocular hypertension (≥25 mmHg) occurred in 22.2% of eyes (8/36), with 19.4% (7/36) requiring new-onset IOP-lowering drops. Conclusion FAc demonstrated efficacy in managing low-grade NIU-PS, reducing the need for additional treatments and controlling intraocular inflammation for an average of 32 months.

Exploring the ocular involvement in multiple myeloma: a comprehensive review of 70-year clinical studies.

To review the ocular symptoms and the related physiopathology in patients diagnosed with multiple myeloma (MM) to evaluate whether the ocular manifestations can be considered a disease hallmark that can guide the clinician's decision-making. A comprehensive review of three databases (PubMed, Scopus, Embase) was conducted until April 25, 2024. Studies reporting intra- or extraocular manifestations of MM were included, excluding cases of other monoclonal gammopathies or therapy-related ocular effects. After screening 1873 initial results and hand-searching references, 82 articles were included. Ophthalmic manifestations may be the first sign or represent MM relapsing. Several eyelid manifestations have been reported, including bilateral eyelid ecchymosis, cutaneous xanthomatosis, necrobiotic xanthogranuloma, localized lipid deposits, ptosis associated with diplopia, and eyelid ectropion. Several reports have reported crystalline deposits throughout all layers of the cornea, including the epithelium, stroma, and endothelium of MM patients. In addition, copper deposition that appears as a greenish-brown deposit affecting the central cornea on Descemet's membrane with unique characteristics has also been rarely reported in MM patients. Beyond anterior segment involvement, the retina and choroid can also be affected in MM with bilateral central retinal vein occlusion, choroidal effusion, ciliary body cysts, Purtscher's retinopathy, and microvascular changes. Early recognition of MM's ophthalmic manifestations is essential to establish an early diagnosis and treatment. Hence, all patients diagnosed with MM should undergo a thorough ophthalmic examination. Therefore, a close collaboration between hematologists and ophthalmologists could lead to earlier diagnoses and potentially impact the course of the disease.

Advances in CT coronary angiography-derived plaque analysis for comprehensive assessment of ischemic heart disease

Abstract Coronary computed tomography angiography (CCTA) has emerged as a pivotal non-invasive imaging modality for detailed assessment of coronary anatomy and plaque characteristics, playing a significant role in diagnosing and managing ischemic heart disease (IHD). Traditional approaches, such as the Segment Stenosis Score, Segment Involvement Score, and Leaman score, offer semi-quantitative evaluations of plaque burden. However, they are limited by their inability to quantify plaque volume precisely. Recent advancements in CCTA software have enabled more accurate, quantitative assessments that strongly correlate with invasive methods like intravascular ultrasonography and optical coherence tomography. These software tools also allow for detailed plaque characterization, categorizing plaques by composition and identifying high-risk features that may predict future cardiovascular events. The emerging photon-counting CT technique further enhances plaque analysis by individually measuring photons to assess plaque structure. Additionally, perfusion CT offers a functional imaging approach to evaluate myocardial blood flow, complementing CCTA by detecting microcirculatory dysfunction and providing insights into myocardial tissue, especially in fibrosis cases. The peri-coronary Fat Attenuation Index (pFAI), a 3D tool analyzing peri-coronary fat, has emerged as a significant prognostic marker, improving risk stratification in IHD. The evaluation of pFAI, particularly in patients with non-obstructive coronary disease, provides valuable information on inflammation and cardiovascular risk, making it a critical component of comprehensive IHD assessment. The advancement of CCTA-derived plaque analysis represents a significant change in cardiovascular imaging, enhancing diagnostic precision and risk assessment. As precision medicine advances, the integration of CCTA plaque analysis is set to transform the treatment of complex cardiovascular diseases.

A case of myxopapillary ependymoma of filum terminale with atypical findings on MRI

Myxopapillary ependymoma is comparatively uncommon lesion of spinal canal with relatively characteristic location and MR imaging features. These lesions are a unique subtype of glioma that develops in the area of the filum terminale and conus medullaris, was first reported by Kernohan in 1932. Despite being slow-growing and generally benign, MPE has a propensity for local recurrence and can spread across the central nervous system. Atypical imaging features of the lesions may include long segment involvement, T1 hyperintensity etc. We are going to present one such atypical imaging presentation of myxopapillary ependymoma

Ophthalmic findings leading to diagnose chronic myeloid leukemia: A multimodal image case report.

PurposeChronic myeloid leukemia (CML) is a rare malignant myeloproliferative disorder characterized by the presence of the Philadelphia chromosome, a reciprocal translocation between chromosomes 9 and 22. Ocular manifestations in CML are infrequent but can be the initial indicators of the disease. We report the case of a 28-year-old male patient with suspected hyperviscosity syndrome secondary to CML, based on fundus findings and supported by multimodal imaging.MethodsMultimodal imaging was performed to assess the ocular manifestations, before and after treatment.ResultsThe patient presented with posterior segment findings consistent with hyperviscosity syndrome, including retinal hemorrhages, vascular dilation, and tortuosity as demonstrated by multimodal imaging techniques. Further investigations confirmed the diagnosis of CML, and treatment with hydroxyurea, allopurinol, and imatinib led to a significant improvement in visual acuity and resolution of posterior segment findings.ConclusionOcular manifestations in CML vary widely and include both anterior and posterior segment involvement. Regular ophthalmic examinations are essential for the early detection of relapses or complications. This case underscores the importance of interdisciplinary collaboration between ophthalmologists and hematologists for the timely diagnosis and management of ocular manifestations in CML.

Comprehensive coronary CT angiography in people living with HIV: a systematic review and meta-analysis

ObjectivesPeople living with HIV (PLWH) were previously shown to have a higher prevalence of non-calcified coronary plaque with discrepant results for coronary stenosis and any plaque prevalence. This systematic review...

Risk factors of incident acute limb ischemia after contemporary femoropopliteal endovascular revascularization from a multicenter registry: A retrospective observational study.

To investigate the incidence of acute limb ischemia (ALI) among patients with femoropopliteal (FP) lesions treated with contemporary endovascular therapy (EVT) and to identify risk factors for ALI after FP-EVT. In this retrospective multicenter registry, we analyzed patients with lower extremity artery disease having FP lesions who underwent EVT between 2017 and 2021. We investigated the incident ALI related to the index EVT and its risk factors. We also assessed the prognosis after the incident ALI. During a median follow-up of 35.3 months, incident ALI was observed in 72 of 3102 patients (2.3%). The Rutherford classification I/IIa/IIb/III was 50.0%, 30.5%, 18.1%, and 1.4%, respectively. Variables independently associated with the incident ALI were chronic limb-threatening ischemia (CLTI; hazard ratio, 1.83; p = 0.015), reference vessel diameter < 6 mm (2.39; p = 0.011), lesion length >25 cm (3.35; p = 0.005) with its time interaction (0.72 per 1 year; p = 0.042), P2/3 segment involvement (2.73; p < 0.001), chronic total occlusion (CTO; 3.40; p < 0.001), and in-stent restenosis/occlusion (3.21; p < 0.001). During a median follow-up of 12.8 months after the ALI event, all-cause mortality was 27.8% and the rate of major amputation was 6.9%. The FP-EVT showed that the occurrence of ALI was 2.3% during a median follow-up of 35.3 months. The independent predictors of the ALI event were CLTI, small vessels, long lesions, CTO, and in-stent restenosis; however, the impact of lesion length was attenuated over time after the index EVT.

Etiological and clinical characterization of longitudinally extensive spinal cord lesions: A 12-year tertiary center experience.

Etiological and clinical characterization of longitudinally extensive spinal cord lesions: A 12-year tertiary center experience.

High-Risk Retinoblastoma Based on International Classification Systems: Analysis of 1362 Eyes.

High-Risk Retinoblastoma Based on International Classification Systems: Analysis of 1362 Eyes.

DOP077 EndoUC: an AI-assisted endoscopic Ulcerative Colitis activity grading application for deployment in clinical trials

Abstract Background Manual scoring of ulcerative colitis (UC) disease activity from endoscopy videos using the Modified Mayo Score (mMS) by experts is known to have high inter-rater and intra-rater variability.1 In clinical trials, central reviewers review endoscopy videos and provide a single score for the entire video leading to a loss of transparency with no evidence of scoring rationale or segmental involvement. We developed an AI-assisted severity scoring application for clinical trials to address this challenge by intelligently highlighting video segments showing pathological information and providing a continuous scoring approach to severity grading. Methods Unlike previous approaches that rely heavily on large-scale, expensive, and restrictive frame-level expert labels, we developed our models on video-level grading available in typical clinical trial settings. We used data from the brazikumab clinical trial [NCT03616821], comprising 423 videos from 249 patients scored on the mMS scale. Our preprocessing module removes uninformative, low-quality frames and applies detection, tracking and alignment algorithms to identify regions of interest across frames. Our EndoUC model has 3 components: a pathology-enriched frame identification module (PEFIM), an aggregator, and a classifier.The PEFIM module identifies regions that characterise signs of UC, such as ulcers or erosions. The aggregator and classifier modules learn to combine the information at the video level. We focus on the clinical utility of the EndoUC model in two ways: (i) having task-specific classifiers focusing on clinical decision boundaries of UC and (ii) enhancing scoring granularity of UC severity prediction using ordinal regression. Results We developed an application to enable experts to review lengthy endoscopy footage in clinical trials efficiently. The app allows seamless navigation to key regions identified by the EndoUC and transparently reveals the basis of the AI model’s assessments. We conducted 5-fold cross-validation on the clinical trial data and evaluated the model on a held-out test set with 87 videos. The remission (mMS 0, 1 vs 2, 3) model performs with an AUC-ROC of 0.85, F1 of 0.87, normal/inactive and severe models with AUC-ROC of 0.81and 0.83 respectively. The continuous grading model has an MSE of 0.42 and MAE of 0.40. Conclusion We developed an AI-assisted reading tool for UC endoscopic severity assessment to help accelerate clinical trails through rapid evaluation of patient eligibility, detection of treatment response grounded by key region evidence, and potential for continuous grading of endoscopic changes.