Modality Of Choice Research Articles

Intussusception and Internal Hernia After Roux-en-Y Gastric Bypass Surgery in a Woman With Twin Pregnancy: A Case Report.

Severe obesity is a global concern now, and bariatric surgery has been proven to be the best solution. Most candidates are women of reproductive age; therefore, an increasing number of pregnant women with the history of gastric bypass is noticed. A 33-year-old woman at 23 weeks' gestation with a twin pregnancy, with a history of bariatric surgery 2 years prior her pregnancy, presented to our hospital with small bowel necrosis due to internal hernia and intussusception, we proceeded to laparotomy and resection of the necrotic segment of the bowel. The patient underwent cesarean section on the 35 weeks of her pregnancy due to preterm labor and intra uterine growth retardation of the fetuses. Since the gravid uterus increases the intraabdominal pressure, the complications of bariatric surgery such as intussusception or internal hernia may occur even more frequently during pregnancy. Although computed tomography scan or ultrasound could assist clinicians for early diagnosis of complications, negative findings could not rule out small bowel obstruction; therefore, in a pregnant woman with persisting abdominal pain, obstipation, and vomiting, exploratory laparotomy or laparoscopy is mandatory. Pregnant women with a history of Roux-en-Y gastric bypass surgery (RYGB) should be considered high-risk obstetric, and symptoms like ongoing abdominal pain, and vomiting should be taken as alarm sign for small bowel obstruction. Computed tomography (CT) scan is the modality of choice for detecting the small bowel obstruction, and is mandatory, taking into consideration the considerable harms to the fetus.

Ultrasound-guided Hydrostatic Reduction of Acute Intussusception in Children at a Tertiary Care Center: An Observational Study

Introduction: Intussusception is common cause of acute emergency responsible for bowel obstruction in infants and toddlers with peak age of incidence between 6-9 months. Ultrasound is imaging modality of choice for diagnosis of intussusception and ultrasound guided hydrostatic enema reduction is standard, nonsurgical, internationally preferred treatment modality for uncomplicated pediatric intussusceptions. This study was aimed to find the outcome of the procedure.Methods: An observational cross-section was carried in a tertiary care center in children presenting with intussusception. Ultrasoud guided hydrostatic reduction was done in all radiologically confirmed intussusception in children presenting to our tertiary hospital from February 2023 to July 2024 fulfilling the inclusion criteria after proper resuscitation. Patients having marked abdominal distension with features of peritonitis were excluded from the study. Ethical approval was obtained from Institutional Review Committee (Reference number: 287/2023). Results: Total 81 patients with 84 intussusceptions underwent ultrasound guided hydrostatic reduction with male to female ratio of 2.86 and mean age 9.49±8.43 months. Hydrostatic reduction was successful in 78 (92.85%) cases. Among successful reductions, 3 (3.84%) patients had recurrence and repeat successful hydrostatic reduction was done. Presenting complain seen were abdominal pain 81 (100%) , vomiting 72 (88.89%). Ileocolic intussusception was seen in 74 (88.09%). Conclusions: The success rate of ultrasound-guided hydrostatic reduction using normal saline for uncomplicated intussusception was consistent with findings from previous studies conducted in similar settings, which utilized both hydrostatic and pneumatic reduction methods.

P-85. Impact of Magnetic Resonance Imaging on Re-Amputation Rates in Diabetic Foot Osteomyelitis

Abstract Background Diabetic foot infections constitute 20% of hospital admissions and result in 80% of amputations annually. It is noteworthy that diabetes is more prevalent among U.S. veterans compared to the general population due to age, exposure to environmental factors during service, and mental health conditions which can contribute to unhealthy behaviors and increased risk of diabetes. Magnetic resonance imaging (MRI) is considered the imaging modality of choice for evaluating diabetic foot osteomyelitis given its higher sensitivity. A staging MRI, may decrease subsequent amputation rates in diabetics with osteomyelitis.Table 1:Patient characteristics and comorbiditiesMRI=magnetic resonance imaging, MI=myocardial infarction, CHF=congestive heart failure, PVD=peripheral vascular disease, CVD=cardiovascular disease, DM=diabetes mellitus, COPD=chronic obstructive pulmonary disease, PUD=peptic ulcer disease, HIV=human immunodeficiency virus Methods A retrospective chart review was conducted to analyze the risk of re-amputation in patients with diabetic foot osteomyelitis hospitalized between 2005 and 2022. Patients with and without MRI guided treatment were compared. The primary outcome was the rate of re-amputation at specific time intervals: 30-day, 60-day, 180-day, and 365-day. Charlson Comorbidity Index scores were calculated for all patients, and a multivariable logistic regression was used to calculate odds ratios and confidence intervals. Veterans were included if they had a diabetic foot infection complicated by osteomyelitis, and requiring amputation. Patients were excluded if they had an initial above-the-knee amputation (AKA) or below-the-knee amputation (BKA), since these are generally definitive treatment for osteomyelitis.Table 2:Treatment CharacteristicsMRI=magnetic resonance imaging, MSSA=methicillin susceptible Staphylococcus aureus, MRSA=methicillin resistant Staphylococcus aureus Results There were 1,463 patients based on ICD-10 codes, of which 475 patients underwent amputation. MRI guided therapy occurred in 106 patients. Multivariable logistic regression analysis revealed a 10-fold decrease in the odds of re-amputation within 30 days (OR=0.1; CI 0.01-0.72), a 3-fold decrease within 60 days (OR=0.32; CI 0.13-0.83), and a 2-fold decrease within the 180-day and 365-day (OR=0.51; CI 0.28-0.94 and OR=0.52; CI 0.3-0.9, respectively) intervals when MRI guidance was utilized.Table 3:Bivariate analysis of re-amputationsMRI=magnetic resonance imaging Conclusion These findings suggest that incorporating a pre-amputation MRI into the diagnostic and treatment approach for osteomyelitis associated with diabetic foot infections may reduce the risk for subsequent amputations.Table 4:Multivariable analysis of re-amputationsMRI= magnetic resonance imaging Disclosures All Authors: No reported disclosures

P-53 PITUITARY STALK INTERRUPTION SYNDROME: A CASE REPORT

Abstract Introduction Pituitary stalk interruption syndrome (PSIS) is a congenital abnormality of the pituitary gland responsible for GH deficiency or global pituitary insufficiency and is usually characterized by the triad of a very thin or interrupted pituitary stalk, an ectopic (or absent) posterior pituitary (EPP), and hypoplasia or aplasia of the anterior pituitary visible on magnetic resonance imaging (MRI). The etiology of this syndrome is not fully understood, and many theories, like perinatal injuries or defective organogenesis due to genetic or environmental factors during pregnancy, are proposed. In family cases of PSIS, rare mutations of HESX1, LH4, OTX3, SOX3 and PROKR2 may be the cause. In the majority of cases, no genetic cause is found. The symptoms and signs of this syndrome typically become apparent in the neonatal period and childhood. Sometimes symptoms can be overlooked, and diagnosis can be delayed. Clinical Case A 22-year-old male presented in our clinic with hypothyroidism and growth hormone deficiency. He had previously received growth hormone (GH) treatment for 6 years until he was 15 years old. He was receiving levothyroxine therapy for hypothyroidism. Complete blood count, serum electrolytes, erythrocyte sedimentation rate, urinalysis, and thyroid function tests were normal. Hormonal analysis showed FSH: 11.9 U/L (N = 1.4-18.1 U/L), LH: 4.1 U/L (N = 1.5-9.3 U/L), prolactin: 9.1 μg/L (N = 5.4-15.4 μg/L), ACTH: 24.5 pg/mL (N = <46), fasting morning cortisol: 17.2 μg/dL (N = 5.2-22.4 μg/dL), total testosterone: 4.03 μg/L (N = 1.64-7.53 μg/L), free testosterone: 6.39 pg/mL (N = 5.4-40 pg/mL), IGF-1: 114 μg/dL (N = 161-384 μg/dL). Brain MRI revealed slightly hypoplastic sella turcica and adenohypophysis measuring 4.2 mm in height, thin infundibulum, and ectopic posterior pituitary located posterior to the infundibulum in the suprasellar cistern. The diagnosis of pituitary stalk interruption syndrome is mainly based on its clinical manifestations, laboratory tests, and imaging examinations. Conclusion PSIS is a rare congenital malformation that presents with significant growth and developmental challenges in children. The symptoms can be disregarded, and the diagnosis will therefore be delayed. Early diagnosis and treatment are crucial for improving growth outcomes and overall quality of life. It must be considered in the presence of combined or isolated hypopituitarism. MRI is the imaging modality of choice for the diagnosis of this condition. Regular monitoring and supportive care are essential components of effective management for these patients.

Imaging paediatric bone marrow in immunocompromised patients.

The bone marrow of immunocompromised patients may exhibit abnormalities due to the underlying disease, adverse treatment effects, and/or complications arising from either source. Such complexity poses a significant diagnostic challenge, particularly in children. Magnetic resonance imaging (MRI) is the modality of choice when evaluating bone marrow in these patients. The high soft tissue contrast of MRI studies allows for detailed evaluation of bone marrow composition, including fat content, cellularity, and vascularisation. During the early years of life, bone marrow undergoes physiological maturation manifesting as a wide range of MRI findings. Understanding the most common MRI features during this phase of development is essential. However, it is equally critical to recognise physiological variations that can mimic pathological changes, as distinguishing between variations and truly pathological abnormalities is crucial for accurate diagnosis and management. This article reviews normal bone marrow and its variations during childhood, as well as the most common alterations presenting in immunocompromised patients.

Ovarian cancer staging and follow-up: updated guidelines from the European Society of Urogenital Radiology female pelvic imaging working group.

To provide up-to-date European Society of Urogenital Radiology (ESUR) guidelines for staging and follow-up of patients with ovarian cancer (OC). Twenty-one experts, members of the female pelvis imaging ESUR subcommittee from 19 institutions, replied to 2 rounds of questionnaires regarding imaging techniques and structured reporting used for pre-treatment evaluation of OC patients. The results of the survey were presented to the other authors during the group's annual meeting. The lexicon was aligned with the Society of American Radiology (SAR)-ESUR lexicon; a first draft was circulated, and then comments and suggestions from the other authors were incorporated. Evaluation of disease extent at diagnosis should be performed by chest, abdominal, and pelvic CT. The radiological report should map the disease with specific mention of sites that may preclude optimal cytoreductive surgery. For suspected recurrence, CT and [18F]FDG PET-CT are both valid options. MRI can be considered in experienced centres, as an alternative to CT, considering the high costs and the need for higher expertise in reporting. CT is the imaging modality of choice for preoperative evaluation and follow-up in OC patients. A structured radiological report, including specific mention of sites that may preclude optimal debulking, is of value for patient management. Question Guidelines were last published for ovarian cancer (OC) imaging in 2010; here, guidance on imaging techniques and reporting, incorporating advances in the field, are provided. Findings Structured reports should map out sites of disease, highlighting sites that limit cytoreduction. For suspected recurrence, CT and 18FDG PET-CT are options, and MRI can be considered. Clinical relevance Imaging evaluation of OC patients at initial diagnosis (mainly based on CT), using a structured report that considers surgical needs is valuable in treatment selection and planning.

Spontaneous craniocervical dissection

Spontaneous dissections of the cerebral arteries are among the leading causes of stroke in young adults. They result from hemorrhage into the outer layers of the arterial wall, which can lead to stenosis or even complete vessel occlusion. Clinical presentations vary, ranging from localized pain to cerebral ischemic complications. Early recognition of dissection warning signs and diagnosis through imaging is crucial due to the high risk of recurrent transient ischemic attack (TIA) or stroke within the first two weeks following a dissection, necessitating immediate therapeutic or prophylactic intervention. Magnetic resonance imaging (MRI) is the imaging modality of choice, as it can reliably visualize all characteristic features of dissection. Typically, thin-slice, fat-saturated 3D black-blood sequences are sufficient to detect the pathognomonic intramural hematoma. Acute treatment and secondary prevention depend on the extent of neurological deficits, the location and size of the dissection, any sequelae, concomitant pathologies, and risk factors. In most cases, spontaneous vascular recanalization or regression of vessel stenosis occurs within several months due to resorption of the mural hematoma.

Lumbar spine facet joint septic arthritis: Two case reports

Introduction: Septic arthritis of the facet joint (SAFJ) is a rare spine condition. Commonly seen in older immune-compromised patients presented with acute back pain, it needs early diagnosis and intervention. Case Series: We report two cases presented to the emergency as acute onset low back pain with fever and high inflammatory markers. In both cases, patients were admitted and diagnosed with septic arthritis of the facet joint and associated epidural abscess. In the first case, blood cultures were sent to support the diagnosis, while in the second case ultrasound-guided aspiration was done. In both cases, cultures were positive for Methicillin-resistant Staphylococcus aureus (MRSA) and diagnosis confirmed with magnetic resonance imaging (MRI) findings. Both patients were treated with intravenous antibiotics and improved clinically. Conclusion: This case shows the importance of thinking about septic arthritis in the facet joint in older patients who present with sudden onset back pain associated with high inflammatory markers if other differentials are excluded. Magnetic resonance imaging is considered the imaging modality of choice in the diagnosis. As well, early diagnosis and management play an important role to prevent complications.

Competency Assessment of Primary Health-care Physicians in Iraq Regarding the Interpretation of Chest X-ray in Acute and Emergency Conditions

Abstract Background: Primary health-care (PHC) physicians may encounter a wide variety of conditions including acute and emergent cases considering the limited access to diagnostic investigation in PHC practice. Chest X-ray (CXR) remains the imaging modality of choice to diagnose pulmonary, cardiac and other chest diseases, and it is the unique imaging technique available in Iraqi PHC centers (PHCCs), relatively inexpensive and has a low dose of radiation exposure. Aim of the Study: Competency assessment of diagnostic accuracy and confidence degree for Iraqi PHC physicians (PHCPs), regarding the interpretation of CXR in acute and emergent conditions. Subjects and Methods: A cross-sectional study that included a convenient sample of 330 participants through an online questionnaire, during the period from January 2023 to January 2024. The study included some background information such as gender, years in practice, training type, interest in pulmonary medicine and diagnostic radiology, and having adequate training on the interpretation of CXR. The questionnaire consists of 10 chest radiographs with brief clinical information for each case. Participants were asked to choose the most likely diagnosis and to rate their degree of confidence in the interpretation of the CXR for each case. Descriptive statistics were presented using tables and graphs, continuous variables summarized by mean and standard deviation. The categorical variables summarized by percentages and frequency distributions and compared using Fisher’s exact test. The level of statistical significance was set at a P < 0.05. Cutoff point of diagnostic accuracy is considered equal or more than 5 correct answers from 10 is competent, and that of confidence rate equal or more than 3 scores from 5 is confident. Results: Overall diagnostic accuracy is 296 (89.7%) and overall diagnostic confidence is 116 (77%). Diagnostic accuracy among family medicine specialist 164 (91.1%) and diagnostic confidence are 138 (76.7%) within their group, while among nonspecialist PHCPs, diagnostic accuracy only 132 (88%) and diagnostic confidence 116 (77.3%) within their group. Proportion of competent family medicine specialists among all competent participants was more than half 164 (55.4%) and for nonspecialists was 132 (44.6%). A moderately positive correlation (r = 0.417) between diagnostic accuracy and confidence level appeared. Cardiogenic pulmonary edema 300 (90.9%) and normal CXR 284 (86.1%) cases had the highest diagnostic accuracy scores, whereas the lowest scores were for lobar collapse 168 (50.9%) and pneumomediastinum 140 (42.4%). More than half of the participants 202 (61.2%) lived in the capital and more than three quarters of the participants 266 (80.6%) were females. Family medicine specialists was constitute the largest number 180 (54.5%) of the participants and more than half of the sample 170 (51.5%) having more than 10 years of experience. Approximately 230 (70%) of the participants had no elective rotation in diagnostic radiology and about half of the sample 162 (49.1%) were uncertain about their training adequacy. More than three quarters of the sample 258 (78.2%) interested in diagnostic radiology and 198 (60%) interested in pulmonary medicine. Conclusions: The competency of Iraqi PHCPs in CXR interpretation in acute and emergency conditions was optimal generally. Nonspecialist PHCPs had fewer competencies than specialists that belong to knowledge and training deficiency. An introduction of radiology training courses in emergent conditions and the use of tele-radiology platform in PHCCs should be considered.

Retinoblastoma and beyond: pediatric orbital mass lesions.

Various space occupying lesions can arise in the orbit, ranging from developmental anomalies to malignancies, and many of the diseases occurring in children are different from the pathologies in the adult population. As the clinical presentation is frequently nonspecific, radiologic evaluation is essential for lesion detection and characterization as well as patient management. While orbital masses may in some cases involve multiple compartments, a simple compartmental approach is the key for the diagnosis on imaging studies, and MRI is the modality of choice. This pictorial review presents the most common and characteristic non-emergent pediatric orbital lesions, stressing their MRI and CT appearances, including specific differentiating features. The lesions are subdivided into 4 compartments: intraocular, intraconal, extraconal, and orbital walls. Retinoblastoma, Coats disease and persistent fetal vasculature; optic pathway glioma and lymphovascular malformations; rhabdomyosarcoma, infantile hemangioma, neurofibroma and lymphoma; neuroblastoma, leukemia/myeloid sarcoma, Langerhans cell histiocytosis and dermoid are reviewed in their respective compartments.

Peritoneal dialysis and its impact on intra-abdominal pressure and respiratory mechanics in the critically ill patient: Can PD take the pressure?

Peritoneal dialysis (PD) was historically the initial kidney replacement modality of choice for patients admitted to the intensive care unit, and there are several advantages to maintaining critically ill PD patients on their usual dialysis therapy. However, in this patient population, there are two contentious questions: how are the respiratory dynamics of mechanical ventilation impacted by the presence of dialysate within the abdomen, and what can be done to mitigate these potential effects? This review discusses the theoretical impact of PD on intra-abdominal pressure (IAP) and evidence for the effect of IAP on respiratory mechanics in mechanically ventilated PD patients.

PRIMARY CHONDROSARCOMA OF RIB: RARE NEOPLASM WITH ATYPICAL PRESENTATION

Background:Chondrosarcoma is uncommon malignant tumor of rib can have atypical presentation based on age, gender and clinical features. However, Computed Tomography is imaging modality of choice and helps aids in diagnosis and guiding treatment. Case Presentation: This was a case of 84 year old lady, who presented as a breast lump. Core needle biopsy gave the differential diagnosis Malignant phylloides with heterologous cartilaginous component, Primary chondroid sarcoma, Metaplastic carcinoma. However, imaging findings led to diagnosis of chondrosarcoma arising from right 4th rib and hence patient underwent en bloc excision of anterior chest wall with chest wall reconstruction. Final histopathology was suggestive of grade 2 chondrosarcoma with medial margin microscopically positive. Patient was kept on 2 monthly follow up after surgery without giving any adjuvant therapy or additional surgery. She was disease free at 6 months follow up. Conclusion: The incidence of rib Chondrosarcoma is rare and presents a diagnostic challenge. Surgical management with wide local excision and reconstruction remains the treatment of choice.

Ultrasound evaluation of superficial lesions caused by ectoparasites in children.

Ectoparasites affect the skin, causing different clinical manifestations through direct mechanical damage, blood consumption, pathogen transmission, hypersensitivity reactions, or toxin inoculation. Dermatological ultrasound is the imaging modality of choice to evaluate these superficial lesions, detecting submillimetric alterations in a non-invasive and innocuous way. This review helps the radiologist describe the imaging findings of lesions caused by mosquitoes, myiasis, bees, spiders, and scorpions, with suggestive ultrasound patterns.

Annotated test-retest dataset of lung cancer CT scan images reconstructed at multiple imaging parameters

Quantitative imaging biomarkers (QIB) are increasingly used in clinical research to advance precision medicine approaches in oncology. Computed tomography (CT) is a modality of choice for cancer diagnosis, prognosis, and response assessment due to its reliability and global accessibility. Here, we contribute to the cancer imaging community through The Cancer Imaging Archive (TCIA) by providing investigator-initiated, same-day repeat CT scan images of 32 non–small cell lung cancer (NSCLC) patients, along with radiologist-annotated lesion contours as a reference standard. Each scan was reconstructed into 6 image settings using various combinations of three slice thicknesses (1.25 mm, 2.5 mm, 5 mm) and two reconstruction kernels (lung, standard; GE CT equipment), which spans a wide range of CT imaging reconstruction parameters commonly used in lung cancer clinical practice and clinical trials. This holds considerable value for advancing the development of robust Radiomics, Artificial Intelligence (AI) and machine learning (ML) methods.

Ergonomic Transgression of the Corridor: A Sojourn of Microscopic to Endoscopic Middle Ear Surgery, the Learning Curve, Lessons Learned, and Reflections

Objective: For the last 20 years, transcanal endoscopic ear surgery has emerged as a viable, ergonomic, and powerful alternative surgical modality of choice replacing the conventional microscopic approach in many ways. This study compares the functional and anatomical outcomes of endoscopic tympanoplasty with microscopic tympanoplasty using full-thickness tragal cartilage as a graft of choice. Methodology: This observational, analytical, retrospective study was conducted in the department of Otolaryngology in a tertiary care hospital over two years. It included an analysis of medical records of 38 patients (above 10 years of age), who underwent conventional microscopic and transcanal endoscopic tympanoplasty (type I) for dry and small/medium size tympanic perforations. Morphological and functional outcomes were compared in both groups by noting the condition of graft and air-bone gap on follow-up. Result: There were 19 patients each in both groups. The mean pre-and post-operative ABG in each group was comparable and the difference was statistically significant in each group ( P< 0.05). Comparing the mean ABG change between both groups, there was a statistically significant difference noted (P<0.05). The success rate was found to be 89.5% (17 /19) in the endoscopic surgery group and 94.7% (18/19) in the microscopic surgery group. The difference in the anatomical success of both groups was not statistically significant. Conclusion: There was no statistically significant difference between both groups regarding graft take-up rates but functionally hearing outcomes were better in the MES group which was statistically significant. Bangladesh J Otorhinolaryngol 2024; 30(1): 5-14

REVISÃO DE LITERATURA: MANEJO DO PACIENTE COM COLANGITE ESCLEROSANTE PRIMÁRIA

The primary sclerosing cholangitis (PSC) is a progressive, idiopathic, immune mediated disease, characterized by intra or extrahepatic cholestasis, Inflammation and fibrosis of the bile ducts, which may progress to liver cirrhosis or cholangiocarcinoma (CCA) in the vast majority of patients. Objective: Analyze what the current literature discusses about the management of PSC. Method: A systematic review was carried out using the PubMed and SciELO database, applying the descriptors "Primary Sclerosing Cholangitis" AND "Cholangite" AND "Clinical management" AND Cholangiocarcmoma. Discussion: It is more common in men, with an average diagnosis at 35 years old. The PSC has a wide range of symptoms and stages of the disease. In the beginning, symptoms are rare and patients may be asymptomatic. The most commonly found symptoms are pruritus, fatigue, right upper quadrant abdominal pain, jaundice, fever, and weight loss. In about 75% of patients with PSC, liver function tests are chronically abnormal and fluctuating with a most commonly found pattern of cholestatic condition with elevation of alkaline phosphatase (AF) and yglutamyl transferase (GGT). Although endoscopic retrograde cholangiopancreatography (ERCP) is conventionally considered the gold standard test for the diagnosis of PSC, the main modality of choice currently for Imaging diagnosis in patients with suspected PSC is magnetic resonance cholangiopancreatography (CPRM). Due to the absence of effective medical therapy for PSC, liver transplantation (LT) remains the only curative option. There is little evidence for the use of medications as a way to inhibit the progression of the disease. Still several new drugs are under investigation, representing the potential to improve survival and clinical outcomes in PSC. Final considerations: We conclude that it is extremely important to approach the management of PSC. The diagnosis is a great challenge since its clinical, laboratory and imaging aspects overlap, as it was portrayed during this exposure. Nevertheless, due to the various differential diagnoses ofjaundice with cholestatic pattern, the etiological search is crucial and the absence of effective medical therapy, with several new drugs under analysis, should guide further studies to improve the survival and clinical outcomes of these patients. Another point to be considered is that there is a scarcity of data in the literature that address the PSC in the Brazilian population.

Cardiovascular magnetic resonance in β-thalassemia major: beyond T2.

Β-thalassemia major (TM) patients underwent regular transfusions to prevent complications of chronic anemia. However, these regular transfusions result in progressive iron accumulation in vital organs, including the heart. Myocardial iron overload can lead to cardiac dysfunction and ultimately to heart failure. Diagnosis of cardiac dysfunction in β-TM patients is usually made through clinical examination, electrocardiogram, and echocardiography. Cardiac magnetic resonance (CMR), through the measurement of T2* relaxation time, represents the diagnostic modality of choice for assessing myocardial iron overload and guiding the iron chelation therapy. Despite a tailored chelation therapy reducing myocardial iron overload, heart failure remains the leading cause of morbidity and mortality even in well-treated β-TM patients. Advances in CMR, including myocardial strain, parametric mapping (T1, T2, and extracellular volume), and late gadolinium enhancement (LGE) measurements, have expanded its role in the diagnosis, prognosis, and follow-up of these patients. This review seeks to offer a thorough overview of the potential uses of CMR in β-TM, extending beyond the established role of T2* measurement in guiding chelation therapy. It delves into the emerging applications of new CMR imaging biomarkers that could improve the overall management of β-TM patients.

Improved diagnostic confidence using Super Resolution CEUS imaging in testicular lesions.

Ultrasound is the most used interdisciplinary non-ionizing imaging technique in clinical pathologies of the testis. The testis may be affected by a plethora of different disorders such as vasculopathies, trauma, infections and manifestations of primary and secondary malignant masses. Conventional ultrasound represents the basic imaging modality of choice to assess scrotal disorders. Contrast-enhanced ultrasound (CEUS) can provide further information to distinguish between benign and malignant testicular mass lesions. The recent introduction of Super Resolution CEUS Micro-Vascular Imaging (MVI SR) and Time of Arrival (TOA SR) parametric mapping compliments the information provided by conventional CEUS, since these two new post-processing techniques improve the visualization of microvascular structures with slow blood flow and provide high-resolution images of the peak contrast enhancement and temporal perfusion patterns. This paper gives a comprehensive overview of differential diagnoses of the testicular disorder and their corresponding sono-morphologic correlates based on representative cases of the Interdisciplinary Ultrasound Center of the University Hospital Munich.

Ultrasonography (USG) Evaluation among Patients with Biliary Obstruction in a Tertiary Care Center

Background: Biliary obstruction is a blockage in the bile ducts that prevents bile from flowing from the liver to the small intestine. Objectives: This study aimed to assess the efficacy of ultrasonography (USG) among patients with a blockage in the bile ducts as known as biliary obstruction. Methods: This was a prospective observational study conducted at the Department of Radiology and Imaging at Sir Salimulliah Medical College Hospital, Dhaka, Bangladesh. This study included patients with clinical suspicion of biliary obstruction who underwent USG. Characteristics of the obstruction were evaluated for both benign and malignant lesions through USG. The findings were then correlated with ERCP, histopathology, or surgery to calculate the diagnostic performance of the former two modalities. Results: Out of 145 patients, 63 were in the malignant group and 82 were in the benign group. The sensitivity, specificity, and accuracy of detecting the nature of obstruction by USG were 33%, 84%, and 48.9%, respectively. The overall diagnostic accuracy of USG in predicting the site of obstruction was 64.3%. Hydatid Cyst and the Main Pancreatic Duct Stricture were the most accurate findings of USG. Conclusions: USG should be the initial screening modality of choice for predicting the level and nature of obstruction in patients with a clinical suspicion of obstructive jaundice.

Proposal for a New Treatment Algorithm for Proximal Humerus Fractures based on a Clinical Survey among 340 Surgeons

BackgroundThe increasing incidence of proximal humeral fractures (PHF) poses complex challenges in determining the optimal therapeutic strategies due to the diverse fracture patterns and individual patient characteristics. Traumatologists and orthopedic surgeons face significant decisions, as potential consequences such as pain, functional limitations, and complications may significantly affect patients' quality of life. Given the varying viewpoints on appropriate treatment modalities, a thorough examination of current care practices is crucial. MethodsAn adaptive online survey was conducted to present realistic case scenarios, aimed at elucidating decision-making processes in the management of proximal humeral fractures. This survey encompassed relevant patient and fracture-related variables, employing a dynamic querying algorithm that featured up to 48 conceivable case scenarios. ResultsAnalysis of 7012 case scenarios unveiled significant differences in treatment preferences across distinct patient age groups. Plate osteosynthesis emerged as the preferred modality for individuals under 50 years of age with complex fracture patterns. On the other hand, a balanced consideration between plate osteosynthesis and reverse shoulder arthroplasty was observed in the 50-70 age cohort. Notably, respondents favored reverse shoulder arthroplasty as the treatment modality of choice for individuals over 70 years of age. A treatment algorithm was developed to outline decision pathways concisely, considering these patient age groups and the option of reverse shoulder arthroplasty. Discussion and ConclusionThis study provides clinically relevant insights into therapeutic decision-making processes in the management of proximal humeral fractures. The illustration of treatment preferences through a visualized algorithm serves as a crucial tool for evidence-based clinical decision-making, offering potential in enhancing the individualized care spectrum for patients with PHF.