Patients Underwent CT Scan Research Articles

RF35 | PSAT262 Comparative Study of Hertel Exophthalmometer and Luedde Exophthalmometer Versus Computed Tomography for Measurement of Proptosis in Normal Subjects

Abstract Background Clinical evaluation of proptosis is measured by an exophthalmometer. Hertel exophthalmometer has long been considered a standard instrument for measurement of eye protrusion. The reading may be subject to error while the examiners read through the integral reflection mirrors. Luedde exophthalmometer, which is a ruler correcting for parallax, is easier to use and less expensive than Hertel exophthalmometer. Since CT scan of orbits or brain provides the most objective assessment of proptosis measurements, we aim to study the correlation between Luedde and Hertel exophthalmometers in comparison with the CT scan for the evaluation of proptosis in normal subjects. Methods This prospective study was carried out between November 2020 and January 2021. Sixty-three patients were enrolled from a single tertiary hospital. All patients underwent CT scan of brain for medical reasons. On the same day, proptosis was measured with Hertel and Dual Luedde exophthalmometer by two independent examiners. Measurement of proptosis from CT scan was performed by one experienced neuroradiologist, using 2 reference measurement techniques. Correlation coefficients between proptosis values measured by each exophthalmometer and CT scan were compared. Results The mean age of the participants was 63 years old and 54% were female. For the right eye, mean proptosis measurement was 14.9+/-1.6 mm by Hertel exophthalmometer, 14.1+/-2.3mm by Luedde exophthalmometer, 16.6+/-2.3 mm by first CT technique, and 13.1 +/- 2.2 mm by second CT technique. For the left eye, mean proptosis measurement was 15.5 +/-1.5mm by Hertel exophthalmometer, 13.7+/-2.3 mm by Luedde exophthalmometer, 16.6+/-2.3 mm by first CT technique and 13.1 +/- 2.2 mm by second CT technique. The Intraclass correlation coefficient (ICC) of Hertel exophthalmometer for proptosis measurement compared to first CT technique and second CT technique were 0.63 and 0.60 for right eye; 0.61 and 0.55 for left eye, respectively. The ICC of Luedde exophthalmometer for proptosis measurement compared to first CT technique and second CT technique were 0.78 and 0.74 for right eye; 0.77 and 0.74 for left eye, respectively. Conclusion There is a good correlation between Hertel and Luedde exophthalmometers in evaluation of proptosis. However, proptosis measured by Luedde exophthalmometer shows superior correlation with CT scan. The result suggests that Luedde exophthalmometer can be routinely used for measurement of proptosis in place of Hertel exophthalmometer, given the simplicity and the inexpensiveness of the instrument. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Monday, June 13, 2022 12:30 p.m. - 12:35 p.m.

Radiological Assessment after Neoadjuvant SBRT in Pancreatic Cancer

<h3>Purpose/Objective(s)</h3> Localized pancreatic cancer is often treated with neoadjuvant SBRT. Patients showing radiological response after SBRT can be considered for surgical resection. Here, we assess the difference in radiological assessment between 8 and 12 weeks post-SBRT. <h3>Materials/Methods</h3> Patients were prospectively enrolled on a phase 1/2 randomized controlled trial of SBRT with or without a vasospasm. The trial was designed to assess the maximal tolerated dose of SBRT in patients with borderline resectable or locally advanced pancreatic cancer. All patients received neoadjuvant chemotherapy and SBRT with 50 or 55Gy in 5 fractions. Following neoadjuvant therapy, patients underwent CT scanning at weeks 8 and 12 post-SBRT. Response was assessed using the modified RECIST criteria: partial response (PR) was considered when the tumor showed at least a 30% decrease in diameter, and disease progression was considered with the tumor showed at least a 20% increase in diameter. We analyzed response/progression between baseline and week 8, and baseline and week 12, and compared the difference between the two timepoints. <h3>Results</h3> In total, 20 patients had CT assessments at 8 and 12 weeks post-SBRT. Compared to baseline, only 1 patient (5%) showed PR at week 8, but 5 patients (25%) showed PR at week 12. The median decrease in diameter for those 5 patients was 24.8% at week 8 vs 35.9% at week 12. Moreover, 1 patient (5%) showed disease progression at week 8, with a 45.3% diameter increase, but showed stable disease compared to baseline at week 12 (6.3% diameter increase). Lastly, when looking at any change in tumor diameter, 11 patients (55%) had a larger decrease in tumor diameter at week 12 compared to week 8 (median decrease week 8: 6.5% vs week 12: 22.1%). <h3>Conclusion</h3> Re-assessing patients at week 12 post-SBRT could show better response rates compared to week 8, and allow more patients to undergo surgical resection. Larger studies are still needed to better assess ideal SBRT follow-up.

Sinusitis among Patients Undergoing CT Scan of Paranasal Sinuses in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Computed tomography imaging provides detailed information about the paranasal sinuses and is now well established as an alternative to standard radiographs in evaluating patients with sinusitis. Sinusitis can have dangerous complications which can even lead to death if not diagnosed and treated on time. This study aimed to find the prevalence of sinusitis among the patients undergoing Computed Tomography scan of paranasal sinuses in a tertiary care centre. A descriptive cross-sectional study was conducted in the Department of Radiology at a tertiary care hospital from 1 October 2021 to 30 April 2022 after taking ethical approval from the Institutional Review Committee (Reference Number: 023-078/079). The patients undergoing Computed Tomography paranasal sinuses and meeting the eligibility criteria were enrolled for the study after taking informed consent. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Among 113 patients, 109 (96.46%) (93.05-99.87, 95% Confidence Interval) patients had sinusitis. The most common subtype was found to be acute sinusitis in 63 (57.79%) individuals. The prevalence of sinusitis was higher than in other studies done in similar settings. computed tomography; paranasal sinuses; sinusitis.

P224 A challenging case of pyrexia of unknown origin of adrenal mass

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMA familiar dictum in tropical countries is to consider the diagnosis of tuberculosis (TB) in a patient with fever of unknown origin until proven otherwise. Often, in resource-limited settings, a response to a trial of empiric anti-tuberculous therapy (ATT) is needed to prove TB. However, chronic granulomatous diseases such as invasive fungal infections and sarcoidosis have clinical features resembling extrapulmonary TB. Thus, the workup for a definitive diagnosis is necessary. A 53-year-old male presented with low grade, intermittent fever, loss of weight and appetite for a duration of 4 months and generalized abdominal pain for the last 2 months. He has lost about 16 kg in the past 6 months. He also reported a mild cough with scanty white mucoid sputum. There was no contact with a case of TB. He developed small oval/circular copper Color patchy lesions in the trunk for the last 1 month (Fig. 1). The general examination of the patient was grossly normal except for hepatomegaly. Routine blood examination, renal and liver function test, and chest X-ray were normal and HIV ELISA was non-reactive. With the strong suspicion of TB, the patient underwent CT scanning of the chest and abdomen was done which showed bilateral heterogeneous adrenal mass with few hypodense areas within measuring right side 3.1 × 1.8 cm and left side 3.1 × 2.5 cm in suprarenal location and liver is enlarged size 19.3 cm with normal attenuation (Fig. 2). There were no clinical features to suggest pheochromocytoma or Cushing's syndrome. The PET-CT revealed metabolically active disease involving bilateral adrenal gland, abdominal and retrosternal lymph node with diffuse hepatomegaly. Transabdominal ultrasound-guided FNA was done from adrenal lesions. The tests for tuberculosis were negative and the cytology reported necrotizing granuloma with intracytoplasmic yeast cells suggestive of histoplasmosis. The adrenal endocrine profile was normal. From skin lesions, a biopsy was done. Direct KOH from skin lesion revealed budding yeast cells while the cultures are awaited. The patient was treated with 3 mg/kg liposomal amphotericin B for 2 weeks followed by daily itraconazole for maintenance. The fever was resolved after 8 days of liposomal amphotericin B and skin lesions softened after 3 weeks of therapy.

P163 Successful management of COVID-19-associated mucormycosis in state of pernambuco, northestearn brazil: 2 case reports

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivesDuring the COVID-19 pandemic, several cases of mucormycosis related to SARS-CoV-2 were reported. This association is still poorly studied due to its recent emergence and makes diagnosis and treatment challenging. Usually, patients who are affected by this infection are immunocompromised by corticosteroid treatment and uncontrolled diabetes mellitus, being mucormycosis a life-threatening opportunistic invasive fungal infection caused by mucoromycetes, which reaches a mortality rate of about 50%, even with treatment. Thus, this association requires as much information as possible about the pathogenesis and treatment.MethodsHere, we report two cases with conclusive diagnosis and positive evolution to mucormycosis associated with COVID-19 after corticosteroid therapy.ResultsThe first case was a 68-year-old woman, hypertensive and diabetic, who was affected by SARS-CoV-2, with intense ocular pain and paralysis of extrinsic ocular muscles of the right eye and eyelid. The patient underwent CT scan of the sinuses with contrast, which showed signs on maxillary. The patient was submitted to sinusectomy with orbital decompression and the material from the surgery was sent for fungal investigation, which 20% KOH direct exam showed hyaline, sparsely-septate, broad, ribbon-like hyphae with irregular right-angle branching. Rhizopus oryzae was isolated on Sabouraud agar. Mucormycosis was diagnosed in the facial sinuses, and resolution of infection was obtained with liposomal amphotericin B. The second case was a 59-year-old woman, obesity degree 3, asthmatic and history of COVID-19, with history of abscesses in oral mucosa and palate, with drainage of brown secretion after 30 days of COVID-19 resolution. After medical discharge, the patient was evaluated by an oral and maxillofacial surgeon to solve an esthetic problem, when the material was collected for biopsy of the mucosal lesions. Histopathological exam showed aseptic thick mycelial filaments presenting right angle bifurcation, suggestive of Mucorales (mucormycosis). The patient was readmitted to the hospital for mucormycosis treatment based on isavuconazole (200 mg, q8 as attack dose on Day 1 and 2, and 3 toward q24), and treatment evolved positively with no need for surgical intervention. We conclude that the extensive use of steroids associated with diabetes is the main factor for the appearance of mucormycosis after COVID-19, but with a conclusive diagnosis and correct treatment, this infection can have a good evolution, resulting in an improvement in the patient's clinical condition, reducing the risk of death for this infection.ConclusionIsavuconazole appears to be a drug with a safe profile and with curative potential for mucormycosis. The possibility of oral use from the third day at its maintenance dose (200 mg/day) with intravenous use in the first 48 h at a dose of 200 mg every 8 h. Diabetic patients are more prone to infection, but patients infected with SARS CoV 2 using corticosteroids have shown to be a risk group for this fungus.

Computed Tomography and Patient Risk: Facts, Perceptions and Uncertainties

Aim: To assess the role of computed tomography for management of Covid-19. Study design: Prospective study Place and duration of study: Department of Radiology, Ghulam Muhammad Mahar Medical College Teaching Hospital Sukkur from 1st November 2020 to 31st December 2021. Methodology: One hundred cases within various ages 5-55 years for analyzing their risk for CT scanning on them by highlighting the facts related to CT scan, patient perceptions and uncertainties regarding it. A 50 radiologist and 50 emergency doctors were also asked questions regarding their knowledge about CT scan risks and their responses were also documented. However previous CT record of patients suffering from carcinoma was also analyzed for understanding the fact related with CT imaging. Results: The mean age of patients undergoing CT scan was 39.5±5.6 years. There were 55% males who underwent CT scans while 45% females. The usual dosage for various radiological procedure shows that highest dose deliverance was given to the patients of CT pulmonary angiogram and coronary angiography. Only 50% of radiologists knew that CT scan is associated with high risk of malignancies. There were only 10% emergency medical doctors who also knew CT imaging relation with malignancy risk. Only 54% patients considered abdomen pelvic scan to be associated with increasing lifetime risk of cancer while 23% of the patients considered chest scan to be associated with escalating the risk of cancer. Conclusion: Computed tomography scan is related with a high risk of radiation exposure. There is a dire need of perception development and risk understanding with medical professionals and general public for minimizing this risk. Key words: Computed tomography, Risk, Facts, Perception, Uncertainties

Predicting hemorrhagic transformation in posterior circulation stroke patients not treated with reperfusion therapies

IntroductionPosterior Circulation (PC) stroke represents one-fifth of all ischemic strokes, with peculiar physiological characteristics. Hemorrhagic Transformation (HT) is a dreaded complication among stroke patients. Many predictive scores of this complication have been proposed, but none is designed specifically for PC stroke patients – therefore, patients who are not eligible for reperfusion therapies (RT) represent about 80% of hospitalized cases. We propose a scoring system to assess the HT risk in PC stroke patients not submitted to RT. MethodsWe retrospectively evaluated data of patients diagnosed with PC stroke not treated with RT from 5 Comprehensive Stroke Centers (four in Brazil, 1 in the US) from 2015 to 2018. All patients underwent CT scan or MRI at admission and a follow-up neuroimaging within seven days. Independent variables identified in a logistic regression analysis were used to produce a predictive grading score. ResultsWe included 952 patients in the final analysis. The overall incidence of HT was 8.7%. Male gender (1 point), NIH Stroke Scale at admission ≥ 5 points (1), blood glucose at admission ≥ 160 mg/dL (1), and cardioembolism (2) were independently associated with HT. The AUC of the grading score (0 to 5 points) was 0.713 (95% CI 0.65–0.78). Subjects with a score ≥ 3 points had an OR of 4.8 (95% CI 2.9–7.9, p < 0.001) for HT. ConclusionsOur score has good accuracy in identifying patients at higher risk of HT. This score may be useful for evaluating secondary prevention and stratifying patients in the context of even clinical trials.

Impact of COVID-19 Pandemic on Trauma CT Imaging

Purpose The goal of this study was to understand the impact of COVID-19 pandemic and associated lockdown measures on the volume, rate, and type of trauma presenting to the emergency department (ED) by using trauma-initiated CT studies to capture patient data. Materials and Methods We performed a retrospective observational study comparing patients undergoing CT scans for trauma during the 1st and 2nd lockdown periods compared to corresponding prepandemic months. During two lockdown periods, public places such as restaurants, libraries, parks, and shops across the province were shut down. Government-led messaging advised that people should stay at home and practice social distancing. The rate of trauma-initiated CT scans and the proportion of different types of traumas were compared between time periods. Results There was no significant difference in overall trauma-initiated CT scans between the prepandemic and pandemic levels. Motor vehicle collision (MVC) cases decreased from 18.2% to 15.6% during the first lockdown period (p = 0.049) and also reduced from 29.1% to 25.2% during the second lockdown period (p = 0.013). Trauma from falls increased from 19.1% to 27.5% (p = 0.036) during the first lockdown, despite no significant change during the 2nd lockdown. Furthermore, the percentage of stab injuries increased from 25.0% to 38.9% while blunt trauma decreased from 68.5% to 54.3% during two lockdowns (p = 0.015). Conclusion The total number of trauma-initiated CT scans did not significantly decrease during the lockdown periods. Stabbings and falls increased during lockdown periods while MVCs and blunt trauma decreased.

Correlation of clinical parameters and objective assessment tools in active thyroid eye disease – Prospective analytical study

Primary objective of this study was to identify the disease in active phase, clinically assess it and start medical management. Secondary objective was to analyze whether the objective tools like B-scan and serum levels of IL-6 and HS-CRP aid in the diagnosis of activity in thyroid eye disease. : The aim wasto analyze the correlation of clinical parameters and significance of objective assessment tools in active thyroid eye disease. Clinically diagnosed cases of TED with lid signs, soft tissue changes, restrictive myopathy and bilateral axial proptosis were included in our study. Patients in chronic stable phase were excluded from study. This was a prospective analytical study, conducted from June 2010 till June 2012. Sample size was thirty patients in the age group of 20 to 60 years. Complete ophthalmology workup and objective disease assessment tools including B scan (OTI 1000 with 7.5-10 MHz) was used in our study. All patients underwent CT scan orbit-axial and coronal view. After assessing the severity and stage of the disease, each patient was managed accordingly using different modalities. : Identifying the disease activity early and aggressive management with systemic steroids in moderately active and severe stage has decreased the morbidity associated with the disease. A- scan with orbital B-scan helps in diagnosing the activity in thyroid eye disease. This procedure is very economical with relatively short examination time and no risk of radiation .Follow up of the patients can also be performed easily. IL-6 and HS-CRP was statistically significantly elevated in patients with severe disease when compared to control group. Hence can help in assessing disease activity in patients with severe disease.

PD04-03 DIAGNOSTIC DILEMMAS: A MULTI-INSTITUTIONAL RETROSPECTIVE ANALYSIS OF ADRENAL INCIDENTALOMA PATHOLOGY BASED ON RADIOGRAPHIC SIZE

You have accessJournal of UrologyCME1 May 2022PD04-03 DIAGNOSTIC DILEMMAS: A MULTI-INSTITUTIONAL RETROSPECTIVE ANALYSIS OF ADRENAL INCIDENTALOMA PATHOLOGY BASED ON RADIOGRAPHIC SIZE David Zekan, Robert King, Ali Hajiran, Apexa Patel, Samuel Deem, and Adam Luchey David ZekanDavid Zekan More articles by this author , Robert KingRobert King More articles by this author , Ali HajiranAli Hajiran More articles by this author , Apexa PatelApexa Patel More articles by this author , Samuel DeemSamuel Deem More articles by this author , and Adam LucheyAdam Luchey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002519.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Adrenal incidentalomas (AIs) are masses >1 cm found incidentally during radiographic imaging. They are present in up to 4.4% of patients undergoing CT scan, and incidence is increasing with usage and sensitivity of cross-sectional imaging. Most result in diagnosis of adrenal cortical adenoma, questioning guidelines recommending removal of all AIs with negative functional workup. This retrospective study analyzes histological outcome based on size of non-functional adrenal masses. METHODS: 10 years of data was analyzed from two academic institutions. Exclusion criteria included patients with positive functional workups, those who underwent adrenalectomy during nephrectomy, <18 years, and incomplete records. AI radiologic and histologic size, histologic outcome, laterality, imaging modality, gender, and age were collected. T-test was used for comparison of continuous variables, and the two-sided Fisher’s exact or chi-square test were used to determine differences for categorical variables. Univariate analysis of each independent variable was performed using simple logistic regression. RESULTS: 73 adrenalectomies met the above inclusion criteria. 60 were detected on CT scan, 12 on MRI, and one on ultrasound. Eight of 73 cases resulted in malignant pathology, 3 of which were adrenocortical carcinoma (ACC). Each ACC measured >6 cm, with mean radiologic and pathologic sizes of 11.2 cm and 11.3 cm. Both radiologic and pathologic size were significant predictors of malignancy (p=0.008 and 0.011). CONCLUSIONS: Our results question the generally-accepted 4 cm cutoff for excision of metabolically-silent AIs. They suggest a 6 cm threshold would suffice to avoid removal of benign lesions while maintaining sensitivity for ACC. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e49 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Zekan More articles by this author Robert King More articles by this author Ali Hajiran More articles by this author Apexa Patel More articles by this author Samuel Deem More articles by this author Adam Luchey More articles by this author Expand All Advertisement PDF DownloadLoading ...

Diagnostic dilemmas: a multi-institutional retrospective analysis of adrenal incidentaloma pathology based on radiographic size

Introduction/backgroundAdrenal incidentalomas (AIs) are masses > 1 cm found incidentally during radiographic imaging. They are present in up to 4.4% of patients undergoing CT scan, and incidence is increasing with usage and sensitivity of cross-sectional imaging. Most result in diagnosis of adrenal cortical adenoma, questioning guidelines recommending removal of all AIs with negative functional workup. This retrospective study analyzes histological outcome based on size of non-functional adrenal masses.Material and methods10 years of data was analyzed from two academic institutions. Exclusion criteria included patients with positive functional workups, those who underwent adrenalectomy during nephrectomy, < 18 years, and incomplete records. AI radiologic and histologic size, histologic outcome, laterality, imaging modality, gender, and age were collected. T-test was used for comparison of continuous variables, and the two-sided Fisher’s exact or chi-square test were used to determine differences for categorical variables. Univariate analysis of each independent variable was performed using simple logistic regression.Results73 adrenalectomies met the above inclusion criteria. 60 were detected on CT scan, 12 on MRI, and one on ultrasound. Eight of 73 cases resulted in malignant pathology, 3 of which were adrenocortical carcinoma (ACC). Each ACC measured > 6 cm, with mean radiologic and pathologic sizes of 11.2 cm and 11.3 cm. Both radiologic and pathologic size were significant predictors of malignancy (p = 0.008 and 0.011).ConclusionsOur results question the generally-accepted 4 cm cutoff for excision of metabolically-silent AIs. They suggest a 6 cm threshold would suffice to avoid removal of benign lesions while maintaining sensitivity for ACC.

Anatomic variations of para-nasal sinuses in patients undergoing CT scan: spectrum, prevalence and implications

Anatomic variations of para-nasal sinuses in patients undergoing CT scan: spectrum, prevalence and implications

Presentation and outcomes of acute appendicitis during COVID-19 pandemic: lessons learned from the Middle East-a multicentre prospective cohort study.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic had a striking impact on healthcare services in the world. The present study aimed to investigate the impact of the COVID-19 pandemic on the presentation management and outcomes of acute appendicitis (AA) in different centers in the Middle East.MethodsThis multicenter cohort study compared the presentation and outcomes of patients with AA who presented during the COVID-19 pandemic in comparison to patients who presented before the onset of the pandemic. Demographic data, clinical presentation, management strategy, and outcomes were prospectively collected and compared.ResultsSeven hundred seventy-one patients presented with AA during the COVID pandemic versus 1174 in the pre-COVID period. Delayed and complex presentation of AA was significantly more observed during the pandemic period. Seventy-six percent of patients underwent CT scanning to confirm the diagnosis of AA during the pandemic period, compared to 62.7% in the pre-COVID period. Non-operative management (NOM) was more frequently employed in the pandemic period. Postoperative complications were higher amid the pandemic as compared to before its onset. Reoperation and readmission rates were significantly higher in the COVID period, whereas the negative appendicectomy rate was significantly lower in the pandemic period (p = 0.0001).ConclusionDuring the COVID-19 pandemic, a remarkable decrease in the number of patients with AA was seen along with a higher incidence of complex AA, greater use of CT scanning, and more application of NOM. The rates of postoperative complications, reoperation, and readmission were significantly higher during the COVID period.

Clinical evaluation of the impact of rectal and bladder filling on prostate position during hypofractionated radiotherapy for prostate cancer

Objective: To evaluate the impact of rectal and bladder filling on prostate position during hypofractionated radiotherapy for prostate cancer. Methods: Three gold fiducials were implanted into the prostate in 25 patients. Each patient underwent CT scanning under four different conditions: full rectum and bladder, full bladder and empty rectum, full rectum and empty bladder, and empty rectum and bladder (primary image). The other three scans were aligned with the primary image by pelvic bone, then by the implanted fiducials. Prostate displacements were determined by computing the difference between these two alignments. The magnitude and directions of displacement were analyzed. Results: A full rectum shifted the prostate most significantly in the anterior (0.93 ± 0.31 cm) and superior directions (0.48 ± 0.30 cm). A full rectum was associated with anterior shifts ≥0.5 cm in 92.0% of the patients, ≥1 cm in 44.0%, while superior shifts ≥0.5 cm were observed in 48.0% and ≥1 cm in 8.0%. A full bladder shifted the prostate mildly in the superior direction (0.19 ± 0.30 cm). A full rectum and full bladder shifted the prostate more in the anterior (1.19 ± 0.37 cm) and superior directions (0.49 ± 0.50 cm). 100% and 56.0% had ≥0.5 cm of anterior and superior displacements. 68.0% and 16.0% had ≥1 cm of anterior and superior shift. Conclusions: Our study demonstrated that a full rectum shifted the prostate mainly anterosuperiorly. The rectal volume’s impact on prostate movement is much larger than that of the bladder.

Frequency and Pattern of Early Complications after Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

Objective: The aim of this study is to determine the frequency of complication among patients after endoscopic third ventriculostomy in obstructive hydrocephalus. Study Design: Descriptive study Place and Duration: Conducted at the department of Neurosurgery, Bacha Khan Medical College Mardan/ Medical Complex Mardan and Frontier Medical and Dental College, Abbottabad for duration of 06 months from April 2021 to September 2021. Methods: There were one hundred and fifteen patients of both genders with ages 1-40 years were presented. Included patients had obstructive hydrocephalus. Detailed demographics, including age, sex, and BMI, were obtained from all patients with signed permission. Patients underwent CT scan and brain MRI. Endoscopic third ventriculostomy was performed among all the cases after indication of symptoms. Post-treatment effectiveness and complication were assessed after follow up within duration of 2-weeks. SPSS 25.0 version was used to analyze all data. Results: Mean age of the patients was 6.2 ±3.25 years. Among 115 cases, 70 (60.9%) were males and 45 (29.1%) were female patients. Aqueductal stenosis was the most common disease found in 77 (67%) cases followed by posterior fossa tumours 20 (17.4%), VP shunt blocked in 17 (14.8%) and CSF ascites in 3 (2.6%) cases. We found complications in 24 (20.9%) cases CSF leak was the most common found in 12 (10.4%) cases, meningitis in 4 (3.5%), seizures and bleeding in 3 (2.6%). Mortality found in 2 (1.7%) cases. Conclusion: We concluded in this study that the endoscopic third ventriculostomy is an effective and safe method for the patients of obstructive hydrocephalus in terms of minimum complication with lower rate of mortality. Keywords: Endoscopic Third Ventriculostomy, Obstructive Hydrocephalus, Mortality, Complications

Evaluation of Daily CT for EPID-Based Transit In Vivo Dosimetry.

PurposeThe difference in anatomical structure and positioning between planning and treatment may lead to bias in electronic portal image device (EPID)-based in vivo dosimetry calculations. The purpose of this study was to use daily CT instead of planning CT as a reference for EPID-based in vivo dosimetry calculations and to analyze the necessity of using daily CT for EPID-based in vivo dosimetry calculations in terms of patient quality assurance.Materials and MethodsTwenty patients were enrolled in this study. The study design included eight different sites (the cervical, nasopharyngeal, and oral cavities, rectum, prostate, bladder, lung, and esophagus). All treatments were delivered with a CT-linac 506c (UIH, Shanghai) using 6 MV photon beams. This machine is equipped with diagnosis-level fan-beam CT and an amorphous silicon EPID XRD1642 (Varex Imaging Corporation, UT, USA). A Monte Carlo algorithm was developed to calculate the transmit EPID image. A pretreatment measurement was performed to assess system accuracy by delivering based on a homogeneous phantom (RW3 slab, PTW, Freiburg). During treatment, each patient underwent CT scanning before delivery either once or twice for a total of 268 fractions obtained daily CT images. Patients may have had a position correction that followed our image-guided radiation therapy (IGRT) procedure. Meanwhile, transmit EPID images were acquired for each field during delivery. After treatment, all patient CTs were reviewed to ensure that there was no large anatomical change between planning and treatment. The reference of transmit EPID images was calculated based on both planning and daily CTs, and the IGRT correction was corrected for the EPID calculation. The gamma passing rate (3 mm 3%, 2 mm 3%, and 2 mm 2%) was calculated and compared between the planning CT and daily CT. Mechanical errors [ ± 1 mm, ± 2 mm, ± 5 mm multileaf collimator (MLC) systematic shift and 3%, 5% monitor unit (MU) scaling] were also introduced in this study for comparing detectability between both types of CT.ResultThe average (standard deviation) gamma passing rate (3 mm 3%, 2 mm 3%, and 2 mm 2%) in the RW3 slab phantom was 99.6% ± 1.0%, 98.9% ± 2.1%, and 97.2% ± 3.9%. For patient measurement, the average (standard deviation) gamma passing rates were 87.8% ± 14.0%, 82.2% ± 16.9%, and 74.2% ± 18.9% for using planning CTs as reference and 93.6% ± 8.2%, 89.7% ± 11.0%, and 82.8% ± 14.7% for using daily CTs as reference. There were significant differences between the planning CT and daily CT results. All p-values (Mann–Whitney test) were less than 0.001. In terms of error simulation, nonparametric test shows that there were significant differences between practical daily results and error simulation results (p < 0.001). The receiver operating characteristic (ROC) analysis indicated that the detectability of mechanical delivery error using daily CT was better than that of planning CT. AUCDaily CT = 0.63–0.96 and AUCPlanning CT = 0.49–0.93 in MLC systematic shift and AUCDaily CT = 0.56–0.82 and AUCPlanning CT = 0.45–0.73 in MU scaling.ConclusionThis study shows the feasibility and effectiveness of using two-dimensional (2D) EPID portal image and daily CT-based in vivo dosimetry for intensity-modulated radiation therapy (IMRT) verification during treatment. The daily CT-based in vivo dosimetry has better sensitivity and specificity to identify the variation of IMRT in MLC-related and dose-related errors than planning CT-based.

Radiation risks during pediatric brain CT procedures in Morocco : A multicentre study

Head CT is a fast and non-invasive method of imaging the brain and skull. It can be used after a cerebral trauma to identify a skull fracture, cerebral edema or a cerebral hematoma. In other cases, it is prescribed in the presence of symptoms suggesting a lesion or a cerebral pathology such as violent headaches or epileptic fits. Children may be more sensitive to radiation and have a longer life span, leaving them at an increased risk of cancer than adults. The purpose of this study is to evaluate the detriment associated with exposure during pediatric CT examinations. Six radiology departments equipped with different CT machines calibrated according to international protocols were used in the study. In all, 180 patients underwent CT scans of the head. The effective radiation dose, cancer risk, and genetic risk were evaluated using the risk factor coefficients of the International Commission on Radiological Protection (ICRP). The effective dose for Moroccan hospitals is (2.70 ± 065) mSv. The cancer risk per head CT scan ranged from 42 to 428 with a mean value of 148 per 1 million head CT examinations. The hereditary risk per brain CT scan ranges from 2 to 16, with a mean value of 5 per 1 million head CT examinations. The effective dose and risk associated with head CT scans were above the average for one-third of the hospitals in this study. The likelihood of cancer and hereditary risk is significant when multiple images are acquired. Almost 66% of the procedures performed with normal results in the study. Yet, staff still need to further optimize the radiation dose during brain procedures.

Lung Function, Radiological Findings and Biomarkers of Fibrogenesis in a Cohort of COVID-19 Patients Six Months After Hospital Discharge

IntroductionImpairment in pulmonary function tests and radiological abnormalities are a major concern in COVID-19 survivors. Our aim is to evaluate functional respiratory parameters, changes in chest CT, and correlation with peripheral blood biomarkers involved in lung fibrosis at two and six months after SARS-CoV-2 pneumonia. MethodsCOVID-FIBROTIC (clinicaltrials.gov NCT04409275) is a multicenter prospective observational cohort study aimed to evaluate discharged patients. Pulmonary function tests, circulating serum biomarkers, chest radiography and chest CT were performed at outpatient visits. ResultsIn total, 313, aged 61.12±12.26 years, out of 481 included patients were available. The proportion of patients with DLCO<80% was 54.6% and 47% at 60 and 180 days. Associated factors with diffusion impairment at 6 months were female sex (OR: 2.97, 95%CI 1.74–5.06, p=0.001), age (OR: 1.03, 95% CI: 1.01–1.05, p=0.005), and peak RALE score (OR: 1.22, 95% CI 1.06–1.40, p=0.005). Patients with altered lung diffusion showed higher levels of MMP-7 (11.54±8.96 vs 6.71±4.25, p=0.001), and periostin (1.11±0.07 vs 0.84±0.40, p=0.001). 226 patients underwent CT scan, of whom 149 (66%) had radiological sequelae of COVID-19. In severe patients, 68.35% had ground glass opacities and 38.46% had parenchymal bands. Early fibrotic changes were associated with higher levels of MMP7 (13.20±9.20 vs 7.92±6.32, p=0.001), MMP1 (10.40±8.21 vs 6.97±8.89, p=0.023), and periostin (1.36±0.93 vs 0.87±0.39, p=0.001). ConclusionAlmost half of patients with moderate or severe COVID-19 pneumonia had impaired pulmonary diffusion six months after discharge. Severe patients showed fibrotic lesions in CT scan and elevated serum biomarkers involved in pulmonary fibrosis.

MPN-388: Assessment of Prevalence and Risk Factors for Subclinical Splanchnic Thrombosis in Patients with Myelofibrosis

Context Splanchnic thrombosis (ST) is a characteristic feature of MPN-associated prothrombotic state. Objective To determine the prevalence of subclinical ST in patients with myelofibrosis and assess disease-related and hereditary factors as potential risk predictors. Design Single-center, cross-sectional. Setting Clinic of Medical Oncology, University Hospital “Sveti Georgi” EAD, Plovdiv, Bulgaria. Patients or Other Participants Patients were considered eligible if diagnosed with myelofibrosis according to WHO 2016 criteria (incl. post-PV and post-ET), >18 years, no symptoms of overt ST, and no previous history of thrombosis. 21 subjects were recruited. Interventions Patients underwent CT scan angiography to detect the presence of vascular occlusion in the splanchnic circulation. Digital droplet PCR was performed to quantitate JAK2 mutant and wild-type allele burden in copies per nanogram DNA. Hereditary thrombophilia was analyzed for a panel of four genes: f.V(R506Q), f.II(20210G>A), PAI(4G/5G), and MTHFR(677C>T) by RT-PCR. Statistical analysis was performed in R v.4.0.4. All patients provided written informed consent. Main Outcome Measures Primary outcome was presence of thrombosis (arterial and/or venous) in the splanchnic circulation. Potential predictors were Jak2mut/ng DNA, WBC, HGB, PLT, spleen size, ruxolitinib therapy, and presence of hereditary thrombophilia. Results Baseline characteristics: mean age 67 ±10.51 years, 53% (11) females, 48% (10) with IPSS int-2/high, 57% (12) on ruxolitinib. FV(R506Q) and f.II(20210G>A) were detected in two patients each (9%), PAI(4G/4G) was detected in 10 patients, only one patient was wild-type homozygous, 3 patients were MTHFR(677TT), and 9 were heterozygous. ST was detected in 7 patients (33%). Jak2mut/ng DNA, WBC, HGB, PLT, spleen size, and ruxolitinib were not found to be significant predictors by logistic regression. 6 out of 7 patients with thrombosis were homozygous mutant [either PAI(4G/4G): 5 patients or MTHFR(677TT): 1 patient] and heterozygous for at least one of the other three genes. The presence of mutant homozygosity and heterozygous carrier state were significantly predictive of ST (Bhereditary = 3.497, 95%CI: 1.22–6.76, p=0.008). Conclusions Subclinical ST has a relatively high incidence in myelofibrosis. However, hereditary rather than disease-related factors emerge as risk factors. Further investigation of PAI(4G/5G) and MTHFR(677C>T) screening utility is warranted. This study was funded by Medical University-Plovdiv [grant SDPD-18/2019].

Deep learning takes the pain out of back breaking work - Automatic vertebral segmentation and attenuation measurement for osteoporosis

BackgroundOsteoporosis is an underdiagnosed and undertreated disease worldwide. Recent studies have highlighted the use of simple vertebral trabecular attenuation values for opportunistic osteoporosis screening. Meanwhile, machine learning has been used to accurately segment large parts of the human skeleton. PurposeTo evaluate a fully automated deep learning-based method for lumbar vertebral segmentation and measurement of vertebral volumetric trabecular attenuation values. Material and methodsA deep learning-based method for automated segmentation of bones was retrospectively applied to non-contrast CT scans of 1008 patients (mean age 57 years, 472 female, 536 male). Each vertebral segmentation was automatically reduced by 7 mm in all directions in order to avoid cortical bone. The mean and median volumetric attenuation values from Th12 to L4 were obtained and plotted against patient age and sex. L1 values were further analyzed to facilitate comparison with previous studies. ResultsThe mean L1 attenuation values decreased linearly with age by −2.2 HU per year (age > 30, 95% CI: −2.4, −2.0, R2 = 0.3544). The mean L1 attenuation value of the entire population cohort was 140 HU ± 54. ConclusionsWith results closely matching those of previous studies, we believe that our fully automated deep learning-based method can be used to obtain lumbar volumetric trabecular attenuation values which can be used for opportunistic screening of osteoporosis in patients undergoing CT scans for other reasons.