Pelvic Computed Tomography Scans Research Articles

Age Estimation through Hounsfield Unit Analysis of Pelvic Bone in the Romanian Population.

Background: Bone density is affected by age- and sex-related changes in the os coxae, often known as the pelvic bone. Recent developments in computed tomography (CT) imaging have created new opportunities for quantitative analysis, notably regarding Hounsfield Units (HU). Objectives: The study aims to investigate the possibility of using HU obtained from os coxae CT scans to estimate age in the Romanian population. Methods: A statistical analysis was conducted on a sample of 80 pelvic CT scans in order to find any significant correlation between age, sex, and variation in density among the different pelvic bone locations of interest. According to the research, pelvic radiodensity measurements varied significantly between male and female participants, with men having greater levels. This technique may be valuable for determining an individual's sex precisely, as evidenced by the substantial association found between HU levels and changes in bone density associated with sex. Results: The analysis of variance underscores that HU values exhibit a significant negative relationship with radiodensity, with a general trend of decreasing HU with increasing age. The equation derived from the ordinary least squares OLS regression analysis can be used to estimate the age of individuals in the Romanian population based on their HU values at specific pelvic sites. Conclusions: In conclusion, the application of HU analysis in CT imaging of the coxae represents a non-invasive and potentially reliable method for age and sex estimation, and a promising avenue in the field of human identification.

Diagnosis and surgical treatment of obturator hernia in the recent decade with long-term follow-up: A single center experience.

Obturator hernia (OH) is a rare and dangerous disease that can lead to life-threatening consequences, and pelvic computed tomography (CT) is widely used for its diagnosis. There is no consensus regarding the surgical approach and repair methods. Retrospective analysis of the clinical and follow-up data of 15 cases of incarcerated hernias patients admitted to the Department of General Surgery, affiliated to Taicang Affiliated Hospital of Soochow University, from January 2011 to December 2022. OH could be precisely diagnosed with pelvic CT scan, except for occult OH and non-strangulated OH. Thirteen patients underwent emergency surgery, with a total complication rate of 76.9% and no mortality. Ten patients underwent open surgery, and 3 patients underwent laparoscopic surgery, which had advantages in terms of total cost and postoperative hospital stay (P < .05). Emergency patients all underwent simple peritoneal closure, and hernial sac excision was simultaneously performed in 6 of them. A recurrence (7.7%) was detected at 38 months after the first operation. There was no statistically significant difference between the 2 tissue repair methods in terms of recurrent rate. Pelvic CT can be used as a gold standard for the diagnosis of incarcerated OH, but it has limited value in occult OH and non-strangulated OH. Laparoscopic surgery is recommended for patients with a short onset time and no abdominal physical signs. Tissue repair is sufficient for incarcerated OH and hernial sac excision may be unnecessary.

Deep learning-based fully automatic Risser stage assessment model using abdominal radiographs.

Artificial intelligence has been increasingly used in medical imaging and has demonstrated expert level performance in image classification tasks. To develop a fully automatic approach for determining the Risser stage using deep learning on abdominal radiographs. In this multicenter study, 1,681 supine abdominal radiographs (age range, 9-18years, 50% female) obtained between January 2019 and April 2022 were collected retrospectively from three medical institutions and graded manually using the United States Risser staging system. A total of 1,577 images from Hospitals 1 and 2 were used for development, and 104 images from Hospital 3 for external validation. From each radiograph, right and left iliac crest patch images were extracted using the pelvic bone segmentation model DeepLabv3 + with the EfficientNet-B0 encoder trained with 90 digitally reconstructed radiographs from pelvic computed tomography scans with a pelvic bone mask. Using these patch images, ConvNeXt-B was trained to grade according to the Risser classification. The model's performance was evaluated using accuracy, area under the receiver operating characteristic curve (AUROC), and mean absolute error. The fully automatic Risser stage assessment model showed an accuracy of 0.87 and 0.75, mean absolute error of 0.13 and 0.26, and AUROC of 0.99 and 0.95 on internal and external test sets, respectively. We developed a deep learning-based, fully automatic segmentation and classification model for Risser stage assessment using abdominal radiographs.

Radiation Doses in Routine CT Examinations for Adult Patients in Saudi Arabia: A Systematic Review.

Computed tomography (CT) is an important imaging technique that produces detailed cross-sectional images for diagnosing medical conditions. However, the associated radiation exposure raises concerns. Establishing diagnostic reference levels (DRLs) helps identify unusual radiation doses and optimize exposure while maintaining diagnostic image quality. The purpose of this systematic review is to review the radiation doses received by adult patients in the head, chest, abdomen, pelvis, abdomen-pelvis (AP), and combined chest, abdomen, and pelvis (CAP) CT scans in Saudi Arabia. A search was conducted in several databases including PubMed and Google Scholar to identify studies that have established DRLs or determined radiation dose for adult CT examinations. Only studies that specifically assessed DRLs in actual adult patients were considered for inclusion. Out of a total of 31 articles that were identified as eligible, 13 were included after a thorough screening process. The values of CTDIv, DLP, and effective doses were determined. The review discovered that CTDIv and DLP were the most frequently used dosimetric quantities. The mean values in terms of CTDIv for head, chest, abdomen, pelvis, AP, and CAP ranged from 40.67 to 61.80 mGy, 5.80 to 14.90 mGy, 8.60 to 16.15 mGy, 10.80 to 17.35 mGy, 14.10 to 16.84 mGy, and 12.00 to 22.94 mGy, respectively. The mean values in terms of DLP for head, chest, abdomen, pelvis, AP, and CAP ranged from 757 to 1212 mGy.cm, 243 to 657 mGy.cm, 369.5 to 549 mGy.cm, 379.6 to 593 mGy.cm, 658 to 940.43 mGy.cm, and 740 to 1493.8 mGy.cm, respectively. There is a fluctuation in radiation dose among CT centers, highlighting a need to provide proper education and training to radiographers. It is recommended to establish a universally accepted standardized protocol based on weight, equivalent diameter, or cross-sectional area for accurate comparisons with national and international DRLs.

Estimation of Organ Doses in Pediatric Patients for Different Imaging Protocols and Examinations

In this study, the Volume Computed Tomography Dose Index (CTDIvol) Dose Length Product (DLP), effective patient doses (ED), and organ doses were calculated for pediatric patients aged 0, 1, 5, and 10 years undergoing computed tomography (CT) examinations using the VirtualDose program, a software designed for reporting such doses. The study utilized a Toshiba Aquilion 16 CT scanner. Head, chest, and pelvis CT scans were simulated with commonly used kVp, mAs, and pitch values. The results indicated a significant difference in organ doses between standard and low-dose protocols. When kVp and mAs values were increased, ED and organ doses increased by an average of 2.5 times. Conversely, when kVp and mAs values were held constant and pitch value was increased, ED and organ doses decreased by an average of 2 times. Physicians requesting pediatric CT scans should continuously evaluate the requested examinations based on their benefits and risks. To reduce organ doses, scanning protocols should be reviewed, and low-dose protocols should be preferred. Additionally, newer generation devices that provide lower dose scanning should be utilized.

Obturator hernia: a persisting clinical diagnostic challenge – a case report

Introduction: The presentation of a strangulated obturator hernia is rare, with it accounting for less than 0.04% of all hernias. Delay in presentation and diagnosis results in complications like bowel ischemia, necrosis, perforation, and peritonitis, thereby increasing morbidity and mortality. Case presentation: The authors report the case of an 85-year-old multiparous woman who presented with a 3-day history of abdominal pain and vomiting. Upon examination, she exhibited hypotension, altered sensorium, and a distended abdomen with visible peristalsis. An abdominal pelvic computed tomography scan confirmed the diagnosis of ‘intestinal obstruction secondary to an incarcerated obturator hernia’. Subsequently, a lower midline laparotomy was performed, successfully reducing the bowel and repairing the hernial orifice. The patient was discharged on the fourth postoperative day, and there has been no hernia recurrence as of her 3-month follow-up. Discussion: The presentation of a strangulated obturator hernia can be elusive. During clinical examination, both the Howship–Romberg sign and the Hannington-Kiffs sign tests may be negative. Laparoscopic obturator hernia repair has been shown to reduce hospital stay and morbidity. A midline laparotomy has the advantage of easy manual reduction, minimizing bowel trauma, accurately accessing the bowel, and facilitating bowel resection. Conclusion: Obturator hernias constitute rare subtypes of abdominal hernias. They typically occur in older women, and patients often present with poor functional status and multiple comorbidities. The clinical diagnostic tests are uncertain, even in patients with a high index of suspicion. Timely diagnosis and appropriate surgical management are crucial for a favorable outcome.

Abstract 7650: An analysis of the prognostic role of sarcopenia derived with fully automated deep learning slice-based muscle estimation in patients with metastatic non-small cell lung cancer (NSCLC)

Abstract Introduction: Sarcopenia, progressive and generalized loss of skeletal muscle mass, is difficult and labor intensive to directly measure as it requires manual segmentations by radiologists from computed tomography (CT) scans. Sarcopenia has been shown to be a prognostic factor in some metastatic cancers. We evaluated the impact of sarcopenia derived via an automated segmentation algorithm on outcomes in the Phase 3 NSCLC clinical trial, CheckMate 227 (NCT02477826) Methods: The sarcopenia score assessment involves automated selection of the L3 vertebra level slice from abdominal or chest, abdomen, and pelvis (CAP) CT scans, followed by automated segmentation of the muscle area from that slice. Sarcopenia scores were derived from previously established definitions of sarcopenia, with values below 41 cm2/m2 for female patients (regardless of BMI) and below 43 cm2/m2 or 53 cm2/m2 for male (based on BMI &amp;lt; 25 kg/m2 or ≥ 25 kg/m2). Among the 967 patients with evaluable scans, sarcopenia at baseline was identified in 68.39% (n=329/481) patients receiving nivolumab (NIVO) with ipilimumab (IPI) and 70.2% (n=341/486) receiving chemotherapy (Chemo). Results: There was a trend of worse overall survival (OS) in patients with baseline sarcopenia across both treatment arms (minimum follow up 49.4 months). In patients with baseline sarcopenia vs ITT, median OS was 16.5 mo vs. 21.8 mo (p= 0.219) within the NIVO + IPI arm and 12.9 mo vs.15.0 mo (p= 0.273) within the Chemo arm respectively. Any increase in muscle mass from baseline to week 12 was associated with better OS for patients treated with NIVO+IPI (n=98) with sarcopenia at baseline compared to those without an increase in muscle mass (median OS 45.3 mo vs.19.5 mo, p= 0.012). This was not seen in those who received Chemo (n=87). Weight and muscle mass were moderately correlated at baseline (r=0.60). Conclusions: We found that in CheckMate 227, baseline sarcopenia is associated with numerically worse OS, regardless of treatment, leading to potential use as a negative prognostic biomarker. Patients with NSCLC receiving immunotherapy might benefit from changes in muscle mass being monitored during treatment. Validation of these findings in other studies and other tumor types is warranted. Citation Format: Wiem Safta, Rafael Santana-Davila, David Paulucci, William J. Geese, Diederik J. Grootendorst. An analysis of the prognostic role of sarcopenia derived with fully automated deep learning slice-based muscle estimation in patients with metastatic non-small cell lung cancer (NSCLC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7650.

Postmenopausal onset of androgen excess: a diagnostic and therapeutic algorithm based on extensive clinical experience

PurposePostmenopausal hyperandrogenism is a rare condition that requires identifying those women bearing a life-threatening tumor. We aimed to study diagnostic work-up and management of postmenopausal androgen excess, proposing an algorithm for clinical decision supporting.MethodsWe conducted an observational cross-sectional study and longitudinal follow-up including 51 consecutive menopausal patients reported for hyperandrogenism between 2003 and 2023 to our clinics. We assessed diagnostic testing accuracy and performance by receiver operating characteristic curves, their respective areas under the curve (AUCROC), and 95% confidence intervals (95%CI), for distinguishing between benign and malignant conditions, and androgen excess source.ResultsMost commonly, postmenopausal hyperandrogenism derived from benign conditions such as ovarian hyperthecosis (n = 9). However, four (8%) patients had borderline/malignant tumors arising at the ovaries (n = 3) or adrenals (n = 1). These latter were more likely to develop virilization than those with benign disorders [specificity(95%CI)]: 0.87 (0.69; 0.92)]. Circulating total testosterone [AUCROC(95%CI): 0.899 (0.795; 1.000)] and estradiol [AUCROC(95%CI): 0.912 (0.812; 1.000)] concentrations showed good performances for discriminating between both conditions. Transvaginal-ultrasonography found two out of three potentially malignant ovarian neoplasms, and another was apparent on a pelvic computed tomography scan. An adrenal computed tomography scan also located an androgen-secreting carcinoma.ConclusionsClinical or biochemical features of an aggressive androgen-secreting tumor should lead to urgently obtaining a targeted imaging. At first, an abdominal-pelvic CT scan represents the best choice to perceive adrenal malignancy, and may identify aggressive ovarian tumors. When warning signs are lacking, a calm and orderly work-up allows properly addressing the diagnostic challenge of postmenopausal hyperandrogenism.

Radiologic patterns of distant organ metastasis in advanced breast cancer patients: Prospective review of computed tomography images.

Breast cancer (BC) metastases to the abdomen and pelvis affect the liver, mesentery, retroperitoneum, peritoneum, bladder, kidney, ovary, and uterus. The study documented the radiological pattern and features of the chest, bone, abdominal and pelvic (AP) metastases among advanced BC patients. The aim is to document the radiological pattern and features of breast cancer metastasis in the chest, abdomen, pelvis and bones. Chest, abdominal, and pelvic computed tomography scan images of 36 patients with advanced BC were collated from Cape Coast Teaching Hospital and RAAJ Diagnostics. The images were prospectively assessed for metastasis to the organs of the chest, AP soft tissues, and bones. Radiologic features of metastasis of the lungs, liver, lymph nodes (LNs), and bones were documented. Patients' demographics, clinical data, and histopathology reports were also collected. The data were captured using UVOSYO and exported to Microsoft Excel templates. The data obtained were descriptively analyzed. Only 2.8% of BCs exhibited metaplastic BC, whereas 97.2% had invasive ductal BC. Triple-negative cases were 55.6%. Of 36 patients, 31 (86.1%), 21 (58.3%), and 14(38.8%) were diagnosed of chest, AP, and bone tissues metastasis, respectively. LN involvement was reported in 26 (72.2%) patients. Majority, 21 (58.3%) were diagnosed of multiple sites metastasis with 15 (41.7%) showing single site. Lungs (77.4%, 24/31) and liver (47.6%, 10/21) were the most affected distant organs. Most bone metastases were lytic lesions (92.9%, 13/14) with the vertebrae (85.7%, 12/14) been the most affected. According to the study, advanced BC patients have a higher-than-average radiologic incidence of lung, liver, bone, and LN metastases.

Three-dimensional Volumetric Visceral and Subcutaneous Fat Analysis on Opportunistic Computed Tomography Imaging of Patients With Greater Trochanteric Pain Syndrome Compared With Those With Predominant Osteoarthritis: A Case-Control Study.

This study aimed to address the gap in knowledge assessing the impact of visceral and subcutaneous body fat on 3-dimensional computed tomography imaging in patients with greater trochanteric pain syndrome (GTPS) in comparison with those primarily diagnosed with osteoarthritis (OA). We evaluated adult patients with a confirmed diagnosis of GTPS from our institutional hip-preservation clinic spanning 2011 to 2022. Selection criteria included their initial clinic visit for hip pain and a concurrent pelvis computed tomography scan. These patients were age- and sex-matched to mild-moderate OA patients selected randomly from the database. Visceral and subcutaneous fat areas were measured volumetrically from the sacroiliac joint to the lesser trochanter using an independent software. Interreader reliability was also calculated. A total of 93 patients met the study criteria, of which 37 belonged to the GTPS group and 56 belonged to the OA group. Both groups were sex and race matched. Average age in GTPS and OA groups was 59.3 years and 56 years, respectively. For GTPS group, average body mass index was 28.9 kg/m 2 , and for the OA group, average body mass index was 29.9 kg/m 2 , with no significant difference ( P > 0.05). Two-sample t test showed no significant differences in the visceral fat, subcutaneous fat, or the visceral fat to total fat volume ratio between the GTPS and OA groups. There was excellent interreader reliability. Our results indicate that there is no significant difference in fat distribution and volumes among GTPS and OA patients. This suggests that being overweight or obese may not be directly linked or contribute to the onset of GTPS. Other factors, such as gluteal tendinopathy, bursitis, or iliotibial band syndrome, might be responsible and need further investigation.

A pictorial review of scrotal and penile pathology on computed tomography.

Computed tomography (CT) may show a variety of scrotal and penile pathologic finding, but is usually not used as a first-line imaging due to its limited soft tissue contrast. Nonetheless, there are three main scenarios for imaging of the scrotum and penis with CT. Pathologies may be found incidentally in patients undergoing abdominal and pelvic CT scanning for different reasons. In emergency settings, CT is frequently performed, and the recognition of scrotal and penile pathologies by the reporting radiologist is crucial to ensure optimal patient treatment and outcome. If MRI scanning cannot be performed due to contraindications or is unavailable in resource, limited CT may be used for the further characterization of scrotal and penile pathology found on ultrasound. This pictorial review wants to familiarize general and emergency radiologists with the anatomy and possible pathological findings of the scrotum and penis on CT.

Correlation of Liver Attenuation with Visceral Fat Area on Computed Tomography Scan: An Analytical Study

Introduction: In the modern world, owing to rapid urbanisation and changes in lifestyles and dietary habits, obesity has emerged as a leading problem. As a result, various morbid conditions have come into the picture which have severe effects on an individual’s life expectancy. Visceral fat plays an important role in causing fatty liver. Aim: To determine the relationship between visceral fat area and liver fat using Computed Tomography (CT). Materials and Methods: A retrospective analytical study was conducted at Dr. D.Y. Patil Medical College, Hospital, and Research Centre Pune, Maharashtra, India. The CT scans of 134 patients who underwent CT scans of the abdomen pelvis and CT KUB/CT IVU between January 2022 and June 2022 were assessed by two experienced body imaging medical doctors. Subjects aged between 18 and 75 years were included without any co-morbidities like diabetes or hypertension. Waist circumference, subcutaneous fat area, and visceral fat area were calculated at the umbilical level. The CT attenuation value was measured in the right hepatic lobe, devoid of focal lesions and vessels, using a standard ROI of approximately 200 mm2 . Similarly, as an internal control, splenic attenuation was also recorded. Statistical tests were employed to determine the significance of the obtained values, including Spearman’s coefficient and Cohen’s criteria. Results: The CT attenuation of the liver (fatty liver) showed a moderate correlation with visceral fat (Spearman’s coefficient: 0.329). The association was statistically significant (p-value=0.0001). The CT attenuation of the liver (fatty liver) showed a weak correlation with subcutaneous fat (Spearman’s coefficient: -0.269). The association was statistically significant (p-value=0.0016). The CT attenuation of the liver (fatty liver) demonstrated a weak-moderate correlation with waist circumference (Spearman’s coefficient: -0.305). The association was statistically significant (p-value=0.0003). Conclusion: Visceral fat area has a stronger correlation with fatty liver than waist circumference and subcutaneous fat. Visceral fat should be considered a risk factor in the development of fatty liver, which may further lead to metabolic syndrome, in order to reduce mortality and morbidity related to it.

Shape phenotype of thigh fat and muscle and risk of major adverse cardiovascular events after fragility hip fracture.

Although sarcopenia has been recognized as a predictor of mortality in elderly patients with hip fracture, the association of thigh fat and muscle with cardiovascular (CV) outcome remains unclear. We examined the impact of computed tomography (CT)-derived shape features of thigh fat and muscle on major adverse CV events (MACE) in elderly patients with hip fracture. We conducted a retrospective analysis of consecutive patients aged ≥65years who presented with hip fracture confirmed on pelvic bone CT scan and underwent hip fracture surgery at our institution from April 2019 to December 2021. The cross-sectional area (CSA) and compactness (CM) of both the muscle and fat at the upper-thigh level were calculated from two-dimensional CT images using AVIEW Research (v1.1.38, Coreline Soft, Co. Ltd, Seoul, South Korea). The shape features of thigh fat and muscle were categorized into four groups based on the combination of CSA and CM: fat CSA (fat area [FA])/fat CM (FCM), muscle CSA (muscle area [MA])/muscle CM (MCM), FA/MCM and MA/FCM. In each of them, subjects were categorized into four subgroups: high CSA/high CM, high CSA/low CM, low CSA/high CM and low CSA/low CM. The primary outcome was MACE after 30days of surgery, defined as a composite of all-cause death, acute myocardial infarction, stroke or hospitalization for heart failure. Of 356 patients enrolled (median age, 82years; 76.7% females), 72 (20.2%) had MACE over a median follow-up of 13.1months (ranges 5.9-21.0months). Patients with MACE had a significantly lower median FA (193.7 vs. 226.2cm2 , P<0.0001) and FCM (0.443 vs. 0.513, P=0.001) compared with those without MACE, but no significant differences were found in MA, MCM and FA-MA ratio between the two groups. In a multivariate Cox regression analysis, low FA (<240.1cm2 ) (adjusted hazard ratio [HR] 2.99, 95% confidence interval [CI] 1.39-6.44, P=0.005) and low FCM (<0.477) (adjusted HR 2.00, 95% CI 1.10-3.63, P=0.023) were associated with an increased risk of MACE. Among the shape phenotypes of thigh fat and muscle, the thigh fat phenotype of low FA/low FCM (adjusted HR 3.13, 95% CI 1.81-5.42, P<0.0001 [reference, high FA/high FCM]) was found to be an independent predictor of MACE. In elderly patients with fragility hip fracture, thigh CT-derived measures of FA and FCM may provide useful prognostic information for predicting adverse CV outcomes.

Comparison of Pelvic Landmarks for Leg Length Discrepancy Measurement With Robotic Arm-Assisted Total Hip Arthroplasty

BackgroundLeg length discrepancy (LLD) is a common complication after total hip arthroplasty (THA) leading to significant morbidity and dissatisfaction for patients. A popular system for robotic arm-assisted THA utilizes preoperative computed tomography (CT) scans for surgical planning. Accurate measurement of leg length is crucial for restoring appropriate patient anatomy during the procedure. This study investigates the interobserver and interlandmark reliability of 3 different pelvic landmarks for measuring preoperative LLD. MethodsWe compiled preoperative pelvic CT scans from 99 robotic arm-assisted THAs for osteoarthritis. Radiologic leg length measurement was performed using the robotic arm-assisted THA application by 2 orthopaedic residents using reference lines bisecting the following pelvic landmarks: the anterior superior iliac spines, acetabular teardrops, and most inferior aspect of the ischial rami. ResultsOn multivariate analysis, there was no significant difference found (P value = .924) for leg length measurement based on the 3 different pelvic anatomical landmarks. Leg length measurements showed interobserver reliability with significant Pearson correlation coefficients (r = 1.0, 0.94, 0.96, respectively) and nonsignificant differences in LLD means between subjects on paired sample (P value = .158, .085, 0.125, respectively) as well as between landmarks on pairwise comparison. ConclusionsThe 3 pelvic landmarks used in this study can be used interchangeably with the lesser trochanter as the femoral reference point to evaluate preoperative LLD on pelvic CT in patients undergoing robotic-arm assisted THA. This study is the first of its kind to evaluate the interobserver and interlandmark reliability of anatomical landmarks on pelvic CT scans and suggests interchangeability of 3 pelvic landmarks for comparing leg length differences.

Non-target embolic events during prostatic embolization with ethylene vinyl alcohol copolymer (EVOH)

BackgroundThis study evaluated nontarget embolization (NTE) during prostatic artery embolization (PAE) with ethylene vinyl alcohol copolymer (EVOH).ResultsTen consecutive patients treated by PAE with EVOH for the presence of disabling benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS) between June 22 and January 2023 were included in this prospective study. The inclusion criteria were as follows: LUTS attributed to BPH, LUTS duration ≥ 6 months, failure to respond to standard pharmacotherapy, IPSS > 18 or QoL score > 2, and prostate volume > 40 mL. Embolization was performed under general anaesthesia. According to established techniques, a microcatheter was positioned bilaterally within the feeding arteries, and EVOH was injected slowly under X-ray control. Unenhanced pelvic computed tomography scans were carried out before and after embolization to assess the NTE. The safety of the prostatic embolization procedure with EVOH was assessed by collecting adverse effects over 3 months of evaluation that included the International Prostate Symptom Score (IPSS) and quality of life (QoL) score.-up evaluations, occurring at 3, 6, and 12months, included International Prostate Symptom Score.Bilateral PAE was technically successful in 9 patients, and unilateral injection was performed in one patient. The postoperative scanner showed a distribution of the embolization material in the two lobes of the prostate in all patients. The procedure time varied from 120 to 150 (mean: 132) minutes. Eight out of 10 patients developed pollakiuria within 24 h; none of the patients had postoperative pain. Two patients required catheterization for postoperative urinary retention. Catheters were removed successfully at the end of the first day for one of these patients and on the tenth day for the other. At the 3-month follow-up, patients showed significant improvement in the International Prostate Symptom Score (n = 10; mean = -11,5; P < 0.01) and quality of life score (n = 10; mean = -3,40; P < 0.01). Only one patient presented one asymptomatic muscular NTE.ConclusionsPAE with EVOH is safe, effective, and associated with few NTEs and no postoperative pain. Prospective comparative studies with longer follow-ups are warranted.Trial registrationIDRCB, 2021-AO29-56–35. Registered 27 May 2022, http://clinicaltrials.gov/study/NCT05395299?cond=embolization&term&rank=1.

PELVİS TİPLERİNİN TRANS-SAKRAL VİDA KORİDOR ÇAPINA ETKİSİNİN DEĞERLENDİRİLMESİ (BİLGİSAYARLI TOMOGRAFİ VERİLERİ KULLANILARAK YAPILAN RETROSPEKTİF ANALİZ.)

Aims: The aim of this study was to investigate the effect of pelvis type on the trans-sacral(TS) screw corridor diameter.&#x0D; Methods: Pelvis computed tomography (CT) scans between 2017 and 2020 were retrospectively reviewed. Age, gender, height, weight and body mass index (BMI) of the patients were determined during the CT examination. Pelvic CT scans were examined using the imaging system's multi-plane reconstruction (MPR) mode, and the TS screw corridor was measured for both the upper and second sacral segments. In addition, pelvic incidence (PI), sacral tilt (SS), and pelvic tilt (PT) values were measured. Pelvis typing was performed using the large transverse diameter, anteroposterior diameter, interspinous, intertuberocytosis, transverse outlet diameter, sagittal mid-pelvic diameter, and sagittal outlet values.&#x0D; Results: 81(38%) male and 132(62%) female patients were included in the study. Gynecoid pelvis type was more common in females and android pelvis in males (p &lt; 0.001). The largest diameters in the TS screw corridor at the S1 level belonged to the anthropoid pelvis type. However, in the TS corridor at the S2 level, there was a significant difference between the pelvis-type groups in the mean values of AP and CC (p &lt; 0.001). The effect of gender difference on the TS screw corridor width at the S1 and S2 levels was significant. An adequate corridor width for the TS screw corridor was detected in 50.8% of females and 67.9% of males at the S1 level, while in 21.2% of females and 70.4% of males at the S2 level.&#x0D; Conclusions: There is a significant difference in the dimensions of the trans-sacral screw corridor according to the pelvis type and gender, with the largest diameter observed in the anthropoid pelvis type and males. In critical situations, especially in males and individuals with android-anthropoid pelvis, the trans-sacral screw option should be considered primarily not only for the S1 trans-sacral corridor but also for the S2 trans-sacral corridor in pelvic posterior ring injuries

Computer-aided diagnosis for screening of lower extremity lymphedema in pelvic computed tomography images using deep learning

Lower extremity lymphedema (LEL) is a common complication after gynecological cancer treatment, which significantly reduces the quality of life. While early diagnosis and intervention can prevent severe complications, there is currently no consensus on the optimal screening strategy for postoperative LEL. In this study, we developed a computer-aided diagnosis (CAD) software for LEL screening in pelvic computed tomography (CT) images using deep learning. A total of 431 pelvic CT scans from 154 gynecological cancer patients were used for this study. We employed ResNet-18, ResNet-34, and ResNet-50 models as the convolutional neural network (CNN) architecture. The input image for the CNN model used a single CT image at the greater trochanter level. Fat-enhanced images were created and used as input to improve classification performance. Receiver operating characteristic analysis was used to evaluate our method. The ResNet-34 model with fat-enhanced images achieved the highest area under the curve of 0.967 and an accuracy of 92.9%. Our CAD software enables LEL diagnosis from a single CT image, demonstrating the feasibility of LEL screening only on CT images after gynecologic cancer treatment. To increase the usefulness of our CAD software, we plan to validate it using external datasets.

Comparative analysis and assessment of radiological investigation reports for abdomen and pelvic computed tomography scans

Background: Medical imaging modalities have significantly improved the accuracy and timeliness of diagnoses over the years; they also present a risk of diagnostic errors due to various factors. One of the primary issues is the variation in findings between preliminary and final reports, specifically for current imaging technologies such as magnetic resonance imaging, and computed tomography (CT) among others. Although several studies have investigated variations between preliminary and final reports in different contexts, research specific to the radiology department is limited. Through this study protocol, we aim not only to help provide a comprehensive evaluation of the variation in findings between preliminary and final diagnostic reports in radiology but also aid in improving the accuracy and quality of patient care and contribute to developing effective strategies to minimize diagnostic errors. Methods: A total of 128 male and female patients presenting to the radiology diagnosis department for abdomen and pelvic CT scans would be considered for the study. The radiological investigation reports for the scans would be interpreted by junior residents and radiologists. The reports will be manually compared to check for similarities, new findings, and exclusions. The degree and frequency of variability will be statistically assessed and reported in tabulations and graphs under the patient's age and gender. Discussion: This study seeks to investigate the differences in interpretations between resident and radiologist reports, consistent with previous research. The results of this study will provide insights into the variations in interpretations, highlighting the importance of continuous training. Examining the findings of a report as a whole can also deliver valuable knowledge into the potential impact on patient care. This can lead to enhancements in radiology reports and overall patient management. The implications involve improving the education of residents, optimising clinical decision-making processes, and promoting positive patient outcomes.

Capsular distension in high-energy femoral shaft fractures is associated with occult femoral neck fracture: a preliminary retrospective comparative study.

To determine the association between hip capsular distension, the computed tomography (CT) capsular sign, and lipohemarthrosis as they relate to occult femoral neck fracture (FNF) in the setting of ipsilateral femoral shaft fracture (FSF). Retrospective comparative study. Level 1 trauma center. Two hundred and forty-two patients with high-energy FSF and no evidence of FNF on preoperative radiographs and pelvis CT. All patients were stabilized with non-reconstruction style nails. Pelvis CT scans were examined for hip capsular distension irrespective of the other side, differing side-to-side measurements of capsular distension (i.e., the CT capsular sign), and lipohemarthrosis. FNF was observed for on postoperative radiographs. Relative risk (RR), number needed to treat (NNT), sensitivity (SN), and specificity (SP) were determined. Fifty-eight patients (24.0%) had capsular distension. Forty-two patients (17.4%) had differing capsular measurements (i.e., the CT capsular sign), and 16 (6.6%) had symmetrical distension from bilateral hip effusions. Eight patients (3.3%) had lipohemarthrosis. Four FNFs (1.7%) were identified. Three patients had capsular distension, 2 had CT capsular signs, and 1 had lipohemarthrosis. The last patient had no CT abnormalities. Only capsular distension (RR = 10, CI = 1.001-90, P = 0.049; SN = 75%, SP = 77%; NNT = 22) and lipohemarthrosis (RR = 23, CI = 1.6-335, P = 0.022; SN = 50%, SP = 96%; NNT = 8) were associated with occult FNF. Capsular distension is associated with FNF irrespective of the contralateral hip. Preemptive stabilization using a reconstruction nail could be considered in the setting of capsular distension or lipohemarthrosis to prevent displacement of an occult FNF. Diagnostic Level III.

Prevalence and predictors of radiological left common iliac vein compression in asymptomatic patients

ObjectiveThe aim of this study was to investigate the prevalence of radiological left common iliac vein (LCIV) compression among the asymptomatic population and identify possible predictors. MethodsContrast-enhanced abdominal and/or pelvic computed tomography scans of eligible asymptomatic patients were examined. The LCIV diameter was measured from different horizontal planes in the venous phase using PACSView. Degree of LCIV compression (Dc) was calculated by a predefined formula and graded as insignificant (Dc < 25%), mild (≥25% Dc < 50%), moderate (≥50% Dc <75%), and severe (Dc ≥ 75%). Venous stenosis was defined as a Dc of ≥50%. Comparison of variables, including gender, age, body mass index (BMI), and comorbidities was performed between the different grades of LCIV compression. ResultsBetween November 2019 and July 2022, 1698 eligible asymptomatic patients (53.1% females; mean age, 39.3 ± 11.8 years; mean BMI, 22.9 ± 3.6 kg/m2) were reviewed. The mean Dc was 46.2% (range, 0.29%-90.4%). Insignificant, mild, moderate, and severe compression were distributed in 14.5%, 38.0%, 42.2%, and 5.2% of the cohort population, respectively. Prevalence of venous stenosis was higher in females than males (58.1% vs 42.2%; χ2 = 15.52; P < .001). Females aged ≥25 and <35 years accounted for the highest proportion of venous stenosis than other age groups and was a significant predictor (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.74-7.79; P < .001). In the Asian BMI classification group, being underweight is associated with venous stenosis (OR, 4.69; 95% CI, 2.70-8.14; P < .001) and obesity may be a protective factor (OR, 0.38; 95% CI, 0.23-0.64; P < .001). There is an inverse relationship between Dc and age and BMI. ConclusionsThe prevalence of radiological LCIV compression on computed tomography scans was high, but all patients were asymptomatic. Female gender, especially those aged ≥25 and <35 years, and underweight were possible predictors for venous stenosis.