Preferred Imaging Modality Research Articles

Tu1501 ADDITION OF LINKED COLOR IMAGING TO WHITE LIGHT ENDOSCOPY IMPROVES DELINEATION PERFORMANCE OF EARLY GASTRIC CANCER LESIONS BY NON-EXPERT ENDOSCOPISTS

Early gastric cancer lesions are subtle, focally distributed, and poorly visible endoscopically. Therefore, endoscopists have difficulties evaluating these subtle early gastric cancer lesions. The aim of this study was to evaluate the role of linked color imaging (LCI) for the visualization of early gastric cancer in comparison to white light endoscopy (WLE) alone, when assessed by non-expert endoscopists. 40 unique cases of early gastric cancer, visualized in both WLE and LCI, were collected for this study. To establish ground truth, all cases were delineated by three expert endoscopists from Japan. Using a web based module, these cases were delineated by 48 non-expert endoscopist assessors of four different countries (Japan, Netherlands, Portugal and Sweden). Endoscopic expertise was divided into different levels: fellow in training, junior endoscopist and senior endoscopist. The module consists of three assessment phases, with a wash-out period of 2 weeks in between each phase. Assessment 1: WLE alone; Assessment 2: LCI alone; Assessment 3: WLE+LCI in a side-to-side display. The outcomes of this study were: 1) overlap between assessors’ delineation and expert ground truth; 2) assessors’ delineation performance in terms of differentiating between neoplastic tissue and normal tissue; 3) ability to delineate the lesions (VAS-scores 1-10); 4) assessors’ preferred imaging modality (WLE, LCI or no preference). Linear mixed-effect models showed a significant increase in assessors’ delineation performance from 77% (SD 26%) in WLE alone and 75% (SD 28%) in LCI alone to 81% (SD 24%) when combining both imaging modalities (P < 0.001). When differentiating neoplastic from non-dysplastic tissue, the combination WLE+LCI also caused increased performance scores (49% in WLE and 49% in LCI to 53% in WLE+LCI; P < 0.001). Japanese assessors performed significantly better than Dutch, Portuguese and Swedish assessors when delineating early gastric cancer lesions, regardless of imaging modality (87% vs. 71%, 72% and 73% respectively; P < 0.001). There was no distinction between the different levels of endoscopic expertise. Median VAS scores were higher for phase 2 (6; IQR 5-8) and 3 (7; IQR 5-8) compared with phase 1 (5; IQR 3-7) for the ability to delineate the lesion (P < 0.001). Assessors preferred LCI over WLE (72.4% vs. 5.2%, 22.4% no preference) for the appreciation of early gastric cancer lesions. The combined use of WLE and LCI resulted in enhanced delineation of early gastric cancer lesions by non-expert endoscopists. Although assessors appreciated the ability of LCI for delineation better than WLE, there was no difference in separate delineation scores for LCI and WLE.

The role of imaging in the diagnosis and management of Peyronie's disease.

Several imaging modalities exist for the assessment of Peyronie's disease. However, comprehensive recommendations for using these objective modalities based on large-scale evidence-based studies do not yet exist. Our objective is to evaluate current imaging techniques and provide a model that we follow in our clinic in the workup and management of Peyronie's disease. Computed tomography and radiography excellently visualize penile plaque calcifications, and MRI adeptly identifies plaques in complex locations, such as the corporal septum. Ultrasonography has extensive applications in plaque localization and characterization. Used along with color Doppler ultrasound, it is capable of detecting vascular abnormalities. Sonoelastography is an emerging subtype of ultrasongraphy that utilizes elastic properties of tissue to identify penile plaques that may not be visualized with other modalities. Ultrasonography is the preferred imaging modality in Peyronie's disease and noninvasively characterizes penile plaques and monitors plaque response to various treatments. At our center, we perform ultrasonography with intracavernosal injection in all patients with Peyronie's disease to evaluate the degree of curvature, plaque characteristics, and concomitant erectile dysfunction to better guide management decisions.

Imaging modalities for inguinal hernia diagnosis: a systematic review.

The aim of the study was to determine which diagnostic modality [Computerized Tomography (CT), Magnetic Resonance Imaging (MRI), or ultrasound (US)] is more precise in terms of sensitivity and specificity in diagnosing inguinal hernia and sub-type of inguinal hernia (direct or indirect). This systematic review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and a search for relevant articles was undertaken in PubMed, Embase, and theCochrane Library. Inclusion criteria were original studies that preoperatively diagnosed patients suspected of inguinal hernia by either CT, MRI, or US and compared diagnostic findings with operative findings or definitive follow-up. The main outcomes were the diagnostic certainty of inguinal hernia and type of hernia by sensitivity and specificity. All eligible studies were searched in the Retraction Watch database to ensure that all included studies were suitable for inclusion. Bubble charts depicting the size of each patient cohort and percentual range for both sensitivity and specificity showed that US was better than CT and MRI in diagnosing inguinal hernia. Bubble charts for US and CT depicted high values within the studies that reported sensitivity and specificity in diagnosing type of hernia. We found that US had the highest sensitivity and specificity. However, it must be taken into consideration that performance is highly dependent on the operator's level of expertise. Based on this systematic review, ultrasound may be the preferred imaging modality when physical examination is inconclusive, given that local expertise in performing US examination for hernia disease is adequate.

Techniques for Improving Ultrasound Visualization of Biopsy Markers in Axillary Lymph Nodes.

Objective:Biopsy markers are often placed into biopsy-proven metastatic axillary lymph nodes to ensure later accurate node excision. Ultrasound is the preferred imaging modality in the axilla. However, sonographic identification of biopsy markers after neoadjuvant therapy can be challenging. This is due to poor conspicuity relative to surrounding parenchymal interfaces, treatment-related alteration of malignant morphology during neoadjuvant chemotherapy, or extrusion of the marker from the target. To the authors’ knowledge, the literature provides no recommendations for ultrasound scanning parameters that improve the detection of biopsy markers. The purpose of this manuscript is 3-fold: (1) To determine scanning parameters that improve sonographic conspicuity of biopsy markers in a phantom and cadaver model; (2) to implement these scanning parameters in the clinical setting; and (3) to provide strategies that might increase the likelihood of successful ultrasound detection of biopsy markers in breast imaging practices.Materials and Methods:An ex vivo study was performed using a phantom designed to simulate the heterogeneity of normal mammary or axillary soft tissues. A selection of available biopsy markers was deployed into this phantom and ultrasound (GE LOGIQ E9) was performed. Scanning parameters were adjusted to optimize marker conspicuity. For the cadaver study, the biopsy markers were deployed using ultrasound guidance into axillary lymph nodes of a female cadaver. Adjustments in transducer frequency, dynamic range, cross-beam (spatial compound imaging), beam steering, speckle reduction imaging, harmonic imaging, colorization, and speed of sound were evaluated. Settings that improved marker detection were used clinically for a year.Results:Sonographic scanning settings that improved biopsy marker conspicuity included increasing transducer frequency, decreasing dynamic range, setting cross-beam to medium hybrid, turning on beam steering, and setting speckle reduction imaging in the mid-range. There was no appreciable improvement with harmonic imaging, colorization, or speed of sound.Conclusion:On a currently available clinical ultrasound scanning system, ultrasound scanning parameters can be adjusted to improve the conspicuity of biopsy markers. Overall, optimization requires a balance between techniques that clinically increase contrast (dynamic range, harmonic imaging, and steering) and those that minimize graininess (spatial compound imaging, speckle reduction imaging, and steering). Additional scanning and procedural strategies have been provided to improve the confidence of sonographic detection of biopsy markers closely associated with the intended target.

Intravenous Immunoglobulin Infusion Reactions in Kawasaki Disease Patients Who Undergo Sedation.

Although IVIG infusions are usually well tolerated, reactions can include hypotension, chills, and, rarely, anaphylactic reactions. Risk of adverse reactions correlates with dose and rate of IVIG infusion. An echocardiogram is the preferred imaging modality to detect coronary artery changes in acute Kawasaki disease (KD), but the quality of the study can be compromised if a child moves much during the imaging procedure. Thus, sedation is often required for children younger than 3 years of age. There is concern regarding coadministration of IVIG and sedatives. Therefore, the purpose of this analysis is to determine when the majority of IVIG infusion reactions occur to help find the optimal time to safely perform a sedated echocardiogram in patients with KD. This is a retrospective, single-center analysis of patients with KD administered IVIG at Rady Children's Hospital San Diego from November 1, 2013, to October 31, 2016. Of the 260 subjects in this study, 34 (13%) had an IVIG infusion reaction consisting of either chills or hypotension. There were no anaphylactic reactions. All infusion reactions occurred within 4 hours of starting IVIG. No hypotension reactions occurred after 4 hours. All subjects were able to complete their IVIG infusion without any further complications. Given that the maximum IVIG infusion rate is reached at 1.5 hours per our hospital's policy and that the overwhelming majority of infusion reactions occurred within the first 4 hours, we found it is safe to coadminister IVIG with sedation 4 hours after initiation of IVIG infusion.

Cardiac Magnetic Resonance Versus Single-Photon Emission Computed Tomography for Detecting Coronary Artery Disease and Myocardial Ischemia: Comparison with Coronary Angiography.

Background: This study aimed to compare the diagnostic accuracy of stress single-photon emission computed tomography (SPECT) and stress cardiac magnetic resonance (CMR) for the assessment of coronary artery disease (CAD) in the same patients, using coronary angiography as the reference standard. Methods: Thirty patients with known or suspected CAD who were referred for exercise SPECT myocardial perfusion imaging (MPI) for the evaluation of myocardial ischemia underwent stress CMR MPI and computed tomography coronary angiography (CTCA) or selective coronary angiography (SCA). The data from the two stress modalities were compared against the data from angiography. Results: In our study population, 30% of the recruited subjects had significant CAD. The CMR sensitivity for the detection of significant CAD and/or myocardial ischemia was 89% and specificity was 76%. For SPECT, the corresponding sensitivity was 78% and specificity was 52%. The negative predictive value was 92% for CMR and 83% for SPECT. The receiver-operating characteristic (ROC) analysis evaluating the presence of significant CAD, CMR (area under the curve (AUC) 0.78) outperformed SPECT (AUC 0.59) (p < 0.01). The ROC analysis evaluating the presence of myocardial ischemia was also in favor of CMR (AUC 0.82) versus SPECT (AUC 0.67) (p < 0.01). Conclusions: CMR has high diagnostic accuracy for the detection of CAD and stress-induced ischemia and appears to outperform SPECT. CMR may thus be the preferred noninvasive imaging modality to assess patients with known or suspected CAD.

Hepatobiliary MRI Contrast Agents: Pattern Recognition Approach to Pediatric Focal Hepatic Lesions.

OBJECTIVE. The purposes of this article are to review currently available hepatobiliary contrast agents, discuss techniques for optimization of pediatric liver MRI with hepatobiliary contrast agents, and review the imaging features of several pediatric hepatic lesions, focusing on their assessment with hepatobiliary contrast agents. CONCLUSION. MRI is the preferred imaging modality for complete assessment of focal liver lesions in the pediatric population. Imaging with gadolinium-based hepatobiliary contrast agents yields beneficial information about many focal liver lesions encountered in pediatric patients.

Ultrasound of sports injuries of the musculoskeletal system: gender differences.

In recent years, women and girls are increasing their sport participation, and female sports are becoming more challenging. While more women and girls are participating in sports, there is still a lack of information about gender-specific lesions. We will therefore evaluate gender differences in sports injuries, analyzing the five sports and sporting activities that are most widespread in the western world: running, soccer, basketball, water sports, and winter sports. The ability to make correct ultrasonographic diagnoses in sports injuries is improving as the technology is advancing. Ultrasonography demonstrates tissue structure with two-dimensional grayscale images, while blood flow can be visualized with color and power Doppler. Furthermore, ultrasonography is the preferred imaging modality for studying soft-tissue lesions dynamically. High-quality diagnostic ultrasound cannot be performed without the knowledge of the underlying clinical background, and an understanding of gender-specific injuries and mechanisms of injuries is therefore important for assessing proper diagnostic and treatment guidelines tailored to phenotypic differences in professional and amateur athletes between male and female.

Comparison of Volumetric Fat Suppressed Proton Density and Standard Routine MR Sequences in the Evaluation of Meniscal Tears

Abstract Background: The knee joint is the most common joint liable for injuries with knee MRI being the most preferred imaging modality for the assessment of knee pain. The com-monest indications are the evaluation of the meniscal lesions, and ligamentous injuries. Arthroscopy is considered the gold standard tool for the assessment of knee derangement, although knee MR exami-nation has shown significant influence upon the clinicians' management decisions. Current standard two dimensional MR protocol is time consuming with limitations of these sequences that have to be considered. Volumetric fat suppressed proton density sequence is used with the advantage of faster acquisition in comparison with standard routine sequences. The volumetric PD FS sequence can demonstrate similar diagnostic results to that of the standard three planes sequences in the assessment of internal knee derangement especially as regards meniscal injuries. Aim of Study: To assess the diagnostic accuracy of volu-metric fat suppressed proton density sequence versus standard two dimensional (2D) sequences at 1.5T MR in the evaluation of meniscal tears. Patients and Methods: The study included 81 patients presenting with suspected post traumatic meniscal injury. Patients were referred to the Kasr Al-Aini Hospital Radiology Department between February 2018 and January 2019 after full clinical examination to evaluate their knee joints using MRI. Results: In our study the results showed typical concord-ance between standard two dimensional (2D) three planes sequences and volumetric fat suppressed proton density sequence in the detection of medial and lateral meniscal tears after using arthroscopy as the gold standard. Both sequences showed sensitivity=95.92%, specificity=100%, Positive Pre-dictive Value (PPV)=100%, Negative Predictive Value (NPV) =94.12% and accuracy=97.53% for Medial Meniscal (MM) tears as well as sensitivity=75%, specificity=100% PPV=100%, NPV=94.2% and accuracy=95.06% for Lateral Meniscal (LM) tears. Conclusion: The volumetric fat suppressed proton density sequence had shorter acquisition time and delivered similar high diagnostic accuracy to the standard 2D sequences in diagnosing meniscal tears.

94: Should we abandon the use of Doppler flow as part of the evaluation of the patient with suspected ovarian torsion? A retrospective study in a large academic center

Ovarian torsion remains a gynecological emergency affecting all age groups. Within the setting of suspected ovarian torsion, pelvic ultrasound is the preferred imaging modality. Ultrasound Doppler interrogation of the ovarian vessel is frequently used to confirm the diagnosis of ovarian torsion. The objective of this study is to determine the value of Doppler flow ultrasound imaging in the preoperative evaluation of the patient with clinical suspicion of ovarian torsion. This is a retrospective study of all patients with the diagnosis of “suspected ovarian torsion” who were taken to the operating room (OR) for surgical management from January 1st, 2014 to December 31st, 2018 in our academic hospital. Patients with diagnosis of suspected ovarian torsion who were managed medically and not taken to the OR were excluded from the analysis. A total of 60 patients met the inclusion criteria, and of those, 58 had Doppler flow imaging for the evaluation of ovarian torsion. Eight patients (13.79%) showed absent flow while 50 patients (86.20%) showed the presence of flow to the ovary. When taken to the OR, 47 had a confirmed diagnosis of ovarian torsion. The results of the use of Doppler flow were as follows: sensitivity 17%, specificity 100%, positive predicted value 100%, and negative predicted value 22%. In our cohort, Doppler flow ultrasound is highly specific but not sensitive for detecting torsion. The use of Doppler flow ultrasound, although with great sensitivity, has an extremely low specificity for the evaluation of the patient with suspected ovarian torsion and should be interpreted with caution.

Routine follow-up imaging has limited advantage in the non-operative management of blunt splenic injury in adult patients

BackgroundTo date, limited evidence exists regarding follow-up imaging during the non-operative management (NOM) of blunt splenic injury (BSI), especially concerning ultrasound as first-line imaging modality. The aim of this study was to investigate the incidence and time to failure of NOM as well as to evaluate the relevance of follow-up imaging. MethodsAll adult patients with BSI admitted to our level I trauma center, including two associated hospitals, between 01/01/2010 and 31/12/2017 were retrospectively analyzed. Demographic data, comorbidities, injury pattern, trauma mechanism, Injury Severity Score, splenic injury grade and free intra-abdominal fluid were reviewed. Additional analysis of indication, frequency, modality, results and consequences of follow-up imaging was performed. Risk factors for failure of NOM were evaluated using fisher's exact test. ResultsA total of 122 patients with a mean age of 43.8 ± 20.7 years (16–84 years) met inclusion criteria. Twenty patients (16.4%) underwent immediate intervention. One-hundred-and-two patients (83.6%) were treated by NOM. Failure of NOM occurred in 4 patients (3.9%). Failure was significantly associated with active bleeding (3 of 4 [75%] failures vs. 8 of 98 [8.2%] non-failures, OR 33.75, 95% CI 3.1, 363.2, p = 0.004), and liver cirrhosis (2 of 4 [50%] failures vs. 0 of 98 [0%] non-failures, OR 197, 95% CI 7.4, 5265.1, p = 0.001). Eighty patients (78.4%) in the NOM-Group received follow-up imaging by ultrasound (US, n = 51) or computed tomography (CT, n = 29). In 57 cases, routine imaging examinations were conducted (43 US and 14 CT scans) without prior clinical deterioration. Fifty-fife (96.4%) of these imaging results revealed no new significant findings. Every failure of NOM was detected following clinical deterioration in the first 48 h. ConclusionTo our knowledge this study includes the largest single centric patient cohort undergoing ultrasound as first-line follow-up imaging modality in the NOM setting of BSI in adult patients. The results indicate that a routine follow-up imaging, regardless of the modality, has limited therapeutic advantage. Indication for radiological follow-up should be based on clinical findings. If indicated, a CT scan should be used as preferred imaging modality.

Tibial tubercle avulsion fractures in children.

To summarize and discuss the fundamentals of pediatric tibial tubercle avulsion fractures (TTAFs) including preferred imaging modalities, systems for fracture classification, frequently associated injuries, treatment options, outcomes, and common complications. Although TTAFs amount to fewer than 1% of all physeal injuries in children, the incidence is increasing, likely because of greater participation in high-level athletics. TTAFs tend to occur in adolescents nearing skeletal maturity who engage in sports with repetitive jumping. The most popular classification system was proposed by Ogden, which defines five fracture types based on the fracture pattern and extent of fragment displacement. Treatment can be nonsurgical or surgical, and indications depend on fracture type. Most fractures are surgical candidates and can be repaired with open reduction and internal fixation (ORIF) or arthroscopy. Arthroscopic approaches can reveal associated soft tissue injuries, such as meniscal tears, and confirm articular reduction. The most common postoperative complication is irritation because of hardware. With proper treatment, both nonsurgical and surgical outcomes are excellent. TTAFs have high rates of union and patients typically return to sports.

Preoperative management of locally advanced rectal cancer and the role of restaging MRI: An australasian perspective

Background: Major advances in the management of locally advanced rectal cancer has led to controversies and varying clinical practices among colorectal surgeons, such as patient selection for neoadjuvant therapy and preferred regimen for neoadjuvant therapy. In addition, the role of restaging scans post-neoadjuvant therapy is still poorly established. Objectives: To examine current practice in the preoperative management of locally advanced rectal cancer in Australasia and determine the value of restaging magnetic resonance imaging (MRI). Design: Cross-sectional study (survey). Setting: Specialist colorectal surgeons in Australia and New Zealand. Participants and Methods: A web-based survey was distributed to the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) members between December 2016 and February 2017. Information on demographics, imaging modalities used for staging, indications and choice of neoadjuvant therapy, as well as utility and perceived value of restaging MRI after neoadjuvant therapy was collected. Respondents were given hypothetical scenarios to assess their management decisions based on the findings of restaging MRI scans. Sample Size: 225. Main Outcome Measures: Preferred imaging modalities for staging and restaging of rectal cancer post-neoadjuvant therapy; indications and preferred regimen for neoadjuvant therapy; and utility and perceived value of restaging scans, particularly MRI, Results: Sixty-two (27.6%) CSSANZ members responded. Main neoadjuvant therapy indications included advanced T3 tumors (80.7% for T3c; 83.9% for T3d), T4 tumors (87.1%), nodal metastases (69.4% for N1; 77.4% for N2), and an involved circumferential resection margin (CRM) (95.2%). Long-course chemoradiotherapy was preferred for neoadjuvant therapy (80.6%). The preferred initial-stage imaging modalities were MRI (100%) and computed tomography of chest, abdomen, and pelvis (CT-CAP) (100%). Fifty-six (90.3%) respondents would perform restaging scans post neoadjuvant therapy in selected patients. An involved CRM was frequently identified as a feature on restaging MRI which may affect management (78.6%), with extramural venous invasion (EMVI) (7.1%) or tumor regression grading (TRG) (26.8%) rated less significant. Conclusion: Preoperative management of locally advanced rectal cancer in Australasia is generally consistent with current guidelines. Restaging MRI after neoadjuvant therapy undoubtedly has a role for guiding patient management, but larger prospective studies are warranted to firmly establish their place in daily clinical practice. Limitations: Poor response rate, leading to a small sample size; study population limited to colorectal surgeons in Australasia; and difficult to assess how restaging scans may change management plan. Conflict of Interest: None.

Role of Non invasive Imaging in Characterisation of Soft Tissue Vascular Anomalies: Comparison of Ultrasound with Contrast Enhanced Magnetic Resonance Imaging

Introduction: Soft tissue vascular anomalies present a diagnostic challenge. In these anomalies, imaging is crucial for therapeutic planning and improvement of prognosis. Ultrasound (US) and Contrast-Enhanced Magnetic Resonance Imaging (CEMRI) are both widely utilised and are valuable imaging modalities, both having distinct advantages and limitations in evaluation of such lesions. Aim: To evaluate soft tissue vascular anomalies using US and CEMRI and assess their agreement in characterisation of these lesions. Materials and Methods: The prospective study included 75 patients with vascular anomalies evaluated by means of US and CEMRI: 71 underwent both US and MRI, three underwent US alone, and one patient underwent MRI alone. Patients of all ages were included. Lesions were characterised based on imaging findings and vascular perfusion characteristics. Histopathological evaluation was done in all patients. Receiver Operating Characteristic (ROC) analysis was used for differentiating data. The agreement of US and CEMRI with histopathological diagnosis were assessed using kappa statistics. Results: Among the soft tissue vascular anomalies, 17 were haemangiomas, 55 were vascular malformations and 3 were other vascular tumours. Majority of the lesions were venous malformations (n=26; 34.66%). A cut-off value of 17.5 cm/sec of peak venous velocity using Colour Doppler showed 100% sensitivity in differentiating Arterio-Venous Malformations (AVM) from haemangiomas using ROC curves. Agreement expressed as kappa was 0.884 (95% CI 0.794-0.973) for US and 0.923 (95% CI 0.850-0.996) for CEMRI demonstrating near perfect agreement with histopathology in both. Conclusion: The findings of this study indicate that both US and CEMRI are accurate in detection and characterisation of soft tissue vascular anomalies showing comparable level of agreement. US may be the preferred imaging modality as it is widely available, relatively inexpensive and non invasive. Contrast enhanced MRI may be reserved as a complementary technique in cases wherein lesion categorisation or extent is ambiguous during diagnosis.

Spinal Epidural Abscess.

Spinal Epidural Abscess.

Inferior vena cava filter thrombosis: An overview

The leading long term and undervalued impediment associated with inferior vena cava (IVC) filter placement is said to be increased risk of venous thrombosis within and below the IVC. Anticoagulation remains the mainstay treatment preference for the management of deep-vein thrombosis (DVT) and pulmonary embolism (PE). Now and then, it is not viable due to bleeding complications or, occasionally, breakthrough PE associated with this treatment method. In these patients, the development of vena cava filters was a significant advancement in their management. Patients with IVC filters predominantly the ones placed with permanent filters are considered to be at a greater risk for the development of recurrent DVT. Cautious applications of IVC filters, along with retrieval of temporary IVC filters in good time, significantly diminishe the risk of IVC thrombosis. The proof of connection of IVC thrombosis with each of the following factors is known: Population demographics, history of or preexisting hypercoagulable states/anticoagulation, the manner in which the thrombus is assessed, and the duration since the filter employment. Most cases of IVC filter thrombosis are asymptomatic. Contrast-enhanced computed tomography is a preferred imaging modality compared to Doppler sonography. Here in this article, we attempt to discuss briefly the present ideas concerned with the indications of IVC filters along with the prevalence, risks, and management of IVC filter thrombosis.

Clinical evidence based review and systematic scientific review in the identification of malignant transformation of inverted papilloma

BackgroundInverted papilloma (IP) is an unusual type of benign tumor that has high recurrence rates and the potential to transform into squamous cell carcinomas (SCC). The mechanism of the transformation process from IP to IP-SCC is uncertain and there is no consensus regarding the best practice for IP-SCC detection. The goal of this study is to identify the best clinical methods to detect for IP-SCC.MethodsAn evidence-based review was performed using Medline and Ovid to obtain all articles up to October 10th, 2019 pertaining to identification of IP malignant transformation. All manuscripts discussing clinical methods or biomarkers were included.ResultsBased on clinical research studies, convoluted cerebriform pattern and apparent diffusion coefficient values on Magnetic Resonance Imaging (MRI) can help differentiate benign IP from SCC and increased SUVmax on PET/CT is associated with higher probability of malignancy although not as specific. No consensus about the best biomarker for IP-SCC has been reached among researchers and continues to be exploratory.ConclusionEndoscopy with biopsy is the gold standard practice to identify IP-SCC; however, MRI is the preferred imaging modality to recognize malignant transformation in cases where biopsy is difficult. Multiple biomarkers have shown positive results, but no single indicator with clinical significance for monitoring malignant transformation process has been found.

The Current and Future Role of Echocardiography for the Detection of Cardiotoxicity Related to Cancer Therapy

The purpose of this review is to outline the role of echocardiography in identifying patients at increased cardiovascular risk for cancer treatment-associated cardiotoxicity. With a wide array of cancer therapeutics, a variety echocardiographic cardiotoxicity phenotypes have been identified. Recent consensus statements from several professional societies have provided a framework for risk assessment prior to cancer therapy that involves assessment and optimization of cardiac risk factors but also involves echocardiographic evaluation of left ventricular (LV) function at baseline, during, and after treatment. While newer echocardiographic techniques such as global longitudinal strain are key to detecting subclinical cardiotoxicity, it is as yet unclear if strain-directed initiation of cardioprotective medications will result in better outcomes. This is the subject of an ongoing clinical trial, the results of which are eagerly awaited. Given the serial nature of echocardiographic assessments in the cancer population, the application of automated techniques for ejection fraction and strain may have the potential to further reduce measurement variability and are also subjects of ongoing research. Echocardiography is the preferred imaging modality for the detection of cardiotoxicity related to cancer therapy. Our expanded understanding of the cardiac side effects of cancer therapy and optimal surveillance strategies for those at risk is predicated on the ascertainment of cardiac outcomes in future clinical trials, for which echocardiography will undoubtedly play a pivotal role.

Comparision between Low-Dose CT and Ultrasound in Diagnosis of Renal and Uretral Stones in Adults

AbstractBackground: Non-contrast computed tomography of the kidneys, ureters, and bladder (CT KUB) is the examination of decision for renal colic when compared to ultrasonography; be that as it may, radiation presentation can be a worry.Aim of Study: Comparison between low dose CT and ultrasound in diagnosis of renal and uretral stones in adults.Patients and Methods: This prospective study was con-ducted on fifty Egyptian adults meeting the inclusion criteria of hading flank pain, suspected to have urinary tract calculi and recruited from Urology Department of Tanta University to Radiology Department at Tanta University Hospitals. All patients were applied to careful history taken, clinical and laboratory examination then underwent imaging studies which include renal ultrasound examination and MDCT-KUB using low dose protocol. Each depicted stone was documented whether it is renal or uretric. All the stones were also defined as single or multiple, unilateral or bilateral and the maximum diameter of them. In case of upper urinary tract calculi reliable secondary signs of obstructing calculi were demonstrated. These include hydronephrosis, hydroureter, ipsilateral renal enlargement and ureter rim sign. The findings were confirmed by comparing to the previous standard CT scans that were done and detected in the medical records for 20 patients, uretroscopy in 12 patients, percutenous nephro lithotomy in 8 patients, medical treatment and more follow-up for 10 patients. The sensitivity, specificity and size accuracy of US was determined using low dose CT as the standard.Results: Low dose CT showed number of renal and ureteral stones more than ultrasound with statistical significant p-value <0.001 with overall stones detected by ultrasound is 43 stones (5 ureteral and 38 renal) while low dose CT showed 96 stones (40 ureteral and 56 renal). The ultrasound missed 12 stones with 80% with mean size 4mm at uretrovesical junction and 10 stones with 83.8% with mean size 6mm at upper third of ureter. The ultrasound missed 100% of the ureteral stones in middle or distal ureter due to abdominal gases. The ultrasound overestimate the size in size group [4 to 1 0mm] by 3.3mm with statistically significant p-value detected. The ultrasound sensitivity, specificity, accuracy for renal stones detection were 67.8%, 100% and 81.2% respectively when compared to low dose ct and the ultrasound sensitivity, specificity, accuracy for ureteral stones detection were 6.90%, 100% and 43.75% respectively when compared to low dose.Conclusion: Low dose CT shows up as preferred imaging modality for uorolithiasis over ultrasound because of its high sensitivity and accuracy in identifying renal and ureteral stones.

1362. A Case Series of Miliary Tuberculosis in North West London

BackgroundMiliary tuberculosis (mTB) is a severe presentation of TB with high mortality. We reviewed data from a cohort of patients with mTB in an area of London serving an ethnically diverse population with the highest TB endemicity in the UK.MethodsRetrospective analysis of laboratory and medical records, radiology and microbiology results of patients with mTB identified from the London TB register from 2012 to 2019 from London North West Hospitals University NHS Trust.Results60 cases with mTB were recorded. 67% of the patients were male. Median age at diagnosis was 36 years (range 13 to 88 years). 60% of patients were South Asian ethnicity. Two patients were HIV positive and 4 had received anti-TNF treatment. 73% (44 patients) patients had miliary nodular opacities on chest radiograph. Of the 16 patients with no chest radiograph evidence of mTB, 14 had computed tomography (CT) of the chest which confirmed miliary nodules. Eleven patients were sputum acid-fast bacilli (AFB) smear-positive, and in 49 patients, culture of sputum isolated Mycobacterium tuberculosis. Ten patients did not have any positive microbiology but were treated for mTB on clinico-radiological basis. Forty patients had fully-sensitive TB; 2 were isoniazid-resistant and 1 multi-drug-resistant. 5 patients in our cohort also had spinal TB. Evidence of cerebral TB was found in 5/17 patients who had a CT brain. Tuberculomas were seen in 10/24 patients who had magnetic resonance imaging (MRI). Only 8 patients had both CT and MRI; MRI revealed2 patients with cerebral TB that CT did not, but this was not statistically significant (P = 0.1573). 7 patients were investigated with lumbar puncture, of which cerebrospinal fluid was smear and culture negative for all. All patients were treated with standard therapy with a mean length of treatment of 11 months. 33 patients have completed therapy. 7 patients died and 2 were lost to follow-up. Those who died had a mean age of 69 years compared with those who survived (44.2 years).ConclusionThe diagnosis of mTB requires a high index of suspicion for central nervous system disease. Our cohort demonstrates that spinal disease needs to be considered in addition to cerebral TB, for which MRI may be the preferred imaging modality. Mortality in our cohort was associated with older age.Disclosures All authors: No reported disclosures.