Previous Scan Research Articles

Frequency of surveillance CT scan ordering in patients with stage II/III colorectal cancer.

106 Background: Patients with stage II/III colorectal cancer (CRC) undergo surveillance CT scans to detect early asymptomatic oligometastatic spread, which can be treated with curative intent. However, randomized clinical trials show no difference in 5-year mortality in those that undergo low intensity surveillance (annual) compared a higher intensity strategy (every 6 months). In Ontario, the Program in Evidence-Based Care (PEBC), Ontario Health (Cancer Care Ontario) guidelines recommend surveillance CT scan for patients with stage II/III CRC every 12 months. We aimed to determine the frequency at which clinicians in our Ontario-based hospital system ordered surveillance CT scans for patients with stage II/III CRC. Methods: This single centre retrospective cohort study included all patients that underwent surgical resection for CRC from April 1, 2018 – March 31, 2019 at our academic tertiary care centre in Ontario, Canada. We excluded patients that were followed at an outside hospital, had stage IV disease, had disease recurrence, had a concurrent neoplasm, or did not have CRC. The primary outcome was the proportion of surveillance CT scans completed 10+ months after the previous scan. We also described sociodemographic and medical characteristics of included patients. Follow-up was until August 2023. Results: We included 200 patients. The median age was 62 years (IQR: 52-70), 48% (N=96) were female, the rectum was the most commonly involved disease site (43%, N=86), 38% (N=76) had stage III disease, and 54% (N=107) received adjuvant chemotherapy. A total of 1286 scans were ordered during the study period. Of these, 67% (N=860) were ordered as surveillance. Of these, 18% (n=155) were completed 10 months or longer from the previous scan. The median time interval between surveillance scans was 6.6 months (IQR: 5.9-7.9). Approximately 20% (n=137 of 630) of surveillance scans ordered by general surgeons were completed 10 months or longer from the previous scan, whereas only 9% (n=18 of 205) of scans ordered by medical oncologists were completed 10 months or longer from the previous scan. Less than 1% of surveillance scans (n=3) identified new metastatic disease. Conclusions: The minority of surveillance CT scans ordered in patients with stage II/III CRC in our hospital were timed in concordance with Ontario-based guidelines. Future studies should seek to standardize ordering habits such that they align with best practices.

Noncardiac chest computerized tomography scan as a predictor for plaque presence in coronary artery.

Coronary artery calcium, a marker of coronary atherosclerosis, is often identified on noncoronary chest computed tomography (CT). We wanted to evaluate the correlation between the presence of coronary plaques in coronary artery catheterization and coronary calcifications as shown in noncardiac chest CT. A retrospective case-control study consisting of cases (N = 63) and controls (N = 29), aged 18-70 years old, residing in northern Israel and treated in the Intensive Cardiac Care Unit of Ziv Medical Center, between January 2020 and November 2022. All participants underwent coronary catheterization and noncoronary CT scans in the 5 years before the catheterization procedure. Data were taken from the participants' electronic files while considering the potential of cardiovascular risk factors. The 92 participants had a mean age of 60.1 ± 10.3 years old. Multivariate logistic regression adjusted to age, sex, and hyperlipidemia showed that calcified coronary artery as shown on a previous noncardiac CT scan was positively and significantly associated with increasing risk of coronary plaque as presented in coronary catheterization: odds ratio = 5.93 (95% confidence interval: 1.85-19.07, P < 0.01) and was also associated with male sex who were more likely to have plaque on coronary catheterization than females: odds ratio = 3.77 (95% confidence interval: 1.29-11.32, P < 0.05). Coronary calcifications on a previous noncoronary CT scan and sex are positively and significantly associated with coronary plaque risk as present in coronary catheterization. Coronary evaluation on CT scans is important for early detection of coronary disease. Early treatment can avoid coronary disease complications and increase patient survival.

Deep CRISPR mutagenesis characterizes the functional diversity of TP53 mutations

The mutational landscape of TP53, a tumor suppressor mutated in about half of all cancers, includes over 2,000 known missense mutations. To fully leverage TP53 mutation status for personalized medicine, a thorough understanding of the functional diversity of these mutations is essential. We conducted a deep mutational scan using saturation genome editing with CRISPR-mediated homology-directed repair to engineer 9,225 TP53 variants in cancer cells. This high-resolution approach, covering 94.5% of all cancer-associated TP53 missense mutations, precisely mapped the impact of individual mutations on tumor cell fitness, surpassing previous deep mutational scan studies in distinguishing benign from pathogenic variants. Our results revealed even subtle loss-of-function phenotypes and identified promising mutants for pharmacological reactivation. Moreover, we uncovered the roles of splicing alterations and nonsense-mediated messenger RNA decay in mutation-driven TP53 dysfunction. These findings underscore the power of saturation genome editing in advancing clinical TP53 variant interpretation for genetic counseling and personalized cancer therapy.

Dynamic Digital Radiography (DDR) in the Diagnosis of a Diaphragm Dysfunction.

Dynamic digital radiography (DDR) is a recent imaging technique that allows for real-time visualization of thoracic and pulmonary movement in synchronization with the breathing cycle, providing useful clinical information. A 46-year-old male, a former smoker, was evaluated for unexplained dyspnea and reduced exercise tolerance. His medical history included a SARS-CoV-2 infection in 2021. On physical examination, decreased breath sounds were noted at the right-lung base. Spirometry showed results below predicted values. A standard chest radiograph revealed an elevated right hemidiaphragm, a finding not present in a previous CT scan performed during his SARS-CoV-2 infection. To better assess the diaphragmatic function, a posteroanterior DDR study was performed in the standing position with X-ray equipment (AeroDR TX, Konica Minolta Inc., Tokyo, Japan) during forced breath, with the following acquisition parameters: tube voltage, 100 kV; tube current, 50 mA; pulse duration of pulsed X-ray, 1.6 ms; source-to-image distance, 2 m; additional filter, 0.5 mm Al + 0.1 mm Cu. The exposure time was 12 s. The pixel size was 388 × 388 μm, the matrix size was 1024 × 768, and the overall image area was 40 × 30 cm. The dynamic imaging, captured at 15 frames/s, was then assessed on a dedicated workstation (Konica Minolta Inc., Tokyo, Japan). The dynamic acquisition showed a markedly reduced motion of the right diaphragm. The diagnosis of diaphragm dysfunction can be challenging due to its range of symptoms, which can vary from mild to severe dyspnea. The standard chest X-ray is usually the first exam to detect an elevated hemidiaphragm, which may suggest motion impairment or paralysis but fails to predict diaphragm function. Ultrasound (US) allows for the direct visualization of the diaphragm and its motion. Still, its effectiveness depends highly on the operator's experience and could be limited by gas and abdominal fat. Moreover, ultrasound offers limited information regarding the lung parenchyma. On the other hand, high-resolution CT can be useful in identifying causes of diaphragmatic dysfunction, such as atrophy or eventration. However, it does not allow for the quantitative assessment of diaphragmatic movement and the differentiation between paralysis and dysfunction, especially in bilateral dysfunction, which is often overlooked due to the elevation of both hemidiaphragms. Dynamic Digital Radiography (DDR) has emerged as a valuable and innovative imaging technique due to its unique ability to evaluate diaphragm movement in real time, integrating dynamic functional information with static anatomical data. DDR provides both visual and quantitative analysis of the diaphragm's motion, including excursion and speed, which leads to a definitive diagnosis. Additionally, DDR offers a range of post-processing techniques that provide information on lung movement and pulmonary ventilation. Based on these findings, the patient was referred to a thoracic surgeon and deemed a candidate for surgical plication of the right diaphragm.

Magnetic Resonance Imaging Reveals Novel Insights into the Dual Mode of Action of Bisacodyl: A Randomized, Placebo-controlled Trial in Constipation.

Bisacodyl is a widely used laxative that stimulates both motility and secretion. Our aim was to exploit the unique capabilities of MRI to define bisacodyl's mode of action. Two placebo-controlled cross-over trials were performed, one using a single dose of Bisacodyl 5 mg while the second dosed daily for 3 consecutive days. Serial MRI was performed every 75 minutes. Primary endpoint: ascending colon water content as assessed by T1AC AUC300-450 minutes. Secondary endpoints included: small bowel water content, whole gut transit time (WGTT), colonic volumes, stool frequency, and consistency using Bristol Stool Form Score (BSFS). Exploratory endpoints: changes in the serial segmental volumes were quantified from the number of "mass movements" defined as episodes when segmental volume change from the previous scan was > 20% of baseline volume. We also measure the time to defecate after dosing. After 3 days of bisacodyl, ascending colon water content (T1) was 62% greater than after placebo, mean difference T1 AUC300-450 minutes 50.2 (61.0) sec.min, 95% CI (9.2, 91.2), P = 0.02, while after a single dose difference was only 11% (P = 0.58). Both single and repeated doses shortened WGTT (P < 0.049) and time to defecate (P 0.01). Only repeated doses significantly increased small bowel water content (P < 0.03), the number of "mass movements" (P = 0.048), bowel frequency (P = 0.006), and BSFS (P = 0.03). Repeated, compared to single dosing of Bisacodyl, additionally increases small bowel and colon water content and increases the number of "mass movements" thereby increasing its laxative effect. MRI is a non-invasive, patient-acceptable technique for evaluating drugs which alter secretion and/or motility.

Dedicated software to harmonize the follow-up of oncological patients

ObjectiveTo test and evaluate a sofware dedicated to the follow-up of oncological CT scans for potential use in the Radiology department. Materials and methodsIn this retrospective study, 37 oncological patients with baseline and follow-up CT scans were reinterpreted using a dedicated software. Baseline CT scans were chosen from the imaging reports available in our PACS (picture archiving and communicatin systems). Follow-up interpretations were independently assessed with the software. We evaluated the target lesion sums and the tumor response based on RECIST 1.1 (Response Evaluation Criteria in Solid Tumors). ResultsThere was no significant difference in the target lesion sums and the tumor response assessments between the PACS data and the imaging software. There was no over or underestimation of the disease with the software. There was a sigificant deviation (progression versus stability) in three cases. For two patients, this difference was related to the evaluation of the response of non-target lesions. The difference in the third patient was due to comparison with a previous CT scan than to the baseline exam. There was a miscalculation in 13 % of the reports and in 28 % of the cases the examination was compared to the previous CT scan. Finally, the tumor response was not detailed in 43 % of the follow-up reports. ConclusionThe use of dedicated oncology monitoring software could help in reducing intepretation time and in limiting human errors.

Dominant negative mutations in yeast Hsp90 indicate triage decision mechanism targeting client proteins for degradation.

Dominant negative (DN) mutations provide valuable tools for investigating protein mechanisms but can be difficult to isolate because of their toxic effects. We used a mutational scanning approach to identify DN mutations in yeast Hsp90. In a previous mutational scan of the ATPase domain of Hsp90, we noticed that many mutations were at very low frequency after outgrowth in cells coexpressing wildtype Hsp90. Most of these depleted variants were located at the hinge of a lid that closes over ATP. To quantify toxic effects in the hinge regions, we performed mutational scanning using an inducible promoter and identified 113 variants with strong toxic effects. We analyzed individual DN mutations in detail and found that addition of the E33A mutation that prevents ATP hydrolysis by Hsp90 abrogated the DN phenotype. FRET assays performed on individual DN mutants indicate the linkage between ATPase activity and formation of the closed structure is disrupted. DN Hsp90 decreased the expression level of two model Hsp90 clients, glucocorticoid receptor (GR) and v-src kinase. Using MG132, we found that GR was rapidly destabilized in a proteasome-dependent manner. Biochemical analyses indicate that ATP hydrolysis by Hsp90 from open conformations can lead to ubiquitin-dependent client degradation.

Development and Clinical Evaluation of a Contrast Optimizer for Contrast-Enhanced CT Imaging of the Liver.

Patient characteristics, iodine injection, and scanning parameters can impact the quality and consistency of contrast enhancement of hepatic parenchyma in CT imaging. Improving the consistency and adequacy of contrast enhancement can enhance diagnostic accuracy and reduce clinical practice variability, with added positive implications for safety and cost-effectiveness in the use of contrast medium. We developed a clinical tool that uses patient attributes (height, weight, sex, age) to predict hepatic enhancement and suggest alternative injection/scanning parameters to optimize the procedure. The tool was based on a previously validated neural network prediction model that suggested adjustments for patients with predicted insufficient enhancement. We conducted a prospective clinical study in which we tested this tool in 24 patients aiming for a target portal-venous parenchyma CT number of 110 HU ± 10 HU. Out of the 24 patients, 15 received adjustments to their iodine contrast injection parameters, resulting in median reductions of 8.8% in volume and 9.1% in injection rate. The scan delays were reduced by an average of 42.6%. We compared the results with the patients' previous scans and found that the tool improved consistency and reduced the number of underenhanced patients. The median enhancement remained relatively unchanged, but the number of underenhanced patients was reduced by half, and all previously overenhanced patients received enhancement reductions. Our study showed that the proposed patient-informed clinical framework can predict optimal contrast enhancement and suggest empiric injection/scanning parameters to achieve consistent and sufficient contrast enhancement of hepatic parenchyma. The described GUI-based tool can prospectively inform clinical decision-making predicting optimal patient's hepatic parenchyma contrast enhancement. This reduces instances of nondiagnostic/insufficient enhancement in patients.

False-Positive Radioiodine Uptake Related to Posttraumatic Scab Demonstrated by SPECT/CT in a Patient With Differentiated Thyroid Cancer.

A 20-year-old man with papillary thyroid cancer received a fourth radioiodine regimen to treat 131 I-avid lung metastases. Posttherapeutic whole-body scan revealed focal radioiodine uptake on the anterior region of the left lower limb that was not visible on previous whole-body scan and which suggested skin contamination. Visual examination of the left leg evidenced a posttraumatic scab caused by a fall 2 weeks before. Skin metastasis was ruled out. 131 I SPECT/CT acquisition ruled out bony uptake and confirmed that the skin uptake was related to the superficial scab.

Mycobacterium paragordonae pulmonary disease with rapidly growing solitary lesions: a case report and literature review.

Mycobacterium paragordonae (MPG) is a novel and uncommon nontuberculous mycobacterium (NTM). We describe a case of MPG pulmonary disease (MPGPD) with a single, rapidly growing, pulmonary mass, which has rarely been reported. A chest CT scan of a 66-year-old woman revealed a rapidly growing solitary mass-like lesion in the upper lobe of the right lung, which was not seen in the previous chest CT scan six months ago. H&E-stained section of the CT-guided percutaneous lung tissue biopsy specimen showed chronic inflammatory changes with epithelioid granulomas. Metagenomic next-generation sequencing (mNGS) of lung tissue biopsy specimen identified MPG with a sequence number of 1617 and a confidence level of 99%. Because the subsequent MPG droplet digital PCR (MPG-ddPCR) test of the lung tissue biopsy was positive, she was eventually diagnosed with MPGPD. She was administered a quadruple oral regimen comprising clarithromycin, levofloxacin, rifampicin, and ethambutol according to the ATS/IDSA protocol for Mycobacterium gordonae (MG) infection. The chest CT scans showed a significant reduction in the lesion one month after the treatment and almost complete resolution four months later. MPGPD is a rare NTM infection. The imaging manifestations of MPGPD are diverse and may even show rapid development. mNGS of tissue biopsy can enable prompt diagnosis of MPG infection and is a good alternative to routine NTM microbial testing. The ATS/IDSA protocol for MG infection is an effective treatment for MPG infection.

Instrumental Diagnosis of Placenta Accreta and Obstetric and Perinatal Outcomes: Literature Review and Observational Study.

Placenta accreta (PA) is a condition where the placenta is pathologically adherent to the uterus due to a defect in the basal decidua with myometrium invasion by chorionic villi and is classified based on the depth of myometrial invasion by histology. However, ultrasound and magnetic resonance imaging have excellent accuracy. In this study, we investigated clinical benefits of early instrumental diagnosis of PA, especially in reducing maternal-fetal complications and improving perinatal outcomes. We also evaluated diagnostic accuracy of ultrasound and magnetic resonance imaging on placental invasiveness assessment. In this review and observational retrospective study, risk factors of PA were collected, and pregnant women underwent third-trimester ultrasound and magnetic resonance imaging (MRI) to evaluate the degree of infiltration. Imaging results compared to histological findings and surgical evaluation. A total of 38 patients were diagnosed with at the University Hospital "San Giovanni di Dio and Ruggi d'Aragona", Salerno, Italy, by second-trimester ultrasound with high sensitivity (100%) and accuracy (86%). Moreover, 37 of them performed MRI and 60.5% were diagnosed with Accreta, 7.9% increta, 10.5% percreta, and 21.1% not accrue with high sensitivity (100%), specificity (88.9%), and accuracy (97.4%). Histological assay confirmed MRI findings in 96.7% of cases. Risk factors of PA were age >35 years and previous CT scans. In unborn babies, mean 1-min Apgar was 4.3 (range, 3-6), and mean 5-min Apgar was 7.13 (range, 7-9). MRI could be a not-invasive, specific, sensitive, and accurate diagnostic tool for assessing the degree of infiltration in PA, and could guide clinical decisions, such as delivery plan, thus reducing perioperative and fetal complications.

Pervasive findings of directional selection realize the promise of ancient DNA to elucidate human adaptation.

We present a method for detecting evidence of natural selection in ancient DNA time-series data that leverages an opportunity not utilized in previous scans: testing for a consistent trend in allele frequency change over time. By applying this to 8433 West Eurasians who lived over the past 14000 years and 6510 contemporary people, we find an order of magnitude more genome-wide significant signals than previous studies: 347 independent loci with >99% probability of selection. Previous work showed that classic hard sweeps driving advantageous mutations to fixation have been rare over the broad span of human evolution, but in the last ten millennia, many hundreds of alleles have been affected by strong directional selection. Discoveries include an increase from ~0% to ~20% in 4000 years for the major risk factor for celiac disease at HLA-DQB1; a rise from ~0% to ~8% in 6000 years of blood type B; and fluctuating selection at the TYK2 tuberculosis risk allele rising from ~2% to ~9% from ~5500 to ~3000 years ago before dropping to ~3%. We identify instances of coordinated selection on alleles affecting the same trait, with the polygenic score today predictive of body fat percentage decreasing by around a standard deviation over ten millennia, consistent with the "Thrifty Gene" hypothesis that a genetic predisposition to store energy during food scarcity became disadvantageous after farming. We also identify selection for combinations of alleles that are today associated with lighter skin color, lower risk for schizophrenia and bipolar disease, slower health decline, and increased measures related to cognitive performance (scores on intelligence tests, household income, and years of schooling). These traits are measured in modern industrialized societies, so what phenotypes were adaptive in the past is unclear. We estimate selection coefficients at 9.9 million variants, enabling study of how Darwinian forces couple to allelic effects and shape the genetic architecture of complex traits.

Pigmented paravenous retinochoroidal atrophy and retinitis pigmentosa-like phenotype in the same patient: A case series.

Concomitant manifestation of PPRCA in one eye and RP-like retinopathy in the fellow eye is a rare clinical entity, with limited published descriptions to date. The aim of this study is to describe comprehensive clinical evaluations and long-term follow-up of three patients affected by this clinical picture. Three patients with concurrent PPRCA and RP-like retinopathy were prospectively re-evaluated and comprehensive assessments were performed. The progression of disease was assessed by comparing best corrected visual acuity (BCVA) and ellipsoid zone (EZ) width with data available from each patient's medical charts and previous SD-OCT scans. Blood samples were collected and tested to rule out autoimmune or infectious ocular diseases, for testing anti-retinal autoantibodies (ARAs) and for genetic analysis. Reduction in BCVA and a progressive concentric loss of the EZ band over time were detected in the eye with RP-like phenotype in all three patients, while in the eye with PPRCA none of the patients showed significant changes in BCVA and only one patient showed a progressive reduction of the EZ width. No clear etiology has been identified. Two or more ARAs subtypes were detected in two out of three patients. PPRCA was demonstrated to be a non-progressive or slowly progressive disease, instead the eye with RP-like phenotype showed a progressive visual impairment, highlighting the importance of shedding light on this condition. Its etiology remains unclear: a genetic trait with different phenotype between the two eyes is conceivable, as well as a potential role of ARAs.

Perihippocampal failure after hippocampal-avoidance brain radiotherapy in small cell lung cancer patients: Cases report and literature review.

Brain metastasis is a major concern, and may occur in roughly 50% of patients during the clinical course of small cell lung cancer (SCLC). Because prophylactic cranial irradiation reduces the incidence of brain metastases and improves overall survival, prophylactic cranial irradiation is recommended for SCLC patients without distant metastases or an extensive stage and have responded well to systemic therapy. Hippocampal-avoidance whole-brain radiotherapy (HA-WBRT) is preferred to preserve hippocampal function while minimizing negative cognitive effects. Reducing the dose delivered to the hippocampus below the therapeutic brain dose may increase the risk of hippocampal progression; thus, HA-WBRT may be associated with a risk of perihippocampal recurrence. Three patients with SCLC received HA-WBRT and developed intracranial failure during clinical follow-up; 3 relapsed with intracranial failure in the perihippocampal region after 12, 13, and 7 months, respectively. Compared to the therapeutic brain dose of cases and the underdose region around the HA region, we matched MRI scans of intracranial failure and previous planning scans of simulation and found a deviation of the underdosed region within the perihippocampal failure of approximately 55% to 63%. Perihippocampal failure is a rare clinical outcome in SCLC patients following HA-WBRT. Perihippocampal failure could be caused by an underdose of radiation or by the aggressiveness of the cancer itself. More research into this topic is encouraged.

The "Tumbling Gallstone Sign" of Obstructive Gallstone Ileus.

The "tumbling gallstone sign" is a diagnostic imaging finding described on radiologic examinations of the abdomen, in patients with cholelithiasis associated with intermittent episodes of gallstone obstructive ileus. Best seen on serial radiographs or CT studies of the abdomen, this sign indicates a sudden change in position of the gallstone(s) within the intestinal lumen from the upper segments of the bowel to the lower segments of the bowel, causing transient mechanical bowel obstruction. The tumbling gallstone sign has been likened to that of the classic childrens' tumbling tower balancing game. On repeat CT scans, the dislodged gallstone(s) may be seen proceeding distally and impact in the ileum at a level lower than that seen on the previous CT scans, analogous to the tumbling gallstone sign.

Pneumonia caused by Enterococcus faecalis and tropical candida in a maintenance hemodialysis patient concomitant with COVID-19: A case report and literature review [RETRACTED

Rationale: Maintenance hemodialysis (MHD) represents a crucial form of renal replacement therapy for patients suffering from end-stage renal disease. These MHD individuals are especially susceptible to pulmonary infections due to compromised immune defenses. High throughout metagenomic sequencing technologies allow for the precise identification of pathogens at the genetic level, leading to personalized treatment plans that improve patient outcomes. This case represents the first reported instance of a mixed pulmonary infection with Enterococcus faecium and Candida tropicalis in a MHD man concomitant with coronavirus disease 2019 (COVID-19), which responded well to anti-infection treatment. The objective of this article is to enhance comprehension of concurrent pulmonary infections in individuals undergoing MHD and to enhance the capability for prompt detection and differential diagnosis. Patient concerns: A MHD man who developed COVID-19 and subsequently experienced recurring chills, high fever, coughing, expectoration, and difficulty breathing after a week. Laboratory analyses indicated elevated markers of inflammation, while a computed tomography scan detected inflammation in both of the patient’s lungs. Diagnosis: Chronic kidney disease stage V, pneumonia, and COVID-19. Interventions: Following initial treatment with a wide range of antibiotics guided by blood and sputum cultures, there was no improvement in the patient’s health. Further examination of the bronchoalveolar lavage fluid through metagenomic next-generation sequencing revealed the exact pathogens responsible for the infection. Outcomes: We lead to a tailored antimicrobial treatment plan that significantly alleviated the patient’s pulmonary inflammation and overall symptoms. The patient’s body temperature reverted back to its normal range, with an absence of any notable coughing or sputum generation. Additionally, there was a marked decrease in inflammatory markers. Furthermore, a chest computed tomography scan exhibited enhanced absorption of pulmonary lesions in comparison to previous scans. Lessons: The greater risk and mortality of pneumonia in MHD patients have not received adequate attention. Such uncommon cases require heightened awareness among clinicians to prevent delays in diagnosis and treatment.

Minimal dose CT for left ventricular ejection fraction and combination with chest-abdomen-pelvis CT

ObjectivesThis prospective study tested the diagnostic accuracy, and absolute agreement with MRI of a low-dose CT protocol for left ventricular ejection fraction (LVEF) measurement. Furthermore we assessed its potential for combining it with Chest-Abdomen-Pelvis CT (CAP-CT) for a one-stop examination. Materials & methodsEighty-two patients underwent helical low-dose CT. Cardiac magnetic resonance imaging (MRI) was the reference standard. In fifty patients, CAP-CT was performed concurrently, using a modified injection protocol. In these, LVEF was measured with radioisotope cardiography (MUGA). Patients >18 years, without contrast media or MRI contraindications, were included. Bias was measured with Bland-Altman analysis, classification accuracy with Receiver Operating Characteristics, and inter-reader agreement with Intra-Class Correlation Coefficient (ICC). Correlation was examined using Pearson's correlation coefficients. CAP image quality was compared to previous scans with visual grading characteristics. ResultsThe mean CT dose-length-product (DLP) was 51.8 mGycm, for an estimated effective dose of 1.4 mSv, compared to 5.7 mSv for MUGA. CT LVEF bias was between 2 % and 10 %, overestimating end-diastolic volume. When corrected for bias, sensitivity and specificity of 100 and 98.5 % for classifying reduced LVEF (50 % MRI value) was achieved. ICC for MUGA was significantly lower than MRI and CT. Distinction of renal medulla and cortex was reduced in the CAP scan, but proportion of diagnostic scans was not significantly different from standard protocol. ConclusionWhen corrected for inter-modality bias, CT classifies patients with reduced LVEF with high accuracy at a quarter of MUGA dose and can be combined with CAP-CT without loss of diagnostic quality.

A METHODICAL APPROACH TO REDUCING HEAT ENERGY EXPENDITURES FOR BUILDING HEATING

The work provides a method of preventing the consumption of heat energy for heating the building. It is noted that the energy statistics of Ukraine foresee an increase in the use of primary energy resources in the period 2020–2030 mainly due to energy saving, which, in turn, will ensure a 30-40% reduction in emissions of harmful substances into the atmosphere and stabilize greenhouse gas emissions. In order to substantiate the ways of reducing money costs for electricity and heat consumption, certain measures are proposed in the work, which demonstrate the greatest economic effect in the shortest time. The evaluation of the quality of thermal protection of the building's enclosing structures was carried out. The analysis of thermograms of enclosing structures based on infrared scanning of surfaces is presented. The thermal imaging survey was carried out in two stages. With the help of a thermal imager, at the first stage, a scan of the enclosing structures was performed in order to identify areas of the enclosing structures that have different temperature fields. Based on the analysis of the thermograms of the previous scan, a program of detailed examination of the areas with temperature anomalies is planned and the reasons for their appearance are clarified. Based on the conducted research, recommendations are given to increase the combined heat transfer resistance of enclosing structures in order to prevent heat energy costs for heating the building.

Rectal duplication cyst presenting with change in bowel habits and rectal bleeding: A case report and literature review

We present a rare case of rectal duplication cyst (RDC) in an adult patient who presented with chronic fluctuating bowel habits and rectal bleeding. A faecal immunochemical test (FIT) and a faecal Calprotectin level showed negative results, and no previous abdomen-pelvis CT scan or MRI was identified. A Colonoscopy was performed, showing a benign rectal lesion causing colonic intraluminal compression leading to rectal ulceration and prolapse, and solitary rectal ulcer syndrome was suspected. A Transanal Minimally Invasive surgery (TAMIS) was performed to excise the lesion, with histopathology findings consistent with a rectal duplication cyst. The patient had no intraoperative complications and made an uneventful recovery. A systematic literature review showed 30 30 adult Rectal supplication cyst case reports. In conclusion, The most common presentation of RDC is anal pain and rectal bleeding. The diagnosis of RDC is challenging, and it requires Surgical resection to confirm the diagnosis.

PRECISE Version 2: Updated Recommendations for Reporting Prostate Magnetic Resonance Imaging in Patients on Active Surveillance for Prostate Cancer

Background and objectiveThe Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) recommendations standardise the reporting of prostate magnetic resonance imaging (MRI) in patients on active surveillance (AS) for prostate cancer. An international consensus group recently updated these recommendations and identified the areas of uncertainty. MethodsA panel of 38 experts used the formal RAND/UCLA Appropriateness Method consensus methodology. Panellists scored 193 statements using a 1–9 agreement scale, where 9 means full agreement. A summary of agreement, uncertainty, or disagreement (derived from the group median score) and consensus (determined using the Interpercentile Range Adjusted for Symmetry method) was calculated for each statement and presented for discussion before individual rescoring. Key findings and limitationsParticipants agreed that MRI scans must meet a minimum image quality standard (median 9) or be given a score of ‘X’ for insufficient quality. The current scan should be compared with both baseline and previous scans (median 9), with the PRECISE score being the maximum from any lesion (median 8). PRECISE 3 (stable MRI) was subdivided into 3-V (visible) and 3-NonV (nonvisible) disease (median 9). Prostate Imaging Reporting and Data System/Likert ≥3 lesions should be measured on T2-weighted imaging, using other sequences to aid in the identification (median 8), and whenever possible, reported pictorially (diagrams, screenshots, or contours; median 9). There was no consensus on how to measure tumour size. More research is needed to determine a significant size increase (median 9). PRECISE 5 was clarified as progression to stage ≥T3a (median 9). Conclusions and clinical implicationsThe updated PRECISE recommendations reflect expert consensus opinion on minimal standards and reporting criteria for prostate MRI in AS.