Radiographic Appearance Research Articles

Odontogenic keratocyst management using guided tissue regeneration: Literature review - Two case reports.

Odontogenic cysts of the jaws are pathologies that require timely recognition and management. The initial diagnosis is based on clinical and radiographic appearance and dental history. A variety of surgical treatments are used for odontogenic keratocyst (OKC) depending on the clinical and radiographic presentation. The aim of this report and literature review is to highlight methods to treat OKC combined with guided tissue regeneration (GTR). Two cases with similar clinical presentations are included. Case 1 was a 60-year-old healthy Caucasian female who presented with jaw expansion around teeth #'s 21 and 22. Initial exam revealed clinical gingival health on an intact periodontium. The patient presented with enlarged gingival tissue between teeth #'s 21 and 22 measuring 9 × 12mm and vital teeth without root displacement radiographically. Case 2 had a similar clinical and radiographic presentation located between teeth #'s 5-6. Case 1 treatment included excisional biopsy with complete enucleation of the cystic lesion. Thereafter, GTR was performed using allograft internally then covered with a xenograft externally, resorbable collagen membrane (RCM), and primary closure. Case 2 was managed with excisional biopsy with lesion enucleation, GTR with allogenic bone graft, enamel matrix derivative and RCM, and primary closure. OKC enucleation combined with GTR using mineralized allograft, enamel matrix derivative, and collagen membrane or a layering technique of allograft internally and xenograft externally covered by a collagen membrane showed proper regeneration with stable periodontium at 6-36 months. Guided tissue regeneration is an acceptable treatment for management of OKC. Complete enucleation of an OKC lesion is important to reduce recurrence. The use of allograft with xenograft or allograft with enamel matrix derivative and RCM can provide proper bone fill after OKC removal. Odontogenic cysts are growths that can form in the jaw or soft tissues around the teeth. If not treated, they can grow larger, damage the bone, and even push teeth out of place. To prevent this, it's important to diagnose and remove them early. The most common way to treat these cysts is through a surgical method called enucleation, where the cyst is carefully removed. In these two cases, enucleation was used along with guided tissue regeneration, a technique to help the bone and tissue heal better after surgery. In the first case, a bone graft (made from human and animal bone) and a special material called a resorbable collagen membrane were used to protect and support the healing area. In the second case, a mineralized bone graft along with a substance that helps repair tissues called an enamel matrix derivative, and the same collagen membrane were used. Both patients healed well, and over the next 6 to 36 months, their bone and tissues around the teeth regenerated properly.

Unraveling melorheostosis: insights into clinical features, diagnosis, and treatment

Abstract Melorheostosis is a rare bone disease characterized by abundant bone formation with a characteristic radiographic appearance that resembles “dripping candle wax.” Recent data has shown that the majority of cases are due to somatic activating mutations in bone. Melorheostosis has several clinical and radiographic presentations, which are now known to be caused by different somatic mutations such as MAP2K1, SMAD3, KRAS, and LEMD3. This review provides a comprehensive look at the clinical features, diagnostic approaches, and current treatment options for melorheostosis, alongside future research directions aimed at improving patient outcomes.

Preparing for downstream tasks in AI for dental radiology: a baseline performance comparison of deep learning models.

To compare the performance of the convolutional neural network (CNN) with the vision transformer (ViT) and the gated multilayer perceptron (gMLP) in the classification of radiographic images of dental structures. Retrospectively collected 2-dimensional images derived from cone beam computed tomographic volumes were used to train CNN, ViT and gMLP architectures as classifiers for 4 different cases. Cases selected for training the architectures were the classification of the radiographic appearance of maxillary sinuses, maxillary and mandibular incisors, presence or absence of the mental foramen and the positional relationship of the mandibular third molar to the inferior alveolar nerve canal. The performance metrics (sensitivity, specificity, precision, accuracy and f1-score) and area under curve (AUC) - receiver operating characteristic and precision-recall curves were calculated. The ViT with an accuracy of 0.74-0.98, performed on par with the CNN model (accuracy 0.71-0.99) in all tasks. The gMLP displayed marginally lower performance (accuracy 0.65-0.98) as compared to the CNN and ViT. For certain tasks, the ViT outperformed the CNN. The AUCs ranged from 0.77-1.00 (CNN), 0.80-1.00 (ViT) and 0.73-1.00 (gMLP) for all of the 4 cases. The difference in performance of the ViT, gMLP and the CNN (the current state-of-the-art) was significant in certain tasks. This difference in model performance for various tasks proves that capabilities of different architectures may be leveraged. The vision transformer, followed by the gated multilayer perceptron are deep learning models that exhibit comparable performance with the convolutional neural network in the classification of dental radiographic images.

Long-term follow-up of ceramic-on-metal total hip arthroplasty.

In 2015, we published the results of our ceramic-on-metal (CoM) total hip arthroplasties (THAs) performed between October 2007 and July 2009 with a mean follow-up of 34 months (23 to 45) and a revision rate of 3.1%. The aim of this paper is to present the longer-term outcomes. A total of 264 patients were reviewed at a mean of 5.8 years (4.6 to 7.2) and 10.1 years (9.2 to 10.6) to determine revision rate, pain, outcome scores, radiological analysis, and blood ion levels. Those who were unwilling or unable to travel were contacted by telephone. The all-cause revision rate at six years was 3.1% (eight THAs), increasing to 8.8% (18 THAs) at ten years. Of these, there were four and then seven bearing-related revisions at six and ten years, respectively. There was a statistically significant deterioration in the visual analogue scale pain score and Oxford Hip Score (OHS) between six and ten years. There were 18 CoM THAs in 17 patients who had a cobalt or chromium level over 4 ppb and ten CoM THAs in nine patients who had a cobalt or chromium level higher than 7 ppb with a statistically significant increase in chromium levels only between the two timepoints. Overall, 84 stems (39.1%) had significant radiolucent lines at ten years compared to 65 (25.5%) at six years. When compared to the original review, there has been a significant deterioration in pain score, OHS, radiograph appearance, and, most critically, survival has fallen to 91.2%, which does not meet the Orthopaedic Data Evaluation Panel (ODEP) 10 A* 95% threshold. Although this bearing is no longer on the market, 2.5% were bearing-related revisions, which have relevance to the discussion around modular dual-mobility implants that have a similar metal interface.

Prognostic Impact of a Histologic Grading Scheme in Dogs Diagnosed With Rib Chondrosarcoma.

Data regarding the outcome of canine rib chondrosarcoma is sparse and varied. While grade of tumour is associated with outcome for canine appendicular chondrosarcoma, the association of grade with outcome for canine rib chondrosarcoma is unclear. This study aimed to correlate the grade of canine rib chondrosarcoma with median survival time. Retrospectively, cases of primary rib chondrosarcoma were identified, and tumours were graded based on a 3-tier adapted human grading scheme. Twenty-two patients were included in the survival analysis. The median survival time was 1427 days (range: 27-3354 days). This was not significantly different for patients with grade I versus II versus III (p = 0.82), grade I-II versus III (p = 0.34), or grade I versus II-III (p = 0.49). No variables assessed including age, weight, tumour location (cranial vs. caudal thorax; left vs. right hemithorax), tumour location on rib (proximal, middle, and distal), radiographic appearance (lytic, proliferative, or mixed), elevated serum alkaline phosphatase activity, grade, grade specific histologic features (matrix production, architecture, pleomorphism, cellularity, necrosis, and total score), adjunct therapy post-surgical excision, development of metastatic disease post-surgery, or local recurrence post-surgery were found to impact the risk of death due to chondrosarcoma. In this limited group of patients, the grading scheme reported here, and the other variables assessed did not appear to offer additional prognostic information. However, this data must be interpreted considering the small sample size and thus low statistical power. Additional studies are needed to determine the true impact of grade on outcome for canine rib chondrosarcomas.

Adductor tubercle appears more posterior on radiographs of knees with trochlear dysplasia

PurposeThe purpose of this study was to compare the radiographic positions of commonly utilized landmarks between symptomatic and normal knees and to assess the influence of morphologic risk factors. Methods3D models were created from knees of patients with patellar instability and compared to control knees. On the 3D models, the adductor tubercle, medial epicondyle and gastrocnemius tubercle were marked. A 2D view was created from these models to simulate radiographs, and the radiographic location of each landmark was described with respect to the anteroposterior relation to the posterior cortical line, and proximal-distal relationship to the posterior condylar line. The position of each landmark was compared between symptomatic and control groups and assessed for variations in position with severity of anatomic risk factors. Results40 patients were included in this study. On the 2D views, the medial epicondyle was found to be more posterior and more distal than in the control group. Association between severity of trochlear dysplasia and posterior position of the adductor tubercle trended toward significance (R=0.43, R2=0.18, p=0.058). In symptomatic knees with trochlear dysplasia, the radiographic landmark for the medial epicondyle was posterior by 3.3mm (p=0.052), adductor tubercle by 2.7mm (p=0.009), and gastrocnemius tubercle by 3.9mm (p=0.010) when compared to symptomatic knees without dysplasia. ConclusionThis study demonstrates that commonly utilized anatomic landmarks are more posterior and distal on radiographs in knees with patellar instability when compared to normal knees. Trochlear dysplasia is associated with the radiographic landmarks of the adductor and gastrocnemius tubercles appearing 3mm posterior to those without dysplasia, and its severity is associated with posterior radiographic appearance of the adductor tubercle. Level of EvidenceIII, Retrospective Case Control

Using Lipid Parameters in Predicting Preterm Infants with Respiratory Distress Syndrome

Background: Respiratory distress syndrome is a clinical diagnosis which is warranted in a preterm newborn with respiratory difficulty, including tachypnea (>60 breaths/min), chest retractions, and cyanosis in room air that persist or progress over the first 48-96 hr of life, and a characteristic chest radiographic appearance. Objective: to assess the cord blood lipid profile for predicting of preterm infants with respiratory distress syndrome. Methods: This is a case control study which was conducted on 50 preterm neonates admitted to the neonatal intensive care unit of Shebin El-Kom teaching hospital between January 2011 and October 2011. Results: the mean of weight gain during pregnancy in mothers of preterm with RDS was lower than the control group and the difference was statistically highly significant (P<0.01). Also, there was significant difference (P<0.05) regarding mode of delivery and antenatal steroid, however; no statistical significant difference was detected regarding maternal age, maternal weight, maternal BMI, pre-gravid height, the ruptured membrane > 24 hr and parity between both groups. the mean of total cholesterol, HDL-cholesterol and LDL-cholesterol in the cord blood was lower in group A than in group B and the difference was statistically highly significant (P <0.01), but there was no significant difference regarding the mean of both triglycerides and VLDL-cholesterol in both groups (P>0.05).the mean of total cholesterol, HDL-cholesterol and LDL-cholesterol was lower in mothers of preterm infants with RDS than in control group and the difference was statistically highly significant (P <0.01), but there was no significant difference was detected regarding the mean of levels triglycerides and VLDL-cholesterol in both groups (P >0.05).the cutoff values of cord blood (total Cholesterol, HDL-C, and LDL-C) below which RDS can be predicted are 80, 45.5 and 23.2 mg/dl respectively with a sensitivity of 83.3%, 86.7% and 86.7% and with specificity of 95%, 80% and 70% respectively. Conclusion: We conclude that RDS is accompanied with lipid alteration in the infants and their mothers. The results of this study point to the importance of measuring of maternal serum and cord blood lipid profile as a predictor for the occurrence of RDS.

Iron Chelators Augment Large Osteochondral Allograft Osseointegration in a Preclinical Canine Model.

Osteochondral allograft transplantation (OCAT) can be a successful joint restoration treatment option for large post-traumatic articular defects but is still associated with significant revision and failure rates. Despite recent advances that have improved OCAT success, insufficient osteochondral allograft (OCA) osseointegration remains a major cause of failure. Deferoxamine (DFO) is an effective angiogenic and osteo-anabolic iron chelator that consistently promotes bone neovascularization and regeneration. This study was designed to investigate local delivery of DFO for augmenting OCA osseointegration using a preclinical canine model for OCAT in the knee and hip as commonly affected joints. On Institutional Animal Care and Use Committee (IACUC) approval, 12 purpose-bred dogs underwent OCAT of the femoral head or femoral condyles with DFO or DFO-free (controls) microspheres in recipient sites. OCA revascularization, cellular repopulation, and integration were evaluated based on functional, diagnostic imaging, microcomputed tomography, histology, and immunohistochemistry outcome measures. Local delivery of DFO into OCAT recipient sites was associated with maintained or improved joint function, superior radiographic appearance, significantly greater trabecular thickness, higher bone volume, and new bone ingrowth compared with DFO-free controls. OCA osseointegration is dependent on cellular repopulation and neovascularization, resulting in new bone ingrowth through creeping substitution, and insufficient osseointegration with resorption and subsidence of the OCA remains a major cause of failure after transplantation. The results of this study suggest that local delivery of DFO using a controlled microsphere release system may reduce resorption and improve revascularization and cellular repopulation to increase new bone ingrowth, potentially expediting OCA osseointegration after transplantation.

Central odontogenic fibroma: retrospective study of six cases with variable histopathologic features using 2022 WHO classification

BackgroundCentral odontogenic fibroma (COF) is a rare benign odontogenic tumor with a wide range of histopathologic features. We evaluated COF diagnosed in our institute with 16 years’ experience using 2022 WHO classification.MethodsOur archives were reviewed and cases diagnosed as COF were selected. Clinical, radiographic and microscopic features were tabulated and analyzed.ResultsOf 13,736 specimens, six cases (0.04%) of COF were discovered. Patients ranged in age from 14 to 44 years. There were two males and four females. Maxilla and mandible were affected equally. Five cases showed radiolucent appearance (4 unilocular, 1 multilocular) and one case showed a mixed radiolucent-radiopaque pattern. Histopathologically, three cases were conventional type (2 epithelium-rich, 1 epithelium-poor). Two cases were the hybrid COF with central giant cell granuloma (CGCG) and one of which was also associated with secondary aneurysmal bone cyst (ABC). The last case with a mixed radiolucent-radiopaque pattern was the ossifying subtype.ConclusionOur results demonstrated that COF is a rare odontogenic tumor and exhibits diverse radiographic and microscopic appearances. The triphasic tumor consisting of the COF, CGCG and ABC, is reported here for the first time, while the ossifying subtype is considered the tenth case reported in the English-language literature. Oral and maxillofacial pathologists and other healthcare personnel must be aware of this rare odontogenic tumor and its variants to achieve the definite diagnosis.Clinical trial numberNot applicable.

New-Onset Refractory Status Epilepticus With Diffuse Cerebral Restricted Diffusion in Young Children: A Novel Clinical-Radiologic Presentation

BackgroundNew-onset refractory status epilepticus (NORSE) is a clinical presentation characterized by explosive-onset refractory status epilepticus (RSE) without evident etiology or active epilepsy, often leading to devastating epilepsy. There is heterogeneity in neuroradiographic findings for NORSE. We encountered a series of young patients with NORSE who had diffuse cerebral restriction in diffusion (DCRD) with similar radiographic appearances as acute encephalopathy with biphasic seizures and late restricted diffusion/acute leukoencephalopathy with restricted diffusion (AESD/ALERD). We explore clinical similarities and proposed pathophysiologic overlaps to highlight a novel clinical-radiologic presentation. MethodsRetrospective review was completed for patients younger than five years meeting NORSE criteria and then screened for radiographic evidence of DCRD. Demographic, clinical, and outcome data were collected. ResultsEleven patients met NORSE criteria, of whom seven displayed DCRD. Immunosuppressant management varied. All patients required multiple antiseizure medications and continuous infusions for RSE. Only one had an etiology identified (genetic). All but one patient developed diffuse, global, and progressive cerebral atrophy. Two patients died: one after prolonged seizure three years post-NORSE and another of unknown causes two months post-NORSE. Of five survivors, three have medically refractory epilepsy. Most survivors have severe disability. ConclusionsWe present a single-center case series of seven patients with NORSE and DCRD, akin to AESD/ALERD. Our patients differed clinically to AESD/ALERD in terms of seizure severity and poorer outcome. There is a need to develop biomarkers for specific NORSE phenotypes. The young child with NORSE and DCRD may represent a novel phenotype with a specific neuroradiographic signature that deserves further attention.

Characteristics and prognosis of hepatocellular carcinoma patients after direct-acting antiviral hepatitis C virus therapy in a single medical center in Egypt

Objective: Hepatocellular carcinoma (HCC) incidence has increased dramatically over the previous two decades and is anticipated to rise further in some countries, notably the United States, by 2030. HCC is most widespread in Asia and Africa, where hepatitis B and C are ubiquitous and lead to the development of chronic liver disease and, finally, HCC. In this study, we examined changes in the characteristics and prognosis of HCC patients, as well as the risk of developing HCC after direct-acting antiviral (DAA) medication.Methods: The study enrolled all individuals who attended the Clinical Oncology and Nuclear Medicine Department, Suez Canal University Hospital, Ismailia, Egypt, with a proven diagnosis of HCC in the period between January 2020 and December 2021. HCC is diagnosed based on radiographic appearance (arterial enhancement phase and delayed washout phase) or compatible histology.Results: This retrospective cohort included 254 HCC patients, separated into three groups. Kaplan-Meier curves with log-rank analysis revealed that hepatitis C virus (HCV) treatment therapy considerably reduced the time to HCC development following hepatitis diagnosis (p < .001). HCV therapy had a substantial impact on progression-free survival and overall survival in HCC patients (p < .001).Conclusions: The emergence of DAA medication has greatly altered the management of HCV patients in the context of HCC. DAAs have been shown to be both safe and beneficial in these individuals, particularly in terms of lowering the risk of hepatic decompensation. DAAs have been reported to enhance overall survival in patients with cirrhotic HCV-related HCC, most likely due to decreased hepatic decompensation.

Radiographically Apparent Acetabular Sourcil Landmarks Are Created by Comparable Regions of the Pelvis With Extraarticular Bone Variably Confounding Estimates of Joint Coverage.

The severity of hip dysplasia is characterized by radiographic measurements that require user definition of the acetabular sourcil edge, a bony landmark for which the corresponding three-dimensional (3D) anatomy is not well defined in any imaging plane. To use digitally reconstructed radiographs to determine: (1) What 3D anatomy is contributing to the "acetabular sourcil" location used to make lateral center-edge angle (LCEA) and anterior center-edge angle (ACEA) measurements in standing AP and false-profile radiographic views, respectively? (2) How do intraobserver and interobserver agreement in LCEA and ACEA translate into agreement of the 3D anatomy being evaluated? (3) How distinct are regions around the acetabular rim circumference that are evaluated by LCEA and ACEA measurements on radiographs? Between January 2018 and May 2019, 72 patients were indicated for periacetabular osteotomy to treat hip dysplasia or acetabular retroversion at our institution. From these patients, a series of 10 patients were identified of the first 12 patients in 2018 who were treated with periacetabular osteotomy, excluding two with missing or low-quality clinical imaging. A second series of 10 patients was identified of the first 11 patients in 2019 who were treated with periacetabular osteotomy and concurrent hip arthroscopy, excluding one who was missing clinical imaging. Pelvis and femoral bone surface models were generated from CT scans of these two series of 10 patients. There were 15 female and five male patients, with a median patient age of 18 years (IQR 17 to 23 years), a preoperative LCEA of 22° (IQR 18° to 24°), and a preoperative ACEA of 23° (IQR 18° to 27°). Exclusion criteria included missing preoperative CT or standard clinical radiographic imaging or severe joint incongruity. To address our first study question, digitally reconstructed radiographs matching each patient's standing AP and false-profile clinical radiographs were created from the segmented CT volumes. A board-certified orthopaedic surgeon and three trained researchers measured LCEA and ACEA on the digitally reconstructed radiographs, and the selected sourcil points were projected back into coordinates in the 3D anatomic space. To address our second study question, intraobserver and interobserver agreement in radiographic coverage angles were related to variations in 3D coordinates of the selected bony anatomy. Lastly, to address our third study question, 3D locations around the acetabular rim identified as contributing to the lateral and anterior sourcil points were summarized across patients in a clockface coordinate system, and statistical analysis of the "time" separating the 3D acetabular contributions of the sourcil edges was performed. The 3D anatomy contributing to the lateral sourcil was a variable length (27 mm [IQR 15 to 34 mm]) span of the laterosuperior acetabular edges, with contributions by the anterior inferior iliac spine in 35% (7 of 20) of hips. The anterior sourcil reflected a 28-mm (IQR 25 to 31 mm) span of bone from the medial ilium (posterior-medial to the anterior-inferior iliac spine and anterior-lateral to the arcuate line) to the anterior and lateral edges of the acetabulum. Interobserver variability was good for LCEA (intraclass correlation coefficient [ICC] 0.82 to 0.83) and moderate to good for ACEA (ICC 0.73 to 0.79), whereas the agreement in identified 3D sourcil locations varied widely (ICC 0.32 to 0.95). The acetabular edge of the 3D anatomy contributing to the anterior sourcil overlapped the circumferential range of the acetabular rim contributing to the lateral sourcil. Projection of two-dimensional radiographic landmarks contributing to the diagnosis of structural hip deformity into 3D allowed for the identification of the overlapping bony anatomy contributing to radiographically visible anterior and lateral sourcil edges. This work leveraging digitally reconstructed radiographs and 3D pelvis anatomy has found that bone outside the joint contributes to the radiographic appearance of the sourcil and may variably confound estimates of joint coverage. Furthermore, the substantial overlap between the acetabular bone contributing to measurement of the LCEA and ACEA would indicate that these angles measure similar acetabular deformity, and that additional measures are needed to assess anterior coverage independent of lateral coverage.

Neurosarcoidosis: Radiographic Appearance and Significance

Neurosarcoidosis: Radiographic Appearance and Significance

Glandular odontogenic cyst: A case series and literature review

AbstractAimThe glandular odontogenic cyst (GOC) is a rare odontogenic cyst with a potentially aggressive growth potential and high recurrence rate. An absence of pathognomonic clinical, radiographic and histopathological features means the glandular odontogenic cyst is rarely included in a differential diagnosis for a well‐defined radiolucent cyst or tumour of the jaw. There is an absence of clarity on the most effective method of treatment for GOCs to reduce recurrence risk.Materials and MethodsIn this case series, we documented the treatment of three male patients who were referred for further investigation of well‐defined, corticated radiolucent lesions. Two lesions were located in the body of the mandible and one in the anterior maxilla. All three patients were in their fifth decade of life. Two patients reported mild discomfort, while one patient was asymptomatic upon presentation.ResultsThe included cases were treated conservatively with enucleation and curettage under general anaesthesia. Histological examination confirmed a diagnosis of GOC in all cases. No clinical or radiographic recurrence has been observed.ConclusionThe clinical, radiographic and histological appearance of the GOC mimics other cysts and tumours of the jaw, most significantly central mucoepidermoid carcinoma. Long‐term follow‐up is recommended due to the potential for recurrence, which is influenced by lesion size, locularity and cortical plate integrity.

Patterns of Pulpal Mineralization in Mandibular Anteriors: A Micro-computed Tomography Analysis

IntroductionCurrent understanding of the morphology of pulpal mineralizations is limited. Understanding the specific location and type of such mineralizations will aid clinicians in diagnosis, case complexity assessment, and treatment planning. Therefore, this study correlated the appearance of a reduced canal volume (CV) in conventional radiographs with the presence of pulp mineralizations (PMs) utilizing micro-computed tomography (CT) analysis. The morphology of PMs utilizing micro-CT technology was also analyzed. MethodsOne hundred and twenty-one extracted permanent mandibular incisors were collected. Periapical radiographs were taken of the teeth to determine if a reduced canal space was present, in which case the sample was included for micro-CT assessment. Various descriptors for PM were then determined and these labels were then applied to the entire sample to demonstrate PM. Numerical analysis was undertaken for all teeth scanned; the following data was extracted: the presence or absence of PMs, types of PM, and their morphological structures; CVs were determined. Cohen's kappa test was used to assess intraexaminer agreement. ResultsBased on radiographic appearance, forty-two teeth were included for micro-CT analysis. PMs were demonstrable in 57% and absent 43% of teeth. When PMs were absent, the CV was significantly smaller compared to when they were present (P < .05). Discrete mineralizations were more frequently located in the coronal and middle thirds compared to diffuse mineralization (P < .01). No differences in the prevalence of the individual features of discrete or diffuse mineralizations were detected (P > .05). ConclusionsTwo detectable forms of PMs were found in micro-CT analysis at all levels of the canal: discrete and diffuse mineralizations. A reduced CV on a PA was reflective of mineralized changes within the pulp but the type of PM could not be determined. PMs occurred at any level of the root canal; clinicians need to be aware of this when performing root canal treatment.

Successful remission of a recurrent metacarpal osteosarcoma of a Warmblood gelding after radiation therapy

SummaryA 15‐year‐old Warmblood gelding was presented with recurrence of a histologically confirmed osteosarcoma of the left second and third metacarpal bones 3 years after initial diagnosis and treatment. Initially, surgical excision was performed, followed by local injection of carboplatin 11 weeks later. The horse was sound after surgery and was used for low‐level dressage and jumping. Three years later, the horse developed an acute onset of lameness in the left forelimb and a painful soft tissue swelling at the proximomedial metacarpal region. Radiographs showed a spiculated periosteal reaction on the medial aspect of the third metacarpal bone, indicating re‐activation of the lesion. Stereotactic radiation therapy was performed with a protocol consisting of three fractions under general anaesthesia (Mo‐We‐Fr schedule), and a total dose of 30 Gy. The technique used was volumetric‐modulated arc therapy guided by cone beam computed tomography for daily positioning. Following the radiation therapy, the horse became sound at walk, and 1 month later, it became sound at trot. Follow‐up by veterinary examination 18 months after final treatment revealed no lameness at walk and trot, and a stable radiographic appearance.

Bengin Tuomrs of the Spine: A Systematic Review

Abstract Background Spine tumors are classified as primary tumors which originate from the spine itself and its adjacent structures and secondary (metastatic) tumors of distant organs which spread hematogenously and lymphatically and are located in the spine and its surrounding tissues. As the spine is well vascularized and has close relationship with regional lymphatic and venous drainage systems (especially Batson’s venous plexus), it is generally susceptible to metastasis. Metastatic tumors are the most common (97%) tumors of the spine. Aim of the Work to give an overview of the most important benign tumors of the spine, their clinical pictures and the typical features in imaging. Patients and Methods Search results will be conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion/exclusion criteria. We will search the MED-LINE database, PubMed, Cochrane Bone and Muscle Trauma Group Specialized Register, Cochrane Register of Controlled Trails (The Cochrane Library) using the following keywords related to: Bengin tumors, spine. Results Giant cell tumors in the spine, particularly lumbar region, are rare but can present with pain and neurologic deficits. Osteoid osteomas and osteoblastomas, more common in the thoracolumbar spine, exhibit distinct radiological features. Osteoblastomas, locally aggressive, cause persistent pain, stiffness, and neurological deficits, often diagnosed in later stages. Spinal osteoblastoma diagnosis relies on CT scans, superior to plain radiography, and may necessitate biopsy for confirmation. Vertebral hemangiomas, usually asymptomatic, can cause compression-related symptoms and are identified through characteristic radiographic and CT appearances. Conclusion Searching the literature, Comparison between clinical picture in various types of begnin tumors we found that all begnin tumors have similar symptoms such as localized pain, neurological symptoms. Hence different methods of investigation should be used such as plain x-ray, CT scan and MRI.

Abstract C064: Racial and Ethnic Variation in Referral Times for Thoracic Oncologic Surgery in a Major Metropolitan Area

Abstract Objective The study objective was to understand the impact of race/ethnicity on access to thoracic surgical care for patients undergoing lung resection for cancer. Methods We performed a retrospective analysis on 206 consecutive patients who underwent lung resection for cancer (120 female, 86 male; median age 66 years), with respect to how race and ethnicity impact time to referral for thoracic surgery to a major healthcare center. Time between initial radiographic appearance of a lung nodule/mass 1 cm or greater to surgical referral and time from surgical referral to operation were evaluated for 121 White, 30 Asian, 26 Hispanic, 12 African American, and 17 mixed or other race patients. The impact of age, sex, median income of patient's household, national and state Area Deprivation Indices, insurance type, and distance between the patient's domicile and our hospital was evaluated. The influence of the referring physician's practice (hospital-based, hospital-affiliated, or private), internal or external referral, race/ethnicity, and level of specialization was also studied. Results African American, Asian, Hispanic, and mixed/other race patients had significantly longer wait times between initial radiographic finding of a lung nodule/mass 1 cm or greater and surgical referral compared with White individuals (median days: African American, 78; Asian, 95; Hispanic, 92; mixed or other, 65; White, 35). Multiple linear regression analysis demonstrated that race/ethnicity was the only significant predictor of prolonged time to surgical referral when adjusted for age, sex, median household income level, national and state Area Deprivation Indices, insurance type, and distance between patient's home and our hospital. The referring physician's type of practice and internal versus external referral were not significant. However, the physician's race/ethnicity and level of specialization had an impact on referral times, with non-specialists referring patients sooner to thoracic surgery compared with specialists who ordered more workup tests. For all patient races/ethnicities, there was no difference in time between surgical referral and day of operation. Conclusions Race and ethnicity have a major impact on the time from initial radiographic appearance of a lung nodule/mass 1 cm or greater to referral for surgical resection for cancer. This study suggests the need to develop strategies to reduce minority wait times and improve timely access to surgery for patients with thoracic malignancies. Citation Format: Moises Hernandez, Cristian Puerta, Nolan Winicki, Patricia Thistlethwaite. Racial and Ethnic Variation in Referral Times for Thoracic Oncologic Surgery in a Major Metropolitan Area [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C064

Evaluation of a Three-Dimensional Printed Interventional Simulator for Cardiac Ablation Therapy Training

Cardiac ablation (CA) is an interventional electrophysiological procedure used to disrupt arrhythmic substrates in the myocardium by inducing localized scarring. Current CA training relies on the master–apprentice model. In different fields of medicine including CA, virtual and physical simulators have proven to enhance, and even outperform, conventional training modalities while providing a risk-free learning environment. Despite the benefits, high costs and operational difficulties limit the widespread use of interventional simulators. Our previous research introduced a low-cost CA simulator using a 3D-printed biatrial cardiac model, successfully recording ten ablation lesions on the phantom myocardium. In this work, we present and evaluate an enhanced version: compared to the previous version, the cardiac phantom’s electrical behavior and ablation settings were optimized to produce consistent lesions, while 3D-printed components improved the haptic and radiographic properties of the simulator. Seven cardiologists compared the experimental simulator’s performance to the leading commercial system from Heartroid in a 24-question survey on a 5-point Likert scale. The four following areas of fidelity were considered: catheter entry, anatomical correctness, radiographic appearance, and mapping and ablation. The experimental simulator significantly outperformed the commercial system (p &lt; 0.01), particularly in radiographic appearance (p &lt; 0.01). The results show the potential for the experimental simulator in routine CA training.

Thorn-induced Injury of the Knee Mimicking Pigmented Villonodular Synovitis (PVNS): A Case Report

Background and Aims: Plain film radiography is the first imaging modality in the detection of most foreign bodies. However, it is not sensitive for detection of radiolucent objects such as organic material including plant thorns. Case report: Herein, we present the case of a 19-year-old male patient, presenting with an 8-month history of right knee pain and laxity, whose radiographic appearance mimicked that of pigmented villonodular synovitis (PVNS) but was found to have a retained neglected plant thorn in his knee. Upon ultrasound evaluation for image-guided biopsy to confirm the provisional diagnosis of PVNS, he was found to have a retained neglected plant thorn in his knee. Discussion: Plant thorn injuries can present as knee synovitis, as in our case, and should be kept in the differential diagnosis. An ultrasound-guided removal is possible and is a useful minimally invasive procedure.