Radiographic Features Research Articles

Predicting cancer detection rates from multiparametric prostate MRI

Introduction: Although the Prostate Imaging-Reporting and Data System (PI-RADS) categorization represents the standard method for assessing the risk of prostate cancer using prostate magnetic resonance imaging (MRI), there exists wide variation in cancer detection rates (CDRs) in real-world practice. We therefore evaluated the association of clinical and radiographic features with CDRs and developed a predictive model to improve clinical management. Methods: We identified men aged 18–89 years with elevated prostate-specific antigen (PSA) or on active surveillance for prostate cancer who underwent MRI-ultrasound (US) fusion biopsy or in-bore MRI-targeted biopsy. The associations of features with the per-lesion CDR (Gleason 6–10) and clinically significant (cs) CDR (Gleason 7–10) were examined using logistic regression, and results were operationalized into a predictive model. Results: Targeted biopsy was performed for 347 lesions in 281 patients. Overall, the CDR was 49.0% and the csCDR was 28.0%. On multivariable analysis, increasing PI-RADS category, no prior prostate biopsies, smaller prostate size, and increasing PSA density were independently associated with higher CDR, while 0–1 prior prostate biopsies, and a solitary PI-RADS 3–5 lesion were associated with higher csCDR. A predictive model provided a greater net benefit than a strategy of performing biopsy in all PI-RADS 3–5 lesions across a wide range of threshold probabilities. Conclusions: Several clinical and radiographic features are independently associated with the risk of prostate cancer in men undergoing MRI-targeted biopsy. A predictive model based on these features can improve clinical decisions regarding biopsy compared to the conventional strategy of performing biopsy for all PI-RADS 3–5 lesions.

Multidisciplinary Canadian consensus on the multimodal management of high-risk and radioactive iodine-refractory thyroid carcinoma

Most follicular cell-derived differentiated thyroid carcinomas are regarded as low-risk neoplasms prompting conservative therapeutic management. Here, we provide consensus recommendations reached by a multidisciplinary group of endocrinologists, medical oncologists, pathologists, radiation oncology specialists, a surgeon and a medication reimbursement specialist, addressing more challenging forms of this malignancy, focused on radioactive iodine (RAI)-resistant or -refractory differentiated thyroid carcinoma (RAIRTC). In this document we highlight clinical, radiographic, and molecular features providing the basis for these management plans. We distinguish differentiated thyroid cancers associated with more aggressive behavior from thyroid cancers manifesting as poorly differentiated and/or anaplastic carcinomas. Treatment algorithms based on risk-benefit assessments of different multimodal therapy approaches are also discussed. Given the scarcity of data supporting management of this rare yet aggressive disease entity, these consensus recommendations provide much needed guidance for multidisciplinary teams to optimally manage RAIRTC.

Improved clinical and radiographic outcomes with expandable cages in transforaminal lumbar interbody fusion: a propensity-matched cohort analysis.

The restoration of sufficient overall lumbar lordosis (LL) and segmental LL (SL) is associated with achieving optimal sagittal balance, decreasing back pain, and enhancing functional outcomes for patients. Expandable cages were developed in hopes of improving radiographic parameters and clinical outcomes, although current clinical evidence is inconclusive. Here, the authors aimed to evaluate the clinical and radiographic outcomes in patients undergoing one- or two-level open transforaminal lumbar interbody fusion (TLIF) with expandable versus static cage placement, using propensity-matched cohorts. An institutional retrospective cohort of patients who underwent one- or two-level open TLIF with either expandable cage or static cage placement was identified. Using relevant preoperative covariates, including age, primary versus revision operation, number of cages implanted, and surgical level implanted, the authors built propensity-matched cohorts. They identified clinical outcomes in both cohorts, including operative characteristics and complication rates, along with pain, weakness, and sensory deficits over follow-up. Furthermore, they extracted and examined preoperative, postoperative, and last follow-up radiographic parameters. A total of 148 patients were included, and they were followed for a mean of 1.7 years (range 0.5-4.3 years). Propensity matching was used to create cohorts of patients who were similar with respect to age, surgical indication, revision status, number of cages implanted, surgical level implanted, and length of follow-up. Patients in both groups had similar preoperative radiographic parameters. Patients with expandable cages saw larger increases in SL, both postoperatively (5.3° ± 7.5° vs 1.6° ± 5.6°, p = 0.006) and at last follow-up (5.7° ± 7.4° vs 1.0° ± 6.1°, p = 0.003). They also saw significant improvements in pelvic incidence minus LL mismatch at last follow-up (-4.4° ± 13.2° vs 5.8° ± 13.8°, p = 0.009). No differences in intraoperative or perioperative complications were found, but patients with expandable cages were less likely to require readmission, develop adjacent-segment disease, or require revision surgery. They were also more likely to be symptom free at 1 month after surgery and at last follow-up. Expandable cages lead to better restoration of radiographic features, including SL and improvements in clinical outcomes, compared with static cages in propensity-matched cohorts in patients undergoing one- or two-level open TLIFs.

Automatic detection of temporomandibular joint osteoarthritis radiographic features using deep learning artificial intelligence. A Diagnostic accuracy study.

The purpose of this study was to investigate the diagnostic performance of a neural network Artificial Intelligence model for the radiographic confirmation of Temporomandibular Joint Osteoarthritis in reference to an experienced radiologist. The diagnostic performance of an AI model in identifying radiographic features in patients with TMJ-OA was evaluated in a diagnostic accuracy cohort study. Adult patients elected for radiographic examination by the Diagnostic Criteria for Temporomandibular Disorders decision tree were included. Cone-beam computed Tomography images were evaluated by object detection YOLO deep learning model. The diagnostic performance was verified against examiner radiographic evaluation. The differences between the AI model and examiner were non-significant statistically, except in the subcortical cyst (P=0.049*). AI model showed substantial to near-perfect levels of agreement when compared to those of the examiner data. Regarding each radiographic phenotype, the AI model reported favorable sensitivity, specificity, accuracy, and highly statistically significant Receiver Operating Characteristic (ROC) analysis (p < 0.001). Area Under Curve ranged from 0.872, for surface erosion, to 0.911 for subcortical cyst. AI object detection model could open the horizon for a valid, automated, and convenient modality for TMJ-OA radiographic confirmation and radiomic features identification with a significant diagnostic power.

Progressive pseudorheumatoid dysplasia involving a novel CCN6 mutation: a case report

ObjectiveThis study aims to report a case of progressive pseudorheumatoid dysplasia (PPRD) with two kinds of cellular communication network factor 6 (CCN6) gene mutation. In this paper, the clinical profile and the process of diagnosis were analyzed, and the related literature was reviewed. A 15-year-old boy, who developed progressive ankle and hip joint pain and enlargement with spine involvement, was diagnosed with PPRD. The erythrocyte sedimentation rate and C-reactive protein (CRP) were in the normal range; rheumatoid factor and anti-cyclic citrullinated peptide antibody (ACPA) were all negative. Human leukocyte antigen 27 (HLA-B27) was also negative. Cene study discovered two kinds of mutations in CCN6 gene: c. 802T&amp;gt;C and c.624dup. Radiographic studies revealed spine platyspondyly and shaped beaked, osteoporosis, and bilateral symmetric bony enlargements of the interphalangeal joints. Hip shows bilateral acetabulum and femoral head bone marrow edema, which revealed hip arthritis. Gene detection, laboratory examination, and typical radiographic features are helpful for the diagnosis of PPRD. This is the first report of c. 802T&amp;gt;C and c.624dup mutations in patients with PPRD in our country.

Radiographic Indicators of Craniocervical Instability: Analyzing Variance of Normative Supine and Upright Imaging in a Healthy Population.

Single-institution retrospective review. To establish baseline ranges and variability of 7 radiographic measurements of the cervical spine in a healthy patient population as potential diagnostic tools for craniocervical instability. Craniocervical instability, common in patients with connective tissue disease such as Ehlers-Danlos Syndrome, often presents with a wide range of symptoms, including neck pain. Current diagnostic methods employ a range of clinical and radiographic features, but diagnostic challenges remain due to missed indications on static imaging and a lack of standardized measurement values and normalized variance. Seventy-two healthy patients with cervical imaging were analyzed. Surgimap software was used to annotate supine computed tomography images, flexion, extension, and neutral x-ray images for measurement. These measurements included the atlanto-dental interval, clival-axial angle, basion-dens interval, basion-axis interval, perpendicular basion to the inferior aspect of C2, also known as Grabb Oakes measurement, and the hard palate to C1 and hard palate to C2. Statistical analysis assessed differences among imaging modalities, and coefficients of variation were calculated for each measurement. Our cohort consisted of a total of 72 patients with a mean age of 64 (SD: 13.54). All measurements except for the basion-axial interval and atlanto-dental interval demonstrated a significant difference between extension and flexion x-ray measurements. clivo-axial angle, hard palate to C1, and hard palate to C2 demonstrated the lowest coefficients of variance across imaging modalities. Understanding normal variance in cervical measurements is invaluable for accurate CCI diagnosis. Using a cohort of healthy patients, this study delineates the distribution and spread of 7 cervical measurements, delineating reference values and variability in these key measurements and highlighting their potential for use as imaging markers for CCI. Level III.

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.

A multi-center, clinical analysis of IDH-mutant gliomas, WHO Grade 4: implications for prognosis and clinical trial design.

Mutations in the Isocitrate Dehydrogenase (IDH) genes, IDH1 or IDH2, define a group of adult diffuse gliomas associated with a younger age at diagnosis and better prognosis than IDH wild-type glioblastoma. Within IDH mutant gliomas, a small fraction of astrocytic tumors present with grade 4 histologic features and poor prognosis. In molecular studies, homozygous deletion of CDKN2A/B is independently predictive of poor prognosis and short survival. As a consequence, 2021 WHO classification now also recognizes this molecular feature, CDKN2A/B deletion, as sufficient for classifying an astrocytoma as IDH-mutant, WHO Grade 4, regardless of histological grading. Here, we investigate outcomes of patients with WHO Grade 4 IDH-mutant astrocytoma both with and without CDKN2A/B deletion, to compare these groups and evaluate clinical and radiographic factors that contribute to survival. We retrospectively identified 79 patients with IDH-mutant astrocytoma with CDKN2A/B deletion detected at initial diagnosis across five international institutions as well as a comparison group of 51 patients with IDH-mutant, astrocytoma, histologically Grade 4 without detectable CDKN2A/B deletion. We assembled clinical and radiographic features for all patients. We find that CDKN2A/B deletion was associated with significantly worse overall survival (OS; p = 0.0004) and progression-free survival (PFS; p = 0.0026), with median OS of 5.0 years and PFS of 3.0 years, compared to 10.1 and 5.0 years for tumors with a grade 4 designation based only on histologic criteria. Multivariate analysis confirmed CDKN2A/B deletion as a strong negative prognosticator for both OS (HR = 3.51, p < 0.0001) and PFS (HR = 2.35, p = 0.00095). In addition, in tumors with CDKN2A/B deletion, preoperative contrast enhancement is a significant predictor of worse OS (HR 2.19, 95% CI 1.22-3.93, p = 0.0090) and PFS (HR = 1.74, 95% CI = 1.02-2.97, p = 0.0420). These findings underscore the severe prognostic impact of CDKN2A/B deletion in IDH-mutant astrocytomas and highlight the need for further refinement of tumor prognostic categorization. Our results provide a key benchmark of baseline patient outcomes for therapeutic trials, underscoring the importance of CDKN2A/B status assessment, in addition to histologic grading, in clinical trial design and therapeutic decision-making for IDH-mutant astrocytoma patients.

Surgical Management of Thoracic Dorsal Arachnoid Webs: A Ten-Year Single-Institution Experience

ObjectiveThoracic dorsal arachnoid webs are intradural membranes that may cause obstruction of CSF flow and spinal cord compression. While well-recognized, they are rare and there is a paucity of long-term data on their natural history and prognosis. We reviewed radiographic features, surgical indications, and pathologic specimens of patients diagnosed with focal thoracic dorsal arachnoid webs. MethodsA radiology database and surgical case logs were queried for thoracic arachnoid webs at a single hospital system for a ten-year period. A retrospective chart review was performed on identified cases. ResultsWe identified 127 patients with dorsal thoracic arachnoid webs. Arachnoid webs were radiographically classified into three morphologic types: Type 1 (54%) causing spinal cord deformity only, Type 2 (32%) producing cord deformity with myelomalacia, and Type 3 (14%) with cord deformity, myelomalacia, and syringomyelia. These arachnoid webs were commonly centered at the upper thoracic T4 segmental level. Forty-one cases (32%) required surgery, generally for thoracic myelopathy with gait instability (46%) and lower extremity numbness and pain (39%). In patients who underwent surgery, 79% experienced symptomatic improvement and 21% remained stable, after an average of 21 months follow-up evaluation. Surgical pathology revealed fibrous connective tissue (100%) with calcifications (26%) or inflammation (7%). ConclusionsThe majority in a large series of patients with dorsal arachnoid webs did not undergo surgical intervention, but those with myelomalacia and syrinx experienced radiographic and clinical deterioration without surgery. Surgery to treat symptomatic arachnoid webs results in significant clinical improvement with low surgical morbidity.

P10.22.B PREDICTING INTRAOPERATIVE 5-ALA-INDUCED TUMOR FLUORESCENCE VIA MRI AND DEEP LEARNING IN GLIOMAS WITH RADIOGRAPHIC LOWER-GRADE CHARACTERISTICS

Abstract BACKGROUND Lower-grade gliomas typically exhibit 5-aminolevulinic acid (5-ALA)-induced fluorescence in only 20-30% of cases, a rate that can be increased by doubling the administered dose of 5-ALA. Fluorescence can depict anaplastic foci, which can be precisely resected to avoid undergrading. We aimed to analyze whether a deep learning model can predict intraoperative fluorescence based on preoperative magnetic resonance imaging (MRI). Material and Methods: The MRI images of gliomas lacking high-grade characteristics (necrosis, extended contrast-enhancement, a.o.) consisted of T1, T1-post gadolinium, and FLAIR sequences. The preprocessed MRIs were fed into an encoder-decoder convolutional neural network (U-Net), pre-trained for tumor segmentation using those three MRI sequences. We used the outputs of the bottleneck layer of the U-Net in the Variational Autoencoder (VAE) as features for classification. We identified and utilized the most effective features in a Random Forest classifier using the principal component analysis (PCA) and the partial least square discriminant analysis (PLS-DA) algorithms. We evaluated the performance of the classifier using a 10-fold cross-validation procedure. RESULTS We evaluated a cohort of 163 glioma patients categorized as fluorescent (n=83) or non-fluorescent (n=80). Our proposed approach’s performance was evaluated using metrics such as mean balanced accuracy, mean sensitivity, and mean specificity. The optimal results were obtained by employing top-performing features selected by PCA, resulting in a mean balanced accuracy of 80% and mean sensitivity and specificity of 84% and 76%, respectively. CONCLUSION Our findings highlight the potential of a U-Net model, coupled with a random forest classifier, for intraoperative fluorescence prediction. We achieved good accuracy using advanced techniques such as deep learning-based tumor segmentation and Variational Autoencoder for radiomics feature extraction. While the model can still be improved, it has the potential for evaluating when to administer 5-ALA to gliomas lacking typical high-grade radiographic features.

Primordial Odontogenic Tumor: A Decade Post-Description Systematic Review.

Primordial odontogenic tumor (POT) is a rare benign tumor arising from odontogenic epithelium and ectomesenchyme. It typically presents in children and young adults. POT is often found in the posterior mandible and frequently presents as asymptomatic swelling. A systematic review of the literature was conducted to comprehensively analyze the clinicopathologic features of this rare entity over the past ten years. A systematic review of POT case series and case reports following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines was performed. Data on demographics and clinical characteristics, including age, sex, clinical presentation, duration of the lesion, location, and radiographic and histological features, were extracted. A quantitative description of immunohistochemical studies reported in the literature was also performed. Treatment, a follow-up period, and recurrence were collected for analysis. This review included 26 studies involving 36 POT cases. Patients often presented with asymptomatic swelling at a median age of 12 years, with a male-to-female ratio of 1.18:1. The posterior mandible was the most commonly affected site, while three cases were noted in the anterior region exclusively in the maxilla. Most lesions appeared as unilocular radiolucencies with well-defined borders; however, five cases exhibited fine trabeculation or radiopacities. The primary histological features observed in POT included ectomesenchymal stroma lined by columnar cells with nuclear reverse polarity. Most cases were treated through enucleation and curettage (50.0%), followed by tumor excision (36.1%). Only one case demonstrated recurrence among the 29 cases with known follow-up information. This study offers comprehensive and current descriptive data on POT, enhancing the ability of clinicians and pathologists to accurately identify these rare lesions and thereby avoid misdiagnosis and inappropriate management.

Osteoblastoma Recurring as High-grade Osteosarcoma

Abstract Introduction/Objective Osteoblastoma is a benign, bone-forming neoplasm that presents as a well-circumscribed lesion amenable to excision. The prognosis is good despite a 20% recurrence risk. Malignant transformation is very rare. Osteoblastoma-like osteosarcoma is a rare form of osteosarcoma that shares similar clinical, radiographic, and pathological characteristics Methods/Case Report A 24-year-old female presented with a large palpable mass in the posterior occiput. The lesion progressively enlarged over 2 years, finally becoming symptomatic. Magnetic resonance imaging demonstrated an extradural posterior fossa expansile skull mass measuring 6.0 x 5.7 x 4.7 cm that showed multiple fluid/fluid levels. The mass was resected. Pathology demonstrated a well-circumscribed neoplasm that was cellular and composed of large polyhedral osteoblasts with eccentric oval nuclei and abundant amphophilic cytoplasm. Tumor cells were intimately associated with numerous small interconnecting, irregular bony trabeculae. Scattered mitotic figures of normal configuration were noted. The findings were compatible with an epithelioid osteoblastoma with prominent secondary aneurysmal bone cyst-like changes. The patient was lost to follow-up but presented 3 years later with severe migraines. Imaging demonstrated a large heterogeneous enhancing mass centered about the occipital cranioplasty with both intracranial and extracranial components. Reexcision was performed. Sections showed a well- circumscribed tumor, delineated by a rim of subperiosteal reactive bone, with an epithelioid morphology. However, it also demonstrated areas of necrosis, extensive sheet-like growth, conspicuous mitoses, and cytological atypia not seen in the previous specimen. Therefore, diagnosis of osteoblastoma-like osteosarcoma was rendered after expert consultation. Results (if a Case Study enter NA) NA Conclusion This case highlights the exceedingly rare evolving nature of osteoblastomas and their high-grade transformation potential.

Three-dimensional MRI analysis of elbow anatomy and kinematics in children with ulnar dimelia.

Ulnar dimelia often presents with restricted elbow movement. To develop a treatment strategy to improve elbow mobility, a detailed understanding of the skeletal deformity is needed. We created 3-D models of the cartilage and bone in the elbows of four children with ulnar dimelia by segmentation of MRI scans. We analysed the anatomy and performed a kinematic analysis. In all four children, the distal humerus was triangular in shape and consisted of a medial epicondyle, an enlarged lateral epicondyle and an anterior epicondyle. By comparing the 3-D images with conventional radiographs, we found that the projection of the enlarged lateral epicondyle created two longitudinal lines, which is a radiographic hallmark feature of the triangular-shaped distal humerus. In addition, during elbow flexion, the radial forearm bone slides along the lateral trochlea rather than rotates. This knowledge can aid surgeons to plan treatment for improving elbow mobility in ulnar dimelia.Level of evidence: IV.

CT and MRI radiographic characteristics of seminal vesicle cysts

PurposeSeminal vesicle cysts are relatively uncommon benign lesions. Early and accurate diagnosis is crucial for guiding appropriate management strategies. The purpose of this study was to investigate the radiographic characteristics of seminal vesicle cysts in order to enhance the diagnostic proficiency of radiologists. MethodsWe conduct a comprehensive descriptive analysis of the CT and MRI findings pertaining to 15 patients with seminal vesicle cyst, complemented by a brief literature review. ResultThe mean age of 15 patients with seminal vesicle cyst was 57.53 ± 17.0 years. Among these patients, 53.33% (8/15) were incidentally detected, while 40% (6/15) presented with symptoms of abdominal or pelvic pain. One patient exhibited hematospermia. In 86.67% (13/15) of cases, the cysts were unilateral, while the remaining 13.33% (2/15) were bilateral. Radiological assessment comprised CT scans for 7 patients, MRI scans for 12 patients, and a combination of both modalities for 4 patients. Imaging characteristics revealed 11 cases of unilocular cysts and 4 cases of multilocular cysts, with the largest measuring approximately 16.0 × 9.8 cm. CT imaging distinctly demonstrated punctate or nodular calcification along the cyst wall in 3 cases. MRI, on the other hand, facilitated the visualization of cystic contents, including mucinous protein in 9 cases and hemorrhagic components in 2 cases. ConclusionThe radiographic manifestations of seminal vesicle cysts exhibit distinct characteristics, CT and MRI imaging modalities are instrumental in facilitating their accurate diagnosis.

Radiographic features and subtypes of congenital thumb duplication type C3 according to Wu et al. and their potential implications for surgical management: new classification and preliminary results

BackgroundWu et al. introduced a modified radiographic system that allows classification of all forms of CTD with excellent interobserver and intraobserver reliability. No study to date has evaluated the radiographic characteristics of Wu et al. type C3 CTD with osseous attachment at the level of the metacarpal.ObjectiveThis study aimed to evaluate the radiographic features of type C3 CTD according to the system of Wu et al., to describe the different anatomical subtypes of the duplication, and to propose a categorization approach to distinguish diverse surgical strategies based on the radiographic anatomy of this specific subtype of duplication.MethodsWe performed a retrospective analysis of 215 patients (221 thumbs) diagnosed with Wu et al. type C3 CTD at our Institution between 2015 and 2021. We evaluated all CTDs by examining the alignment of the interphalangeal (IP) and metacarpophalangeal (MP) joints and by assessing the presence of abnormal hypertrophic epiphysis of the primary thumb on posteroanterior (PA) radiographs. The proposed classification system has four types: Type I with good alignment of both MP and IP joints, Type II with ulnar deviation of the MP joint, Type III with radial deviation in the MP joint and Type IV with abnormal hypertrophic epiphysis of the distal phalanx of the main thumb with ulnar deviation of the IP joint with or without ulnar deviation of the MP joint.ResultsThere were 140 male and 75 female patients with CTD (221 thumbs). There were 65 left, 144 right and 6 bilateral forms. The right-to-left, male-to-female and unilateral-to-bilateral ratios were 2.2:1, 1.9:1 and 35.8:1 respectively. The mean age at surgery was 22.3 ± 11.8 months (range, 8–80). The proposed classification system allowed the classification of all CTDs (n = 221). Specifically, 53 fingers were classified as Type I (24%), 136 as Type II (61.5%), 21 as Type III (9.5%), and 11 as Type IV (5%).ConclusionThe proposed system is based on radiographic pathoanatomy and complements that of Wu et al. by identifying four distinct subtypes of deformity. It has the potential to improve inter-professional communication and guide surgery in patients with Wu et al. type C3 CTD. However, our results are preliminary and further research is needed to validate them.Level of evidenceIII.

Characteristics and temporal evolution of asymptomatic diffusion-weighted imaging lesions in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL).

The role of asymptomatic diffusion-weighted imaging-positive (aDWI+) lesions in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) patients remains unclear, and their radiographic features may differ from those of symptomatic diffusion-weighted imaging-positive (sDWI+) lesions. We aimed to investigate the clinicoradiographic characteristics of aDWI+ lesions in CADASIL patients. We conducted a retrospective analysis using data from the Taiwan CADASIL Registry. aDWI+ lesions were defined as incidentally detected DWI+ lesions without corresponding acute neurological deficits. We compared the baseline clinical characteristics of patients with and without aDWI+ lesions and analyzed their radiological features and evolution in relation to sDWI+ lesions. Among 154 enrolled patients (mean age 62 ± 10 years), 17 (11%) had aDWI+ lesions. Baseline clinical characteristics were similar in the two groups, but those with aDWI+ lesions had more lacunes (median 8 vs. 2), multiple cerebral microbleeds (CMBs; 85% vs. 40%), and anterior temporal white matter hyperintensity (WMH; 47% vs. 14%). Multivariable analysis showed that aDWI+ lesions were associated with anterior temporal WMH (odds ratio 5.7, 95% confidence interval 1.5-21.0) after adjusting for multiple lacunes, multiple CMBs, and total WMH score. Compared to sDWI+ lesions, aDWI+ lesions were more often small infarcts (<1 cm; 89% vs. 23%) and less likely to involve the corticospinal tract (11% vs. 96%). Among the 11 aDWI+ lesions with follow-up magnetic resonance imaging, seven became microinfarcts, three became lacunes, and one disappeared. aDWI+ lesions in CADASIL are not uncommon and are associated with higher burdens of small vessel disease and anterior temporal WMH. Further research is needed to assess their long-term impact on CADASIL.

Microbial diversity in primary endodontic infections: demographics and radiographic characteristics.

To analyze if the microbiome community composition in primary endodontic infections is associated with clinical or radiographic factors. Seventy-one patients with primary endodontic infections were evaluated for percussion tenderness, presence of a sinus tract, presence of caries, sex, probing depth > 4mm, and age. Samples from the root canals were obtained and the microbiome was subsequently characterized by 16S rRNA amplicon sequencing. For the radiographic analysis, a subset of 12 samples with a periapical index (PAI) ≤ 2 were compared with 19 samples with PAI of 5. The Shannon and Chao1 indices were used to measure alpha diversity. Differences in abundances of genera were evaluated using the Kruskal-Wallis test with Bonferroni's correction. Differences in community composition were evaluated using analysis of similarity (ANOSIM) with Bray-Curtis dissimilarity matrices. No significant differences in microbiome composition relative to clinical factors were found using ANOSIM. Teeth within the two categories of periapical index showed a similar number of species richness, and alpha diversity values P > 0.05. Community composition was significantly affected by the periapical index (ANOSIM P = 0.039, R = 0.10). Larger radiographic lesions demonstrated significant increase in Prevotellaceae, Olsenella, and the motile bacteria Oribacterium, Selenomonadaceae spp., and Treponema. Clinical factors associated with apical periodontitis have a limited impact on the root canal microbiome composition. Community composition appears to be affected in teeth with large apical lesions.

Radiographic findings in dogs with 360 degrees gastric dilatation and volvulus.

Gastric dilatation and volvulus (GDV) is a life-threatening emergency that requires urgent intervention. Radiographic features associated with 360-GDV in dogs have not been investigated. The aim of this retrospective observational study is to describe radiographic features and clinical variables in dogs affected with 360-GDV and to report agreement rates between different radiologists. We also report the sensitivity and specificity of radiographs to diagnose 360-GDV in dogs. Confirmed 360-GDV cases were retrieved, and the radiographic findings were compared with dogs presenting with gastric dilatation (GD) and 180-GDV. Images were reviewed and graded by three blinded board-certified radiologists. A total of 16 dogs with confirmed 360-GDV were identified. The median age was 10 years old (2-13 years). The sensitivity for detection of 360-GDV ranged between 43.7% and 50%, and the specificity between 84.6% and 92.1%. Interobserver agreement on final diagnosis was substantial (Kappa=0.623; 0.487-0.760, 95% CI). The highest agreement rate was in cases of 180-GDV (87%), followed by the GD cases (72%) and 360-GDV (46%). Severe esophageal distension and absence of small intestinal dilation were the only radiographic features specifically associated with 360-GDV. A similar pyloric position was found between GD and 360-GDV. Additional radiographic variables that could help differentiate GD from 360-GDV include the degree of gastric distension and the peritoneal serosal contrast. Two cases with 360-GDV were misdiagnosed by the three radiologists as GD. In conclusion, radiographically, 360-GDV cases can reassemble GD and vice versa. Radiologists and clinicians should be aware of the low sensitivity of radiographs for the detection of 360-GDV.

Analysis of selective neurocritical care admission costs following elective endovascular treatment of unruptured intracranial aneurysms.

No consensus exists on the necessity of neurocritical care unit (NCU)-level care following unruptured intracranial aneurysm (UIA) treatment. We aim to identify patients requiring NCU-level care post-treatment and determine potential cost savings utilizing a selective NCU admission protocol. A retrospective analysis of all UIA patients who underwent endovascular treatment at a single center from 2017-2022 was conducted. Data on demographics, preprocedural variables, radiographic features, procedural techniques, intra/postoperative events, and length of stay (LOS) were collected. Multivariable analysis was performed to identify patients requiring NCU-level care post-treatment. Cost analysis using hospital cost data (not charges/reimbursement) was performed using simulated step-down and floor protocols for patients without NCU indications following a hypothetical six-hour post-anesthesia care unit observation period. Of 209 patients, 179 were discharged within 24 h and 30 had prolonged LOS. In our analysis, intra- and postoperative events independently predicted prolonged LOS. In our subanalysis, 47 patients demonstrated NCU needs: 24 with intraoperative indications, 18 with postoperative indications, and five with both. Of the 23 with postoperative indications, 20 were identified within six hours, while three were identified within six to 24 h. The median variable cost per patient for the current NCU protocol was $31,505 (IQR, $26,331-$37,053) vs. stepdown protocol $29,514 (IQR, $24,746-$35,011;p = 0.061) vs. floor protocol $26,768 (IQR, $22,214-$34,107;p < 0.001). Total variable costs were $6,211,497 for the current NCU protocol vs. $5,921,912 for the step-down protocol (4.89% savings) and $5,509,052 for the floor protocol (12.75% savings). Most patients requiring NCU-level care following UIA treatment were identified within a six-hour postoperative window. Thus, selective NCU admission for this cohort following a six-hour observation period may be a logical avenue for cost reduction. Our analysis demonstrated 5% and 13% savings for uncomplicated patients using step-down and floor admission protocols, respectively.

Association Between Radiographic Features of Hypertrophic Pachymeningitis and its Underlying Diagnoses

Association Between Radiographic Features of Hypertrophic Pachymeningitis and its Underlying Diagnoses