Radiographic Correlation Research Articles

Pathology-based brain arterial disease phenotypes and their radiographic correlates

IntroductionBrain arterial diseases, including atherosclerosis, vasculitis, and dissections, are major contributors to cerebrovascular morbidity and mortality worldwide. These diseases not only increase the risk of stroke but also play a significant role in neurodegeneration and dementia. Clear and unambiguous terminology and classification of brain arterial disease phenotypes is crucial for research and clinical practice. Material and methodsThis review aims to summarize and harmonize the terminology used for brain large and small arterial phenotypes based on pathology studies and relate them to imaging phenotypes used in medical research and clinical practice. Conclusions and resultsArteriosclerosis refers to hardening of the arteries but does not specify the underlying etiology. Specific terms such as atherosclerosis, calcification, or non-atherosclerotic fibroplasia are preferred. Atherosclerosis is defined pathologically by an atheroma. Other brain arterial pathologies occur and should be distinguished from atherosclerosis given therapeutic implications. On brain imaging, intracranial arterial luminal stenosis is usually attributed to atherosclerosis in the presence of atherosclerotic risk factors but advanced high-resolution arterial wall imaging has the potential to more accurately identify the underlying pathology. Regarding small vessel disease, arteriosclerosis is ambiguous and arteriolosclerosis is often used to denote the involvement of arterioles rather than arteries. Lipohyalinosis is sometimes used synonymously with arteriolosclerosis, but less accurately describes this common small vessel thickening which uncommonly shows lipid. Specific measures of small vessel wall thickness, the relationship to the lumen as well as changes in the layer composition might convey objective, measurable data regarding the status of brain small vessels.

Pseudocirrhosis: A Case Series with Clinical and Radiographic Correlation and Review of the Literature

Background and aimsPseudocirrhosis is a poorly understood acquired morphologic change of the liver that occurs in the setting of metastatic malignancy and radiographically resembles cirrhosis. Pseudocirrhosis has been primarily described in metastatic breast carcinoma, with few case reports arising from other primary malignancies. We present 29 cases of pseudocirrhosis, including several cases from primary malignancies not previously described.MethodsRadiologic, clinical, demographic, and biomedical data were collected retrospectively and analyzed. We compared clinical and radiologic characteristics and outcomes between patients with pseudocirrhosis arising in metastatic breast cancer and non-breast primary malignancies.ResultsAmong the 29 patients, 14 had breast cancer and 15 had non-breast primaries including previously never reported primaries associated with pseudocirrhosis, melanoma, renal cell carcinoma, appendiceal carcinoid, and cholangiocarcinoma. Median time from cancer diagnosis to development of pseudocirrhosis was 80.8 months for patients with primary breast cancer and 29.8 months for non-breast primary (p = 0.02). Among all patients, 15 (52%) had radiographic features of portal hypertension. Radiographic evidence of portal hypertension was identified in 28.6% of breast cancer patients, compared to 73.3% of those with non-breast malignancies (p = 0.03).ConclusionPseudocirrhosis has most commonly been described in the setting of metastatic breast cancer but occurs in any metastatic disease to the liver. Our study suggests that portal hypertensive complications are more common in the setting of non-breast primary cancers than in metastatic breast cancer. Prior exposure to multiple chemotherapeutic agents, and agents known to cause sinusoidal injury, is a common feature but not essential for the development of pseudocirrhosis.

Recent Patterns of Radiotherapy Use in Multiple Myeloma: Clinical Outcomes and Possible Radiologic, Biochemical, and Genomic Correlates of Response

Background/Objectives: Systemic therapies for multiple myeloma (MM) have advanced considerably, changing the landscape of MM treatment paradigms. Yet, the use of radiotherapy (RT) has remained heterogeneous, and even controversial, due to minimal data on outcomes. With the ultimate goal of guiding the design of prospective trials incorporating RT, we initiated a study of our institutional experience treating MM with RT since 1/1/2000. Here we report a preliminary feasibility analysis of an initial sample cohort, identifying patterns of RT use, outcomes, and the impact of RT on radiographic and biochemical markers, with genomic characterization for more recently treated patients. Materials/Methods: 506 pathologically confirmed MM patients who received RT to 1190 sites between 1/1/2000 and 6/1/2022 were identified. Patient, disease, and treatment characteristics were analyzed for 50 consecutive patients treated in 2019 (recent sampling but with reasonable follow for analysis) and tested for association with cumulative incidence of local and distant failure (LF, DF) using univariable and multivariable analysis. Genomic data was obtained via next generation sequencing using an institutional targeted sequencing panel (Memorial Sloan Kettering IMPACT). Results: Among the 50 patients analyzed (median 63 years), 90 lesions were treated with RT, 33% with concurrent systemic therapy, to a median dose of 20 Gy (8-46 Gy) over a median of 5 fractions (1-25). RT Indications were pain (56%), critical structure involvement (25%), peri-operative (9%), salvage/consolidation (8%), and bridging therapy (2%). Median size of RT-treated lesions was 4.2 cm (1.4-7.9) and included non-vertebral bones (62%), spine (24%), and extramedullary sites (14%). The median number of lines of pre-RT therapy was 7 (1-14) and 51% had >9 lesions on imaging, 47% involving both medullary and extramedullary sites. Pre-RT PET imaging was performed in a majority of patients (62%). With a median follow-up of 12.4 months (0.5-46), LF occurred in 5% of treated sites and 89% had DF, most commonly in both medullary + extramedullary (51.4%) sites. Of the patients with DF, 93% had sustained local control of the irradiated site. Absolute decreases 1-week to 1-month post-RT were observed in marrow plasma cell percentage, (median 4.0%), M spike (0.30 g/dL), total protein (0.3 g/dL), K:L ratio (0.01), lesion size (1.5cm), and lesion SUV (3.1) but in this limited sample, none were significantly associated with disease control. A cohort of 62 RT-treated MM patients from 2016-2022 had genomic data available; most common tumor mutations were in TP53 (35%), HIST1 (34%), NRAS (34%), and KRAS (23%). Conclusion: In this pilot analysis of a sampling cohort of RT-treated MM, we report on patterns of utilization, outcomes, and biochemical and radiographic correlates. Ultimately, we aim to characterize the role of RT in the modern era of systemic therapy to guide the design of future prospective trials and to inform novel approaches for incorporating RT into the treatment paradigm. At the meeting, we will present data from a larger cohort of MM patients, with further sub-analyses on the relevance of baseline imaging to subsequent irradiated lesions, as well as toxicity and outcomes data with the use of radiotherapy in conjunction with newer systemic agents (bi-specific antibodies and chimeric antigen receptor T-cell therapy).

The Importance of Pelvic Obliquity in Assessing Spinal Coronal Alignment: Normative Values, Demographic, and Radiographic Correlations.

Prospective, cross-sectional study. In a geographically diverse population of asymptomatic volunteers, we sought to report the incidence of pelvic obliquity (PO), establish normative values of PO across patient factors, and assess the correlation of PO with radiographic parameters. PO is defined as the misalignment of the pelvis and can be assessed through several anatomic landmarks. Significant PO, whether caused by leg-length discrepancy or not, can lead to coronal malalignment which causes severe pain and disability. Significant emphasis has been placed on achieving appropriate sagittal alignment in recent decades; however, a greater understanding of coronal alignment is needed, and PO is a crucial aspect of evaluating the coronal plane in adult spinal deformity patients. Asymptomatic adult volunteers, ages 18-80 years, enrolled patients from 5 countries (France, Japan, Singapore, Tunisia, and the United States) in the "multiethnic alignment normative study" cohort (IRB 201812144). The included volunteers had no known spinal disorder(s), no significant neck or back pain (Visual Analog Scale: ≤2; Oswestry Disability Index: ≤20), and no abnormal alignment (Cobb ≤20°). PO was measured in the frontal plane as the distance between the highest points of each acetabulum, calculated along the vertical axis in millimeters (mm). The incidence of PO was defined as PO ≥10mm. Kruskal-Wallis, Wilcoxon rank-sum, Pearson correlation, and linear regression were used. A total of 467 patients were included, and PO values by age, sex, body mass index, and country were provided. The overall incidence of PO ≥10mm was 4.3%, and a nonsignificant trend toward increased PO with age was seen ( P = 0.077). No significant differences were seen in PO between sex, ethnicity, or body mass index groups. No significant correlation existed between PO and other commonly used coronal radiographic measurements. PO ≥10mm occurred in 4.3% of asymptomatic volunteers. Despite the importance of recognizing PO in preventing coronal malalignment, PO did not seem to be associated with other radiographic and demographic information, which underscores the importance of intentionally assessing for any PO before surgery. These results in an asymptomatic population provide a foundation for studying PO in patients with spinal pathology.

Correlation of Serum Insulin-Like Growth Factor-1 and Hand Wrist Radiographs as Skeletal Maturity Indicators: an Ex-Vivo Study

Introduction: Conventional Hand and Wrist radiographs, have certain drawbacks of exposing orthodontic patients to unnecessary radiation hazards and subjectivity to errors. Serum insulin-like growth factor 1 (IGF-1) levels have been reported to increase until the pubertal peak in literature. The present study aims to assess the relationship between serum IGF-1 and skeletal maturity indicators Materials and Methods: Lateral cephalograms of 60 patients were assigned SMI stage according to Fishman’s classification system. The serum IGF-1 levels of the patients were also evaluated. Correlation between the serum IGF-1 levels, age of the patient, and their SMI stage was analyzed. Results: Pearson's coefficient of correlation revealed a non-significant weak positive correlation (p=0.69; >0.05) between age and IGF-1 levels, and a non-significant weak negative correlation (p =0.52; >0.05) between SMI stages and IGF-1 levels. Results of the ANOVA test indicated that there was no significant difference between mean IGF-1 levels across the different age groups and eleven SMI groups. However, there was a significant difference noted in the mean IGF-1 levels and the restructured SMI categories and groups. Conclusion: The moderate correlation between age and serum IGF-1 fluctuations during puberty underscores the hormone's pivotal role in adolescent growth. This positions serum IGF-1 as a potentially specific and reliable marker for assessing mandibular growth modifications, offering a radiation-free alternative to conventional radiographic methods

Validation of targeted next-generation sequencing of cell-free DNA from archival cerebrospinal fluid specimens for the detection of somatic variants in cancer involving the leptomeninges: Cytopathologic and radiographic correlation.

Leptomeningeal metastases occur across multiple solid and lymphoid cancers, and patients typically undergo cytopathologic assessment of cerebrospinal fluid (CSF) in this setting. For patients diagnosed with metastatic cancer, the detection of actionable somatic mutations in CSF can provide clinically valuable information for treatment without the need for additional tissue collection. The authors validated a targeted next-generation sequencing assay for the detection of somatic variants in cancer (OncoPanel) on cell-free DNA (cfDNA) isolated from archival CSF specimens in a cohort of 25 patients who had undergone molecular testing of a prior tumor specimen. CSF storage time and volume had no impact on cfDNA concentration or mean target coverage of the assay. Previously identified somatic variants in CSF cfDNA were detected in 88%, 50%, and 27% of specimens diagnosed cytologically as positive, suspicious/atypical, and negative for malignancy, respectively. Somatic variants were identified in 81% of CSF specimens from patients who had leptomeningeal enhancement on magnetic resonance imaging compared with 31% from patients without such enhancement. These data highlight the stability of cfDNA in CSF, which allows for cytopathologic evaluation before triage for next-generation sequencing assays. For a subset of cases in which clinical suspicion is high but cytologic or radiographic studies are inconclusive, the detection of pathogenic somatic variants in CSF cfDNA may aid in the diagnosis of leptomeningeal metastases.

Radiation in a New Era of Multiple Myeloma Management: Patterns of Utilization, Clinical, Radiologic, and Biochemical Outcomes, and Possible Genomic Correlates of Response

Systemic therapies for multiple myeloma (MM) have advanced considerably, improving patient outcomes. Yet, the use of radiotherapy (RT) has remained heterogeneous, and even controversial, due to minimal data on outcomes. With the ultimate goal of guiding the design of prospective trials incorporating RT, we initiated a study of our institutional experience treating MM with RT since 1/1/2000. Here we report a preliminary feasibility analysis of an initial sample cohort, identifying patterns of RT utilization, outcomes, and impact of RT on radiographic and biochemical markers, with genomic characterization for more recently treated patients. Five hundred six pathologically confirmed MM patients who received RT to 1190 sites between January 1, 2000, and June 1, 2022, were identified. Patient, disease, and treatment characteristics were analyzed for 50 consecutive patients treated in 2019 and tested for association with local and distant failure (LF, DF) using univariable and multivariable analysis. Genomic data was obtained via next generation sequencing using an institutional targeted sequencing panel. Amongthe 50 patients analyzed (median 63 years), 90 lesions were treated with RT, 33% with concurrent systemic therapy, to median dose of 20 Gy (8-46 Gy) over a median of 5 fractions (1-25). RT Indications were pain (56%), critical structure involvement (25%), peri-operative (9%), salvage/consolidation (8%), and bridging therapy (2%). Median size of RT-treated lesions was 4.2 cm (1.4-7.9) and included non-vertebral bones (62%), spine (24%), and extramedullary sites (14%). The median number of lines of pre-RT therapy was 7 (1-14) and 51% had >9 lesions on imaging, 47% involving both medullary and extramedullary sites. With median follow-up of 12.4 months (0.5-46), LF occurred in 5% of treated sites and 89% had DF, most commonly in both medullary + extramedullary (51.4%) sites. Absolute decreases 1-week to 1-month post-RT were observed in % of marrow plasma cell (median 4.0%), M spike (0.30 g/dL), total protein (0.3 g/dL), K:L ratio (0.01), lesion size (1.5cm), and lesion SUV (3.1) but in this limited sample, none were significantly associated with disease control. A cohort of 62 RT-treated MM patients from 2016-2022 had genomic data available; most common tumor mutations were in TP53 (35%), HIST1 (34%), NRAS (34%), and KRAS (23%). In this pilot analysis of a sampling cohort of RT-treated MM, we report on patterns of utilization, outcomes, and biochemical and radiographic correlates. At the meeting, we will present the full analysis of the >500 MM patients and further analyze emerging genomic data. We aim to characterize the role of RT in the modern era of systemic therapy to guide the design of future prospective trials and to inform novel approaches for incorporating RT into the treatment paradigm.

Processing speed and memory test performance are associated with different brain region volumes in Veterans and others with progressive multiple sclerosis.

Cognitive dysfunction and brain atrophy are both common in progressive multiple sclerosis (MS) but are seldom examined comprehensively in clinical trials. Antioxidant treatment may affect the neurodegeneration characteristic of progressive MS and slow its symptomatic and radiographic correlates. This study aims to evaluate cross-sectional associations between cognitive battery components of the Brief International Cognitive Assessment for Multiple Sclerosis with whole and segmented brain volumes and to determine if associations differ between secondary progressive (SPMS) and primary progressive (PPMS) MS subtypes. The study was based on a baseline analysis from a multi-site randomized controlled trial of the antioxidant lipoic acid in veterans and other people with progressive MS (NCT03161028). Cognitive batteries were conducted by trained research personnel. MRIs were processed at a central processing site for maximum harmonization. Semi-partial Pearson's adjustments evaluated associations between cognitive tests and MRI volumes. Regression analyses evaluated differences in association patterns between SPMS and PPMS cohorts. Of the 114 participants, 70% had SPMS. Veterans with MS made up 26% (n = 30) of the total sample and 73% had SPMS. Participants had a mean age of 59.2 and sd 8.5 years, and 54% of them were women, had a disease duration of 22.4 (sd 11.3) years, and had a median Expanded Disability Status Scale of 6.0 (with an interquartile range of 4.0-6.0, moderate disability). The Symbol Digit Modalities Test (processing speed) correlated with whole brain volume (R = 0.29, p = 0.01) and total white matter volume (R = 0.33, p < 0.01). Both the California Verbal Learning Test (verbal memory) and Brief Visuospatial Memory Test-Revised (visual memory) correlated with mean cortical thickness (R = 0.27, p = 0.02 and R = 0.35, p < 0.01, respectively). Correlation patterns were similar in subgroup analyses. Brain volumes showed differing patterns of correlation across cognitive tasks in progressive MS. Similar results between SPMS and PPMS cohorts suggest combining progressive MS subtypes in studies involving cognition and brain atrophy in these populations. Longitudinal assessment will determine the therapeutic effects of lipoic acid on cognitive tasks, brain atrophy, and their associations.

Radiographic correlation of Gonial Angle with Age and Gender among Pediatric Patient visiting a Tertiary Hospital: A Retrospective Study

Introduction: The mandible is one of the largest and most rigid bone in the facial skeleton. The mandibular parameters like gonial angle, bigonial width and ramus heights can be used to determine a correlation with an individual’s age and gender. This can be an important legal ramifications and its assessment has a great role in forensic and orthodontic purposes. Objective: To assess the radiographic correlation of gonial angle with age and gender. Methods: A total of 325 Orthopantomographs (OPG) were evaluated which included 168 male and 157 female dentate subjects. It was further categorized into three groups: Group I (3-9 years), Group II (10-15 years) and Group III (16-17 years). The gonial angle was measured bilaterally and the data were statistically analyzed. Results: The mean age of the subjects was 12.24+3.79 yrs. The mean values (in degrees) of right (126.71+5.89) and left gonial angles (129.92+5.86) were higher on females compared to males. However, it was not statistically significant. The mean values of right and left gonial angles were higher on the age group 8-12yrs (126.70+ 6.52 and 128.56+ 5.83) and lowest on the age group 13-17yrs (125.40+ 6.84 and 126.93+7.35) which also showed statistically insignificant in all age groups. Conclusions: The morphometric analysis of the mandible through radiographic measurements may be useful in estimating an individual’s age and gender when comparing to known population. Gonial angle has been used as an adjunct parameter which has an implications on forensic identifications as well as orthodontic analysis.

Reliability of Radiographic Imaging Characteristics for Osteochondritis Dissecans of the Capitellum

Background: A primary challenge in the treatment of capitellar osteochondritis dissecans (OCD) is accurate imaging assessment. Radiographic classification consensus is not available in the current literature, and correlation of radiographs with lesion stability and resultant best treatment is lacking. Purpose: To determine the inter- and intrarater reliability of the presence or absence and common radiographic characteristics of capitellar OCD lesions. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: Anteroposterior, lateral, and oblique radiographs for 29 cases were reviewed by 7 orthopaedic surgeons. Images were assessed for elbow anthropometry and morphology, OCD presence, lesion characteristics, the presence of progeny bone and progeny features, and radial head abnormalities. Intra- and interrater reliability was assessed using Fleiss and Cohen kappa for nominal variables and intraclass correlation coefficients (ICCs) for continuous variables. Results: Surgeons demonstrated substantial to excellent inter- and intrarater reliability when assessing elbow characteristics: anthropometric (interrater ICC, 0.94-0.99; intrarater ICC, 0.82-0.96) and morphologic (Fleiss, 0.61-0.76; Cohen, 0.68). When the OCD lesion was assessed, fair to moderate interrater agreement was found for classifying the absence or presence of a lesion (Fleiss, 0.28-0.46) and the location of the OCD (Fleiss, 0.24-0.52), poor agreement for assessing the contour of the lesion (Fleiss, 0.00-0.09), and excellent agreement for measuring the size of the lesion (ICC, 0.82-0.94). Poor to fair interrater agreement was found for radial head abnormalities (Fleiss, 0.00-0.27). Progeny bone visualization and fragmentation demonstrated moderate interrater agreement (Fleiss, 0.43-0.47) where displacement of the bone demonstrated poor interrater agreement (Fleiss, 0.11-0.16). Intrarater agreement for OCD lesion characteristics, progeny bone visualization, and progeny bone features was moderate to excellent. Conclusion: Given only the fair to moderate agreement among raters for identifying OCD on radiographs, this imaging modality may not serve as a dependable screening tool in isolation. Additional imaging should be obtained if the clinical presentation suggests capitellar OCD and a definitive diagnosis is not possible with radiographs. However, clinicians can reliability measure the size of radiographically apparent OCD, suggesting that radiographs may serve as an appropriate imaging modality for follow-up care.

TRAFFIC JAM IN THE VASCULATURE: A CASE OF PULMONARY LEUKOSTASIS

TRAFFIC JAM IN THE VASCULATURE: A CASE OF PULMONARY LEUKOSTASIS

Functional and clinical outcome of anterior cruciate ligament reconstruction with peroneus longus autograft and correlation with MRI after 3 years

IntroductionAutograft options for anterior cruciate ligament reconstruction over the years have gone from bone-patellar tendon-bone to hamstring to peroneus longus tendon. Considering the drawbacks of other autografts, we analyse peroneus longus autograft holistically as a viable alternative. Materials and methodsThis was a prospective study of 113 patients undergoing anterior cruciate ligament reconstruction with peroneus longus autograft between January 2017 and November 2018 for isolated, full-thickness ACL tears. Functional analysis was done using the Tegner-Lysholm score pre-operatively, at 6 months, 1 year, 2 years, and 3 years postoperatively. At terminal follow-up, stability was checked clinically by Lachman test, residual morbidity of donor site was assessed using foot and ankle disability index, and radiographic correlation was done with magnetic resonance imaging. ResultsThe mean diameter of the graft after tripling was 9 ± 0.71 mm and the average length before tripling was found to be 27.07 ± 2.76 cms. At terminal follow-up, 101 patients showed excellent, while 12 patients showed good outcomes. The mean foot and ankle disability index was 94.8 ± 3. 90.27% of patients had no laxity on clinical examination, and magnetic resonance imaging of all the patients at terminal follow-up showed good graft uptake. ConclusionsPeroneus longus autograft shows intraoperative consistency and gives excellent functional outcome, clinical stability, and no donor site morbidity even three years postoperatively.

Florid cemento-osseous dysplasia-related osteonecrosis: A series of cases

ObjectiveThe aim of this study was to assess the clinicopathological features of florid cemento-osseous dysplasia (FCOD)-related osteonecrosis highlighting their histopathological aspects and bone structure. MethodsTwenty-two FCOD-related osteonecrosis cases were evaluated retrospectively. Osteonecrosis, osteomyelitis, bacterial colonization, bone resorption, reactive bone, osteon-like structure, lamellar bone, and basophilic lines were analyzed. Specific staining and fluorescence and polarized light microscopy analyses were also performed.Results: The mandible was more affected by FCOD-related osteonecrosis. There was a predominance of African-Brazilian women in the fifth and seventh decades of life. Osteomyelitis was present in 82 % of cases whereas bone resorption and bacterial colonization were present in 100 % of FCOD-related osteonecrosis cases. Thick basophilic lines were seen in all cases (100 %). Actinomycosis and osteoclasts were not often. ConclusionsThis study showed female adult preference, mandibular location, and some findings such as osteomyelitis, bone resorption, and bacterial colonization were histopathological features more frequent in FCOD-related osteonecrosis. In the absence of a close clinical and radiographic correlation, the morphology of the necrotized bone similar to cementum could help to recognize FCOD.

Revisiting Middle East Respiratory Coronavirus (MERS-CoV) Outbreak Chest Radiographic Initial Findings, Temporal Progression, and Correlation to Outcomes: A Multicenter Study.

ObjectivesAccounts of initial and follow-up chest X-rays (CXRs) of the Middle East respiratory coronavirus (MERS-CoV) patients, and correlation with outcomes, are sparse. We retrospectively evaluated MERS-CoV CXRs initial findings, temporal progression, and outcomes correlation.Materials and methodsFifty-three real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR)-confirmed MERS-CoV patients with CXRs were retrospectively identified from November 2013 to October 2014. Initial and follow-up CXR imaging findings and distribution were evaluated over 75 days. Findings were correlated with outcomes.ResultsTwenty-two of 53 (42%) initial CXRs were normal. In 31 (68%) abnormal initial CXRs, 15 (48%) showed bilateral non-diffuse involvement, 16 (52%) had ground-glass opacities (GGO), and 13 (42%) had peripheral distribution. On follow-up CXRs, mixed airspace opacities prevailed, seen in 16 (73%) of 22 patients 21-30 days after the initial CXRs. Bilateral non-diffuse involvement was the commonest finding throughout follow-up, affecting 16 (59%) of 27 patients 11-20 days after the initial CXRs. Bilateral diffuse involvement was seen in five (63%) of eight patients 31-40 days after the initial CXRs. A bilateral diffuse CXR pattern had an odds ratio for mortality of 13 (95% CI=2-78) on worst and 18 (95% CI=3-119) on final CXRs (P-value <0.05).ConclusionInitially, normal CXRs are common in MERS-CoV patients. Peripherally located ground-glass and mixed opacities are common on initial and follow-up imaging. The risk of mortality is higher when bilateral diffuse radiographic abnormalities are detected.

“Reverse roussouly”: cervicothoracic curvature ratios define characteristic shapes in adult cervical deformity

To investigate normal curvature ratios of the cervicothoracic spine and to establish radiographic thresholds for severe myelopathy and disability, within the context of shape. Adult cervical deformity (CD) patients undergoing cervical fusion were included. C2-C7 Cobb angle (CL) and thoracic kyphosis (TK), using T2-T12 Cobb angle, were used as a ratio, ranging from -1 to + 1. Pearson bivariate r and univariate analyses analyzed radiographic correlations and differences in myelopathy(mJOA > 14) or disability(NDI > 40) across ratio groups. Sixty-three CD patients included. Regarding CL:TK ratio, 37 patients had a negative ratio and 26 patients had a positive ratio. A more positive CL:TK correlated with increased TS-CL(r = 0.655, p = < 0.001)and mJOA(r = 0.530, p = 0.001), but did not correlate with cSVA/SVA or NDI scores. A positive CL:TK ratio was associated with moderate disability(NDI > 40)(OR: 7.97[1.22-52.1], p = 0.030). Regression controlling for CL:TK ratio revealed cSVA > 25mm increased the odds of moderate to severe myelopathy and cSVA > 30mm increased the odds of significant neck disability. Lastly, TS-CL > 29 degrees increased the odds of neck disability by 4.1 × with no cutoffs for severe mJOA(p > 0.05). Cervical deformity patients with an increased CL:TK ratio had higher rates of moderate neck disability at baseline, while patients with a negative ratio had higher rates of moderate myelopathy clinically. Specific thresholds for cSVA and TS-CL predicted severe myelopathy or neck disability scores, regardless of baseline neck shape. A thorough evaluation of the cervical spine should include exploration of relationships with the thoracic spine and may better allow spine surgeons to characterize shapes and curves in cervical deformity patients.

Dactylolysis Spontanea: Possible Immunohistologic Etiology Discovered in a Rare Presentation of Bilateral Fourth Digits

Dactylolysis spontanea is a rare, progressive disease characterized by fibrous soft-tissue constriction around the base of an appendage. It most commonly occurs bilaterally in the fifth toes of male patients and often progresses to spontaneous autoamputation. The broad spectrum of clinical severity, poorly characterized natural clinical timeline, and previous lack of specific confirmatory tests make this condition difficult to diagnose and treat in the early stages where it may be amendable to conservative treatment. We present a case report of a 29-year-old woman with dactylolysis spontanea involving bilateral fourth digits. The diagnosis of dactylolysis spontanea was made based on clinical and radiographic correlations and by excluding other similar conditions. Following surgical removal of the digits, exploratory histopathologic analysis demonstrated the novel presence of positive glucose transporter 1 immunohistochemical staining. Although the diagnosis of dactylolysis spontanea has historically been considered a diagnosis of exclusion and is often complicated by the heterogeneous clinical presentations, glucose transporter 1 staining offers clinicians a valuable tool in assisting with the diagnosis of this condition. This may finally elucidate the etiology of this rare condition.

Radiographic Correlation In Bilateral Impacted Lower Third Molars: A Retrospective CBCT Based Study

Radiographic Correlation In Bilateral Impacted Lower Third Molars: A Retrospective CBCT Based Study

Atrioventricular Discordance with Pulmonary Atresia, Double-outlet Right Ventricle, and Isolated Levocardia: A Case Report of a Rare Congenital Heart Disease

Almost all cases of isolated levocardia or situs inversus with levocardia are associated with congenital heart disease. We report a case of situs inversus with levocardia, double-outlet right ventricle, atrioventricular discordance, pulmonary atresia, patent ductus arteriosus, atrial septal defect, and ventricular septal defect in a neonate. An overview of anatomy and relevant definitions with radiographic correlation will be presented along with a synopsis of current medical literature.&nbsp

Delineating the risk factors of venous congestion: An analysis of 455 deep inferior epigastric perforator flaps with radiographic correlation

Venous congestion occurs in 2-15% of DIEP flaps for breast reconstruction. We previously showed that thicker suprascarpal fat pads are associated with increased SIEV caliber and may, by extension, indicate a dominant superficial venous system. In this study, we aim to provide clinical correlation and to determine the risk factors of venous congestion in order to identify high-risk patients who may benefit from prophylactic SIEV dissection. An IRB-approved retrospective study was performed in patients who underwent DIEP flap reconstruction from August 2011 to August 2020. Radiographic measurements of suprascarpal fat pad thickness and SIEV diameter were collected per hemi-abdomen from preoperative imaging. The statistical analysis explored whether certain variables were associated with venous congestion. A total of 258 patients underwent 455 DIEP flaps. Suprascarpal fat pad thickness was positively correlated with SIEV diameter (r=0.51, p<0.001), each with a mean caliber of 19.8mm and 2.5mm, respectively. Seven flaps (1.5%) developed venous congestion, with five requiring SIEV salvage and secondary venous anastomosis. Congested flaps had significantly thinner suprascarpal fat pads (12.3vs. 20.0mm, p=0.043). All six congested flaps with imaging had suprascarpal thickness less than 18mm, compared to 182 out of 335 non-congested flaps with imaging (p=0.035). The risk of venous congestion following DIEP flap reconstruction is significantly increased with thinner suprascarpal fat pads, suggesting that the mechanism of venous congestion may not be limited to superficial venous dominance. We recommend prophylactic SIEV dissection in all patients with suprascarpal fat pad thickness less than 18mm.

Pulmonary Pathology of End-Stage COVID-19 Disease in Explanted Lungs and Outcomes After Lung Transplantation.

ObjectivesPatients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may develop end-stage lung disease requiring lung transplantation. We report the clinical course, pulmonary pathology with radiographic correlation, and outcomes after lung transplantation in three patients who developed chronic respiratory failure due to postacute sequelae of SARS-CoV-2 infection.MethodsA retrospective histologic evaluation of explanted lungs due to coronavirus disease 2019 was performed.ResultsNone of the patients had known prior pulmonary disease. The major pathologic findings in the lung explants were proliferative and fibrotic phases of diffuse alveolar damage, interstitial capillary neoangiogenesis, and mononuclear inflammation, specifically macrophages, with varying numbers of T and B lymphocytes. The fibrosis varied from early collagen deposition to more pronounced interstitial collagen deposition; however, pulmonary remodeling with honeycomb change was not present. Other findings included peribronchiolar metaplasia, microvascular thrombosis, recanalized thrombi in muscular arteries, and pleural adhesions. No patients had either recurrence of SARS-CoV-2 infection or allograft rejection following transplant at this time.ConclusionsThe major pathologic findings in the lung explants of patients with SARS-CoV-2 infection suggest ongoing fibrosis, prominent macrophage infiltration, neoangiogenesis, and microvascular thrombosis. Characterization of pathologic findings could help develop novel management strategies.