Radiographic Diagnosis Research Articles

Efficacy of ultrasonography in the diagnosis of dento-maxillofacial swellings among an urban population in Nigeria

Context: Ultrasonography as an imaging modality in dentistry has been explored in recent years. It is particularly useful in the examination of superficial structures where the use of a high frequency linear transducer produces clearer sonographic images. Aim: To evaluate the efficacy of ultrasound when compared with other known diagnostic examinations. Materials and Methods: This was a prospective cross-sectional study involving patients with maxillofacial swellings in Aminu Kano Teaching Hospital. They were classified as malignant neoplasms, benign cysts, abscesses and infections and lymphoma, according to clinical, radiographic and ultrasound and diagnosis independently. The findings from these methods were then compared to the gold standard histologic findings. Chi-square test, Pearson contingency coefficient, and 2 x 2 contingency table were used in evaluating the diagnostic accuracy, sensitivity as well as the specificity of the examinations. Results: A total of 36 patients comprising 21 males and 15 females with mean age of 34.97 years were recruited. Diagnostic accuracy of ultrasound was 50% in the diagnosis of malignant tumors, 95.8% in benign cystic swellings, 50% in abscesses and infections, and 100% in lymphoma. Significant relationship exists between ultrasonography with histology, clinical and radiographic diagnosis with a contingency coefficient of 0.833, 0.759, and 0.798, respectively. Overall, the accuracy, sensitivity and specificity of ultrasound was 86.1%, 90.3%, and 60%, respectively. Conclusion: Ultrasonography provides accurate imaging of the maxillofacial region and provides information about the pathological characteristic of lesion, its extent, and relationship with the surrounding structures. Inclusion of ultrasonography to the clinical and histopathological examinations increases the accuracy of orofacial swelling diagnosis.

Radiographic diagnosis and surgical management of compound composite odontome with supernumerary tooth and impacted central incisor – A rare case report

Odontomas are the most frequent hamartomatous developmental abnormality. The condition is frequently associated with one or more unerupted teeth and is often detected through the failure of teeth to erupt at the expected time. Although most cases are found impacted within the jaw, there are instances where odontomas have erupted into the oral cavity. Majority of the odontomas are asymptomatic nonetheless these anomalies can cause delayed eruption, impaction, or even result in retention of primary teeth. Odontomas are atypical calcified conglomeration of dental tissues such as enamel, dentin, pulp, and cementum and emerge from odontogenic epithelium thus, they are mixed odontogenic tumor. According to the literature, its origin can be local trauma, infection, or genetic mutations, however, the exact cause is unknown. This case report presents a compound composite odontome in a 25-year-old patient along with its related clinical and radiological manifestations and the surgical management and emphasis on the early diagnosis and treatment planning.

Combined Type IPMN: Radiographic versus Endoscopic Diagnosis

Introduction: Main duct and combined type pancreatic intraductal papillary mucinous neoplasm (IPMN) are associated with significant rates of high-risk pathology. The diagnosis is suggested radiographically, but endoscopic interventions are generally performed for confirmation. The goal of this study was to evaluate whether these interventions change management and increase accuracy in patients thought to have combined type IPMN based upon imaging alone. Methods: Patients thought to have main duct or combined type IPMN based on imaging were evaluated retrospectively. The outcome of endoscopic interventions performed on these patients was reviewed. Final pathology was available for patients who underwent resection. Results: 142 patients were felt to have main duct IPMN radiographically. 89 of those patients underwent EUS and 49 of these patients ultimately underwent resection. Final pathology showed main duct IPMN in 39 patients. 55 patients were felt to have combined type IPMN radiographically. 39 of these patients underwent EUS. 21/39 patients had an elevated CEA. 18/39 patients were felt to have combined type IPMN by endoscopic appearance. 24/55 patients ultimately underwent resection. Final pathology showed combined type (or main duct) IPMN in 23 patients with four harboring adenocarcinoma. Of the 24 patients that underwent resection, 11 had an elevated CEA and 12 were felt to have combined type IPMN by endoscopic appearance. Conclusions: Diagnosis of combined type IPMN on high-quality imaging is highly predictive of final pathology. Endoscopic interventions subject patients to additional procedural complications but often add little and may not improve accuracy.Tabled 1Main Duct IPMNRadiographic Diagnosis of Main Duct IPMN142EUS Diagnosis of Main Duct IPMN57/89Number Resected49Final Pathology Main Duct IPMN39/49 (80%) Malignancy6/49 (12%)Combined Type (Mixed-Type) IPMNRadiographic Diagnosis of Combined Type IPMN55EUS Diagnosis of Combined Type IPMN18/39Number Resected24Final Pathology Combined Type or Main Duct IPMN23/24 (96%) Malignancy4/24 (16%) Open table in a new tab Table: IPMN Diagnosis by Different Diagnostic Modalities.

Three-Dimensional Distance Maps of Ankle and Syndesmotic Joints from Weightbearing CT in Progressive Collapsing Foot Deformity: A Retrospective Case-Control Study

Category:AnkleIntroduction/Purpose:Recently, weightbearing computed tomography (WBCT) has been utilized to provide more comprehensive and accurate assessment of complex foot and ankle deformities, notably to diagnose and stage Progressive Collapsing Foot Deformity (PCFD). The 3D data provided by WBCT has enabled the developed of novel tools like distance mapping (DM), coverage mapping (CM), and volume measurements. Over the past year, novel DM and CM have shown promise in providing sensitive automated measures of peritalar subluxation, a major component of PCFD. However, the early effects of PCFD on the tibiotalar joint have not yet been quantified. This study sought to use DM and CM to objectively characterize the effects of PCFD on the tibiotalar and tibiofibular joints. We hypothesized that changes seen in early PCFD will be identified.Methods:IRB approval for retrospective review of patient data from 2014-2020 was obtained to identify patients with clinical and radiographic diagnoses of PCFD. The first consecutive 20 patients with symptomatic flexible PCFD and high-resolution weightbearing CT examination without arthritis that had not undergone prior surgery were selected and compared with 20 controls. Fully automated volume measurements of the syndesmosis at 1cm, 3cm, and 5cm from the tibiotalar joint were performed as well as of the medial and lateral tibiotalar gutters based on models created in Disior Bonelogic. Distance Maps (DMs) were obtained for the tibiofibular incisura, tibiotalar joint, and gutters. Coverage maps (CMs) were created using the measured 3DDMs to identify joint interaction, subluxation, and impingement. Data were checked for normality using the Shapiro- Wilk W test. Two-tailed independent samples student t-tests or Wilcoxon Tests were used to assess differences between groups.Results:There were significant decreases in coverage of all 3 anterior regions of the tibiotalar joint in PCFD patients when compared to controls along with corresponding significant increases in coverage of all 3 posterior regions (Figure). There were no significant differences in mean or minimum distances in any region of the tibiotalar joint surface. Significant increases in average and minimum DMs of the anterior medial (36%, p<0.01, 19%, p<0.03) gutter were observed with significant decreases in coverage of both anterior medial and anterior lateral regions. Significant decreases in the average and minimum distances of the tibiofibular joint were found anteriorly in PCFD patients compared to controls (-26%, p<0.006). There were no significant differences in overall syndesmotic distance or volume at any level.Conclusion:The results of our study were able to identify that, compared to controls, patients with early stage PCFD demonstrated significant tibiotalar and tibiofibular joint changes ahead of developing the tibiotalar narrowing associated with arthritis and syndesmotic widening associated with instability. Decreases in anterior coverage with increases posteriorly support early plantarflexion of the talus in PCFD. When combined with plantarflexion of the talus and unchanged syndesmotic volume, decreases in anterior tibiofibular distances support the absence of syndesmotic joint instability in early PCFD. Novel tools may assist with clinical decision-making regarding restoration of normal tibiotalar and tibiofibular alignment during PCFD correction.

PCN2: Parallel CNN to Diagnose COVID-19 from Radiographs and Metadata

COVID-19 constitutes one of the devastating pandemics plaguing humanity throughout the centuries; within about 18 months since its appearing, the cumulative confirmed cases hit 173 million, whereas the death toll approaches 3.72 million. Although several vaccines became available for the public worldwide, the speed with which COVID-19 is spread, and its different mutant strains hinder stopping its outbreak. This, in turn, prompting the desperate need for devising fast, cheap and accurate tools via which the disease can be diagnosed in its early stage. Reverse Transcription Polymerase Chain Reaction (RTPCR) test is the mainstay tool used to detect the COVID-19 symptoms. However, due to the high false-negative rate of this test, physicians usually use chest radiographs as an adjunct or alternative tool. Although radiographs screening is wide-available, low-cost, and its results are timely, relying on radiologists to interpret them manually stands against using radiographs as a diagnostic tool. Motivated by the need to speed up the radiographic diagnosis of COVID-19 and to improve its reliability, this paper proposes a novel deep-learning framework dubbed Parallel Deep Neural Networks for COVID-19 Diagnosis (PCN2). PCN2 treats the radiographs and their metadata simultaneously by running two CNNs in parallel. Firstly: a 2-dimensional CNN (2DCNN) to capture the spatial information from the radiographs due to its super competency in this domain. Secondly, a 1-dimensional CNN (1DCNN) to extract the medical knowledge presented in the metadata. By this integration, PCN2 can make perfect classifications even for those cases in which the infection signs in radiographs are unclear due to being the disease in early-stage, confounded by other markers or overlapped by other diseases. Extensive assessments of PCN2 carried out using several datasets demonstrate average diagnostic accuracy of 99.9 and 0.99 F1-score.

Diagnostic features of lumbar canal osteochondroma and review of literature

Osteochondroma is a common benign primary bone tumor that can be multiple or solitary and is usually caused by a developmental defect in the growth plate. Osteochondroma usually arises from an osteochondroma near the ends of long bones and is less likely to occur in the spine. Data show that the incidence of single spinal osteochondroma is only 1.3%-4%, and the most common sites are cervical vertebra, thoracic vertebra, thoracolumbar and lumbar vertebra. Osteochondroma of the lumbar spine is rare because its ossification center generally ossified around 30 years of age, later than cervical and thoracic vertebrae. Only about 30% of patients with osteochondroma of the lumbar spine had intact cartilage caps. If the thickness of the cartilage cap is assessed, it is difficult to see on conventional radiographs. Conventional radiographic assessment is usually used to diagnose osteochondroma in the extremities, whereas radiographic diagnosis of osteochondroma in the spine is more difficult. This case was reported as a female patient with a single osteochondroma, which occurred in the lumbar spine and had a complete cartilage cap during the operation. This case is rare, which can provide some help for clinical practice to avoid misdiagnosis and missed treatment of this kind of disease.

Comparison of Multi-Label U-Net and Mask R-CNN for panoramic radiograph segmentation to detect periodontitis.

Periodontitis, the most prevalent chronic inflammatory condition affecting teeth-supporting tissues, is diagnosed and classified through clinical and radiographic examinations. The staging of periodontitis using panoramic radiographs provides information for designing computer-assisted diagnostic systems. Performing image segmentation in periodontitis is required for image processing in diagnostic applications. This study evaluated image segmentation for periodontitis staging based on deep learning approaches. Multi-Label U-Net and Mask R-CNN models were compared for image segmentation to detect periodontitis using 100 digital panoramic radiographs. Normal conditions and 4 stages of periodontitis were annotated on these panoramic radiographs. A total of 1100 original and augmented images were then randomly divided into a training (75%) dataset to produce segmentation models and a testing (25%) dataset to determine the evaluation metrics of the segmentation models. The performance of the segmentation models against the radiographic diagnosis of periodontitis conducted by a dentist was described by evaluation metrics (i.e., dice coefficient and intersection-over-union [IoU] score). Multi-Label U-Net achieved a dice coefficient of 0.96 and an IoU score of 0.97. Meanwhile, Mask R-CNN attained a dice coefficient of 0.87 and an IoU score of 0.74. U-Net showed the characteristic of semantic segmentation, and Mask R-CNN performed instance segmentation with accuracy, precision, recall, and F1-score values of 95%, 85.6%, 88.2%, and 86.6%, respectively. Multi-Label U-Net produced superior image segmentation to that of Mask R-CNN. The authors recommend integrating it with other techniques to develop hybrid models for automatic periodontitis detection.

PELVIC INCIDENCE AND OSTEITIS PUBIS IN PROFESSIONAL SOCCER PLAYERS.

ABSTRACTIntroduction. Osteitis pubis is a common inflammatory disease of the pubic symphysis, defined as a chronic pain syndrome caused by repetitive microtrauma. Since adaptative changes are necessary in the pelvis to adjust the equilibrium of the myotendinous structures, the aim of this study was to evaluate the correlation between pelvic incidence and osteitis pubis among professional soccer players. Materials and Methods. An observational, cross-sectional study was performed with professional soccer players from five teams during pre-season. Athletes with previous congenital pelvic abnormalities or a history of surgery were excluded. Radiographs of the pelvis were analyzed by two radiologists and assessed for findings consistent with osteitis pubis, and the following parameters were measured: pelvic incidence (PI), sacral inclination (SI), and pelvic version (PV). Results. A total of 107 subjects were included in the study, with a mean age of 25.6 ± 3.1 years. Findings compatible with osteitis pubis were present in 74.8% of the subjects (80/107). There was no statistical correlation between osteitis pubis and PI (52.3°±12.7° vs. 48.4°±10.8°; p=0.156), SI (43.1°±9.8° vs. 39.9°±10.1°; p=0.146), or PV (9.2°± 6.3° vs 8.6°± 7.5°; p=0.649). Agreement between readers was excellent (p<0.0001). Conclusion. There was no significant correlation between pelvic parameters and radiographic diagnosis of osteitis pubis. Leve of Evidence II; Diagnostic study.

SIZE OF KNEE OSTEOPHYTES is under‐estimated as Assessed by MRI USING CT AS A REFERENCE STANDARD

The radiographic diagnosis of knee osteoarthritis (OA) is based on the presence of a definite osteophyte (OP). Epidemiologic studies and clinical trials commonly employ MRI using standard clinical sequences and OP assessment is one of the features included. Commonly used sequence protocols in such studies are based on triplanar fat suppressed T2- or proton density-weighted sequences with bony features as well as fibrous and lipomatous tissues appearing hypointense. This may potentially result in underestimation of such features including osteophyte assessment. Computed tomography (CT) is considered as the modality of choice for the analysis of OPs and may therefore be considered a reference standard. To explore the diagnostic performance of routine MRI as used in observational studies and clinical trials of knee OA for the assessment of OPs in all three knee compartments and the femoral notch using CT as a reference standard. The Strontium Ranelate Efficacy in Knee Osteoarthritis Trial (SEKOIA) clinical trial explored the effect of 3 years of treatment with strontium ranelate in patients with primary knee OA. All patients included in the current study participated in the CT sub-study of SEKOIA. In the current investigation, baseline data from three different centers were used. OPs were scored using a modified MOAKS scoring system in the patellofemoral (PFJ), the medial tibio-femoral (TFJ) and the lateral TFJ. Size was assessed from 0 to 3 in 18 locations. Descriptive statistics were used to describe differences in ordinal grading between CT and MRI. In addition, weighted-kappa statistics were employed to assess agreement between scoring using the two methods. Finally, sensitivity, specificity, positive predictive value and negative predictive value as well as AUC measures of diagnostic performance were employed using CT as the reference standard. Mean age of the randomized patients was 62.9 ±7.5 years with a majority of women (70%). Body mass index was 29.9±5.0 kg/m 2 . The target knee JSW was 3.50±0.84 mm at baseline, patients were Kellgren and Lawrence grade 2 (62%) or 3 (38%). Included were 74 patients with available MRI and CT data. Altogether 1332 locations were evaluated. For the PFJ MRI detected 141 (72%) of 197 CT-defined OPs with a w-kappa of 0.58 (95% CI [0.52-0.65]). In the medial TFJ, MRI detected 178 (81%) of 219 CT-OPs with a w-kappa of 0.58 (95% CI [0.51-0.64]). For the lateral compartment these numbers were 84 (70%) of 120 CT-OPs with a w-kappa of 0.58 (95% CI [0.50-0.66]). Regarding disagreement, for the PFJ MRI underestimated OP size in 94 cases (21%) and over-estimated in 27 cases (6%). For the medial TFJ these numbers were 90 (20%) and 29 (7%), and for the lateral TFJ 67 (15%) and 15 (3%). Details of the diagnostic performance analysis are presented in Table 1 . MRI underestimates presence and size of osteophytes in all 3 knee compartments. However, the sensitivity of >0.9 for OP detection in the medial compartment, which is commonly the compartment of relevance in clinical DMOAD trials, reflects that MRI is adequately able to detect osteophytes that commonly define structural disease. CT may be helpful particularly reading assessment of small osteophytes particularly in early disease. No funding was received for this sub-analysis of the SEKOIA Study AG has received consultancies, speaking fees, and/or honoraria from Pfizer, Novartis, AstraZeneca, Merck Serono, and TissueGene and is President and shareholder of Boston Imaging Core Lab (BICL), LLC a company providing image assessment services. FWR is Chief Medical Officer and shareholder of BICL, LLC. and has received consultancies, speaking fees, and/or honoraria from Calibr –California Institute of Biomedical Research and Grünenthal, GmbH CORRESPONDENCE ADDRESS: frank.roemer@uk-erlangen.de .

Clinical validation of a spectroscopic liquid biopsy for earlier detection of brain cancer.

BackgroundDiagnostic delays impact the quality of life and survival of patients with brain tumors. Earlier and expeditious diagnoses in these patients are crucial to reduce the morbidities and mortalities associated with brain tumors. A simple, rapid blood test that can be administered easily in a primary care setting to efficiently identify symptomatic patients who are most likely to have a brain tumor would enable quicker referral to brain imaging for those who need it most.MethodsBlood serum samples from 603 patients were prospectively collected and analyzed. Patients either had non-specific symptoms that could be indicative of a brain tumor on presentation to the Emergency Department, or a new brain tumor diagnosis and referral to the neurosurgical unit, NHS Lothian, Scotland. Patient blood serum samples were analyzed using the Dxcover® Brain Cancer liquid biopsy. This technology utilizes infrared spectroscopy combined with a diagnostic algorithm to predict the presence of intracranial disease.ResultsOur liquid biopsy approach reported an area under the receiver operating characteristic curve of 0.8. The sensitivity-tuned model achieves a 96% sensitivity with 45% specificity (NPV 99.3%) and identified 100% of glioblastoma multiforme patients. When tuned for a higher specificity, the model yields a sensitivity of 47% with 90% specificity (PPV 28.4%).ConclusionsThis simple, non-invasive blood test facilitates the triage and radiographic diagnosis of brain tumor patients while providing reassurance to healthy patients. Minimizing time to diagnosis would facilitate the identification of brain tumor patients at an earlier stage, enabling more effective, less morbid surgical and adjuvant care.

Evaluation of Root Canal Morphology of Maxillary First Premolars by Cone Beam Computed Tomography

Aim. The study aimed to evaluate the root and canal system in maxillary 1st premolar teeth in our patients using cone-beam computed tomography in subpopulation of Pakistan in Lahore. Material &amp; methods. This retrospective study in vivo assessed Cone Beam Computed Tomography (CBCT) imaginings of maxillary 1st premolars from February 2017 to January 2019. This study determined the number of roots, canals and root canal conformation as described by Vertucci’s classification. Results. 150 subjects aged 17-75 years were enrolled with 90 females and 60 males. From 200 1st maxillary pre-molars, 75% of the teeth had two roots. 21% had one root. 4% had three roots. 94% teeth had two canals. Three canals were detected in 4% teeth. One canal in 2% teeth. Regarding canal configuration, type I canal in 72% cases and type V canal in 13% of cases. Conclusion. The Cone-beam computed tomography system is par excellence diagnostic modality than radiographic diagnosis providing improved and exact knowledge of root and canal variations plus configuration. Keywords: CBCT, Maxillary premolars, Endodontic treatment, Vertucci’s classification, root canal.

Odontogenic Keratocyst Is Frequently Misdiagnosed for a Lateral Periodontal Cyst in Premolar and Anterior Tooth-Bearing Areas

IntroductionRadiolucent lesions with gingival swelling found in the premolar and intercanine region can elicit a different clinical diagnosis than one confirmed by histologic findings. The purpose of the study is to identify and present the frequency of the unexpected microscopic diagnosis of odontogenic keratocyst (OKC) in a location preoperatively favoring a lateral periodontal cyst (LPC) with similar clinical and radiographic appearance. MethodsA retrospective analysis of biopsies received from 2011 and 2019 was performed, and the number of LPC and OKC cases was assessed. The alignment of clinical and radiographic diagnosis to histologic findings and anatomic location was analyzed, and the number of OKC cases preoperatively misdiagnosed as LPCs was identified. ResultsA total of 79,257 biopsies were received. Of those, 184 were diagnosed as LPCs and 742 as OKCs. For all preoperatively diagnosed LPCs, the clinical and histologic diagnosis aligned; however, 182 of 742 OKCs were submitted with a clinical misdiagnosis of LPCs. The location of these lesions with the unanticipated diagnosis overlapped with those for LPCs, specifically the maxillary and mandibular anterior and premolar regions. ConclusionsRadiolucent lesions with gingival swelling in the premolar and intercanine region are frequently clinically and radiographically misdiagnosed. A biopsy should be considered in all cases to establish the correct pathologic diagnosis and treatment course.

The Influence of Ankle Position on Radiographic Diagnosis of Acute Achilles Tendon Rupture

No previous study has demonstrated the relationship between the ankle position and radiographic diagnosis of acute Achilles tendon rupture. The purpose of this study was to investigate the influence of ankle position in the presence of diagnostic radiographic signs in acute Achilles tendon rupture. A retrospective review of 154 ankle lateral radiographs of acute Achilles tendon rupture was performed. Ankle position was classified as dorsiflexion, neutral, or plantar flexion by measurement of the tibiotalar angle. Kager's triangle, Toygar's angle, Arner's sign, and thickening of the Achilles tendon were assessed as diagnostic radiographic signs, and their relations to ankle position were analyzed. Interobserver reliabilities of radiographic signs were moderate to substantial (kappa value, range 0.41-0.68). All 4 signs were significantly more visible in ankle plantar flexion than dorsiflexion. The presence of Toygar's angle and positive Arner's sign were significantly increased in ankle plantar flexion compared to neutral, while the presence of Kager's triangle, and thickening of the Achilles tendon did not differ according to ankle position. The diagnostic radiographic signs of acute Achilles tendon rupture were better presented in ankle plantar flexion position than neutral and dorsiflexion positions. Neutral and dorsiflexion ankle positions should be avoided when performing lateral radiographs of patients with suspected acute Achilles tendon rupture.

305. Cholecystitis as a Possible Immunologic Consequence of COVID-19; Case Series from a Large Healthcare System

BackgroundGastrointestinal manifestations are commonly seen in COVID-19 disease with up to 50% of patients reporting nausea or diarrhea. Cholecystitis has been described in rare cases related to COVID-19, possibly in consequence of immune activation, but biliary disease from SARS-CoV-2 infection is not well described. We examined a case series of patients with both COVID-19 and cholecystitis at our institution.MethodsWe performed a retrospective chart review of all patients with a diagnosis of cholecystitis within 3 months of SARS-CoV-2 infection; looking at clinical, laboratory, and radiographic characteristics of this population. Results30 individuals were identified with a diagnosis of cholecystitis within 3 months of diagnosis of SARS-CoV-2 infection. Most patients presenting with cholecystitis were female and obese (see Table 1). 14 individuals were diagnosed with SARS-CoV-2 infection during the same presentation as their cholecystitis diagnosis, usually as part of pre-operative screening. Of 16 individuals diagnosed with SARS-CoV-2 prior to their cholecystitis presentation, a mean of 24 and 17 days elapsed between SARS-CoV-2 infection and cholecystitis symptom onset and radiographic diagnosis, respectively (see Figure 1). Most of these patients had mild respiratory disease, with only 9 developing an oxygen requirement, and only 3 requiring mechanical ventilation. While 17 patients were treated surgically for their cholecystitis, this did not appear to impact symptom resolution.Table 1. Patient Characteristics Figure 1. Time between COVID-19 and Cholecystitis ConclusionCholecystitis may be an uncommon complication of COVID-19 disease. Cholecystitis may manifest most often 2-4 weeks following SARS-CoV-2 infection. This timing is similar to that in Multisystem Inflammatory Syndrome following SARS-CoV-2 infection and given similarities in timing to we hypothesize that cholecystitis in our patients could be driven by immune activation.Disclosures Christopher Polk, MD, Atea (Research Grant or Support)Gilead (Advisor or Review Panel member, Research Grant or Support)Humanigen (Research Grant or Support)Regeneron (Research Grant or Support) Mindy Sampson, MD, Regeneron (Grant/Research Support) Catherine Passaretti, MD, Nothing to disclose

984. Diagnostic Utility of Bronchoalveolar Lavage Pneumocystis jirovecii DNA Polymerase Chain Reaction Assay in Patients with Hematological Malignancies and Hematopoietic Cell Transplantation

Abstract Background Pneumocystis jirovecii, an ubiquitous fungus, can lead to opportunistic pneumonia (PJP) in patients with hematological malignancies (HM) and hematopoietic cell transplantation (HCT) with mild to severe presentation. Unlike patients with HIV, diagnosis of PJP pneumonia is often challenging in patients with HM/HCT possibly related to lower fungal burden versus atypical presentation. The gold standard for diagnosis of PJP from bronchoalveolar lavage fluid (BALF) is cytology, followed by direct fluorescent antigen (DFA), however, in the context of lower fungal burden, quantitative polymerase chain reaction (PCR) is increasingly used. PCR DNA load cut-off for diagnosis of PJP is not established. The objective of this study is to assess the correlation between three tests (cytology, DFA and PCR) and diagnosis of PJP (colonization, possible, probable or proven infection). Methods In this retrospective study at City of Hope, HM/HCT patients with BALF performed to investigate pneumonia who tested positive for any of the 3 tests were included. The study period is from July 2014 to July 2020. All patients had a clinical and radiographic diagnosis of pneumonia. Results Eighty-five patients were identified to have at least one positive diagnostic test for PJP. Twenty (23.5%) patients had a PCR with less than 84 copies/mL, and colonization was suspected in these patients. Of the remaining 65 patients, 46 had all 3 tests done. Twenty seven (58.7%) patients only had positive PCR ranging from 106 to 588,000 copies/mL with negative DFA and cytology. Twelve (26.1%) patients had either DFA or cytology positive with a positive PCR, and in 6 patients (13%) all 3 tests were positive. All of these 18 patients had clinical presentation and radiographic findings consistent with PJP. Quantitative or qualitative serum beta-D-glucan (BDG) level was available in 28 patients and 17 had a positive test with a level &amp;gt;80 pg/ml. Conclusion PJP PCR is a very sensitive test that can lead to early detection of PJP pneumonia in HM/HCT with lower sensitivity of DFA/cytology unless the fungal burden is high. However, the optimal cut off PCR value associated with disease needs to be clinically validated in our patient population and a concurrent serum BDG level can increase diagnostic yield. Disclosures All Authors: No reported disclosures

Esophageal discoid foreign body detection and classification using artificial intelligence.

Early and accurate radiographic diagnosis is required for the management of children with radio-opaque esophageal foreign bodies. Button batteries are some of the most dangerous esophageal foreign bodies and coins are among the most common. We hypothesized that artificial intelligence could be used to triage radiographs with esophageal button batteries and coins. Our primary objective was to train an object detector to detect esophageal foreign bodies, whether button battery or coin. Our secondary objective was to train an image classifier to classify the detected foreign body as either a button battery or a coin. We trained an object detector to detect button batteries and coins. The training data set for the object detector was 57 radiographs, consisting of 3 groups of 19 images each with either an esophageal button battery, esophageal coin or no foreign body. The foreign bodies were endoscopically confirmed, and the groups were age and gender matched. We then trained an image classifier to classify the detected foreign body as either a button battery or a coin. The training data set for the image classifier consisted of 19 radiographs of button batteries and 19 of coins, cropped from the object detector training data set. The object detector and image classifier were then tested on 103 radiographs with an esophageal foreign body, and 103 radiographs without a foreign body. The object detector was 100% sensitive and specific for detecting an esophageal foreign body. The image classifier accurately classified all 6/6 (100%) button batteries in the testing data set and 93/95 (97.9%) of the coins. The remaining two coins were incorrectly classified as button batteries. In addition to these images with a single button battery or coin, there were two unique cases in the testing data set: a stacked button battery and coin, and two stacked coins, both of which were classified as coins. Artificial intelligence models show promise in detecting and classifying esophageal discoid foreign bodies and could potentially be used to triage radiographs for radiologist interpretation.

Reabsorções dentárias internas

The mechanism of action of the so-called internal resorption of dentine is only one, either internal or external. Resorption can be produced&#x0D; by pathological causes. It is stressed how important is the precocious&#x0D; diagnosis. Radiographic diagnosis is commented. It is suggested the treatment by pulpectomy. The prognosis depends upon the resorption extension area.

Knee Avulsion Injuries: What can I Get From a CT?

Acute bone and soft-tissue injuries to the knee are commonly seen in emergency departments as well as in the outpatient clinic. Most commonly, these injuries result from a direct blow, a fall, or a twisting injury. Prompt and accurate diagnosis relies heavily on imaging and is mandatory to facilitate adequate management and prevent potential complications [1]. Radiographs are usually the initial imaging modality in the evaluation of the acutely injured knee but have a low yield. Computed Tomography (CT) may be performed as the next imaging study for the evaluation of suspected radiographically occult fractures. In patients with radiographic diagnosis of knee fracture, CT is frequently performed for further classification and characterization of the fracture severity and for prediction or diagnosis of associated meniscal and ligamentous injuries [12]. The knee has numerous tendinous, ligamentous, and meniscal attachments, which make it particularly vulnerable to avulsion injuries after trauma. These include avulsions of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), Segond (small bony avulsion of the anterolateral ligament at the lateral tibial rim that indicates a ACL tear) and reverse Segond (small medial tibial avulsion fracture that indicates a PCL tear) fractures, fibular head avulsion fracture, arcuate complex avulsion, fracture avulsions of the medial collateral ligament, iliotibial band avulsion, avulsions of the semimembranosus, and quadriceps tendons, and patellar sleeve fractures. In the setting of acute twisting trauma to the knee, CT scan has high sensitivity and specificity in detecting bony avulsion fractures and a high negative predictive value for excluding ligamentous injuries (e.g.: ACL avulsion fracture) [3] (Figure 1). Radiologists should recognize the pattern of these injuries and their underlying mechanism to understand the substantial damage that it frequently represents. This presentation will outline the imaging appearances of common knee avulsion fractures. Specific examples will be used to highlight clinical relevance and learning points.

“Meta-analysis of regenerative endodontics outcomes with antibiotics pastes and calcium hydroxide. The apex of the iceberg”

PorposeThe aim of this study was to evaluate, through a meta-analysis, the predictability of Regenerative Endodontic therapies with antibiotic pastes and calcium hydroxide [Ca(OH)2], related to four variables as follows: root dentin wall thickening, apical closure, apical repair and root lengthening. MethodsLiterature electronic searches were performed in Pubmed - MEDLINE, Scopus and Lilacs-BVS platforms using appropriate search terms, Mesh (Medical Subject Headings), DeCS (Health Sciences Descriptors) and Boolean operators comprising articles published between 2009 and 2020. Thirty-two original indexed papers were included making a total of 758 regenerative endodontic procedures. A descriptive meta-analysis was performed. ResultsDentin wall thickening was present in 66% (CI95: 58%–73%) of the cases treated with antibiotic paste, while when Ca(OH)2 was used, a percentage of 53% (CI95: 26%–78%), was obtained. When antibiotic paste was used, apical closure was found in the 66% (CI95: 58%–73%) of the regenerative endodontic procedures, while when Ca(OH)2 was used, 88% (CI95: 80%–93%) of the cases were found to reach apical closure. Root lengthening and apical repair were found satisfactory for both disinfection protocols. ConclusionsThere could be differences between the two treatments since a higher percentage of root dentin wall thickening was found when using antibiotic pastes, while a higher percentage of apical closure was found when calcium hydroxide was used. Development of more clinical studies would be necessary in order to confirm the observed differences. The proposed approach could provide a useful contribution for endodontists when planning regenerative endodontic procedures, so as to guide decision-making to the best elective treatment and to select the appropriate disinfection method in accordance with preoperative radiographic diagnosis of root development stage, then increasing the predictability of regenerative endodontic treatment and reducing potential risk of root fractures.

Infectious Complications Following Chimeric Antigen Receptor T-Cell Therapy for Hematologic Malignancy

BackgroundCAR T-cell therapy has shown remarkable efficacy for the treatment of hematologic malignancy. However, this novel adoptive cell therapy is associated with toxicities such as cytokine release syndrome (CRS), CAR-T related encephalopathy syndrome (CRES/ICANS) and infection. While as one of the most common toxicities after CAR T-cell therapy in the first month, infectious complications have not been systematically studied. we aim to explore the incidence, clinical and microbiological characteristics and identify high risk factors for infection in patients with ALL, NHL, and MM. The trial was registered on the Chinese Clinical Trial Registry (ChiCTR-OIC-17011180; ChiCTR1800018143).Methods72 patients with ALL, 56 patients with NHL and 42 patients with MM from January 2016 to December 2020 are involved in the cohort and the baseline data and the clinical characteristics of infection are retrospectively analyzed within 28 days. Infections were defined as a microbiologic, histopathologic, corroborating laboratory, radiographic or clinical diagnosis, and classified as bacterial (bacteremia or site infection), viral (respiratory or other), or fungal (proven or probable). Infection severity was classified as mild, moderate, severe, life-threatening, or fatal. (Young et al.Biol Blood Marrow Transplant 2016; 22:359-70.)CRS was graded by ASTCT. We used univariate and stepwise multivariable Poisson regression to identify associations between baseline clinical characteristics and infection density, and Cox proportional hazards regression to assess high-risk factors for infection.ResultsAmong 170 patients, a total of 119 infections occurred in 99 patients within 28 days, with a cumulative infection rate of 58.2%. The incidence of infection in ALL patients is higher than that of MM and NHL patients. Among 72 ALL patients, 46 (63.9%) patients developed infections, and among 42 MM patients, 24 patients (53.1%) developed infections. The difference in infections between these two groups of patients was statistically significant (Chi-Square test, P=0.038<0.05). There was no significant difference in infection between the ALL and NHL groups, and the MM patients and NHL groups had no significant difference in infection (Chi-square test: ALL vs NHL P=0.168; NHL vs MM P=0.497) .78 patients had 98 bacterial infections and the cumulative incidence of bacterial infection was 45.9%. The cumulative incidence of viral infection was 8.24%, and fungal infection was 4.12%. Bacterial infections are the main types of infections in patients with different tumors, followed by viral infections, and finally fungal infections. There was no statistic significant difference in the severity of infection among different tumors, whether it was the number of patients or events (Kruskal-Wallis test, P=0.646 ,P=0.605）75 infection events occurred in patients who were agranulocytosis, and 90% of patients with bloodstream infections had neutropenia at the time of infection. When agranulocytosis lasted for 28 days, the cumulative infection rate was 38.8%. 91 patients had both CRS and infection. The cumulative incidence of CRS and infection was 68.8% and 58.2%, respectively. Among patients with grade 3-4 CRS, 18 of 30 infections (60%) occurred after the peak of CRS.The adjusted baseline characteristic model showed that ALL patients, previous 30 days of infection history, refractory disease, ANC<0.5×10 9/L before infusion and≥4 prior antitumor treatment regimens had a higher infection density within 28 days; Grade 3 or 4 CRS was the only high-risk factor related to infection after infusion in the multivariate analysis.ConclusionsInfection is one of the common complications of CAR-T cell therapy in patients with hematological malignancy. Bacterial infections occur in most patients regardless of the type of disease. ALL patients, previous 30 days of infection history，refractory disease, ANC<0.5×10 9/L before infusion and Grade 3 or 4 CRS are risk factors for infection.Keywords：chimeric antigen receptor t cell；hematological malignancy；bacterial infection [Display omitted] DisclosuresNo relevant conflicts of interest to declare.