Radiological Criteria Research Articles

Clinical and radiologic criteria to predict endoscopic third ventriculostomy success in non-communicating pediatric hydrocephalus

ObjectiveEndoscopic third ventriculocisternostomy (ETV) became the relevant treatment option for non-communicating pediatric hydrocephalus. ETV success was predicted in relation to age, diagnosis, and previous shunt implantation. Radiological factors are usually taken for indication decision-making. The aim of this study is to investigate radiological signs of non-communicating hydrocephalus for ETV success in a single-center retrospective analysis.Patients and methodsETV interventions were collected from a 10-year period (2010–2019) from our institution. Clinical patient characteristics such as prematurity, age, diagnosis, and previous shunt treatment and follow-up in terms of possible shunt implantation or revision surgeries were investigated. Radiological data was retrieved from the in-house PACS system to analyze preoperative signs for non­communicating hydrocephalus such as ventricular size, pressure gradients at the third ventricle, and any signs of obstruction from internal towards external cerebral spinal fluid communication. Fisher’s test was used to demonstrate the significance of each individual predictor. A multivariable model was built using the backward elimination method with multiple logistic regression.ResultsFrom 136 ETV interventions, 95 met the inclusion criteria (age < 18 years; > 6-month follow-up; MR image data availability, treatment goal for shunt independence). In chi-square statistical evaluation of single parameters age > 6 months (OR 32.5; 95% CI 4.8–364), ventricular width (FOHR < 0.56; OR 6.1; 95% CI 2.2–16.3) and non-post-hemorrhagic hydrocephalus as underlying diagnosis (OR 13.1; 95% CI 1.9–163) showed significant increased odds ratio for shunt independence during follow-up. Logistic regression analysis for multiple parameters showed age > 6 months (OR 29.3; 95% CI 4.1–606) together with outward bulged lamina terminalis (OR 4.6; 95% CI 1.2–19.6), smaller FOHR (continuous parameter; OR 2.83 × 10−5; 95% CI 4.7 × 10−9–0.045), and non-4th-ventricular-outlet obstruction (4thVOO; OR 0.31; 95% CI 0.09–1.02) as significant factors for ETV success.ConclusionETV has become a relevant treatment for non-communicating hydrocephalus, with typical MR image characteristics. Analyzing radiological markers as predictors for success smaller ventricular width and outward displaced lamina terminalis was relevant in combination with age > 6 months. Since the analysis is based on single-center experience, a larger cohort of patients with a multi-center approach should further investigate the combined clinical and radiological criteria.

Hypersensitivity Pneumonitis Radiologic Features in Interstitial Lung Diseases

The radiologic criteria of hypersensitivity pneumonitis (HP) guidelines focus on four HP compatible features (HPCF) in high-resolution computed tomography (HRCT): ground glass opacities, mosaic attenuation, air-trapping, and centrilobular nodules. However, evidence to support these criteria are limited. Consecutive interstitial lung disease (ILD) patients who underwent HRCT between 2016 and 2021 in three medical centers were included. We assessed the prevalence of HPCF in each ILD and their association with HP diagnosis. We evaluated the impact of HPCF amount for HP diagnosis and the performance of the radiologic criteria by the ATS/JRS/ALAT and CHEST HP guidelines. 436 patients with ILD were included (mean age 66, 48% females), of them, 56 (13%) with HP. All four HPCF were more prevalent in HP than in non-HP ILD (p<0.001 for all). In multivariate analysis, air-trapping was the strongest independent predictor (AOR 4.1, 95% CI 2-8.4, p<0.001). Centrilobular nodules were present almost exclusively in HP and smoking-related ILD. The amount of HPCF in HRCT had an excellent predictive ability for HP diagnosis (receiver operating characteristic AUC 0.85, 95% CI 0.80-0.90). The radiologic criteria of both guidelines had high specificity for "typical HP" and high sensitivity for "compatible with HP", although with low positive predictive values. Our findings remained robust even when including only patients that had a diagnostic biopsy. The presence and amount of HPCF in HRCT predicted HP diagnosis in real-life settings. While current HP radiologic criteria demonstrated good diagnostic performance, our findings highlight areas for future improvement.

Outcomes of Treatment of Intra-Articular Distal Radius Fractures with Volar Locked Plates in Patients Above 50 Years

Objective: Outcomes of the treatment of intra-articular distal radius fractures seen in patients above 50 years with volar locked plates were evaluated.  Study design: Twenty Eight patients (8 female and 20 male) treated in our clinic with volar locked plates because of intra-articular distal radius fractures were evaluated after a 17-month (range 8-30 months) follow-up. Mean age of the patients was 45.2 (range 50-64) years. Fractures were classified according to Frykman and AO classifications. According to the Frykman classification, 2 patients had type 3 (7%), 1 patient had type 4 (5.5%), 14 patients had type 7 (50%) and 11 patients had type 8 (37.5%) fractures. According to the AO classification, 6 patients had B2 (23.5%), 4 patients had C1 (14%), 11 patients had C2 (37.5%) and 7 patients had C3 (25%) fractures. All patients were evaluated clinically and radiologically. Clinical outcomes of the patients were evaluated using Gartland and Werley’s evaluation scores and DASH-T scores. Radiologic outcomes were evaluated according to the radiologic evaluation criteria modified by Steward et al.  Results: According to the evaluation scores of Gartland and Werley, 20 patients yielded excellent (72%), 5 patients good (18%) and 3 patients moderate (10%) results. Mean DASH-T score of the patients was 34 (range 31 to 40).  Conclusions: Treatment of intra-articular distal radius fractures seen above 50 years of age with volar locked plates is an efficient and safe method. Use of volar locked plates reduces the complication risk of reduction loss and need for grafts in osteoporotic fractures.

Spinal cord conduction disorders among neurological complications of degenerative dystrophic diseases of the cervical spine

Neurological complications of degenerative dystrophic diseases of the cervical spine depend on the involvement of functionally significant structures of the cervical spine in the pathological process. Current diagnostic techniques do not always accurately diagnose the involvement of these structures in the pathological process. This fact requires constant study and development of the novel methods for diagnosing degenerative dystrophic diseases of the cervical spine. In this regard, the purpose of the study is to identify various clinical and pathogenetic forms of the clinical course of degenerative dystrophic diseases of the cervical spine with the presence of manifestations of spinal cord conduction disorders based on the study of clinical symptoms and neuroimaging data of the cervical spine. The work is based on the study of clinical manifestations and magnetic resonance imaging of the cervical spine in the preoperative period in 457 patients with degenerative diseases of the cervical spine aged from 22 to 64 years. Among the patients, women predominated: 271 cases (59.3 %). Men made up 40.7 % (186 cases). Pathology in the form of a herniated intervertebral disc was detected at the levels of CV–CVI in 192 cases (42.0 %), CVI–CVII in 179 cases (39.2 %), CIV–CV in 45 cases (9.8 %), and CVII — ThI in 41 cases (9.0 %). Disc herniation at two levels simultaneously was diagnosed in 6.7 % (31 cases). The complex of patient examination included general clinical, neurological, and neuroimaging studies using MRI of the cervical spine. Damage to one of the functionally significant anatomical structures of the cervical spine occurred in 48.4 % (221 cases). Simultaneous involvement of two or more of these structures in the pathological process was diagnosed in 51.6 % (236 cases). Comparison of the neurological symptoms of the disease with magnetic resonance imaging data of the cervical spine makes it possible to diagnose five forms of degenerative dystrophic diseases of the cervical spine: 46.8 % — radicular, 1.5 % — myelic, 38.1 % — combined myelo-radicular, 7.5 % — combined radicular angiocerebral, and 6.1 % — combined myelo-radicular and angiocerebral. Notably, symptoms of spinal cord conduction disorders were identified in myelic, combined myelo-radicular, and combined myelo-radicular and angiocerebral forms. Due to the possible presence of a combination of spinal cord conduction disorders with symptoms of compression or irritation of the spinal cord roots and vertebral artery among neurological complications, the clinical manifestations of the disease acquire a significant polymorphism of symptoms, which is always associated with difficulties in diagnosing degenerative dystrophic diseases of the cervical spine. The identified clinical and radiological criteria for myelic, combined myelo-radicular, and combined myelo-radicular and angiocerebral forms of the course of this pathology of the cervical spine are decisive in the differential diagnosis with any other pathology of the spinal cord and for determining the feasibility of individual medical rehabilitation measures.

Upper and Lower Endoscopic Findings in Mesenteric Panniculitis Patients: A Case-Control Study.

Background: The natural history and prognosis of mesenteric panniculitis (MP) are not well-described. Despite referral for colonoscopy being common for this indication, colonoscopy findings in MP patients have not been reported. Therefore, we aimed to describe upper and lower gastrointestinal (GI) endoscopy findings in patients with mesenteric panniculitis, compared to matched controls, to investigate their clinical outcomes including incidence of malignancy and mortality. Methods: Retrospective case-control study was conducted, and included patients who were diagnosed with mesenteric panniculitis according to Coulier radiologic criteria on abdominal computerized tomography between 1/2005 and 12/2019, and followed to 12/2021. The case group was compared to a matched control group without MP on abdominal CT. Clinical data and the upper and lower endoscopies' reports were reviewed in both groups. We excluded patients who, beyond diagnosis of MP, were also diagnosed with current malignancy, significant intra-abdominal morbidity or inflammatory bowel disease. Results: The initial set of 376 patients with MP, after exclusion, included 187 patients. A total of 56.1% were male, with a mean age 60 ± 15 years. Of them, 74 (39%) patients underwent follow-up CT scans, which demonstrated, in 66 (89.2%) patients, a stable MP without any aggravation. Colonoscopy was performed in 89 MP patients, and 98/187 controls. No significant difference in the colonoscopies' findings was found between the two groups. Gastroscopy was performed in 84 MP and 79 controls. No case of gastric cancer was found. No statistically significant difference was found in the rate of gastroscopy findings. By the end of the follow-up period, malignancy was diagnosed in four patients of the MP group. None were colon cancer. The mortality rate in the MP group was 3.2%, without a significant difference compared to the controls. None were MP related. Conclusions: MP identified on abdominal CT is not associated with pathologic endoscopy findings or future diagnosis of colon cancer, and also has no impact on mortality rate. Since repeating abdominal CT did not reveal any disease progression, the necessity of follow-up imaging for MP should be carefully reconsidered.

Radiological indicators of chronicity in patients with acute symptomatic pulmonary embolism treated with ultrasound-assisted catheter-directed thrombolysis: a study of 180 consecutive cases

Abstract Background Radiological signs of chronic thrombi are present in up to 20% of patients that present acutely with pulmonary embolism (PE). Ultrasound-Assisted Catheter-Directed Thrombolysis (USAT) can swiftly reverse right ventricular dysfunction in patients with acute PE. Purpose To investigate the frequency of radiological signs of chronic PE and pre-existing chronic thromboembolic pulmonary hypertension in patients treated with USAT and their impact on early and long-term hemodynamic and clinical outcomes. Methods The index CT scans of patients receiving USAT for acute intermediate-high and high-risk PE at a tertiary academic institution (2017-2022) were adjudicated by three expert radiologists blinded for treatment scheme and outcomes. Changes in invasively-measured mean pulmonary artery pressure (mPAP) at 24 hours post USAT, presence of post-PE impairment (PPEI), and CTEPH diagnoses after at least 3 months were studied. A total of 15 radiological signs of chronicity were assessed, including 6 major criteria that have been previously validated to raise the suspicion of pre-existing CTEPH. In this study, acute-on-chronic PE was defined when at least 3 of the 6 validated radiological criteria for chronicity were present together with acute findings. Pre-existing CTEPH was defined based on the results of follow-up (vs. index) CT scan and on the anatomical consistency of pathology specimens after pulmonary endarterectomy. PPEI was defined by the presence of residual respiratory symptoms and right ventricular dysfunction during follow-up. Results Of 180 consecutive patients (median age 65 years, 61% men, 17% high-risk PE), 31 had at least 3 of 6 radiological criteria at the time of acute presentation; Table 1. The median modified Miller Score was 24 points and baseline mPAP was 35 mmHg in both groups. The absolute mPAP reduction after USAT was 11 (Q1-Q3: 5-17) mmHg in patients with &amp;lt;3 and 10 (Q1-Q3: 5, 17) mmHg in those with ≥3 criteria; Table 2. Three (1.7%) patients were diagnosed with CTEPH after a median of 3 months and underwent pulmonary endarterectomy: in all 3 patients, CTEPH was pre-existing. At least 3 of the 6 previously validated criteria were present in all CTEPH patients at index CT. In the 3 patients with acute PE on pre-existing CTEPH, the median baseline mPAP was much higher (median 53 mmHg) than in the remaining patient group and the absolute reduction after USAT was 9 mmHg, corresponding to a relative reduction of 19%. During follow-up, PPEI was more frequent in patients with &amp;lt;3 signs (n=4, 2.7%) than in those with ≥3 signs (n=4, 12.9%). Conclusion(s) The evaluation of six radiological parameters in initial CT scans successfully identified all cases of pre-existing CTEPH in patients presenting with acute PE. However, these parameters did not prove effective in determining which patients would benefit from USAT in terms of mPAP reduction.Baseline characteristicsHemodynamic and clinical outcomes

Role of clipping in aneurysmal subarachnoid hemorrhage: a post hoc analysis of the Earlydrain trial

The choice between clipping and coiling of ruptured cerebral aneurysms in subarachnoid hemorrhage (SAH) remains controversial. The recently published Earlydrain trial provides the opportunity to analyze the latest clip-to-coil ratio in German-speaking countries and to evaluate vasospasm incidence and explorative outcome measures in both treatment modalities. We performed a post hoc analysis of the Earlydrain trial, a multicenter randomized controlled trial investigating the use of an additional lumbar drain in aneurysmal SAH. The decision whether to clip or to coil the ruptured aneurysm was left to the discretion of the participating centers, providing a real-world insight into current aneurysm treatment strategies. Earlydrain was performed in 19 centers in Germany, Switzerland, and Canada, recruiting 287 patients with aneurysmal SAH of all severity grades. Of these, 140 patients (49%) received clipping and 147 patients (51%) coiling. Age and clinical severity based on Hunt-Hess/WFNS grades and radiological criteria were similar. Clipping was more frequently used for anterior circulation aneurysms (55%), whereas posterior circulation aneurysms were mostly coiled (86%, p < 0.001). In high-volume recruiting centers, 56% of patients were treated with clipping, compared to 38% in other centers. A per-year analysis showed a stable and balanced clipping/coiling ratio over time. Regarding vasospasm, 60% of clipped versus 43% of coiled patients showed elevated transcranial Doppler criteria (p = 0.007), reflected in angiographic vasospasm rates (51% vs. 38%, p = 0.03). In contrast to the Earlydrain main results establishing the superiority of an additional lumbar drain, explorative outcomes after clipping and coiling measured by secondary infarctions, mortality, modified Rankin Score, Glasgow Outcome Scale Extended, or Barthel-Index showed no significant differences after discharge and at six months. In clinical practice, aneurysm clipping is still a frequently used method in aneurysmal SAH. Apart from a higher rate of vasospasm in the clipping group, an exploratory outcome analysis showed no difference between the two treatment methods. Further development of periprocedural treatment modalities for clipped ruptured aneurysms to reduce vasospasm is warranted.

An update on pancreatic cancer imaging, staging, and use of the PACT-UK radiology template pre- and post-neoadjuvant treatment.

Pancreatic ductal adenocarcinoma continues to have a poor prognosis, although recent advances in neoadjuvant treatments (NATs) have provided some hope. Imaging assessment of suspected tumours can be challenging and requires a specific approach, with pancreas protocol CT being the primary imaging modality for staging with other modalities used as problem-solving tools to facilitate appropriate management. Imaging assessment post NAT can be particularly difficult due to a current lack of robust radiological criteria to predict response and differentiate treatment induced fibrosis/inflammation from residual tumour. This review aims to provide an update of pancreatic ductal adenocarcinoma with particular focus on three points: tumour staging pre- and post-NAT including vascular assessment, structured reporting with introduction of the PAncreatic Cancer reporting Template-UK (PACT-UK) radiology template, and the potential future role of artificial intelligence in the diagnosis and staging of pancreatic cancer.

Evaluation of vascular invasion in pancreatic head tumors and its impact on radical surgical treatment

Objective. To evaluate the informativeness and sensitivity of radiological criteria for vascular invasion in pancreatic head tumors in comparison with intraoperative data and results of routine pathological examination. Materials and methods. The study included 98 patients with ductal adenocarcinoma of the pancreatic head with suspected venous invasion and spread of tumor growth along the vessels of the portomesenteric axis, who were operated on at the Department of Pancreatic and Bile Duct Surgery of the National Research Center of Surgery and Transplantation named after O. A. Shalimov in the period from 2019 to 2023. Group 1 included 51 (52.0%) patients who underwent radical surgery with resection of the superior mesenteric/hepatic portal vein and extended lymph and neurodissection, and group 2 included 47 (48.0%) patients who had positive vascular margins of pancreatic resection according to routine pathological examination. Diagnostic criteria for vascular alterations were developed. A comparative analysis of the informativeness of the developed criteria and the results of a routine pathological examination was performed. The edges of the pancreatic resection were evaluated, including the neck of the gland, common bile duct, duodenum/gastric duct, and the bed of the superior mesenteric/hepatic portal vein and superior mesenteric artery separately. R1 status was defined as the presence of tumor cells at a distance of less than 1 mm to the resection margin. Results. According to the criteria of the National Comprehensive Cancer Network (NCCN) 2023.2, 61 (62.2%) patients had a marginally resectable stage of ductal adenocarcinoma of the pancreatic head and tumor contact with the superior mesenteric/hepatic veins according to multislice computed tomography of the abdominal cavity. In group 1, there were 36 (70.6%) such patients, in group 2 – 25 (53.2%). According to the proposed radiologic criteria for vascular invasion, tumor contact with the superior mesenteric/hepatic portal veins was suspected in 76 (77.6%) patients, which is higher than in the standard approach. Determination of vascular alterations according to the results of our study is a more reliable method for diagnosing invasion of the superior mesenteric/hepatic portal vein (χ2 = 5.46, p = 0.019) and predicting the performance of radical surgery, including vascular resection. Conclusions. The proposed criteria for the radiological diagnosis of vascular invasion at the preoperative stage increased the sensitivity of this method from 62.2 to 77.6%. The most frequent radiological signs of vascular alteration are vascular wall irregularity (47.7%) and parapancreatic tissue density (62.5%). In the presence of any of the radiological signs of vascular alteration, resection of the affected area of the superior mesenteric/hepatic portal vein with extended lymph and neurodissection is indicated, which allows a statistically significant increase in the number of R0 resections.

Differentiating the Structural and Functional Instability of the Craniocervical Junction.

This paper presents the anatomical and biomechanical aspects of chronic instability of the craniocervical junction (CCJ) with a discussion on clinical diagnostics based on mobility tests and provocative tests related to ligamentous system injuries, as well as radiological criteria for CCJ instability. In addition to the structural instability of the CCJ, the hypothesis of its functional form resulting from cervical proprioceptive system (CPS) damage is discussed. Clinical and neurophysiological studies have shown that functional disorders or organic changes in the CPS cause symptoms similar to those of vestibular system diseases: dizziness, nystagmus, and balance disorders. The underlying cause of the functional form of CCJ instability may be the increased activity of mechanoreceptors, leading to "informational noise" which causes vestibular system disorientation. Due to the disharmony of mutual stimulation and the inhibition of impulses between the centers controlling eye movements, the cerebellum, spinal motoneurons, and the vestibular system, inadequate vestibulospinal and vestibulo-ocular reactions occur, manifesting as postural instability, dizziness, and nystagmus. The hyperactivity of craniocervical mechanoreceptors also leads to disturbances in the reflex regulation of postural muscle tone, manifesting as "general instability". Understanding this form of CCJ instability as a distinct clinical entity is important both diagnostically and therapeutically as it requires different management strategies compared to true instability. Chronic CCJ instability significantly impacts the quality of life (QOL) of affected patients, contributing to chronic pain, psychological distress, and functional impairments. Addressing both structural and functional instability is essential for improving patient outcomes and enhancing their overall QOL.

The Efficacy, Safety, and Persistence of Therapy after Non-Medical Switching from an Originator Adalimumab in Inflammatory Bowel Disease: Real-Life Experience from Two Tertiary Centres.

During the last two decades, an increased number of molecules with multiple mechanisms of action have been approved for the treatment of inflammatory bowel disease (IBD), with a substantial increase in the costs related to therapy, which has become a concern for payers, regulators, and healthcare professionals. Biosimilars are biologic medical products that are highly structurally similar to their reference products; have no clinically meaningful differences in terms of immunogenicity, safety, or effectiveness; and are available at a lower price. Materials and Methods: This was an observational prospective study conducted in two IBD centres in Bucharest and included 53 patients, 27 male (M) and 26 female (F), diagnosed with IBD according to standard clinical, endoscopic, radiological, and histological criteria, who were non-medically switched at the indication of the National Insurance House to a biosimilar of Adalimumab. Aims: The aim was to determine the rates of clinical remission, adverse effects, and treatment persistence at one year. Results: No significant differences were found in terms of the faecal calprotectin (FC) and C-reactive protein (CRP) levels 6 and 12 months after changing from the originator biologic treatment to a biosimilar. Only one patient required a change in their biological treatment following the clinical and biological loss of response. The main adverse effect reported by the patients was pain at the injection site. Of the 53 patients, only 2 reported pain at the injection site, and 1 patient reported experiencing abdominal pain and rectal bleeding immediately after the switch, but no recurrence was observed clinically or endoscopically. Conclusions: This observational study is the first to be carried out in Romania that shows that, after a non-medical switch, biosimilars of Adalimumab are as efficient and safe as the originator Adalimumab in the clinical treatment of patients with IBD.

Pancreatic steatosis is a strong risk factor for post-ERCP pancreatitis: An emerging concept

ObjectiveThe Endoscopic Retrograde Cholangiopancreatography (ERCP) is the treatment of choice for biliary obstruction but is associated with post-ERCP pancreatitis (PEP) in around 5 % of cases. No radiological criteria have been evaluated for predicting PEP risk. DesignThis retrospective study examined records of 1365 patients who underwent ERCP at our center between 2014–2023. Only sphincterotomy-naïve patients were included. CT scans within 30 days of ERCP were reviewed for radiological criteria. The optimal pancreatic density cut-off was determined using AUROC and Youden index. Logistic regression was used for analyses. ResultsPEP occurred in 75 patients (6.1 %). The CT scan was performed before ERCP for 565 of the total population. A fatty pancreas, defined as a spontaneous density less than -50HU, was statistically associated with PEP (OR: 7.35; 95 % CI: 1.56–26.5 p = 0.004), as well as with biliary obstruction due to stones (OR: 0.61; 95 % CI: 0.38–0.98; P = 0.04), the need for precut (OR: 2.19; 95 % CI: 1.35–3.51; P = 0.001), cannulation of the main pancreatic duct (OR: 2.23; 95 % CI: 1.36–3.59; P = 0.001), and the use of a pancreatic stent (OR: 2.48; 95 % CI: 1.29–4.47; P = 0.004). In multivariate analyses, only obstruction unrelated to gallstones (OR = 2.63; 95 % CI: 1.16–6.25; P = 0.024) and a low pancreatic density (<-50HU) (OR=7.94, 95 %CI: 1.59–31.09; P = 0.005) remains significantly associated with the risk of PEP, including after adjustment for age and sex (P = 0.006). ConclusionA very low pancreatic fat density could be a significant risk factor for post-ERCP pancreatitis with potential clinical and research implications. Further validation is needed.

Endocrine sequelae after pediatric craniopharyngioma treatment: a single-center retrospective cohort study.

Craniopharyngiomas (CP) are rare brain tumors with a low mortality rate, but with significant morbidity, in part due to the various long-term endocrine sequelae related to hypothalamic/pituitary deficiencies. Our objective was to assess the prevalence of endocrine dysfunction and outcome after treatment of CP at our institution and to apply the novel diagnostic criteria for hypothalamic syndrome (HS). In addition, we give an overview of treatments already attempted for hypothalamic obesity (HO). This retrospective cohort study included children treated and followed up for CP at the pediatric oncology and endocrinology department at University Hospitals Leuven between January 2000 and December 2023. Clinical and endocrine characteristics were collected during a five-year period following diagnosis of CP. The Müller radiological criteria and the novel diagnostic criteria for HS were applied. A brief literature review regarding treatments already attempted for HO was conducted. Fifteen patients with pediatric CP were included in thestudy, all of whom developed endocrine sequelae over time. Seven patients (47 %) presented with at least one hormonal deficit, and eight patients (53 %) developed panhypopituitarism over time. HO was clinically confirmed in nine patients (60 %). 10 patients (67 %) met the diagnostic criteria for HS. Currently, no overall effective treatment strategies are available for HO. Long-term endocrine sequelae and HO are highly prevalent in pediatric CP. Continuing multidisciplinary care to improve the quality of life of these patients is necessary. International cooperation and further long-term prospective trials for the treatment of HO are needed.

Comparative Study of Epidemiology of HCC in the (HCV) Patients in the Egyptian Population before and after Hepatitis C National Screening Program (100 Million Seha)

Abstract Background HCC is considerd one of the most common tumors in Egypt and one of the most common predisposing factors is HCV Objectives The aim of this study is to determine the clinical characteristics and relevance between HCC patients before and after national screening of HCV (two groups) according to child score, stage of disease, effect of treatment at clinical oncology department of Ain Shams University, Cairo, Egypt Subjects and Methods This retrospective analytical study included HCC patients (pathologically confirmed or diagnosed by radiological criteria) from Clinical Oncology Department, Ain Shams University Faculty of Medicine, Cairo, Egypt. from January 2017 to December 2020. and stratified into two groups 1stgroup was for patients who were diagnosed as HCC 2 years before national screening program of HCV (100 million seha), 2nd group was for patients who presented after national screening program Results In Group (1) most of the patients were diagnosed as HCV (86) patients (97.7%) of the patients with Co HBV infection (4) patients (4.2%), in Group (2) most of the patients were diagnosed as HCV (92) patients declined to (82.1%) while Co HBV declined to (1) patient (1%), number of patients who had Child A classification in Group (1) (36) patients and Child C (7) patients (10.9%), in Group (2) number of the patients who were Child A (62) patients (69.7%), Child C (3) patients (3.4%), in Group (1) number of patients who were ECOG PS 1 (26) patients (41.3%) while ECOG PS 4 were (4) patients (6.3%), On the other hand in Group 2 number of the patients who had ECOG PS1 (46) patients (46.5%) while ECOG PS 4 declined to (2) patients (2%), According to (BCLC) in Group 1, number of the patients with BCLC (C), (56) patients (63.6%), BCLC (A) were only (10) patients (11.4%) of the patients, BCLC (D) (5) patients (5.7%), in Group (2), BCLC (C) (62) patients declined to (54.4%), BCLC (A) increased to (32) patients (28.1%), BCLC (D) (3) patients (2.6%) of the total patients in Group 2. Conclusion our study demonstarted the efficacy of national screening program of HCV in the screening, diagnosis and treatment of HCC, we conducted that the results of the screening program could affect the diagnosis and treatment of HCC so its very considrable that discovery of HCC in earlier Child classification, Stage after national screening affected the treatment.

A Study on Urinary Amylase and Serum Amylase in Diagnosing Acute Pancreatitis.

Acute pancreatitis is a prevalent condition often characterized by abdominal pain, yet its early diagnosis remains challenging due to the limitations of current diagnostic tests, particularly serum amylase. This study aimed to evaluate the effectiveness of urinary amylase compared to serum amylase in diagnosing acute pancreatitis, with a focus on its sensitivity and prolonged detection capabilities. Conducted over two years at a tertiary care hospital, Dr. D. Y. Patil Medical College,Hospital and Research Centre in Pune, India, the study included 60 patients suspected of acute pancreatitis based on clinical and radiological criteria. Participants aged 20 to 60 were included, while those with chronic pancreatitis, pancreatic malignancies, or significant comorbidities were excluded. Serum and urinary amylase levels were measured, and statistical analysis was performed using MS Excel and IBM SPSS version 27(IBM Corp., Armonk, NY). The study population had a mean age of 37.90 years, predominantly that is 50 (83.3%) were male. The median serum amylase level was 311 U/L, while urinary amylase levels averaged 501 U/L. Significant findings included urinary amylase levels being significantly higher in females compared to males. Diagnostic imaging revealed various pancreatic conditions, including acute pancreatitis with complications. Urinary amylase proves to be a valuable diagnostic marker for acute pancreatitis, offering several advantages over traditional serum amylase measurements. Integrating urinary amylase measurement into clinical practice can enhance diagnostic accuracy and provide a more comprehensive approach to diagnosing acute pancreatitis.

T2 Hyperintensities in Children with Neurofibromatosis Type 1

Areas of increased signal intensity, known as T2 hyperintensities (T2Hs), observed on T2-weighted magnetic resonance imaging (MRI) scans, are linked to a spectrum of brain abnormalities in children with neurofibromatosis type 1 (NF1). Defining the radiological characteristics that distinguish non-neoplastic from neoplastic T2Hs in children with NF1 is crucial. Then, we could identify lesions that were most likely to require oncologic surveillance. We conducted a single-center retrospective review of all available brain MRIs from 98 children with NF1 and 50 healthy pediatric controls. All T2Hs identified on MRI were characterized based on location, imaging features, and the presence of lesion-related symptoms. Subsequently, all T2Hs were classified using newly established criteria and categorized into 3 distinct groups: low-risk tumor lesions, medium-risk tumor lesions, and high-risk tumor lesions. Lesions deemed to be high-risk will be recommended for surgical treatment. T2Hs were present in 61 (62.2%) individuals of the NF1 cohort. T2Hs were a highly sensitive (100%; 95% confidence interval 92.9%-100.0%) and specific (62.2%; 95% confidence interval 51.9%-71.8%) marker for the diagnosis of NF1. In children aged 4-10, the detection rate of T2Hs is significantly higher than in children under 4years old and those aged between 10 and 18 (P < 0.05). T2Hs were most frequently located in basal ganglia, cerebellar hemispheres, and brainstem. During the follow-up process, none of the lesions categorized as low-risk or medium-risk tumor lesions progressed to high-risk tumor lesions. Seven patients had high-risk tumor lesions and underwent surgical treatment. The pathological assessment identified 5 cases of glioma among the 7 patients, along with 1 case of gliosis and 1 case of vascular dysplasia. Low-risk and medium-risk tumor lesions can both be classified as unidentified bright objects . Unidentified bright objects constituted the majority of T2Hs in children with NF1. High-risk tumor lesions should be considered as probable tumors. With the application of standardized radiologic criteria, a high prevalence of probable brain tumors will be identified in this at-risk population of children, which underscores the importance of vigilant and appropriate oncological surveillance to ensure timely detection and intervention for these tumors.

A Comprehensive Study of Risk Factors, Etiology, and Infarction Patterns in Cerebrovascular Accidents at a Tertiary Care Hospital in India.

Background Stroke is a debilitating cerebrovascular condition characterized by sudden neurological deficits. The incidence of stroke is rising in India, posing significant public health concerns. This study aims to examine the risk factors and etiology of stroke using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification and analyze infarct areas in cerebrovascular accidents (CVA) at a tertiary care hospital. Methodology This cross-sectional, hospital-based observational study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to Be University), Pune, India, from January 2023 to January 2024. The study included 100 adult patients diagnosed with CVA based on clinical and radiological criteria. Patients aged 18 years and older were eligible, while those with a history of head trauma or those below 18 years were excluded. The investigation protocol included routine biochemical assessments and radiological investigations, such as computed tomography (CT), magnetic resonance imaging (MRI) with angiography or venography, and Doppler ultrasound of bilateral carotid arteries. Results The study population consisted of 100 patients, with 84 males (84%) and 16 females (16%). Age distribution showed 44% were over 60 years old, 23% aged 51-60 years, 15% aged 31-40 years, 14% aged 41-50 years, and 4% aged 21-30 years. Hypertension was the most prevalent risk factor, affecting 75% of patients, with a higher occurrence in males (62%), compared to females (13%). Smoking was observed in 51% of patients, and alcohol consumption was seen in 50%. Other significant risk factors included dyslipidemia (39%), diabetes mellitus (33%), chronic kidney disease (11%), ischemic heart disease (10%), atrial fibrillation (4%), valvular heart disease (4%), and pregnancy or postpartum conditions (2%). Ischemic stroke was predominant, occurring in 80% of patients, while hemorrhagic stroke occurred in 20%. High occurrences of ischemic strokes were noted in the frontal lobe (41%), parietal lobe (37%), occipital lobe (27%), and temporal lobe (26%), with the internal capsule region also showing significant numbers (27%). According to the TOAST classification, the most prevalent cause of stroke in this study was undetermined etiology with two or more causes, accounting for 32% of cases, followed by large artery atherosclerosis, which accounted for 30%. Cardioembolic stroke was identified in 11% of the patients, with 4% due to atrial fibrillation, 3% due to acute myocardial infarction, 3% due to rheumatic valvular heart disease, and 1% due to infective endocarditis. Conclusion This study highlights the significant prevalence of hypertension, smoking, alcohol consumption, and hyperhomocysteinemia as major risk factors for stroke. Ischemic strokes were predominant, with high occurrences in the cerebral lobes and gangliocapsular region. These findings emphasize the need for targeted prevention strategies, including managing hypertension and lifestyle modifications such as smoking cessation and reducing alcohol consumption, to mitigate the risk of stroke. Effective management of blood pressure, lipid levels, and blood glucose is crucial for stroke prevention. Recognizing gender-specific differences and addressing comorbidities through an integrated approach can enhance patient outcomes and reduce the burden of stroke.

Chordoma: Site-Wise Predilections and Pathological Tenets

Abstract Background: Chordomas are rare tumours of presumptive notochordal origin, mostly occurring in the axial skeleton of the body. These tumours are slow growing but are locally invasive neoplasms. Diagnosis requires qualification of the radiological, histopathological, and immunohistochemical criteria. Management predominantly comprises surgical resection with negative margins. Objective: Our study aimed to analyse the clinico-pathological spectrum of these rare chordoma cases visiting our tertiary care institute. Materials and Methods: The study was retrospective, comprising chordoma cases reported histopathologically between January 01, 2013, and August 31, 2023 (a total period of 10.5 years). Clinico-radiological data were recorded. Histopathological diagnosis was separately reviewed by two pathologists. All data were statistically analysed. Results: In total, 41 chordoma cases were received, with a mean age of 43.2 + 17.4 years (6–72 years). Male:female ratio was 1.2:1. Spheno-occipital region chordomas (27 cases) were most common, followed by sacrococcygeal (8 cases) and vertebral (6 cases) chordomas. Symptoms varied with location. However, the commonest presenting complaint was pain. These region-wise chordoma categories were statistically compared in terms of patients’ age, male:female ratio, symptomatic duration, tumour size, histopathological tumour type, and recurrence on follow-up. Of these, only patients’ age and tumour size were found to be statistically significant (P value was 0.011 and 0.0004, respectively). Conclusion: Clinico-pathological parameters vary with the anatomical location of chordoma. We present the experience of this rare tumour in terms of clinico-radiopathological features visiting our tertiary care institute in northern India.

Systemic C-Reactive Protein Predicts Cerebral Vasospasm and Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage: A Retrospective Observational Study

Aneurysmal subarachnoid hemorrhage (aSAH) is often complicated by cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI), which significantly impact patient outcomes. The study aimed to investigate the predictive value of systemic serum biomarker levels for CVS and DCI following aSAH. We retrospectively analyzed data for 450 aSAH patients admitted to University Hospital Düsseldorf between January 2011 and October 2021. Serum biomarkers were measured on admission. The occurrence of CVS and DCI was assessed based on clinical and radiological criteria. Multivariate logistic regression analysis was performed to determine the independent association of serum biomarkers with CVS and DCI. We compared the predictive values of various models using the area under the receiver operating characteristic curve. Of the 450 patients, 126 (28.0%) developed CVS, 123 (27.3%) developed DCI, and 62 (13.8%) developed co-occurring CVS and DCI. Patients with CVS, DCI, or both had significantly higher admission C-reactive protein (CRP) levels than those without these complications (P<0.001). Elevated CRP levels were independently associated with an increased risk of CVS, DCI, and co-occurring CVS and DCI (P<0.05). CRP demonstrated a higher predictive value for CVS (area under the curve [AUC]: 0.811) and co-occurring CVS and DCI (AUC: 0.802) compared to DCI alone (AUC: 0.690). Our findings suggest that admission systemic CRP levels can serve as a more valuable predictor for developing CVS than DCI following aSAH. Incorporating CRP into clinical assessments may aid in risk stratification and early intervention strategies for patients at high risk of these complications.

High-Dose Furmonertinib in Patients With EGFR-Mutated NSCLC and Leptomeningeal Metastases: A Prospective Real-World Study

IntroductionLeptomeningeal metastasis (LM) is one of the most severe complications of NSCLC. Furmonertinib is a pan-EGFR tyrosine kinase inhibitor (TKI) with a high rate of brain penetration and a wide therapeutic window. Here, we evaluated the efficacy and safety of high-dose furmonertinib in patients with EGFR-mutated NSCLC and LM. MethodsThis prospective real-world study included patients with EGFR-mutated NSCLC and LM treated with a high-dose furmonertinib (240 mg once daily) as a monotherapy or in combination with other treatments. The primary end point was overall survival, and the secondary end points included time to treatment discontinuation and clinical response rate. Additional efficacy evaluations included changes in brain magnetic resonance imaging by the response assessment in neuro-oncology–LM radiologic criteria. We also introduced next-generation sequencing–based assays to evaluate genomic and epigenomic features of cell-free DNA (cfDNA) in patients’ cerebrospinal fluid (CSF) samples and to analyze their associations with patient outcomes. ResultsWe enrolled 48 patients, of whom 35 (72.9%) had received third-generation EGFR TKIs. The median overall survival was 8.43 months (95% confidence interval: 5.48–11.39 mo), while the median time to treatment discontinuation was 8.27 months (95% confidence interval: 5.40–11.14 mo), and the clinical response rate was 75%. The LM objective response rate and disease control rate assessed with response assessment in neuro-oncology-LM radiologic criteria were 50.0% and 92.1%, respectively. The adverse event profiles were consistent with previous reports of furmonertinib. Briefly, 22 (45.8%) had adverse events possibly related to furmonertinib and 3 (6.3%) had a grade 3-elevated aminotransaminase or nausea or leucopenia, leading to a dose reduction to 160 mg daily. Furthermore, methylation analysis of cfDNA in CSF revealed that there was a considerable correlation between the changes of aberrant methylated fragments from lung cancer cells and the response of the patients. Meanwhile, the copy number burden scores derived from the low-pass whole genome sequencing assay may offer another objective and effective method for the diagnosis and evaluation of treatment efficacy in LM. ConclusionsIn the real world, the high-dose furmonertinib-based treatment may potentially have clinical efficacy and tolerable safety in patients of EGFR-mutated NSCLC with LM, even in patients previously treated with other third-generation EGFR TKIs. Methylation and copy number burden analysis of cfDNA in CSF may be considered objective indicators for the diagnosis of LM and evaluation of treatment response.