Radiological Examination Research Articles

Neurofibromatosis type1 adult surveillance form for Austria.

Neurofibromatosis type1 (NF1) is arare autosomal dominant tumor predisposition syndrome with abirth prevalence of approximately 1in 2000-3000 individuals. Management of both benign and malignant tumors arising in individuals with NF1 is demanding and tumors may be difficult to treat. Both standardized and individual surveillance programs are therefore highly important to prevent morbidity and mortality in patients with NF1. The guidelines for the clinical management of NF1 recently proposed by the European Reference Network for Genetic Tumor Risk Syndromes provide the cornerstone of the present surveillance form and were discussed through three rounds of voting and afinal consensus meeting involving experts from five Austrian and one German clinical NF1 centers for adults and one patient organization representative. Subsequently, 31items within 4categories were integrated into the proposed surveillance form for Austria. All recommendations, unless otherwise specified, pertain to primarily asymptomatic patients in routine follow-up. At healthcare transition from pediatric to adult surveillance or the initial visit in adulthood, we suggest athorough clinical, laboratory and radiological examination to obtain abaseline for future diagnostics. To comply with the general screening recommendations in Austria, we suggest extending the frequency of clinical visits from annual to biennial at 50years of age. In cases of clinical dynamics, early follow-up is recommended to facilitate early detection of potential complications. Particular emphasis should be placed on preventive patient education.

Performance of Prenatal Ultrasound Screening for the Relative Positioning of Mesenteric Vessels.

Abnormal relative positioning of the superior mesenteric artery (SMA) and vein (SMV) can lead to intestinal malrotation that predisposes to midgut volvulus. The aim of this study was to assess the prenatal ultrasound ability to visualize the relative position of SMA and SMV in normal pregnancies. Prospective cohort study performed in Montpellier University Hospital Centre, including 80 fetuses during routine 3rd trimester ultrasound scan. For each fetus included, the relative position of the vessels on an axial image was defined as SMV on the right, forward, or on the left of SMA. Doppler imaging was additionally used if necessary. Data were compared to the neonatal abdominal scans performed by pediatric radiologist. The superior mesenteric vessels were identified in 79 fetuses. Prenatal findings showed a usual relative position of the vessels, that is, the vein on the right of the artery, in 96.2%. In 2 cases, the vein was strictly in front of the artery, and in 1 case, the vein was on the left side of the artery. Seventy-four neonates were examined and comparison with prenatal finding showed a perfect agreement (Kappa coefficient of 100%). An intestinal malrotation was postnatally diagnosed corresponding to the case where vein was on the left side of the artery. This study showed that the relative position of the SMA and SMV could be assessed using ultrasound prenatal examination with a perfect agreement with postnatal findings. In case of abnormal vessels positioning more examinations should be promote including prenatal MRI and postnatal conventional radiologic examinations to confirm intestinal malrotation.

Omission of sentinel lymph node biopsy in patients with clinically axillary lymph node-negative early breast cancer (OMSLNB): protocol for a prospective, non-inferiority, single-arm, phase II clinical trial in China

IntroductionSentinel lymph node biopsy (SLNB) is a standard procedure for patients with clinically assessed negative axillary lymph nodes (cN0) during early-stage breast cancer (EBC). However, the majority of EBC patients...

Dentigerous cyst of inflammatory origin: a case report

To document a case of a dentigerous cyst of inflammatory origin which developed due to periapical infection from a grossly carious deciduous tooth. An 11-year-old male patient presented with a 4-month history of swelling within the right mandible. Radiological examination showed a cystic lesion in association with an impacted, displaced tooth 44 with an overlying carious 85. Marked expansion of the buccal bone was noted.

THE INFLUENCE OF THE QUALITY OF X-RAY IMAGES FROM TELEMEDICINE ON THE COLLECTIVE EFFECTIVE DOSE OF PATIENTS

Ensuring a quality of diagnostic radiology along with increasing efficiency is a key task for healthcare system for both municipal medical facilities and private medicine. When a defective X-ray image is obtained, there is a need to re-conduct a examination, which in turn entails reputational, temporary and economic losses for a medical facility. Repeated examination makes an additional contribution to the patient’s radiation exposure also. The paper shows that for facilities providing telemedicine services, implementation of a clinical audit for diagnostic examinations using information technology is efficient. In 2022 2059 error x-ray images were identified applying a similar system, which is 0.084% of the total number of telemedicine radiology examinations. A collective effective dose due to defective examinations was 3,613 man-Sv, which is less than 0.11% of the total collective dose.

Performance of an interdisciplinary hospital team in pediatric palliative care

The article aims to report a rare case of a patient diagnosed with Thanatophoric Dysplasia admitted to the Neonatal Intensive Care Unit of a tertiary hospital in a city in the inner state of São Paulo. The female infant has been hospitalized since birth, with history, physical, and radiological examination suggestive of Thanatophoric Dysplasia and an unaltered karyotype test, whose evolution and severity made it necessary to institute minimally invasive care. She remained in the Neonatal Intensive Care Unit for five months and 23 days requiring invasivemechanical ventilation through a tracheostomy and gastrostomy feeding, until the irreversible nature of the condition was determined. The purpose of this case report aims to promote reflection on the importance of a multidisciplinary approach to patient care, providing quality of life, orthothanasia, and the importance of family-centered care practices.

Serial Case of CT Scan Imaging in Fracture of Midface Region

Background: Fractures in the face region are frequently seen in motor vehicle accidents, as the face is highly exposed during such incidents. Motor vehicle accidents are common in Bali, with fracture of the face region is the 2nd most common injury found in radiologic examination. Computed tomography (CT) scans are crucial for assessing these fractures, allowing for an accurate evaluation of severity to plan the patient treatment. Case: We present serial cases CT scan images of complex midface fractures such as Le Fort, tripod, NOE and orbital wall fracture and its characteristic imaging on CT-imaging. Conclusions: CT scan may guide treatment plans aimed at minimizing disability and enhancing the patient's quality of life. Understanding the imaging characteristics of midface fractures is thus essential for effective diagnosis and management.

Head and Neck Paragangliomas: 16-year Single-center Experience and Mini Review on Diagnosis, Treatment, and Follow-up.

To investigate head and neck paraganglioma cases treated at a tertiary center from 2007 to 2023. The research includes a thorough examination of published studies that have focused on long-term outcomes. The additional goal is to contribute to the existing knowledge on head and neck paraganglioma, with a particular emphasis on refining diagnostic algorithms, treatment selection, and follow-up procedures. A total of 44 patients were retrospectively analyzed, and 39 were included. Demographic information, symptoms, radiological examination results, types, stages, and postoperative complications were recorded. A review was conducted to select articles that reported single-center experiences with large cohorts, long follow-ups, and different treatment modalities since 2010. The mean age of the patients was 54 years, and the female/male ratio was 3.55:1. Among the 39 cases examined, 18 and 19 were identified as cervical paraganglioma and 19 as temporal bone paraganglioma. All patients initially underwent surgical resection. The mean follow-up duration was 5.42 years. Four residual cases and two recurrences were identified postoperatively, and a Gamma Knife was used as additional treatment. Subsequently, 17 articles were selected and summarized, and then a flowchart was prepared showing the possible options for diagnosis, treatment, and follow-up. Preoperative staging is essential for surgical planning and predicting potential intraoperative complications. Based on our findings and review of the articles, we have prepared a flowchart that includes all possibilities depending on the tumor stage to help in the diagnosis, treatment, and follow-up of head and neck paragangliomas.

Wolf in sheep’s clothing: a case of primary lung adenosquamous carcinoma mimicking traumatic pulmonary pseudocyst

BackgroundTraumatic pulmonary pseudocyst is a rare “cystlike” lung lesion that typically develops following blunt chest trauma. It differs from lung cancer associated with cystic airspaces in terms of pathogenic mechanisms, clinical manifestations, and radiological features. Furthermore, there are few reports of the diagnostic bias between traumatic pulmonary pseudocyst and lung cancer associated with cystic airspaces. Here, we present a rare case of lung cancer associated with cystic airspaces that mimicks traumatic pulmonary pseudocyst.Case presentationA 61-year-old man with no chest medical or surgical history, no chest radiologic examination within the last five years, and no smoking history had an air-filled “cystlike” lesion surrounded by solid components and ground-glass opacities in the middle third of the right upper lobe of the lung during a computed tomography evaluation following blunt chest trauma. He was initially diagnosed with traumatic pulmonary pseudocyst and treated conservatively. On the third post-trauma day, he experienced hemoptysis, which was successfully treated with intravenous hemostatic medication. On the ninth post-trauma day, he exhibited a significant hemoptysis and a moderate dyspnea. A subsequent chest computed tomography scan demonstrated that the solid components had entered the lesion’s cavity and significantly expanded, and the surrounding ground-glass opacities had slightly enlarged. A contrast-enhanced chest computed tomography scan and a three-dimensional reconstruction computed tomography image confirmed that the solid components were a hematoma caused by damage to the right upper pulmonary vein. A right upper lobectomy was performed based on the concern about severe intrapulmonary bleeding. An intraoperative frozen section analysis showed significant bleeding in the lung parenchyma. Adenosquamous carcinoma was unexpectedly identified during the postoperative pathological examination of the resected specimen. A diagnosis of primary lung adenosquamous carcinoma was made. He was discharged on the seventh postoperative day and followed up for two years without any recurrence.ConclusionsThe potential of lung cancer associated with cystic airspaces should be considered for “cystlike” lung lesions discovered in elderly patients after blunt chest trauma. A comprehensive review of the medical history, meticulous analysis of the radiological findings, and close monitoring can help clinicians reduce the risk of diagnostic bias.

Calcific uraemic arteriolopathy: A rare but devastating complication of end-stage renal failure

Calcific uraemic arteriolopathy is a rare complication of end-stage renal failure. It has a grave prognosis with 1-year survival of under 50%. It occurs due to subcutaneous small vessel calcification, thrombosis, with subsequent tissue necrosis. Calcific uraemic arteriolopathy is a rare complication of end-stage renal failure. It carries a grave prognosis with 1-year survival of under 50%. It occurs due to subcutaneous small vessel calcification, thrombosis, with subsequent tissue necrosis. We described a case of calcific uraemic arteriolopathy in a 58-year-old man who presented with violaceous indurations over bilateral lower limbs, as well as large necrotic ulcer with adjacent eschars at the lower abdomen. Although skin biopsy is the gold standard for diagnosis, it is often avoided due to potential poor wound healing. On the other hand, in radiographs or computed tomography, fine linear or serpiginous subcutaneous calcifications are typical manifestations, which represent underlying small vessel calcifications. Radiological examinations, therefore, play an important role to establish the diagnosis.

The Use of Autogenous Rib Graft in Craniofacial Reconstruction: Case Series Study

Background: Hard tissue defects in the maxillofacial region due to trauma or ablative surgery result in functional and cosmetic problems. The method of choice in the treatment of facial defects is autogenous bone grafts. Objectives: To evaluate the use of rib grafts in the reconstruction of craniofacial deformities. Methods: This prospective study was presented for the reconstruction of craniofacial deformity using a rib bone graft. These cases were collected from the Maxillofacial Surgery Unit from October 2011 to November 2020. The sample consisted of 16 patients (14 males and 2 females, with a mean age of 34 years). The patients were divided according to the site of the defect. In all cases, a single rib was harvested. The fifth rib was taken. Bone graft fixation by bone plate, direct screws, and transosseous wiring. The success of the bone grafting was assessed by clinical and radiological examination. Results: The overall success rate in this study was 87.5%, while we had bone graft resorption in two cases (12.5%) of mandibular reconstruction. Only one case experienced donor site complications, a pleural tear, which successfully underwent suturing and chest tube insertion. Conclusions: Free autogenous rib was successfully used to reconstruct defects in the maxillofacial regions. It gives the best result when minimum loading is needed. Stabilization of the graft by rigid internal fixation and good adaptation to the recipient site helped to minimize complications.

Institutional Review of Usage and Referral Pattern of Radiologic Voiding Examinations (Contrast-Enhanced Voiding Urosonography and Voiding Cystourethrogram)

Institutional Review of Usage and Referral Pattern of Radiologic Voiding Examinations (Contrast-Enhanced Voiding Urosonography and Voiding Cystourethrogram)

Reconstruction of internal carotid artery in the resection of paraganglioma of head and neck

Objective:This study aims to discuss the necessity，surgical method and effect of reconstruction of internal carotid artery （ICA） in the resection of paraganglioma of head and neck. Methods:We retrospectively analyzed the data of the patients who underwent head and neck paraganglioma resection and ICA reconstruction in Peking Union Medical College Hospital from May 2015 to August 2023. The demographic characteristics, preoperative examinations, diagnoses, surgical techniques, and follow-up information were collected. Results:Six patients were enrolled, including four females and two males, with an average age of（39.8±13.0） years. All the patients presented mainly complaining local masses with or without pain. Four cases underwent surgery through Fisch infratemporal fossa approach type A+B, and one through approach type A and one through transcervical approach. Five patients had vascular reconstruction using the great saphenous vein while one patient used an artificial vessel. The average follow-up period was（43.8±31.6） months. One patient had tumor recurrence after 3 years and underwent second surgery to remove the residual tumor, and the other 5 patients had no tumor recurrence. One patient had acute bridging vessel embolism, and the other was found to have occlusion of the bridging vessel at follow-up. Conclusion:Carotid revascularization during resection of paraganglioma of head and neck is an important technique to completely remove the tumor, cure the disease, ensure intracranial blood supply, and reduce cerebrovascular complications. The "pre-reconstruction technique " is an effective method to minimize the duration of brain blood flow interruption, compared to traditional carotid revascularization. Close observation is necessary, along with regular radiological examinations to assess the patency of transplanted vessels, and the residual or recurrent tumors.

Constructing a Large Language Model to Generate Impressions from Findings in Radiology Reports.

Background The specialization and complexity of radiology makes the automatic generation of radiologic impressions (ie, a diagnosis with differential diagnosis and management recommendations) challenging. Purpose To develop a large language model (LLM) that generates impressions based on imaging findings and to evaluate its performance in professional and linguistic dimensions. Materials and Methods Six radiologists recorded imaging examination findings from August 2 to 31, 2023, at Shanghai General Hospital and used the developed LLM before routinely writing report impressions for multiple radiologic modalities (CT, MRI, radiography, mammography) and anatomic sites (cranium and face, neck, chest, upper abdomen, lower abdomen, vessels, bone and joint, spine, breast), making necessary corrections and completing the radiologic impression. A subset was defined to investigate cases where the LLM-generated impressions differed from the final radiologist impressions by excluding identical and highly similar cases. An expert panel scored the LLM-generated impressions on a five-point Likert scale (5 = strongly agree) based on scientific terminology, coherence, specific diagnosis, differential diagnosis, management recommendations, correctness, comprehensiveness, harmlessness, and lack of bias. Results In this retrospective study, an LLM was pretrained using 20 GB of medical and general-purpose text data. The fine-tuning data set comprised 1.5 GB of data, including 800 radiology reports with paired instructions (describing the output task in natural language) and outputs. Test set 2 included data from 3988 patients (median age, 56 years [IQR, 40-68 years]; 2159 male). The median recall, precision, and F1 score of LLM-generated impressions were 0.775 (IQR, 0.56-1), 0.84 (IQR, 0.611-1), and 0.772 (IQR, 0.578-0.957), respectively, using the final impressions as the reference standard. In a subset of 1014 patients (median age, 57 years [IQR, 42-69 years]; 528 male), the overall median expert panel score for LLM-generated impressions was 5 (IQR, 5-5), ranging from 4 (IQR, 3-5) to 5 (IQR, 5-5). Conclusion The developed LLM generated radiologic impressions that were professionally and linguistically appropriate for a full spectrum of radiology examinations. © RSNA, 2024 Supplemental material is available for this article.

Diabetic Gastroparesis: Diagnosis, Management, and Future Perspectives

Gastroparesis, a complication of diabetes, is characterized by delayed gastric emptying without obstruction. It arises from chronic hyperglycemia-induced damage to the autonomic and enteric nervous systems, manifesting primarily as nausea, vomiting, early satiety, and bloating. This condition severely impacts quality of life and glycemic control, increasing the risk of further diabetes-related complications. Early diagnosis and treatment are essential, involving stringent glycemic control, lifestyle changes, pharmacological therapy, and sometimes surgical interventions. Diagnostic approaches include ruling out other causes, followed by tests like scintigraphy, radiological examination, and breath tests. Treatment begins with dietary modifications and, if necessary, progresses to enteral or parenteral nutrition. Glycemic management is crucial, with specific medications either recommended or contraindicated. Pharmacological treatments include metoclopramide and domperidone, though both have significant side effects. Emerging therapies involve ghrelin and motilin agonists, and antidepressants like mirtazapine. Gastric electrical stimulation, endoscopic, and surgical procedures offer additional treatment avenues for severe cases. Effective management of gastroparesis can substantially improve patient outcomes and long-term diabetes management.

Multiple sclerosis and amyotrophic lateral sclerosis: is there an association or a red flag? A case report and literature review

BackgroundMultiple sclerosis (MS) is an inflammatory disease of the central nervous system that causes damage to the myelin and axons and is caused by genetic or environmental factors. Amyotrophic lateral sclerosis (ALS) is characterized by rapidly progressive degeneration of the motor neurons resulting in the presence of upper and lower motor-neuron signs and symptoms.Case presentationA 46-year-old female patient presented with symmetrical weakness of the lower limbs and numbness that developed over weeks. Magnetic resonance imaging (MRI) of the brain exhibited typical demyelination features, high signal abnormality involving the periventricular and subcortical white matter, and an oval-shaped lesion. The patient was diagnosed with MS based on the clinical presentation and radiological examination. However, there was rapid progression of the symptoms, involvement of bulbar dysfunction, and muscle atrophy. Furthermore, the patient did not respond to acute therapy and immunotherapy, which made the diagnosis of MS less likely or suggested that it could be associated with another diagnosis. Her neurophysiological test met the criteria of ALS, and she was started on riluzole.Literature reviewWe reviewed all articles from 1986 to 2023, and there were 32 reported cases describing the co-occurrence of ALS and MS in different populations. Our case is the 33rd, and to our knowledge, it is the only case reported in the Middle East and specifically in Saudi Arabia. The main proposed mechanism according to postmortem examinations is a combination of degenerative and inflammatory processes with a cascade of production of reactive oxygen species and nitric oxide, which lead to cell death and apoptosis during concomitant ALS with MS.ConclusionThe co-occurrence of ALS and MS is extremely rare, but it can be explained by pathogenesis related to neurodegeneration, inflammation, or genetic susceptibility. Rapid progressive motor and bulbar symptoms could be red-flag symptoms, extensive evaluation might be needed for these patients.

Diagnostic Accuracy of Mammography and Ultrasonography Screening for Breast Cancer in Pregnant and Lactating Women

Breast cancer was of significant health concern affecting women worldwide. Objective: To assess diagnostic accuracy of mammography and ultrasonography in differentiating malignant and benign breast lesions in pregnant and lactating women. Methods: A cross sectional retrospective study was conducted at Radiology department of Shahida Islam Medical Complex, Lodhran from May 2023 to April 2024. A sample size of 242 females was calculated. Electronic medical records were reviewed for radiological examination including screening ultrasound and mammography. All those pregnant and lactating females on which ultrasound and mammograms were performed were included. SPSS version 23.0 was used for data analysis. Diagnostic accuracy of both ultrasound and mammography were calculated in terms of malignant or benign and sensitivity and specificity. Mann-Whitney U test was applied between mammography, ultrasonography and BI-RADS categories. Results: Of 242 females, 110 underwent mammography and 132 underwent ultrasound. Negative mammography was observed in 71 females in which at biopsy, 24 were benign. Negative ultrasound with only benign lesion was seen in 68 females and 10 of which were confirmed at biopsy. Specificity of ultrasonography was 100 %, sensitivity 85.7 %, positive predictive value of 100 % while negative predictive value of 25 %. Specificity of mammography was 100 %, sensitivity 92.3 %, positive predictive value of 100 % while negative predictive value of 42.8 % (p<0.001). Conclusions: Although both ultrasound and mammography were found to be specific, use of mammography was considered better in terms of sensitivity and diagnostic accuracy.

Radiographic assessment of incidental bone lesions of the proximal humerus: a prevalence study.

An increased prevalence of benign lesions has been associated with the increased use of radiological tools in orthopedic practice. To investigate the inter-observer reliability of the radiographic detection of lesions on the proximal humerus between different observers. X-ray radiological examinations of 17,243 patients were performed by an orthopedic surgeon to assess the presence of proximal humeral bone lesions. After this initial screening, 201 patients with lesions were identified and these 201 scans were assessed by three different physicians: an orthopedic oncologist, an orthopedic surgeon, and a musculoskeletal radiologist. Of the 201 patients with lesions, 80 had magnetic resonance imaging in addition to X-rays and were assessed. The diagnosis of the lesions was determined by each participant according to their radiological appearance to assess inter-observer reliability. The prevalence of proximal humeral lesions was determined by the orthopedic surgeon to be 1.165% (201 of 17,243 patients). In 201 patients with a lesion, the mean age was 48 ± 17 years (range = 18-91 years). According to the assessments of the orthopedic oncologist, orthopedic surgeon, and musculoskeletal radiologist, the most common bone lesion identified was enostosis, with prevalence percentages of 53.7%, 59.7%, and 64.7%, respectively. A noteworthy consensus exists in the collective diagnosis of bone lesions among the three investigators, demonstrated by a substantial agreement with Fleiss' κ at 0.74 (P < 0.001). There was remarkable agreement between the three investigators on the collective diagnosis of bone lesions. Enostosis was the most common bone lesion at the proximal humerus in our series.

Amyand’s Hernia: A Case Report

Amyand's hernia is defined as the presence of the appendix vermiformis (inflamed or non-inflamed) within the inguinal hernia sac. It is seen in approximately 1% of inguinal hernia cases. This extremely rare condition is often diagnosed conventionally, at surgery. However, with the increasing use of computed tomography (CT) and ultrasonography (US) examinations, preoperative diagnosis is also possible. The treatment approach varies depending on whether the appendix inside the hernia sac is inflamed or not. For this reason, imaging examinations are of great importance in making a diagnosis and directing treatment. As a result of imaging examinations in an elderly patient in our clinic, colon, small intestine segments, omentum and appendix were detected in the right inguinal canal. Since the appendix was also located within the hernia sac, the case was called Amyand's hernia. In this article, we wanted to draw attention to Amyand's hernia in general and the place of radiological examination in diagnosis and treatment of this disease.

Tips for success, managing the paediatric patient in radiology.

Paediatric radiology is a fascinating and diverse field of medicine with many opportunities to gain expertise in a range of imaging modalities and body areas. Working with children makes imaging both rewarding and challenging, due to the wide range of patient ages encountered and the inherent variation in developmental needs. This requires a patient-focussed approach to manage their anxiety and ensure cooperation of the patient and their carers. Several approaches to dealing with children have been developed including recognising individual needs, empathising with the child and carers, and involving the use of play and a range of age-relevant preparation materials. All of these make the radiology imaging environment and encounter a more effective and collaborative process. The purpose of this manuscript is to present a practical guide to overcoming these challenges, by making the child the focus of their radiological examination.