Radiological Appearance Research Articles

Microbiological Evaluation of Paediatric Chronic Haematogenous Osteomyelitis in a Tertiary Care Hospital in Northern India and its Association with Radiological Appearance: A Retrospective Study

Introduction: Chronic osteomyelitis in the paediatric age group is a frequent complication of improperly treated acute haematogenous osteomyelitis, leading to devastating complications such as pathological fractures and deformities in affected children. There is a growing need to comprehend the disease process and develop improved treatment strategies. Aim: To evaluate bacterial culture and antibiotic sensitivity patterns in children and adolescents with chronic haematogenous osteomyelitis in North India and to explore associations between radiological patterns and antibiotic sensitivity. Materials and Methods: The present retrospective study was conducted in the Department of Orthopaedics of tertiary care centre, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, North India, from July 2018 to June 2020. Total 100 children and young adolescents with chronic osteomyelitis who reported to OPD of hospital with pus discharge from an extremity persisting for more than six weeks, along with radiological features indicative of chronic osteomyelitis. Parameters such as site of infection, illness duration, blood parameters, bacteriological culture reports, etc., were examined. Radiological evaluation was performed using the Beit CURE (BC) classification. Data were analysed and represented in the form of frequencies and percentages. The Chi-square test was used to compare proportions, with significance set at p-value<0.05. Results: The median age of the study population was 13 years, there were 32 (32%) females and 68 (68%) males. The majority of cases (70%) belonged to the B1-B3 group. Staphylococcus aureus was responsible for 86 (86%) cases, followed by Pseudomonas aeruginosa in 7 (7%) cases. Out of the 86 Staphylococcus aureus (S. aureus) isolates, 58 (67.44%) were Methicillin-resistant Staphylococcus aureus (MRSA). Multidrug resistance was observed among gram-negative species, as well. Pseudomonas aeruginosa showed resistance to fluoroquinolones in 4 (57%) cases, aminoglycosides in 2 (28%) cases, and carbapenem in 1 (14%) case, which is considered highly effective in treating serious infections caused by multidrug resistant Gram-negative species. No significant association was found between drug sensitivity patterns and radiological features in the present study. Conclusion: Staphylococcus aureus remains the most predominant organism isolated from deep tissue cultures. Among S. aureus isolates, MRSA was the most frequently identified. Identifying the causative organism may be challenging in some cases. Among cases where the offending microbe was identified, drug resistance was widespread among both Gram-negative and Gram-positive specimens. No significant relationship was found between the radiological appearance of infected bone and the pattern of antibiotic resistance.

Classical Radiological Signs and Appearances of Surgical Importance with Corresponding Operative Pictures: A Pictorial Review

The advent of various new-age radiological modalities over the years has brought about paradigm shifts in diagnostics for clinicians all over the world. These advancements have refined medical practice immeasurably. Accurate diagnosis have, in turn, enabled surgeons to administer appropriate and timely surgical therapy to their patients. The timeline of path-breaking radiological inventions from X-rays to Ultrasonics, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and beyond, bears living testimony to the role that preoperative imaging plays in a surgeon’s daily life. The present review paper nostalgically remembers and acknowledges the pioneers of this remarkable journey. Additionally, it shares the authors’ experiences with classical radiological signs and appearances correlated with their corresponding surgical ‘first look’ pictures from some of the rare and interesting cases the authors have encountered over the years. The present cases exhibit diverse presentations, clinical signs, radiological findings and diagnosis. The crucial role played by radiology in clinicians’ daily lives, particularly in accurately diagnosing rare conditions, underscores the need to report these diverse cases.

Rad-Phi2: Instruction Tuning Phi2 for Radiology

Small Language Models (SLMs) have shown remarkable performance in general domain language understanding, reasoning and coding tasks, but their capabilities in the medical domain, particularly concerning radiology text, is less explored. In this study, we investigate the application of SLMs for general radiology knowledge specifically question answering related to understanding of symptoms, radiological appearances of findings, differential diagnosis, assessing prognosis, and suggesting treatments w.r.t diseases pertaining to different organ systems. Additionally, we explore the utility of SLMs in handling text-related tasks with respect to radiology reports within AI-driven radiology workflows.We fine-tune Phi2, a SLM with 2.7 billion parameters using high-quality educational content from Radiopaedia, a collaborative online radiology resource. The resulting language model, RadPhi2-Base, exhibits the ability to address general radiology queries across various systems (e.g., chest, cardiac). Furthermore, we investigate Phi2 for instruction tuning, enabling it to perform specific tasks. By fine-tuning Phi2 on general domain tasks followed by radiology-specific tasks related to chest X-ray reports, we create RadPhi2. Our empirical results reveal that Rad-Phi2-Base and Rad-Phi2 perform comparably or even outperform larger models such as Mistral-7B-Instruct-v0.2 and GPT-4 providing concise and precise answers.

Real-world experience of nintedanib for progressive fibrosing interstitial lung disease in the UK.

Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting. 26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collected via electronic survey. 24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD. We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting.

Ultrasonographic Characteristics of Thyroid Nodules with Nondiagnostic and Atypia of Undetermined Significance in Fine-Needle Aspiration Cytology.

This study aimed to investigate ultrasound (US) features of thyroid nodules categorized as nondiagnostic (ND) and atypia of undetermined significance (AUS) according to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and their potential implications for clinical management. A retrospective study was conducted on patients who underwent thyroid nodules FNAC between 2019 and 2023. Nodules falling into the ND and AUS categories were analyzed for US features, nodule size, composition, echogenicity, shape, margin, echogenic foci, the distribution of the American College of Radiology's Thyroid Imaging Reporting and Data System (ACR TI-RADS) categories, and other parameters. The study included a total of 1,199 patients and 1,252 nodules (ND: 1110; AUS: 142). No significant differences in age, gender, nodule features, echogenicity, shape, margin, echogenic foci, TI-RADS scores, localization, number of nodules, or thyroid parenchymal disease presence were found between the ND and AUS categories (p > 0.05). Also, no statistically significant difference in nodule size (<10 mm vs. ≥10 mm) existed between the ND and AUS categories (p = 0.475). Both showed predominantly solid composition and hyperechoic/isoechoic echogenicity. High proportions of TI-RADS 4 nodules were observed in both groups, with 727 (65.5%) in ND and 95 (66.9%) in AUS. This study found no statistically significant differences in US characteristics between the ND and AUS categories, indicating potential similarities in their radiological appearances. Also, no significant difference in nodule size (<10 mm and ≥10 mm) was observed between these categories. Clinical management should consider further investigations, including repeat FNAC, due to the diagnostic challenges and malignancy risk in both categories.

Langerhans cell histiocytosis diagnosed with spontaneous regression

Langerhans cell histiocytosis (LCH) is an uncommon disease spectrum that occurs mostly in children and young adults and is characterized by the proliferation of Langerhans cells in the affected organ or tissue. Due to its nonspecific clinical findings and symptoms and variable radiological appearances, sometimes problems can be experienced in the diagnosis of Langerhans cell histiocytosis. Histopathological results are still the basis for the diagnosis of LCH rather than imaging techniques. However, MRI not only characterizes the lesion but also plays an important role in the follow-up of the lesion and in the evaluation of the response to any treatment. In this case, the radiological and histopathological features of eosinophilic granuloma are discussed together with the follow-up MRI findings of a five-year-old girl who was diagnosed with eosinophilic granuloma (EG) with spontaneous regression findings in her clinico-radiological follow-up. The rarity of spontaneous regression of eosinophilic granuloma and the lack of a definitive histopathology make this case unique.

Geometric variability in radiological appearance of third ventricle in congenital hydrocephalus- is it really so pliable? Or do we need to visualize it differently? A two-case study and literature review

Enlargement of third ventricle is seen due to multiple causes, usually associated with hydrocephalus. Raised intracranial pressure (ICP) is the most common indication for a cerebrospinal fluid diversion procedure. However, congenital anomalies like Dandy walker malformation (DWM) may not always manifest with raised ICP. Identifying neurological delay and neurocognitive parameters and correlating this with existing anatomical features is extremely important. We discuss this report of two cases of patients with DWM where abnormal morphology of the third ventricle was analysed and used to interpret clinical neurological delay.

Bench to Bedside Development of [18F]Fluoromethyl-(1,2-2H4)choline ([18F]D4-FCH).

Malignant transformation is characterised by aberrant phospholipid metabolism of cancers, associated with the upregulation of choline kinase alpha (CHKα). Due to the metabolic instability of choline radiotracers and the increasing use of late-imaging protocols, we developed a more stable choline radiotracer, [18F]fluoromethyl-[1,2-2H4]choline ([18F]D4-FCH). [18F]D4-FCH has improved protection against choline oxidase, the key choline catabolic enzyme, via a 1H/2D isotope effect, together with fluorine substitution. Due to the promising mechanistic and safety profiles of [18F]D4-FCH in vitro and preclinically, the radiotracer has transitioned to clinical development. [18F]D4-FCH is a safe positron emission tomography (PET) tracer, with a favourable radiation dosimetry profile for clinical imaging. [18F]D4-FCH PET/CT in lung and prostate cancers has shown highly heterogeneous intratumoral distribution and large lesion variability. Treatment with abiraterone or enzalutamide in metastatic castrate-resistant prostate cancer patients elicited mixed responses on PET at 12-16 weeks despite predominantly stable radiological appearances. The sum of the weighted tumour-to-background ratios (TBRs-wsum) was associated with the duration of survival.

Radiological evaluation before and after treatment with an osseointegrated bone-anchor following major limb amputation-a guide for radiologists.

Osseointegrated implants have been developed to allow direct skeletal fixation of a prosthesis as an alternative to traditional socket-fitted prostheses for patients who have suffered from a major limb amputation. The implants contribute to improvements in functional outcome and quality of life and radiological evaluation plays a crucial role in pre- and post-operative assessment. This article acts as a guide for radiologists who may be tasked with providing the radiological information required by surgeons and prosthetists. We also look at the radiological appearances of complications that may arise in patients treated with an osseointegrated implant. Plain X-rays are used to screen patients who wish to undergo treatment. Limb-length X-rays are then used to measure the length of any residual bone, and comparisons can be made with the normal side (if present). From this, decisions about the likely size of the implant and the need for further amputation can be made. CT scans enable accurate assessment of the medullary cavity and cortical thickness. Post-operatively, plain X-rays form the mainstay of the routine monitoring of the bone-implant interface. Potential complications include infection, aseptic loosening, mechanical fracture of the implant and periprosthetic fracture. Infection and aseptic loosening can be seen as a lucency at the bone-implant interface which (if left untreated) can lead to loss of the implant. Implant and periprosthetic fractures are radiographically obvious. Radiologists involved in the care of patients undergoing treatment with an osseointegrated implant should become familiar with the imaging requirements so they can contribute to optimal patient outcomes.

Radiological and Clinical Prognostic Factors of Recurrence of Subacute and Chronic Subdural Hematomas

Objectives. To assess characteristic data of patients hospitalized due to subacute subdural hematomas (SSDHs) and chronic subdural hematomas (CSDHs) and to evaluate radiological findings and establish predictors of hematoma recurrence of SSDHs and CSDHs patient populations. Methods. 149 patients with SSDHs and CSDHs who underwent surgery at Kaunas Clinics Neurosurgery Department from 2020 to 2021 were analyzed. Based on recurrence rate, patients were divided into different subtypes based on computer tomography (CT) imaging. Descriptive analysis, hypothesis testing and correlation matrix were performed using Excel spreadsheet and R programming language with the significance at p-value &lt; 0.05. Results. Out of 149 patients, SSDHs and CSDHs were observed in 89 males (59.6%) and 60 (40.3%) females. Mean of the patients age was 71.1±15 years. Dichotomizing results based on recurrence (cut-off value of 25%), 2 groups were made: 1) low reoperation rate –hypodense sedimented (10%), isodense (21.6%), hypodense (22.2%); 2) high reoperation rate – hypodense bridging (26.7%), hypodense trabecular (27.8%), hypodense with acute bleeding (28.6%), hypodense laminar (30%), isodense with acute bleeding (33.3%). Conclusion. It is concluded that based on 25% reoperation rate high-recurrence and low-recurrence chronic subdural hematomas groups were similar in all terms apart from the hematoma thickness (mm), which leads to a fact that radiological appearance of higher recurrence hematomas should be carefully taken into consideration.

Air bronchogram on chest CT in radiological pure-solid appearance lung cancer: Correlation analysis with genetic pathological features and survival outcomes

PurposeTo investigate the correlation of air bronchogram sign with clinicopathological characteristics and prognosis in patients with clinical stage (c-stage) I non-small cell lung cancer (NSCLC) with radiological pure-solid appearance. MethodWe retrospectively evaluated 276 patients with pure-solid c-stage I NSCLC and assessed the correlation between the air bronchogram and clinicopathological characteristics. A Cox proportional hazards model was performed to identify the effect of air bronchogram and clinicopathological variables on oncological outcomes. Recurrence-free survival (RFS) and overall survival (OS) were calculated by Kaplan-Meier curves and were compared using log-rank tests. ResultsPresence of air bronchogram was associated with a well differentiated degree (P =.026), higher incidence of EGFR mutation (P <.001) and lower recurrence(P =.021). Kaplan-Meier survival curves showed that air bronchogram group was associated with favorable RFS(67.0% vs. 50.2%; P =.015). A multivariable analysis revealed that air bronchogram and EGFR mutation were independent significant prognostic factors associated with RFS (hazard ratio [HR] = 0.495, 95% confidence interval [CI]: 0.322–0.761, P =.001; HR = 1.625, 95% CI: 1.074–2.457, P =.021; respectively), but not with OS. Additionally, we found that pathological lymph node metastasis was identified as an independent prognostic factor associated with poor RFS and OS(HR = 2.808, 95% CI: 1.913–4.123, P <.001 for RFS; HR = 1.983, 95% CI: 1.185–3.318, P =.009 for OS). ConclusionsPresence of air bronchogram was associated with well differentiated degree, higher incidence of EGFR mutation and had additional positive prognostic value for RFS in c-stage I NSCLC with a radiological pure-solid appearance.

Syndromic Hearing Loss in Children.

Pattern recognition of specific temporal bone radiological phenotypes, in association with abnormalities in other organ systems, is critical in the diagnosis and management of syndromic causes of hearing loss. Several recent publications have demonstrated the presence of specific radiological appearances, allowing precise genetic and/or syndromic diagnosis, in the right clinical context. This review article aims to provide an extensive but practical guide to the radiologist dealing with syndromic causes of hearing loss.

Imaging Features of Gastrointestinal Neoplasms Complicating Inflammatory Bowel Diseases.

Inflammatory bowel diseases (IBD) are chronic inflammatory diseases affecting the gastrointestinal (GI) tract. Patients with IBD, besides other non-neoplastic complications, are also at increased risk of GI malignancies such as colorectal cancer, small bowel adenocarcinoma and lymphoma. The principal purpose of imaging in patients with IBD to assess complications and to stage a clinically known cancer. In addition, the goal of imaging has expanded to include the diagnosis of GI malignancies in clinical situations where colonoscopy cannot be performed or is incomplete. In addition, imaging allows the detection of cancers in patients where the development of either disease-related or treatment-related neoplasia is clinically suspected. The purpose of this review is to present the different imaging techniques used to detect GI malignancies in IBD patients and describe the radiological appearances of GI malignancies in IBD patients.

Retrospective analysis of respiratory virus infections in adults with hematologic malignancies.

The study aimed to evaluate respiratory virus infections in adult patients with hematological malignancies (HM). The medical records of patients who were followed up by the hematology clinic at Başakşehir Çam and Sakura City Hospital between March 2021 and March 2023 with a diagnosis of HM and who underwent real-time polymerase chain reaction (RT-PCR) testing for nasopharyngeal/oropharyngeal specimens taken with suspected respiratory tract infection constituted the study data. Infections were symptomatic in 64.56% of patients, and the most common symptoms were fever (48.10%) and cough (18.99%). The mortality rate was 25.32% over a two-year period. When the samples were examined, positive test frequency was 43.04%, and the three most common pathogens were Influenza A (10.13%), SARS-CoV-2 (8.86%), and rhinovirus/enterovirus (7.59%). The frequency of positive tests from HMs was highest in patients with AML (p=0.042). Respiratory PCR kit positivity was higher in patients who had any symptoms (p=0.002) and cough (p=0.003). Test positivity was higher in patients with any pathological radiological finding (p=0.039) and ground glass appearance (p=0.010). The risk of death was found to be 5.848 times higher in patients with dyspnea compared to those without (OR: 5.848, 95% CI: 1.143-29.915, p=0.034). Respiratory tract virus panel PCR test positivity is more common in patients with HM presenting with respiratory tract infection symptoms in the presence of AML diagnosis, symptomatic infection, cough, radiological findings, and ground glass appearance. Mortality risk is high in HM patients with respiratory tract virus infection who have shortness of breath.

MENINGIOMA-06 CYSTIC MENINGIOMA CASE STUDY AND LITERATURE REVIEW

Abstract BACKGROUND Intracranial meningiomas are generally solid tumors with a characteristic radiological appearance. The incidence of cystic meningioma is very low. withe an estimated frequency of 1.6 to 11.7%. It is often misinterpreted on radiological only the anatomopathological exams study can confirm the diagnosis. We report an unusual case of cystic meningioma through which we discuss pathogenic, clinical, radiological and therapeutic characteristics. CASE The patient is a 46 years old woman, with left parieto-occipital headaches for three months with recent appearance of right hemiparesis. The brain scan showed a lesion occupying the left posterior cystic parietal space with a solid nodule and perilesional edema, and enhancement of the solid component and cystic wall. The patient was operated using a left posterioparietal approach.The intraoperative appearance was that of a well defined encapsulated lesion attached to the dura mater, whitish in colour with a cystic part containing xanthochromic liquid and a solid nodule. The tumor is completely extra-axial with a plane of cleavage relative to the peritumoral cortical surface having facilitated its complete excision. Histological examination of the resected confirmed the diagnosis of cystic meningioma. There was no recurrence after 20 months of follow up. CONCLUSION Cystic meningioma is a rare entity. The diagnosis is often difficult to make preoperatively. Dural tail is a specific radiological sign, but not enough to evoke the diagnosis of meningioma with total precision. The surgical excision must be complete especially before signs of contrast of the cystic wall, in order to avoid a possible recurrence or anaplastic transformation.

Surgically treated pneumonic-type lung adenocarcinoma with long survival characteristics

Aims: Pneumonic-type lung adenocarcinoma is defined as a pneumonia-like area of infiltration or consolidation involving a region of the lung. These carcinomas, which are suitable for curative treatment options and have a long survival when detected at an early stage, may resemble infectious or inflammatory lung diseases due to their radiological appearance and clinical findings, may lead to potential delays or difficulties in diagnosis, and this may cause progression in patients who are suitable for curative treatment options.&#x0D; Methods: A total of 41 patients which were surgically treated between 2011-2020 and diagnosed pathologically with pneumonic-type adenocarcinoma. The patents’ TTF-1, type of operation, pathological stages, overall/progression-free survival, as well as overall/progression-free survival according to the type of operation and radiological appearance, were also evaluated.&#x0D; Results: The study included 41 patients. Although overall survival times were long, there was no statistically significant defference between wedge resection and lobectomy group in overall survival by operation type. Although progression-free survival times were long, there was no statistically significant defference between wedge resection and lobectomy group in progression-free survival by operation type. There was no statistically significant difference between solid and consolidated groups in terms of overall survival and progression-free survival according to radiological appearances. There was no statistically significant difference between TTF-1 positive and negative groups in overall survival.&#x0D; Conclusion: Pneumonic-type lung adenocarcinomas respond to curative treatments when diagnosed at an early stage. The optimal treatment method for operable patients is surgery, which is associated with prolonged survival.

Surgical management of supracondylar fracture femur by retrograde intramedullary Green Seligson Henry nail: a clinical study

Background: Femoral shaft fractures in young people are frequently due to some type of high-energy collision. The most common cause of femoral fracture is a motor vehicle crash. Treatment for the femoral shaft is at most priority. Hence, the study is aimed to evaluate the results of the retrograde femoral nailing in supracondylar femoral fractures concerning knee flexion, mobilization of patients, and early weight-bearing. Methods: The study is conducted from October 2019 to October 2021 with 25 patients having supracondylar fractures of the femur. The age group of patients was 15-70 years. Patients with midshaft femur fractures, nonunion, malunion, and pathological fractures were excluded. Chest X-ray post anterior view electrocardiography was performed in patients. Operative procedure was followed and postoperative management was done for all the patients. Radiological evidence of callus and consolidation was analyzed. Neer’s rating system and Sander’s functional evaluation scale were used to find the points for pain, working and walking capacity, range of motion and radiological appearance, etc. Results: In the study, 25 patients are admitted with supracondylar fractures of the femur. The closed or open reduction method and the retrograde intramedullary supracondylar Green Seligson Henry (GSH) nail were used for internal fixation. The patients were followed for a period of 3 to 24 months. The results of Neers and Sander’s evaluation scoring system determined good to excellent results in 65% of cases. Conclusion: To conclude from the study results, it was noted that retrograde intramedullary supracondylar nail is an ideal fixation system for distal third femoral fractures, especially the extraarticular type.

The Cambridge Experience with Lower Limb Long Bone Non-union Following Fixation and the Treatment Algorithm.

Non-unions have been traditionally classified as atrophic, oligotrophic and hypertrophic and their management was primarily dictated by that. In our Unit, we have based our treatment rationale mainly on the stability of the metalwork and the presence of symptoms rather than the radiologic appearance of the non-union or the presence of infection. The aim was to present the treatment algorithm for lower limb long bone non-union following operative fixation. All patients treated for a femoral or tibial non-union following fixation between 2014 and 2020 in our unit and with a minimum follow-up of 2 years were included. Non-union was defined as having no evidence of fracture healing in any cortices six months after the index procedure. Union was defined as bridging callus in at least three cortices visualized on at least two orthogonal radiographs. Information retrieved included demographic and fracture characteristics, presence of infection, evidence of metalwork stability and treatment. Outcome measures included union rate, time to union and complications. Data were analysed with the Statistical Program for Social Sciences (SPSS) using contingency tables and linear regression. A p-value of less than 0.05 was considered statistically significant. Seventy-seven consecutive patients were included in the study. Union was achieved in 91% of the cases, while union was noted in all the patients treated non-operatively. The mean time to union was 14.49 months (9.98). Complications were encountered in 20 of the patients and the most common were docking site non-union and metalwork breakage. Infection was the only factor that affected time to union in a statistically significant manner (p = 0.006). The results of our study suggest that in cases of long bone non-union following operative fixation using signs of metalwork instability and the presence of clinical symptoms as the main indication for surgical intervention provides a satisfactory outcome. This approach prevented operative management in a large proportion of patients. This article presents an algorithmic approach that could aid clinicians in their decision-making in long-bone non-union management. Therapeutic level III. Poutoglidou F, Krkovic M. The Cambridge Experience with Lower Limb Long Bone Non-union Following Fixation and the Treatment Algorithm. Strategies Trauma Limb Reconstr 2023;18(2):100-105.

Retroperitoneal Fibrosis

Retroperitoneal fibrosis (RPF) is a rare condition with an incidence of 1.3 per 100 000 population with a peak age of onset at 40 – 65 years old. The idiopathic form of RPF, also known as Ormond’s disease, is more common and makes up about 75% of the case. Here, we are presenting a case of a woman who was referred to our center due to worsening serum creatinine and was diagnosed with retroperitoneal fibrosis. This case has been taken up due to the rarity of the case and to discuss the radiological appearance specifically the CT appearance of retroperitoneal fibrosis. We have also discussed methods to differentiate between primary and secondary retroperitoneal fibrosis specifically based on CT findings. This is to provide guidance for the diagnosis and prompt management of cases, especially in district hospitals with no advanced diagnostic equipment such as MRI or the ability to biopsy.

Neuroendocrine Carcinoma of the Urinary Bladder: CT Findings and Radiomics Signature.

Background: We present a case series of Neuroendocrine Carcinoma of the Urinary Bladder (NECB) to analyse their radiologic appearance on CT, find a "Radiomic signature", and review the current literature. Methods: 14 CT cases of NECB were reviewed and compared with a control group of 42 patients with high-grade non-neuroendocrine bladder neoplasm for the following parameters: ring enhancement; implantation site; dimensions; density; margins; central necrosis; calcifications; number of lesions; wall thickness; depth of invasion in the soft tissue; invasion of fat tissue; invasion of adjacent organs; lymph-node involvement; abdominal organ metastasis. To extract radiomic features, volumes of interest of bladder lesions were manually delineated on the portal-venous phase. The radiomic features of the two groups were identified and compared. Results: Statistical differences among NECB and control group were found in the prevalence of male sex (100% vs. 69.0%), hydronephrosis (71.4% vs. 33.3%), mean density of the mass (51.01 ± 15.48 vs. 76.27 ± 22.26 HU); product of the maximum diameters on the axial plane (38.1 ± 59.3 vs. 14.44 ± 12.98 cm2) in the control group, trigonal region involvement (78.57% vs. 19.05%). About the radiomic features, Student's t-test showed significant correlation for the variables: "DependenceNonUniformity" (p: 0.048), "JointAverage" (p: 0.013), "LargeAreaLowGrayLevelEmphasis" (p: 0.014), "Maximum2DDiameterColumn" (p: 0.04), "Maximum 2DDiameterSlice" (p: 0.007), "MeanAbsoluteDeviation" (p: 0.021), "BoundingBoxA" (p: 0.022) and "CenterOfMassB" (p: 0.007). Conclusions: There is a typical pattern (male patient, large mass, trigonal area involvement) of NECB presentation on contrast-enhanced CT. Certain morphological characteristics and encouraging results about Radiomic features can help define the diagnosis.