Routine Diagnostic Imaging Research Articles

The Fatty Dilemma: A Rare Instance of Extra- and Intravascular Lipoma of the Brachiocephalic Vein

AbstractOftentimes, incidental findings are made on routine diagnostic imaging. An intra- and extravascular lipoma is one example of an important incidental finding. Intravascular lipomas are rare benign vascular tumors that are typically asymptomatic. They are most commonly found in the inferior vena cava but have also been recorded in the superior vena cava, brachiocephalic vein, subclavian vein, internal jugular vein, external jugular vein, and common femoral vein. Here, we presented the case of a 64-year-old female patient with an incidentally discovered intra- and extravascular lipoma affecting the right subclavian and brachiocephalic veins. While benign, intravascular lipoma on imaging can resemble a malignant tumor such as leiomyosarcoma or thrombus. As a result, appropriate identification and classification of this imaging finding is crucial for avoiding an exorbitant and futile workup.

Radiographers’ perspectives on interactional processes during older persons diagnostic medical imaging encounters: a qualitative study

BackgroundWithin a diagnostic medical imaging context, an interaction encompasses communication, physical contact and emotional support. These intricacies are an integral part in achieving a successful medical imaging outcome. An increasing ageing population presents unique challenges and leads to a higher demand for medical imaging services. There is a paucity of literature exploring the specialised knowledge and skills required by radiographers to service optimal person-centred care for elderly patients. The purpose of the study was to explore radiographers’ perspectives on interactional processes during older persons diagnostic medical imaging encounters.MethodsThe study used a qualitative exploratory research design with a descriptive approach to gain insights from 12 purposively sampled Australian radiographers, through open-ended interviews conducted online or by telephone. Verbatim transcripts were produced, and a thematic analysis employed until data saturation had been reached.ResultsThe three themes that emerged from the data analysis were: (1) optimising care and communication, (2) expectations and preconceptions and (3) physical and emotional comfort and safety. Generally, the approach to undertaking older persons examinations entailed more adaptive and flexible competencies and skills in comparison to the familiarised routine diagnostic medical imaging encounters with the younger cohort. Radiographers shared aspects on striking a balance between efficiency and proficiency with the elderly patient needs, preferences, values, safety and well-being considerations. This required swift, complex decision-making and judgement calls due to the unpredictable nature of the context in which the elderly person was situated. The result was the adaptation of examination protocols through equipment manipulation, with minimal disruptions to emotional and physical comfort, achieved through interventions and support strategies.ConclusionThe results highlight the many considerations for radiographers during a short clinical interaction. There is optimism in adding value to the elderly persons experience through a complex interactional process. It is anticipated that the identified skills will inform on best practice principles to achieve an elderly person-centred care medical imaging outcome.

Imaging for assessment of cancer treatment response to immune checkpoint inhibitors can be complementary in identifying hypophysitis.

Hypophysitis is reported in 8.5%-14% of patients receiving combination immune checkpoint inhibition (cICI) but can be a diagnostic challenge. This study aimed to assess the role of routine diagnostic imaging performed during therapeutic monitoring of combination anti-CTLA-4/anti-PD-1 treatment in the identification of hypophysitis and the relationship of imaging findings to clinical diagnostic criteria. This retrospective cohort study identified patients treated with cICI between January 2016 and January 2019 at a quaternary melanoma service. Medical records were reviewed to identify patients with a documented diagnosis of hypophysitis based on clinical criteria. Available structural brain imaging with magnetic resonance imaging (MRI) or computed tomography (CT) of the brain and 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography with computed tomography (FDG-PET/CT) were assessed retrospectively. The main radiological outcome measures were a relative change in pituitary size or FDG uptake temporally attributed to cICI. There were 162 patients (median age 60 years, 30% female) included. A total of 100 and 134 had serial CT/MRI of the brain and FDG-PET/CT, respectively. There were 31 patients who had a documented diagnosis of hypophysitis and an additional 20 who had isolated pituitary imaging findings. The pituitary gland enlargement was mild, and the largest absolute gland size was 13 mm, with a relative increase of 7 mm from baseline. There were no cases of optic chiasm compression. Pituitary enlargement and increased FDG uptake were universally transient. High-dose glucocorticoid treatment for concurrent irAEs prevented assessment of the pituitary-adrenal axis in 90% of patients with isolated imaging findings. Careful review of changes in pituitary characteristics on imaging performed for assessment of therapeutic response to iICI may lead to increased identification and more prompt management of cICI-induced hypophysitis.

Abstract 17372: Cardiac Magnetic Resonance in Takotsubo Disease: Impact on Outcomes and Resource Utilization

Introduction: Takotsubo cardiomyopathy (CM), characterized by transient left ventricular dysfunction, presents diagnostic and management challenges. The utility of cardiac magnetic resonance (CMR) in Takotsubo CM is uncertain. We investigate CMR's impact on outcomes and resource utilization in Takotsubo CM. Methods: A retrospective analysis was conducted with TriNetX. Two cohorts with Takotsubo CM, with and without CMR within 1 month of diagnosis, were matched for lipidemias, hypertension, diabetes, sarcoidosis, and heart diseases (n=1,422 per cohort), Risks assessed 30-day, 1- and 5-year outcomes, resource utilization, and medication/procedure usage. Results: The CMR group had 3.9% (1.5% vs 5.4%, p=0.000) lower risk of mortality within 30 days and 2.6% (4.6% vs 7.2%, p=0.003) lower risk between 1 and 5 years. Hospitalization rates were similar, while complication risks (cardiomyopathy, heart failure) were higher in the CMR group at 1 and 5 years. The CMR group had higher utilization of GDMT, with similar usage for some treatments. Risk of pacemaker or implantable defibrillator usage were 4.9% higher within 30 days (5.8% vs 0.8%, p=0.000) and 5.8% higher within 1 year (8.2% vs 2.5% p=0.000) in the CMR group. Conclusions: Takotsubo patients undergoing CMR exhibited increased risk of concomitant diagnoses of CM/heart failure/pericarditis, received treatments earlier in the disease course, and experienced lower risk of mortality. These results support utilization of CMR as a routine diagnostic imaging modality in patients with suspected Takotsubo CM for comprehensive evaluation to guide treatment decisions and improve patient prognosis.

Magnetic resonance spectroscopy (MRS) of multifidus muscle metabolites in chronic low back pain (CLBP).

The purpose of the study was to investigate several potential imaging biomarkers of CLBP that may be useful for diagnosis and treatment efficacy evaluation. Proton magnetic resonance spectroscopy (1H-MRS) was used to detect the content and ratio of creatine (Cr), choline (Cho), and lipid (Lip) in the multifidus muscle (Mm) in patients with CLBP and to test for relationships between these metabolites and pain severity and duration. Sixty patients with CLBP (experimental group) and sixty-nine asymptomatic volunteers (control group) underwent routine diagnostic magnetic resonance imaging of the lumbar spine. 1H-MRS was acquired with single-voxel MR spectroscopy. The MRS region of interest for measuring Cho, Cr, and Lip concentrations was determined at the L4/5 multifidus muscle (Mm), bilaterally. The contents and ratios of Cr, Cho, and Lip in bilateral and ipsilateral-to-pain (or matched control side) Mm were obtained, and the integral ratios of different metabolites obtained by using Cr as an internal reference were statistically analyzed. There were no significant within-group differences in the contents and ratios of Lip, Cr, Cho, Lip/Cr, and Cho/Cr between the left and right Mm of the healthy control group (p > 0.05) or the CLBP group (p > 0.05). The CLBP group showed a much higher Lip and Lip/Cr ratio in the bilateral Mm compared to the healthy control group (p < 0.05) but there were no between-group differences in Cr, Cho, or the Cho/Cr ratio (p > 0.05). The severity of CLBP was correlated with Lip (p < 0.05). Using 1H-MRS, we demonstrated higher Lip and Lip/Cr ratios in the Mm of patients with CLBP, compared to asymptomatic controls. Mm Lip was correlated with CLBP intensity. An increase in Lip in the Mm may be a characteristic finding in CLBP and may offer a useful prognostic marker for guiding rehabilitation strategies.

Tension-type Headache and Migraine as Manifestations of Chronic Post-Traumatic Headache: Case Report

Introduction: A subsequent headache that appears within seven days of a head injury is referred to as a post-traumatic headache (PTHA) (or after regaining consciousness after the head trauma). If a post-traumatic headache lasts longer than three months after the injury, it is referred to as chronic or chronic post-traumatic headache (CPTHA). Case Report: A 17-year-old male comes to the neurology outpatient clinic with complaints of headache. The headache has been felt since 3 months ago, 3 days after the patient suffered a blow to his left head from falling from a chair. At that time, the patient fainted about 15 minutes later; the patient regained consciousness and had no complaints. Pain is felt on the left side of the head, throbbing, mild-moderate intensity, and feels heavier when there is a loud sound or seeing a too-bright light. Discussion: Like other primary headaches, post-traumatic headache is diagnosed clinically. Laboratory and routine diagnostic imaging studies are unnecessary and have minimal clinical utility. Brain MRI did not reveal any structural changes in patients with PTHA following injury. Conclusion: Chronic post-traumatic headaches often occur after brain injury, especially after minimally traumatic brain injury. The clinical picture is variable and may be similar to tension-type headaches and/or migraines.

Imaging Methods to Quantify the Chest and Trunk Deformation in Adolescent Idiopathic Scoliosis: A Literature Review.

Background context: Scoliosis is a three-dimensional deformity of the spine with the most prevalent type being adolescent idiopathic scoliosis (AIS). The rotational spinal deformation leads to displacement and deformation of the ribs, resulting in a deformity of the entire chest. Routine diagnostic imaging is performed in order to define its etiology, measure curve severity and progression during growth, and for treatment planning. To date, all treatment recommendations are based on spinal parameters, while the esthetic concerns and cardiopulmonary symptoms of patients are mostly related to the trunk deformation. For this reason, there is a need for diagnostic imaging of the patho-anatomical changes of the chest and trunk in AIS. Aim: The aim of this review is to provide an overview, as complete as possible, of imaging modalities, methods and image processing techniques for assessment of chest and trunk deformation in AIS. Methods: Here, we present a narrative literature review of (1) image acquisition techniques used in clinical practice, (2) a description of various relevant methods to measure the deformity of the thorax in patients with AIS, and (3) different image processing techniques useful for quantifying 3D chest wall deformity. Results: Various ionizing and non-ionizing imaging modalities are available, but radiography is most widely used for AIS follow-up. A disadvantage is that these images are only acquired in 2D and are not effective for acquiring detailed information on complex 3D chest deformities. While CT is the gold standard 3D imaging technique for assessment of in vivo morphology of osseous structures, it is rarely obtained for surgical planning because of concerns about radiation exposure and increased risk of cancer during later life. Therefore, different modalities with less or without radiation, such as biplanar radiography and MRI are usually preferred. Recently, there have been advances in the field of image processing for measurements of the chest: Anatomical segmentations have become fully automatic and deep learning has been shown to be able to automatically perform measurements and even outperform experts in terms of accuracy. Conclusions: Recent advancements in imaging modalities and image processing techniques make complex 3D evaluation of chest deformation possible. Before introduction into daily clinical practice, however, there is a need for studies correlating image-based chest deformation parameters to patient-reported outcomes, and for technological advancements to make the workflow cost-effective.

Assessment and prediction of glioblastoma therapy response: challenges and opportunities.

Glioblastoma is the most aggressive type of primary adult brain tumour. The median survival of patients with glioblastoma remains approximately 15 months, and the 5-year survival rate is <10%. Current treatment options are limited, and the standard of care has remained relatively constant since 2011. Over the last decade, a range of different treatment regimens have been investigated with very limited success. Tumour recurrence is almost inevitable with the current treatment strategies, as glioblastoma tumours are highly heterogeneous and invasive. Additionally, another challenging issue facing patients with glioblastoma is how to distinguish between tumour progression and treatment effects, especially when relying on routine diagnostic imaging techniques in the clinic. The specificity of routine imaging for identifying tumour progression early or in a timely manner is poor due to the appearance similarity of post-treatment effects. Here, we concisely describe the current status and challenges in the assessment and early prediction of therapy response and the early detection of tumour progression or recurrence. We also summarize and discuss studies of advanced approaches such as quantitative imaging, liquid biomarker discovery and machine intelligence that hold exceptional potential to aid in the therapy monitoring of this malignancy and early prediction of therapy response, which may decisively transform the conventional detection methods in the era of precision medicine.

UROLITHIASIS IN FOXES: ASSESSMENT OF 65 UROLITH SUBMISSIONS TO THE MINNESOTA UROLITH CENTER FROM 1981 TO 2021.

This article summarizes urinary stone submissions from foxes in human care to the Minnesota Urolith Center over 40 years. A previous report documented the analysis of uroliths from foxes that were submitted between 1981 and 2007.13 New data compiled from 2008 to 2021 included an additional 38 stones submitted from foxes, totaling 65 fox urolith submissions from 1981 to 2021. Struvite and cystine uroliths were most common, with the remainder comprised of calcium phosphate, calcium oxalate, compound, mixed, or miscellaneous material. Most stones were submitted from male foxes. Seventy-two percent of the stones were urocystoliths, and from 2010 to 2021, most stones were diagnosed antemortem and removed surgically. More than half of the stones were submitted from red foxes (Vulpes vulpes) and fennec foxes (Vulpes zerda). Urolithiasis in foxes may be an underrecognized condition, and data from this study suggest that clinicians should consider routine urinalysis and diagnostic imaging as part of the preventive medicine program for fox species, especially red foxes and fennec foxes.

Vasospasm-Related Death after Aneurysmal Subarachnoid Hemorrhage: A Retrospective Case-Control Study.

Background: Vasospasm after the rupture of an intracranial aneurysm is a frequent phenomenon and is the main cause of morbidity and mortality in patients who have survived intracranial hemorrhage and aneurysm treatment. We analyzed the diagnosis and management of patients with aneurysmal subarachnoid hemorrhage who eventually died from ischemic brain damage due to vasospasm. Methods: Between January 2007 and December 2021 (15 years), a total of 1064 patients were diagnosed with an aneurysmal intracranial hemorrhage in a single comprehensive neurovascular center. Vasospasm was diagnosed in 408 patients (38.4%). A total of 187 patients (17.6%) died within 90 days of the aneurysm rupture. In 64 of these 187 patients (33.7%), vasospasm was considered to be the cause of death. In a retrospective analysis, demographic and clinical data for patients without, with non-fatal, and with fatal vasospasm were compared. The patients with fatal vasospasm were categorized into the following subgroups: “no diagnosis and treatment” (Group a), “delayed diagnosis” (Group b), “cardiovascular complications” (Group c), and “vasospasm-treatment complications” (Group d). Results: Among the patients with fatal vasospasm, 31 (48.4%) were assigned to group a, 26 (40.6%) to group b, seven (10.9%) to group c, and none (0%) to group d. Conclusion: The early recognition of severe posthemorrhagic vasospasm is a prerequisite for any treatment and requires routine diagnostic imaging in all unconscious patients. Aggressive endovascular vasospasm treatment may fail to prevent death but is infrequently the cause of a fatal outcome.

Breast Cancer Survivorship Programme: Follow-Up, Rehabilitation, Psychosocial Oncology Care. 1st Central-Eastern European Professional Consensus Statement on Breast Cancer.

Follow-up includes ongoing contact with and health education of the patient, surveillance and control of the adverse effects of surgery, oncological therapies or radiotherapy, screening of metachronous cancers, and comprehensive (physical, psychological and social) patient rehabilitation, which may be enhanced by a healthy lifestyle. Primary attention should be paid to early detection and, when needed, curative treatment of local/regional tumour recurrences. Similarly, with the hope of curative solution, it is important to recognize the entity of a low-mass and relatively indolent recurrence or metastasis (oligometastasis); however, there is still no need to investigate distant metastases by routine diagnostic imaging or assess tumour markers. Below there is a list of possible sources of support, with respect to adjuvant hormone therapy continued during long-term care, social support resources, pivotal points and professional opportunities for physical and mental rehabilitation. Individual solutions for specific issues (breast cancer risk/genetic mutation, pregnancy) are provided by constantly widening options. Ideally, a complex breast cancer survivorship programme is practised by a specially trained expert supported by a cooperative team of oncologists, surgeons, breast radiologists, social workers, physiotherapists, psycho-oncologists and psychiatrists. The approach of follow-up should be comprehensive and holistic.

A probabilistic deep motion model for unsupervised cardiac shape anomaly assessment.

Automatic shape anomaly detection in large-scale imaging data can be useful for screening suboptimal segmentations and pathologies altering the cardiac morphology without intensive manual labour. We propose a deep probabilistic model for local anomaly detection in sequences of heart shapes, modelled as point sets, in a cardiac cycle. A deep recurrent encoder-decoder network captures the spatio-temporal dependencies to predict the next shape in the cycle and thus derive the outlier points that are attributed to excessive deviations from the network prediction. A predictive mixture distribution models the inlier and outlier classes via Gaussian and uniform distributions, respectively. A Gibbs sampling Expectation-Maximisation (EM) algorithm computes soft anomaly scores of the points via the posterior probabilities of each class in the E-step and estimates the parameters of the network and the predictive distribution in the M-step. We demonstrate the versatility of the method using two shape datasets derived from: (i) one million biventricular CMR images from 20,000 participants in the UK Biobank (UKB), and (ii) routine diagnostic imaging from Multi-Centre, Multi-Vendor, and Multi-Disease Cardiac Image (M&Ms). Experiments show that the detected shape anomalies in the UKB dataset are mostly associated with poor segmentation quality, and the predicted shape sequences show significant improvement over the input sequences. Furthermore, evaluations on U-Net based shapes from the M&Ms dataset reveals that the anomalies are attributable to the underlying pathologies that affect the ventricles. The proposed model can therefore be used as an effective mechanism to sift shape anomalies in large-scale cardiac imaging pipelines for further analysis.

113. Correlation between the spinal instability neoplastic score (SINS) and patient reported outcomes

<h3>BACKGROUND CONTEXT</h3> The spinal instability neoplastic score (SINS) is used to define neoplastic-related spinal instability. Mechanical instability is one of the criteria for surgical intervention in patients with spinal metastases; however, data are limited regarding the association between mechanical instability and patient reported outcomes (PROs). <h3>PURPOSE</h3> The objective of this study was to investigate the correlation between the SINS score, individual components of the SINS score and patient reported health related quality of life. <h3>STUDY DESIGN/SETTING</h3> An international multicenter prospective observational study was conducted by the AOSpine Knowledge Forum Tumor on patients who underwent treatment for spinal metastases. <h3>PATIENT SAMPLE</h3> Patients who underwent treatment for spinal metastases, treated either with radiotherapy alone or surgery with or without adjuvant radiotherapy were eligible for inclusion in the observational cohort study. <h3>OUTCOME MEASURES</h3> Data pertaining to demographics, tumor and treatment information were prospectively collected. Patient-reported outcomes were evaluated at baseline, 6 weeks and 12 weeks post-treatment with the SF-36, SOSGOQ, EQ-5D. The SINS score was assessed using routine diagnostic imaging. <h3>Methods</h3> The Spearman's rank correlation coefficient was used to assess the association between SINS, PRO at baseline and change in PROs. An analysis of variance was performed to detect the important factors on SOSGOQ2.0 total score. <h3>RESULTS</h3> A total of 307 patients, including 174 patients who underwent surgery+/- radiotherapy and 133 patients who underwent radiotherapy were eligible for analyses. In the surgery+/- radiotherapy group, 18 patients were classified as having a stable lesion (SINS 0-6), 118 as potentially unstable (SINS 7-12), and 38 as unstable (SINS 13-18) as compared to 55 stable, 71 potentially unstable, and 7 unstable lesions in the radiotherapy-alone group. At baseline, the total SINS score and the presence of mechanical pain was significantly associated with the SOSGOQ pain domain (r=-0.519, P<0.001) and the NRS pain score (r=0.445, P<0.001) for all patients. The presence of mechanical pain demonstrated to be moderately associated with a positive change in PROs at 12 weeks post-treatment. In a multivariate model, SINS demonstrated the greatest impact (P<0.001) on the SOSGOQv2.0 at baseline as compared to other variables. <h3>Conclusions</h3> Spinal instability, as defined by the SINS score, significantly correlated with PROs at baseline and change in PROs post-treatment. Mechanical pain, as a single SINS component, showed the highest correlations with PROs. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

End of treatment cone-beam computed tomography (CBCT) is predictive of radiation response and overall survival in oropharyngeal squamous cell carcinoma

BackgroundImage guidance in radiation oncology has resulted in significant improvements in the accuracy and precision of radiation therapy (RT). Recently, the resolution and quality of cone beam computed tomography (CBCT) for image guidance has increased so that tumor masses and lymph nodes are readily detectable and measurable. During treatment of head and neck squamous cell carcinoma (HNSCC), on-board CBCT setup imaging is routinely obtained; however, this CBCT imaging data is not utilized to predict patient outcomes. Here, we analyzed whether changes in CBCT measurements obtained during a course of radiation therapy correlate with responses on routine 3-month follow-up diagnostic imaging and overall survival (OS).Materials/methodsPatients with oropharyngeal primary tumors who received radiation therapy between 2015 and 2018 were included. Anatomical measurements were collected of largest nodal conglomerate (LNC) at CT simulation, end of radiation treatment (EOT CBCT), and routine 3-month post-RT imaging. At each timepoint anteroposterior (AP), mediolateral (ML) and craniocaudal (CC) measurements were obtained and used to create a 2-dimensional (2D) maximum.ResultsCBCT data from 64 node positive patients were analyzed. The largest nodal 2D maximum and CC measurements on EOT CBCT showed a statistically significant correlation with complete response on 3-month post-RT imaging (r = 0.313, p = 0.02 and r = 0.318, p = 0.02, respectively). Furthermore, patients who experienced a 30% or greater reduction in the CC dimension had improved OS (Binary Chi-Square HR 4.85, p = 0.028).ConclusionDecreased size of pathologic lymph nodes measured using CBCT setup imaging during a radiation course correlates with long term therapeutic response and overall survival of HNSCC patients. These results indicate that CBCT setup imaging may have utility as an early predictor of treatment response in oropharyngeal HNSCC.

Correlation Between the Spinal Instability Neoplastic Score (SINS) and Patient Reported Outcomes.

International multicenter prospective observational cohort study on patients undergoing radiation +/- surgical intervention for the treatment of symptomatic spinal metastases. To investigate the association between the total Spinal Instability Neoplastic Score (SINS), individual SINS components and PROs. Data regarding patient demographics, diagnostics, treatment, and PROs (SF-36, SOSGOQ, EQ-5D) was collected at baseline, 6 weeks, and 12 weeks post-treatment. The SINS was assessed using routine diagnostic imaging. The association between SINS, PRO at baseline and change in PROs was examined with the Spearmans rank test. A total of 307 patients, including 174 patients who underwent surgery+/- radiotherapy and 133 patients who underwent radiotherapy were eligible for analyses. In the surgery+/- radiotherapy group, 18 (10.3%) patients with SINS score between 0-6, 118 (67.8%) with a SINS between 7-12 and 38 (21.8%) with a SINS between 13-18, as compared to 55 (41.4%) SINS 0-6, 71(53.4%) SINS 7-12 and 7 (5.2%) SINS 13-18 in the radiotherapy alone group. At baseline, the total SINS and the presence of mechanical pain was significantly associated with the SOSGOQ pain domain (r = -0.519, P < 0.001) and the NRS pain score (r = 0.445, P < 0.001) for all patients. The presence of mechanical pain demonstrated to be moderately associated with a positive change in PROs at 12 weeks post-treatment. Spinal instability, as defined by the SINS, was significantly correlated with PROs at baseline and change in PROs post-treatment. Mechanical pain, as a single SINS component, showed the highest correlations with PROs.

Do young patients with high clinical suspicion of appendicitis really need cross-sectional imaging? Proceedings from a highly controversial debate among the experts' panel of 2020 WSES Jerusalem guidelines.

The widespread use of cross-sectional imaging in suspected appendicitis is debated. Recent guidelines have demonstrated conflicting views and the debate continues. In April 2020 the World Society of Emergency Surgery (WSES) published the update of the Jerusalem Guidelines on the diagnosis and treatment of acute appendicitis. The role of pre-operative imaging was a particular difficult point to reach a definitive decision, leading to pro-con arguments and an ad hoc Delphi survey with a consensus statement. The systematic review of the literature performed during the guidelines development, which has been summarized in this current opinion paper, demonstrated that the use of AIR and AAS scores as clinical predictors of acute appendicitis is a cost-effective method to reduce the negative appendectomy rate and can stratify patients into high-risk group with specificity of up to 94%. There are currently two principal management strategies for patients with suspected appendicitis: the score-based risk-stratification followed by a diversified management depending on the estimated risk of appendicitis, and the imaging-based strategy advocating routine diagnostic imaging in all patients except those deemed having low probability of appendicitis. In patients younger than 40 years old who have been scored for high probability for acute appendicitis (AIR score 9-12, Alvarado score 9-10, and AAS ≥ 16), CT scan adds little value in the diagnosis. A high-probability score of acute appendicitis may be used to select patients younger than 40 years old in which imaging is not needed.Evidence LevelII (Systematic Reviews and Meta-analyses).

Deep Learning Model for Cell Nuclei Segmentation and Lymphocyte Identification in Whole Slide Histology Images

Anti-cancer immunotherapy dramatically changes the clinical management of many types of tumours towards less harmful and more personalized treatment plans than conventional chemotherapy or radiation. Precise analysis of the spatial distribution of immune cells in the tumourous tissue is necessary to select patients that would best respond to the treatment. Here, we introduce a deep learning-based workflow for cell nuclei segmentation and subsequent immune cell identification in routine diagnostic images. We applied our workflow on a set of hematoxylin and eosin (H&amp;E) stained breast cancer and colorectal cancer tissue images to detect tumour-infiltrating lymphocytes. Firstly, to segment all nuclei in the tissue, we applied the multiple-image input layer architecture (Micro-Net, Dice coefficient (DC) $0.79\pm 0.02$). We supplemented the Micro-Net with an introduced texture block to increase segmentation accuracy (DC = $0.80\pm 0.02$). We preserved the shallow architecture of the segmentation network with only 280 K trainable parameters (e.g. U-net with ∼1900 K parameters, DC = $0.78\pm 0.03$). Subsequently, we added an active contour layer to the ground truth images to further increase the performance (DC = $0.81\pm 0.02$). Secondly, to discriminate lymphocytes from the set of all segmented nuclei, we explored multilayer perceptron and achieved a 0.70 classification f-score. Remarkably, the binary classification of segmented nuclei was significantly improved (f-score = 0.80) by colour normalization. To inspect model generalization, we have evaluated trained models on a public dataset that was not put to use during training. We conclude that the proposed workflow achieved promising results and, with little effort, can be employed in multi-class nuclei segmentation and identification tasks.

Study of contrast induced nephropathy intravenous iodinated contrast media in routine diagnostic imaging in Talangana population

Study of contrast induced nephropathy intravenous iodinated contrast media in routine diagnostic imaging in Talangana population

MET-08 Air in cistern or ventricle after brain metastasis surgery is a predictor of early postoperative intracranial recurrence

INTRODUCTION: The operations of brain metastasis are on the increase as a result of more routine diagnostic imaging and improved extracranial systemic treatment strategies. Opening of the cistern or ventricle during tumor resection may promote local recurrence and cerebrospinal fluid dissemination. We investigated whether the air found in the cistern/ventricle on postoperative Computed tomography (CT) was a predictor of postoperative recurrence.METHODS: Between 2012 and 2019, 27 patients with single brain metastasis were treated with gross total resection at our hospital. The patients in which air was found in the cistern or ventricle of the head CT on the day after surgery was designated as air(+) group, and the patients without air was designated as air(-) group. The primary outcome was the local recurrence, as diagnosed with neuroimaging. The death due to other than brain metastasis was defined as competing risk.RESULTS: CT air(+) group was 17 patients, whereas CT air(-) group was 10 patients. There was no significant difference between the two groups, such as age and sex. Estimated 1-year brain tumor recurrence rate was 70% in the air(+) group and 5.9% in the air(-) group. (p = 0.004). On the other hand, no significant difference was observed in estimated 1-year competing risk between in the air(+) group (10%) and in the air(-) group (2.4%).CONCLUSION: En bloc resection of brain metastasis is effective, but there was no report on the risk of opening the cistern or ventricle. Our results indicate that postoperative air presence in the cistern or ventricle could be a predictor of early postoperative recurrence. In metastatic brain tumor removal, the cistern and ventricle should not be opened, and close follow-up should be done if air in the cistern or ventricle is detected on postoperative CT.

Vascularized Lymph Node Transfer: A Primer for the Radiologist.

Lymphedema, the accumulation of lymphatic fluid in the tissues, is a chronic disease and a major cause of long-term morbidity and disability. Lymphedema is usually a secondary condition, often caused by prior oncologic therapy, such as surgery for cancers, radiation therapy, and chemotherapy. Treatment for lymphedema has traditionally been conservative and limited, but new surgical and microsurgical procedures have arisen in recent years. Vascularized lymph node transfer (VLNT) is one of the most promising new microsurgeries. VLNT involves the transfer of functional lymph nodes (LNs) from a healthy donor site to an area of the body with damaged or diseased lymphatic drainage. The goal of the transplant is to restore physiologic LN drainage and improve lymphedema. Donor LNs are commonly found in the groin, axilla, neck, omentum, or submental region. Imaging can be used for preoperative planning to identify donor sites with the richest number of LNs. This can help identify those patients who may be candidates for VLNT and can help identify the best anatomic site for surgical harvest in those candidates. Imaging can be performed with US, CT, or MRI. VLNT preoperative imaging often requires acquisition techniques and reconstruction parameters that differ from those used in routine diagnostic imaging. Furthermore, to properly identify target LNs, the radiologist must be aware of surgical anatomic landmarks. Online supplemental material is available for this article. ©RSNA, 2020.