Serial Computed Tomography Scans Research Articles

Assessing Pubic Symphysis Evolution in Guinea Pigs (Cavia procellus): Insights From Computer Tomography on Primiparous and Non-Breeding Females.

In guinea pigs (Cavia porcellus), dystocia is a common occurrence. Several factors have been identified in the literature, including the ossification of the pubic symphysis following failure to breed before 9-12 months of age. The objective of this study was to investigate the ossification of pubic symphysis and its evolution during growth in two groups of females. The first group consisted of non-breeding females, while the second group comprised females introduced to breeding at 4-6 months of age. Twelve pairs of sows were selected for comparison, with one non-breeding and one breeding sow in each pair. Symphysis width and tissue density were assessed using micro-computed tomography. Measurements included the distance between the acetabula, width and bone density of the pubic symphysis. Serial computed tomography scans were performed on each sow over several months, both before and after parturition. The results revealed a significantly higher symphysis width in females that had bred. In addition, symphysis ossification was absent in both breeding and non-breeding sows, contrary to previous descriptions of this species. Therefore, dystocia in guinea pigs may not be attributable to ossification of the pubic symphysis.

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.

Guide to extraluminal fish bone retrieval with serial computed tomography scans: a case series

BackgroundFish bone ingestion is commonly encountered in emergency department. It poses a diagnostic and therapeutic challenge particularly when it migrates extraluminally, necessitating a comprehensive and multidisciplinary approach for successful management.Case presentationHere we reported four cases of extraluminal fish bone. The first patient was a 68-year-old Chinese man who had odynophagia shortly after a meal involving fish. The second was a 50-year-old Iban man who reported a sharp throat pain after consuming fish 1 day prior. The third patient was a 55-year-old Malay woman who developed throat pain and odynophagia after consuming fish 1 day earlier. The fourth patient, a 70 year-old Iban man, presented late with odynophagia, neck pain, swelling, and fever 1 week after fish bone ingestion. These unintentional fish bone ingestions faced challenges and required repeat computed tomography scans using multiplanar reconstruction in guiding the surgical removal of the fish bone.ConclusionWe underscore the significance of multiplanar reconstruction in pinpointing the fish bone’s location, demonstrating the migratory route, and devising an accurate surgical plan.

In vivo Assessment of AMP2, a Novel Ceramic-Binding BMP-2, in Ovine Lumbar Interbody Fusion.

Assessment of bone formation in an ovine interbody fusion study. To compare OsteoAdapt SP, which consists of AMP-2, a modified variant of recombinant human bone morphogenetic protein (rhBMP-2) bound to a tricalcium phosphate-containing carrier, to autologous iliac crest bone graft (ICBG) in a lumbar interbody fusion model. Treatment of lumbar disk degeneration often involves spinal fusion to reduce pain and motion at the affected spinal segment by insertion of a cage containing bone graft material. Three graft materials were compared in this study-ICBG and OsteoAdapt SP (low or high dose). The sheep underwent lateral lumbar fusion surgery with PEEK or Titanium interbody cages packed with OsteoAdapt SP (low or high dose) or ICBG. Outcomes were evaluated at 8-, 16- and 26- weeks. Newly formed bone quality, bone mineralization, and fusion were assessed by manual palpation, qualitative and semi-quantitative histopathology, histomorphometry, computed tomography (CT), and micro-CT (mCT) analysis. OsteoAdapt SP was implanted into 43 animals and ICBG into 21 animals (L3-L4). No group showed evidence of systemic toxicity by multiple assessments. All levels were fused by manual palpation at 26 weeks. Serial CT scans showed increasing fusion scores over time. Both doses of OsteoAdapt SP resulted in robust new bone formation and progression of fusion in the interbody cage. Range of motion tests for treatment groups was lower compared with ICBG at 8- and 16 weeks. Similarly, histology at eight weeks demonstrated more robust new bone formation for both OsteoAdapt SP groups compared to autograft. We have demonstrated the preclinical safety and efficacy of OsteoAdapt SP in a clinically relevant large animal model, supporting faster and more robust new bone formation within the interbody cage, comparable to or better than the gold standard, ICBG, in all measures.

Predictive Factors for Regression versus Progression of Nonevacuated Posttraumatic Acute Extradural Hematoma.

Study Design This study was a retrospective study conducted from October 2020 to October 2022 on 106 posttraumatic patients with acute extradural hematomas (EDHs) who were initially planned for conservative treatment. 74 patients had spontaneous EDH regression (EDHR), while 32 patients developed EDH progression (EDHP) and were shifted for surgery. The two groups were statistically compared regarding the different demographic, clinical, and radiographic factors to identify the significant predictors for regression versus progression of acute posttraumatic EDH. Objectives Conventionally, urgent evacuation is the accepted management for EDH. However, several recent reports have described successful conservative management in selected patients. There are no adequate clues to verify patients who will have spontaneous EDHR from those at risk for EDHP and delayed surgery. The main objective of this study was to identify the significant predictors for possible regression versus progression of acute posttraumatic EDH initially planned for nonsurgical treatment. Materials and Methods A retrospective study conducted over 2 years, included 106 head trauma patients with acute EDH, who were admitted to our department and were initially planned for conservative treatment. Various demographic, clinical, and radiographic factors were analyzed to verify the significant predictors for spontaneous EDHR (EDHR group) versus EDHP and subsequent surgical evacuation (EDHP group). Results The mean age was 20.37 ± 12.712 years and the mean Glasgow Coma Scale score (GCS) was 12.83 ± 2.113. Total 69.8% of patients showed spontaneous EDHR, while 30.2% developed EDHP and were shifted for surgical evacuation. Statistical comparison showed that higher GCS ( p = 0.002), frontal location ( p = 0.022), and concomitant fissure fracture ( p = 0.014) were the significant predictors for EDHR, while younger age ( p = 0.006), persistent nausea/vomiting ( p = 0.046), early computed tomography (CT) after trauma ( p = 0.021), temporal location ( p < 0.001), and coagulopathy ( p = 0.001) were significantly associated with EDHP. Conclusion Patients with traumatic EDH fitting the criteria of initial nonsurgical treatment necessitates 48 hours of close observation and serial CT scans at 6, 12, 24, and 48 hours to confirm the regression or early detect the EDHP. Patients with high GCS, frontal hematomas, and associated fissure fracture are at low risk for EDHP. Increased alertness is mandatory for young age and patients with persistent nausea/vomiting, early CT scan, temporal hematomas, or coagulopathy.

Solitary lung adenocarcinoma: follow-up CT, pathological-molecular characteristics, and surgical prognosis for different morphological classifications

ObjectiveTo investigate the dynamic changes during follow-up computed tomography (CT), histological subtypes, gene mutation status, and surgical prognosis for different morphological presentations of solitary lung adenocarcinomas (SLADC).Materials and methodsThis retrospective study compared dynamic tumor changes and volume doubling time (VDT) in 228 patients with SLADC (morphological types I–IV) who had intermittent growth during follow-ups. The correlation between the morphological classification and histological subtypes, gene mutation status, and surgical prognosis was evaluated.ResultsAmong the 228 patients, 66 (28.9%) were classified as type I, 123 (53.9%) as type II, 16 (7%) as type III, and 23 (10.1%) as type IV. Type I had the shortest VDT (254 days), followed by types IV (381 days) and III (501 days), and then type II (993 days) (p < 0.05 each). Type I had a greater proportion of solid/micropapillary-predominant pattern than type II, and the lepidic-predominant pattern was more common in type II and III than in type I (p < 0.05 each). Furthermore, type II and IV SLADCs were correlated with positive epidermal growth factor receptor mutation (p < 0.05 each). Lastly, the Kaplan–Meier curves showed that the disease-free survival was longest for patients with type II tumors, followed by those with type III and IV tumors, and then those with type I tumors (p < 0.001 each).ConclusionA good understanding of the natural progression and pathological-molecular characteristics of different morphological SLADC types can help make accurate diagnoses, develop individual treatment strategies, and predict patient outcomes.Critical relevance statementA good understanding of the natural progression and pathological-molecular characteristics of different morphological solitary lung adenocarcinoma types can help make accurate diagnoses, develop individual treatment strategies, and predict patient outcomes.Key points• Type I–IV solitary lung adenocarcinomas exhibit varying natural progression on serial CT scans.• Morphological classification of solitary lung adenocarcinomas predicts histological subtype, gene status, and surgical prognosis.• This classification of solitary lung adenocarcinomas may help improve diagnostic, therapeutic, and prognosticating abilities.Graphical

Pericardial Hematoma Following Coronary Angiography

ntroduction: Pericardial hematoma is defined as an accumulation of blood in the pericardial space, located in close proximity to the myocardium and deep to the fibrous pericardial sac, which encloses the heart. Case Description: We present a rare case of pericardial hematoma following percutaneous coronary intervention in an individual presenting with stenotic vein graft following symptoms of a myocardial infarction. Initial computed tomography (CT) scan demonstrated hematoma in the pericardial space. This finding was managed conservatively and hematoma was deemed stable on serial CT scans. Discussion: In this urgent situation, CT imaging proves valuable due to its speed, convenience, and accuracy in visualizing the target area from different perspectives. Although patients may appear stable initially after a perforation, a pericardial hematoma can rapidly spread, leading to unstable blood flow that requires prompt intervention and long-term monitoring.

Catheter Tract Hemorrhages and Intracerebral Hemorrhage Outcomes in the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage Trial.

Factors associated with external ventricular catheter tract hemorrhage (CTH) are well studied; whether CTH adversely influence outcomes after intracerebral hemorrhage (sICH), however, is poorly understood. We therefore sought to evaluate the association between CTH and sICH outcomes. We performed a post hoc analysis of the Clot Lysis: Evaluating Accelerated Resolution of Intraventricular Hemorrhage trial. The exposure was CTH and evaluated on serial computed tomography scans between admission and randomization (approximately 72 hours). The primary outcomes were a composite of death or major disability (modified Rankin Score >3) and mortality alone, both assessed at 6 months. Secondary outcomes were functional outcomes at 30 days, permanent cerebrospinal fluid (CSF) shunt placement, any infection, and ventriculitis. We performed logistic regression adjusted for demographics, comorbidities, sICH characteristics, and treatment assignment, for all analyses. Of the 500 patients included, the mean age was 59 (SD, ±11) years and 222 (44%) were female. CTH occurred in 112 (22.4%) patients and was more common in minority patients, those on prior antiplatelet therapy, and patients who had more than 1 external ventricular drain placed. The end of treatment intraventricular hemorrhage volume was higher among patients with CTH (11.7 vs 7.9 mL, P = .01), but there were no differences in other sICH characteristics or the total duration of external ventricular drain. In multivariable regression models, CTH was not associated with death or major disability (odds ratio, 0.7; 95% CI: 0.4-1.2) or death alone (odds ratio, 0.8; 95% CI, 0.5-1.4). There were no relationships between CTH and secondary outcomes including 30-day functional outcomes, permanent CSF shunt placement, any infection, or ventriculitis. Among patients with sICH and large intraventricular hemorrhage, CTH was not associated with poor sICH outcomes, permanent CSF shunt placement, or infections. A more detailed cognitive evaluation is needed to inform about the role of CTH in sICH prognosis.

Chemical pancreatectomy in non-human primates ablates the acini and ducts and enhances beta-cell function

Chronic pancreatitis is a debilitating disease affecting millions worldwide. These patients suffer from bouts of severe pain that are minimally relieved by pain medications and may necessitate major surgeries with high morbidity and mortality. Previously, we demonstrated that “chemical pancreatectomy,” a pancreatic intraductal infusion of dilute acetic acid solution, ablated the exocrine pancreas while preserving the endocrine pancreas. Notably, chemical pancreatectomy resolved chronic inflammation, alleviated allodynia in the cerulein pancreatitis model, and improved glucose homeostasis. Herein, we extensively tested the feasibility of a chemical pancreatectomy in NHPs and validated our previously published pilot study. We did serial computed tomography (CT) scans of the abdomen and pelvis, analyzed dorsal root ganglia, measured serum enzymes, and performed histological and ultrastructural assessments and pancreatic endocrine function assays. Based on serial CT scans, chemical pancreatectomy led to the loss of pancreatic volume. Immunohistochemistry and transmission electron microscopy demonstrated exocrine pancreatic ablation with endocrine islet preservation. Importantly, chemical pancreatectomy did not increase pro-nociceptive markers in harvested dorsal root ganglia. Also, chemical pancreatectomy improved insulin secretion to supranormal levels in vivo and in vitro. Thus, this study may provide a foundation for translating this procedure to patients with chronic pancreatitis or other conditions requiring a pancreatectomy.

Advanced non-small-cell lung cancer treated with first-line pembrolizumab plus chemotherapy: tumor response dynamics as a marker for survival.

The study investigated tumor burden dynamics on computed tomography (CT) scans in patients with advanced non-small-cell lung cancer (NSCLC) during first-line pembrolizumab plus chemotherapy, to provide imaging markers for overall survival (OS). The study included 133 patients treated with first-line pembrolizumab plus platinum-doublet chemotherapy. Serial CT scans during therapy were assessed for tumor burden dynamics during therapy, which were studied for the association with OS. There were 67 responders, with overall response rate of 50%. The tumor burden change at the best overall response ranged from - 100.0% to + 132.1% (median of - 30%). Higher response rates were associated with younger age (p < 0.001) and higher programmed cell death-1 (PD-L1) expression levels (p = 0.01). Eighty-three patients (62%) showed tumor burden below the baseline burden throughout therapy. Using an 8-week landmark analysis, OS was longer in patients with tumor burden below the baseline burden in the first 8weeks than in those who experienced ≥ 0% increase (median OS: 26.8 vs. 7.6months, hazard ratio (HR): 0.36, p < 0.001). Tumor burden remained below their baseline throughout therapy was associated with significantly reduced hazards of death (HR: 0.72, p = 0.03) in the extended Cox models, after adjusting for other clinical variables. Pseudoprogression was noted in only one patient (0.8%). Tumor burden staying below the baseline burden throughout the therapy was predictive of prolonged overall survival in patients with advanced NSCLC treated with first-line pembrolizumab plus chemotherapy, and may be used as a practical marker for therapeutic decisions in this widely used combination regimen. The analysis of tumor burden dynamics on serial CT scans in reference to the baseline burden can provide an additional objective guide for treatment decision making in patients treated with first-line pembrolizumab plus chemotherapy for their advanced NSCLC. • Tumor burden remaining below baseline burden during therapy predicted longer survival during first-line pembrolizumab plus chemotherapy. • Pseudoprogression was noted in 0.8%, demonstrating the rarity of the phenomenon. • Tumor burden dynamics may serve as an objective marker for treatment benefit to guide treatment decisions during first-line pembrolizumab plus chemotherapy.

Diagnosis and treatment of a novel Mycobacterium haemophilum associated pneumonia in an African pygmy hedgehog (Atelerix albiventris)

AbstractAn unknown age (at least 1.5‐year old), male, entire African pygmy hedgehog (Atelerix albiventris) was presented for decreased appetite, lethargy and laboured breathing. Pulmonary radiographic lesions consistent with pneumonia were noted in serial computed tomography scans. The hedgehog initially responded well to treatment with azithromycin and orbifloxacin for several months, but its health declined upon discontinuation of treatment. After continued decline despite resumed antibiotic therapy, the patient was humanely euthanised. A postmortem examination was performed, and histologic examination identified severe granulomatous bronchointerstitial pneumonia with intralesional acid‐fast staining bacteria. Samples from the lung and liver were positive for Mycobacterium haemophilum by PCR and further DNA sequencing. This report describes the clinical presentation, diagnosis, treatment and outcome of a pulmonary infection caused by M. haemophilum in a hedgehog.

Magnetic Resonance Imaging in the Management of Significantly Displaced Adolescent Posterior Sternoclavicular Joint Injuries.

Computed tomography (CT) scans are the standard imaging modality for the diagnosis and treatment guide for adolescent posterior sternoclavicular joint (SCJ) injuries. However, the medial clavicular physis is not visualized and it is not possible to differentiate between a true SCJ dislocation and a physeal injury (PI). An magnetic resonance imaging (MRI) scan can visualize the bone and the physis. We treated a series of patients with adolescent posterior SCJ injuries diagnosed on CT scan. Patients underwent an MRI scan to differentiate between a true SCJ dislocation and a PI and to further differentiate between a PI with or without residual medial end clavicular bone contact. Patients with a true SCJ dislocation and a PI with no contact underwent an open reduction and fixation. Patients with a PI with contact were treated nonoperatively with repeat CT scans at 1 and 3 months. At final follow-up SCJ clinical function was assessed using Quick-DASH, Rockwood, modified Constant, and single assessment numeric evaluation (SANE) scores. Thirteen patients (2 female and 11 male) with an average age of 14.9 years (12 to 17) were included in the study. Twelve patients were available at final follow-up (mean 50mo, 26 to 84). One patient had a true SCJ dislocation and 3 had an off-ended PI and were treated with an open reduction and fixation. Eight patients had a PI with residual bone contact and were treated nonoperatively. For these patients serial CT scans showed that the position was maintained, with a serial increase in callus formation and bone remodeling. The average follow-up was 42.9 months (24 to 62). At final follow-up the mean Quick-disabilities of the arm, shoulder and hand (DASH) was 0.4 (0 to 2.3), Rockwood was 15, modified Constant was 98.8 (89 to 100) and SANE was 99.5% (95 to 100). In this case series of significantly displaced adolescent posterior SCJ injuries MRI scans allowed identification of true SCJ dislocations and off-ended PIs, which were successfully treated by open reduction, and PIs with residual physeal contact which were successfully treated nonoperatively. Level IV-case series.

Evaluation of Volumetric Lymph Node Measurements in Cutaneous T-Cell Lymphoma Patients Enrolled in the Mavoric Trial: An Interim Analysis

Lymph node assessment is an important component of staging, classification, and treatment response assessment in cutaneous T-cell lymphoma (CTCL). Although a biopsy is the only definitive way to assess nodal involvement, radiologic evaluation is commonly used in practice given its practicality. Current radiologic criteria are adapted from guidelines for lymphomas with primarily nodal involvement and have not been validated in CTCL patients. These criteria are limited by linear measurements which fail to accurately capture small and/or asymmetric nodal involvement in CTCL and may lead to flawed estimations of the overall disease burden. Furthermore, unidimensional and bidimensional measurements are subject to significant inter- and intra-observer variability. More accurate methods of lymph node evaluation are needed to improve risk stratification and treatment response assessment in CTCL. Recent advances in digital imaging techniques have made it possible to obtain volumetric tumor measurements. This technique has shown promise as a more accurate imaging biomarker than unidimensional measurements in several solid cancer types, offering improved sensitivity for changes in tumor burden during treatment. Volumetric lymph node measurements have been shown to be superior to unidimensional measurements in distinguishing between benign and malignant lymph nodes in systemic lymphoma, however volumetric measurements have never been studied in CTCL. The aim of this study was to assess the utility of volumetric lymph node measurements in CTCL using this novel imaging technique. We analyzed imaging and clinical data from the mogamulizumab versus vorinostat in previously treated cutaneous T-cell lymphoma (MAVORIC) trial which included 372 CTCL patients randomized to receive either mogalizumab or vorinostat. The majority of patients randomized to vorinostat crossed over to mogalizumab due to disease progression or intolerance. As part of the trial, patients underwent computed tomography (CT) scans at baseline and regular follow-up intervals to assess for lymph node response to treatment. In our study, target lymph nodes in serial CT scans were measured by a team of radiologists using a response assessment system built on open-source software known as the Weasis imaging platform. Semi-automated segmentation algorithms were used to quantify unidimensional and bidimensional measurements as well as lymph node volumes. Our preliminary data suggests that there is a correlation between unidimensional, bidimensional, and volumetric lymph node measurements. For the first time, we validate volumetric lymph node measurement as a viable method of lymph node assessment in CTCL. This implicates lymph node volume as an alternative metric for lymph node assessment in CTCL that has the potential to improve the accuracy of current nodal assessment criteria. Additional research is underway to determine whether volumetric lymph node measurements are superior to uni- and bidimensional measurements in assessing treatment response and predicting clinical outcomes in CTCL.

High-Density Lipoprotein and Long-Term Incidence and Progression of Aortic Valve Calcification: The Multi-Ethnic Study of Atherosclerosis.

Aortic valve calcification (AVC) shares pathological features with atherosclerosis. Lipoprotein components have been detected in aortic valve tissue, including HDL (high-density lipoprotein). HDL measures have inverse associations with cardiovascular disease, but relationships with long-term AVC progression are unclear. We investigated associations of HDL cholesterol, HDL-particle number and size, apoC3-defined HDL subtypes, and, secondarily, CETP (cholesteryl ester transfer protein) mass and activity, with long-term incidence and progression of AVC. We used linear mixed-effects models to evaluate the associations of baseline HDL indices with AVC. AVC was quantified by Agatston scoring of up to 3 serial computed tomography scans over a median of 8.9 (maximum 11.2) years of follow-up in the Multi-Ethnic Study of Atherosclerosis (n=6784). After adjustment, higher concentrations of HDL-C (high-density lipoprotein cholesterol), HDL-P (HDL particles), large HDL-P, and apoC3-lacking HDL-C were significantly associated with lower incidence/progression of AVC. Neither small or medium HDL-P nor apoC3-containing HDL-C was significantly associated with AVC incidence/progression. When included together, a significant association was observed only for HDL-C, but not for HDL-P. Secondary analyses showed an inverse relationship between CETP mass, but not activity, and AVC incidence/progression. In exploratory assessments, inverse associations for HDL-C, HDL-P, large HDL-P, and apoC3-lacking HDL with AVC incidence/progression were more pronounced for older, male, and White participants. ApoC3-containing HDL-C only showed a positive association with AVC in these subgroups. In a multiethnic population, HDL-C, HDL-P, large HDL-P, and apoC3-lacking HDL-C were inversely associated with long-term incidence and progression of AVC. Further investigation of HDL composition and mechanisms could be useful in understanding pathways that slow AVC.

Rapidly progressive interstitial lung disease in patients with anti-melanoma differentiation-associated gene 5-positive dermatomyositis: serial changes on HRCT.

Anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibodies in patients with dermatomyositis are associated with rapidly progressive interstitial lung disease (RP-ILD). Computed tomography (CT) plays a central role in the diagnosis of RP-ILD and may help characterize the temporal changes. We report five anti-MDA5-positive dermatomyositis patients with serial CT scans spanning their acute RP-ILD disease course. Our case series highlights the variable imaging pattern that can manifest in this setting, including diffuse alveolar damage and nonspecific interstitial pneumonia patterns. Three patients in our series died within 4months of their disease onset, whereas the other two patients survived. The serial CT changes in anti-MDA5 disease are dynamic and variable; therefore, it is imperative to maintain a broad differential when faced with these HRCT patterns to improve the diagnosis and management of this underrecognized entity.

Is It Possible to Replace Conventional Radiography (CR) with a Dose Neutral Computed Tomography (CT) of the Cervical Spine in Emergency Radiology-An Experimental Cadaver Study.

The purpose of this experimental study on recently deceased human cadavers was to investigate whether (I) the radiation exposure of the cervical spine CT can be reduced comparable to a dose level of conventional radiography (CR); and (II) whether and which human body parameters can be predictive for higher dose reduction potential (in this context). Materials and Methods: Seventy serial CT scans of the cervical spine of 10 human cadavers undergoing postmortem virtual autopsy were taken using stepwise decreasing upper limits of the tube current (300 mAs, 150 mAs, 110 mAs, 80 mAs, 60 mAs, 40 mAs, and 20 mAs) at 120 kVp. An additional scan acquired at a fixed tube current of 300 mAs served as a reference. Images were reconstructed with filtered back projection and the upper (C1-4) and lower (C4-7) cervical spine were evaluated by three blinded readers for image quality, regarding diagnostic value and resolution of anatomical structures according to a semiquantitative three-point-scale. Dose values and individual physical parameters were recorded. The relationship of diagnostic IQ, dose reduction level, and patients’ physical parameters were investigated. The high-contrast resolution of the applied CT protocols was tested in an additional phantom study. Results: The IQ of the upper cervical spine was diagnostic at 1.69 ± 0.58 mGy (CTDI) corresponding to 0.20 ± 0.07 mSv (effective dose) in all cadavers. IQ of the lower cervical spine was diagnostic at 4.77 ± 1.86 mGy corresponding to 0.560 ± 0.21 mSv (effective dose) in seven cadavers and at 2.60 ± 0.93 mGy corresponding to 0.31 ± 0.11 mSv in four cadavers. Significant correlation was detected for BMI (0.8366; p = 0.002548) and the anteroposterior (a.p.) chest diameter (0.8363; p = 0.002566), shoulder positioning (0.79799; p = 0.00995), and radiation exposure. Conclusions: Conventional radiography can be replaced with a nearly dose-neutral CT scan of the cervical spine.

Longitudinal Changes in Bone Mineral Measurements Inside and Outside Radiation Fields Used for Cervical Cancer Treatment

PurposeWe compared the magnitude of changes in bone mineral density (BMD), within and outside the radiation field, among women who received pelvic radiation therapy (RT) with or without chemotherapy for cervical cancer. Methods and MaterialsIn this secondary analysis of a prospective study, we analyzed serial computed tomography scans and dual-energy x-ray absorptiometry scans from 78 patients who received definitive RT or chemoradiation therapy (CRT) for cervical cancer at a single institution from 2008 to 2015. BMD values at L1, L2, L3, and L4 were measured. We compared changes in BMD within the radiation field (ie, at L4) with those outside the field (ie, at L1). Linear mixed models were also used to examine the effect of RT on changes in BMD over time and covariate adjustment. ResultsThe median age of the 78 patients was 45.5 years (range, 23-88 years); all received RT and 76 (97%) received concurrent CRT. Treatment was associated with significant declines in BMD in all 4 lumbar vertebral bodies over time (P < .05), with nadir at 3 months for L4 and at 1 year for L1. Pairwise comparisons at 3 months and 2 years after treatment indicated that BMD in L4 (within the RT field) had improved (P = .037), but BMD in L1 (outside the RT field) was no different at 3 months and 2 years. ConclusionsSignificant BMD declines were observed in all lumbar vertebral bodies immediately after RT. However, in-field vertebral bodies reached nadir BMD earlier than those located outside the RT field. Our results suggest that treatment and patient-related factors other than RT may contribute to declines in BMD after treatment for cervical cancer. Routine bone density screening and post-RT therapy with hormones may be beneficial for selected patients who receive CRT for cervical cancer.

A155 ASEPTIC ABSCESS SYNDROME IN INFLAMMATORY BOWEL DISEASE: A CASE REPORT

BackgroundAseptic abscess syndrome (AAS) is a rare extraintestinal manifestation of inflammatory bowel disease (IBD) and it is characterized by the formation of sterile collections of neutrophils in various organs. Misdiagnosis frequently leads to unnecessary surgical procedures and prolonged courses of antibiotics. There are only 61 reportable cases of AAS in the international literature and 2 cases in Canada. This case and the associated literature review highlight the diagnostic considerations, treatment options and disease course of this rare disease.AimsTo describe a case of AAS in IBD.MethodsCase report and review of the literature.ResultsA 24-year-old male with a history of ulcerative pancolitis (UC) initially presented with a 3-week history of malaise, abdominal pain, and fevers with a computed tomography (CT) scan showing multiple splenic abscesses. Over the next year, he had multiple readmissions for recurrent sepsis from culture negative multi-focal abscesses. Serial CT scans revealed new abscesses in the liver, scrotum, and lungs with interval progression in size. Unsuccessful attempts to isolate a culprit organism which included serological markers and cultures from blood, bronchial washings, aspirate from abscesses, and surgical tissue. All samples demonstrated frank pus with suppurative granulomatous inflammation. The patient was trialed on various courses of antibiotics without improvement. Therefore, a decision was made to treat for AAS given his IBD history. Antibiotics were discontinued and prednisone was initiated with rapid improvement in symptoms and biochemistry. In the three years following, he was transitioned to a combination of infliximab and azathioprine. He had rapid resolution of his abscesses on serial CT scans following steroid and anti-TNF therapy. Currently, he is no longer on steroids and his CRP has normalized with no recurrence of his symptoms.ConclusionsAAS has often been associated with IBD, particularly Crohn’s disease and more rarely in UC. Case series have shown that AAS is not strongly associated with IBD activity as only 55% of cases have concomitant IBD flare and abscess formation. The syndrome continues to pose a diagnostic conundrum among specialists as there is no established diagnostic criteria and thus AAS remains a diagnosis of exclusion. This has led many patients to suffer from AAS for prolonged periods and receive unnecessary investigations and treatments. Steroids remain the gold standard for initial induction of remission. However, the ideal regimen for maintenance therapy is still evolving and case reports have described the effects of immunotherapy and biologics on AAS. AAS has a substantial impact on quality of life and is very responsive to therapy; this case report reminds the clinician that AAS should be considered in patients with IBD presenting with multifocal abscesses unresponsive to antimicrobials. Serial CT scan (coronal view) of abdomen demonstrating multiple hepatic abscesses (blue arrows)Funding AgenciesNone

Usage of image registration and three-dimensional visualization tools on serial computed tomography for the analysis of patients with traumatic intraparenchymal hemorrhages

The aim of this study was to apply registration and three-dimensional (3D) display tools to assess the evolution of intraparenchymal hemorrhage (IPH) in patients with traumatic brain injury (TBI). We identified 109 TBI patients who had two computed tomography (CT) scans within 4 days retrospectively. The IPH was manually outlined. The registration was performed in 39 lesions from 29 patients with lesion volume < 1.5 cm on both baseline and follow-up CT. The center of mass (COM) of each lesion was calculated, and the distance between baseline and follow-up CT was used to evaluate the registration effect. The mean distances of COM before registration in the XYZ, XY, and YZ coordinates were 20.5 ± 10.2 mm, 17.8 ± 9.4 mm, and 15.9 ± 9.4 mm, respectively, which decreased significantly (p < 0.001) to 7.9 ± 4.9, 7.8 ± 5.0, and 6.1 ± 4.1 mm after registration. A 3D short video displaying the rendering view of all lesions in 34 randomly selected patients from baseline and follow-up scans were presented side-by-side for comparison. The detection rate of new IPH lesions increased in 3D videos (100%) as compared with axial CT slices (78.6–92.9%). A very high interrater agreement (k = 0.856) on perceiving IPH lesion progression upon viewing 3D video was noted, and the absolute volume increase was significantly higher (p < 0.001) for progressive lesions (median 7.36 cc) over non-progressive lesions (median 0.01 cc). Compared to patients with spontaneous hemorrhagic stroke, evaluation of multiple small traumatic hemorrhages in TBI is more challenging. The applied image analysis and visualization methods may provide helpful tools for comparing changes between serial CT scans.

Automated Assessment of Renal Calculi in Serial Computed Tomography Scans.

An automated pipeline is developed for the serial assessment of renal calculi using computed tomography (CT) scans obtained at multiple time points. This retrospective study included 722 scans from 330 patients chosen from 8544 asymptomatic patients who underwent two or more CTC (CT colonography) or non-enhanced abdominal CT scans between 2004 and 2016 at a single medical center. A pre-trained deep learning (DL) model was used to segment the kidneys and the calculi on the CT scans at each time point. Based on the output of the DL, 330 patients were identified as having a stone candidate on at least one time point. Then, for every patient in this group, the kidneys from different time points were registered to each other, and the calculi present at multiple time points were matched to each other using proximity on the registered scans. The automated pipeline was validated by having a blinded radiologist assess the changes manually. New graph-based metrics are introduced in order to evaluate the performance of our pipeline. Our method shows high fidelity in tracking changes in renal calculi over multiple time points.