Siemens Medical Solutions USA Research Articles

Delta Neutrophil Index as a New Marker of Purulent Inflammation in Men With Non-odontogenic Abscesses of the Neck.

Introduction If non-odontogenic abscesses and phlegmons (all purulent inflammations where the etiology is not a diseased tooth) of the neck are not promptly treated, they can lead to serious complications and even end in the death of the affected patient. Classical markers of inflammation such as plasma concentration of leukocytes (WBC), neutrophils (Neu), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) are elevated in inflammatory neck diseases, but none of them has been proven as a definite marker in the prediction of this type of pathology. This necessitates the search and analysis of new indicators that could be used in the diagnosis, follow-up, and prognosis of patients with purulent neck infections. Potentially, such a marker could be the delta neutrophil index (DNI), which is increasingly entering clinical practice as a prognostic indicator in critically ill patients with life-threatening illnesses, including sepsis and systemic inflammatory response syndrome (SIRS). In the world literature, there are no data that have been studied in patients with purulent diseases of the neck of non-odontogenic origin, which is the aim of this original article. Materials and methods This retrospective study included 40 men with an average age of 46 (18-87) years with non-odontogenic abscesses and phlegmons of the neck who were hospitalized and operated on. In all of them, the concentration of leukocytes, eosinophils (Eo), neutrophils, and mature polymorphonuclear neutrophil leukocytes (PMN) was examined on an automatic 5-Diff hematology analyzer, ADVIA 2120i (SiemensMedical Solutions USA, Malvern, PA). Thus, it was calculated according to the formula for calculating DNI (DNI% = (Neu%+Eo%) - PMN%). Retrospectively, 30 healthy men with an average age of 42 (18-81) years were used as a control group, in which the same indicators were examined during a preventive examination. Results and discussion Comparing the mean values of WBC, Neu, and DNI between the studied patients with non-odontogenic purulent neck infections (n=40) and the healthy male controls (n=30) it was found that all three indicators of inflammation are significantly higher in the ill men, and these differences are statistically significant (p<0.05): 10.19 ±2.68x103/L versus 7.37 ±1.93x103/L for leukocytes, 7.68 ±2, 76x103/L versus 4.13 ±1.48x103/L for neutrophils, and 1.11±0.83% versus -1.07±1.22% for DNI. Therefore, the high mean numbers of measured WBC and Neu in men with non-odontogenic purulent neck infections were associated with an increase in their mean calculated DNI. This gives us reason to think that while WBC and Neualone are not sufficient for definitive diagnosis, treatment follow-up, and prediction of disease outcome, in combination with DNI they become reliable indicators in purulent neck infections. Conclusions The DNI correlates well with other well-known and established indicators of inflammation, such as the concentration of leukocytes and neutrophils in the peripheral blood of patients. Its calculation is fast as an implementation procedure and is economically beneficial. Its independent use in the diagnosis and treatment of these diseases is about to be investigated and analyzed.

A-167 Repeatedly Positive Serum and Urine Beta-HCG Results in Non-Pregnant Patients—Application of Clinical Decision Support

Abstract Background In January of 2020, a 48-year-old woman, status post bilateral tubal ligation was postponed colonoscopy due to a positive urine and serum pregnancy point of care (POC) test. The quantitative serum HCG levels were normal at 4.9 mIU/mL (reference range 0–8 mIU/mL). Follow-up showed that over the prior year there were other 6 similar incidents when nonpregnant patients showed positive qualitative pregnancy results with quantitative HCG levels within “nonpregnancy” normal range being brought to the attention of the laboratory. Methods We assessed the possibility of a detection/measurement error including possible interfering antibodies. The likelihood of interfering substances/antibodies that would interact with 2 different types of POC detection systems (urine qualitative—Clinitest HCG Pregnancy test from Siemens Medical Solutions USA, serum qualitative—Pregnancy HCG Rapid Test from Cardinal Health) and serum quantitative—is very low, especially given that both serum and urine specimens were affected, and interfering antibodies are not normally excreted into urine. Testing of the diluted sample showed results like the neat specimen which further excludes interferences in the quantitative reaction as well as a possible hook effect. Based on this we concluded that the results were accurate.Chart review showed that 6 months prior, she had another quantitative HCG test performed using the same instrumentation obtaining a value of 6.6 mIU/mL. At this time a transvaginal ultrasound excluded the presence of any masses or abnormal findings. FSH (47.8 mIU/ml) and LH (49.8 mIU/ml) were found to be within the perimenopausal range. Qualitative serum and urine test were found to be repeatedly positive, while the quantitative tests were within nonpregnancy range, over several months. Retrospective chart review of the other 6 cases revealed similar pattern. Pregnancy, certain tumors (gestational trophoblastic neoplasia, ovarian germ cell tumor), kidney failure and menopause will manifest with increased HCG production. In (peri)menopausal women the pituitary produces HCG up to 14 mIU/mL in association with increased levels of FSH. The qualitative tests were repeatedly positive over several months while the quantitative results remained unchanged, excluding the diagnosis of pregnancy or tumors, and supporting the conclusion that these results are menopause related. Results To avoid similar future incidents we added the following comment to the POC test results: “If the result does not fit the clinical picture, please repeat testing on a new sample collected 48–72 h later or order serum HCG quantitative” We also added for the quantitative HCG result, the following comment: “Peri- and postmenopausal patients may have increased HCG of pituitary origin up to 14 mIU/mL. If the result does not fit the clinical picture, FSH measurement can be used for additional information.” During the 12 months preceding the implementation of the comments we had 6 incidents of positive qualitative HCG results in non-pregnant (peri)menopausal patients brought for investigation, and none during the 24 months after that. Conclusion The addition of the interpretative comment as clinical decision support increased the efficiency of the medical service, staff engagement and most importantly, patient satisfaction and safety.

What is your diagnosis? Urine from a dog.

What is your diagnosis? Urine from a dog.

The Androstenedione Roche Elecsys immunoassay has superior comparability to the LC-MS/MS assay than the Siemens Immulite immunoassay

Androstenedione (ASD) is a biomarker used in the diagnostic workup of hyperandrogenism, congenital adrenal hyperplasia, premature adrenarche, and polycystic ovary syndrome (PCOS). The Elecsys ASD competitive electrochemiluminescence immunoassay (Roche Diagnostics, Indianapolis, IN) is a new assay recently available in the US. ObjectiveThis study evaluated the analytical and clinical performance of the Elecsys ASD assay. Design & MethodsWe evaluated the linearity/analytical measuring range (AMR), precision, and accuracy of the Elecsys ASD assay on the cobas e601 analyzer. ASD was measured in serum/plasma in the Elecsys ASD, Immulite (Siemens Medical Solutions USA, Inc. Malvern, PA), and LC-MS/MS assays. Reference intervals (RI) were evaluated across genders, menopausal status, and in children. Statistical analysis was performed using EP evaluator and R program. ResultsThe Elecsys ASD assay had a linear response across the AMR. The intra- and inter-assay coefficients of variation at various concentrations were ≤4.5%. The Elecsys ASD assay had a mean difference of −0.04 ng/mL (−1.7%) with the LC-MS/MS assay, whereas the Immulite assay had a mean difference of 1.17 ng/mL (66%) and −1.22 ng/mL (−38%) compared to the LC-MS/MS and Elecsys ASD assays, respectively. The Roche recommended RIs for healthy men (0.280–1.52 ng/mL) and postmenopausal women (0.187–1.07 ng/mL) were successfully verified. The RIs for children were adopted from published data. For pre-menopausal women, a RI of <1.60 ng/mL was established. The ASD concentrations in women with and without PCOS overlapped. ConclusionsThe Elecsys ASD assay has superior comparability to the LC-MS/MS assay than the Immulite assay.

Can virtual touch tissue imaging quantification be a reliable method to detect anterior talofibular ligament type I injury at the acute, subacute, and chronic stages?

Anterior talofibular ligament (ATFL) injury affects ankle joint stability. To date, very few studies have examined tissue stiffness changes inside injured ligaments. Virtual touch tissue imaging quantification (VTIQ) allows for the non-invasive quantitative measurement of tissue stiffness. The present study aimed to examine the efficacy of VTIQ as a method for detecting ligament injury. A total of 206 patients diagnosed with unilateral ATFL type I injury (81 acute cases, 69 subacute cases, and 56 chronic cases) were reviewed retrospectively. Shear wave velocity (SWV) values were collected from both the injured and non-affected sides of the ATFL using a virtual touch tissue imaging quantification technique (ACUSON Oxana 2, Siemens Medical Solutions USA, Inc.). The average SWV of injured ATFL was 4.09±1.15 m/s in the acute group, 5.60±1.39 m/s in the subacute group, and 7.74±1.44 m/s in the chronic group (P<0.001). The SWV values of the ATFL on the non-affected side were almost identical (acute 7.50±1.12 m/s, subacute 7.53±1.06 m/s, and chronic 7.61±1.30 m/s; P>0.05). The injured ATFL had a significantly lower SWV value than the non-affected ATFL in the acute and subacute groups (P<0.001); however, there was no significant difference in the chronic group (P>0.05). Concerning the validity of SWV as a predictor of acute and subacute ATFL injury, the receiver operator characteristics curve analysis showed that the best cut-off point for SWV was 6.165 m/s, with 84.3% sensitivity, 88.5% specificity, and an area under the curve of 0.93 (95% CI, 0.90-0.95). VTIQ is a reliable sonographic method for detecting acute and subacute ATFL type I injury.

MP43-01 A PROSTATE BIOPSY RISK CALCULATOR BASED ON MAGNETIC RESONANCE IMAGING: DEVELOPMENT, VALIDATION, AND COMPARISON TO THE PBCG RISK CALCULATOR

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV (MP43)1 Sep 2021MP43-01 A PROSTATE BIOPSY RISK CALCULATOR BASED ON MAGNETIC RESONANCE IMAGING: DEVELOPMENT, VALIDATION, AND COMPARISON TO THE PBCG RISK CALCULATOR Hiten D. Patel, Elizabeth L. Koehne, Steven M. Shea, Andrew Fang, Marielia Gerena, Alex Gorbonos, Marcus L. Quek, Robert C. Flanigan, Ari Goldberg, Soroush Rais-Bahrami, and Gopal N. Gupta Hiten D. PatelHiten D. Patel More articles by this author , Elizabeth L. KoehneElizabeth L. Koehne More articles by this author , Steven M. SheaSteven M. Shea More articles by this author , Andrew FangAndrew Fang More articles by this author , Marielia GerenaMarielia Gerena More articles by this author , Alex GorbonosAlex Gorbonos More articles by this author , Marcus L. QuekMarcus L. Quek More articles by this author , Robert C. FlaniganRobert C. Flanigan More articles by this author , Ari GoldbergAri Goldberg More articles by this author , Soroush Rais-BahramiSoroush Rais-Bahrami More articles by this author , and Gopal N. GuptaGopal N. Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002064.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Implementation of multiparametric MRI (mpMRI) prior to prostate biopsy has improved detection of clinically significant prostate cancer (csPCa) through use of mpMRI–transrectal ultrasound fusion-guided biopsies, but imaging findings are not considered in traditional prediction tools. Therefore, we aimed to develop, validate, and compare a PCa risk calculator (RC) incorporating mpMRI findings to the Prostate Biopsy Collaborative Group (PBCG) RC. METHODS: Patients without a diagnosis of PCa receiving mpMRI prior to prostate biopsy in the Prospective Loyola University mpMRI (PLUM) Prostate Biopsy Cohort (2015-2020) were included for training and internal validation. Data from a separate institution served as external validation. Clinical variables included age, race, family history, digital rectal examination, prior negative biopsy, PSA, mpMRI prostate volume, and presence of any PI-RADS v2 mpMRI lesion. PSA density (PSAD) was based on mpMRI volume. A multinomial logistic regression model was constructed with outcomes of no cancer, clinically insignificant PCa (Gleason 3+3), and csPCa (Gleason ≥3+4). Receiver operating characteristics and calibration curves were evaluated. Decision curve analysis (DCA) was conducted. RESULTS: A total of 1,010 patients were separated into training (N=674) and validation (N=336) cohorts with a separate population for external validation (N=371). In the training cohort, 322 (47.8%) were diagnosed with PCa and 208 (30.9%) represented csPCa. The PLUM model included standard clinical variables with addition of log-transformed PSAD, mpMRI volume, and PI-RADS score. The multinomial PLUM RC outperformed the PBCG RC in the training (AUC: 0.859 vs. 0.660,p<0.001), internal validation (AUC: 0.882 vs. 0.678,p<0.001), and external validation (AUC: 0.839 vs. 0.694,p<0.001) samples for detection of csPCa. The PBCG RC was prone to overprediction while the PLUM RC was well calibrated. At a cost level of missing 7.5% of csPCa, the PLUM RC could have avoided 41.0% (566/1381) of biopsies compared to 19.1% (264/1381) for PBCG. On DCA at a threshold probability of 15%, PLUM was equivalent to a strategy of avoiding 13.8 biopsies per 100 without missing any csPCa compared to 2.7 biopsies per 100 for PBCG. CONCLUSIONS: Addition of mpMRI findings to standard clinical variables significantly improved the ability of the PLUM RC to detect PCa and csPCa compared to the PBCG RC. A large proportion of biopsies could be avoided using the PLUM RC in shared decision-making to inform the decision for prostate biopsy. Source of Funding: Efforts to support data extraction and maintenance of The Prospective Loyola University mpMRI Prostate Biopsy Cohort database is supported by funding from Siemens Medical Solutions USA, Inc. This work was funded in part by Junior Faculty Development Grant (ACS-IRG 001-53) and by Developmental funds from the UAB Comprehensive Cancer Center Support Grant (NCI P30 CA 013148) granted to Soroush Rais-Bahrami © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e781-e781 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiten D. Patel More articles by this author Elizabeth L. Koehne More articles by this author Steven M. Shea More articles by this author Andrew Fang More articles by this author Marielia Gerena More articles by this author Alex Gorbonos More articles by this author Marcus L. Quek More articles by this author Robert C. Flanigan More articles by this author Ari Goldberg More articles by this author Soroush Rais-Bahrami More articles by this author Gopal N. Gupta More articles by this author Expand All Advertisement Loading ...

MP05-18 VARIABILITY IN PROSTATE CANCER DETECTION AMONGST UROLOGISTS AND RADIOLOGISTS IN A HIGH VOLUME MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING FUSION BIOPSY CENTER

You have accessJournal of UrologyProstate Cancer: Detection & Screening I (MP05)1 Sep 2021MP05-18 VARIABILITY IN PROSTATE CANCER DETECTION AMONGST UROLOGISTS AND RADIOLOGISTS IN A HIGH VOLUME MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING FUSION BIOPSY CENTER Sarah E. Sweigert, Hiten D. Patel, Elizabeth L. Koehne, Steven M. Shea, Robert C. Flanigan, Marcus L. Quek, Alex Gorbonos, Ari Goldberg, and Gopal N. Gupta Sarah E. SweigertSarah E. Sweigert More articles by this author , Hiten D. PatelHiten D. Patel More articles by this author , Elizabeth L. KoehneElizabeth L. Koehne More articles by this author , Steven M. SheaSteven M. Shea More articles by this author , Robert C. FlaniganRobert C. Flanigan More articles by this author , Marcus L. QuekMarcus L. Quek More articles by this author , Alex GorbonosAlex Gorbonos More articles by this author , Ari GoldbergAri Goldberg More articles by this author , and Gopal N. GuptaGopal N. Gupta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001972.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As use of multiparametric magnetic resonance imaging (mpMRI) of the prostate increases, detection of prostate cancer (PCa) may be influenced by inter-user variability of individual radiologists and urologists. We aimed to evaluate the impact of radiologist and urologist variability on detection of PCa with mpMRI transrectal ultrasound (TRUS)-guided prostate biopsies for Prostate Imaging Reporting and Data System (PI-RADS) 3-5 lesions. METHODS: Men undergoing mpMRI TRUS-guided biopsies of PI-RADS 3-5 lesions (systematic and targets) from the Prospective Loyola University mpMRI-Biopsy Cohort (PLUM) were included. Data were stratified by individual radiologist and urologist to evaluate variation in PI-RADS grading, detection of PCa on any biopsy cores, and detection of PCa (Grade Group ≥2) on targeted biopsy cores. Multivariable logistic regression (MVR) models evaluated adjusted variation between radiologists and urologists. Area under the curve (AUC) comparisons assessed the relative impact of radiologists and urologists compared to a baseline predictive model. RESULTS: A total of 865 patients were included across 5 urologists and 10 radiologists. There was significant variability in number of PI-RADS lesions identified (8.3% to 48.4% reporting 3+ lesions, p<0.001), but no significant variability in grade of PI-RADS lesions (13.8% to 33.3% calling PI-RADS 5 lesions, p=0.39) by individual radiologist. PCa detection ranged from 34.5% to 66.7% by radiologist and 29.2% to 55.8% by urologist with similar trends by PI-RADS score and among targeted cores. Relative to the median on adjusted MVR, odds ratios ranged from 0.60 to 2.76 for radiologists and 0.51 to 1.22 for urologists. Addition of radiologist to the baseline predictive model increased AUC for the outcomes of any positive core (0.858 to 0.866, p=0.02), positive targeted core (0.873 to 0.880, p=0.02), and positive clinically significant targeted core (0.871 to 0.878, p=0.04) while addition of urologist was not significant. CONCLUSIONS: There is notable variability by radiologist and urologist in detection of any and clinically significant PCa using mpMRI TRUS-guided prostate biopsies. Radiologist variation contributed to greater impact on PCa detection. Source of Funding: The PLUM Prostate Biopsy Cohort database is supported by funding from Siemens Medical Solutions USA, Inc © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e85-e86 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah E. Sweigert More articles by this author Hiten D. Patel More articles by this author Elizabeth L. Koehne More articles by this author Steven M. Shea More articles by this author Robert C. Flanigan More articles by this author Marcus L. Quek More articles by this author Alex Gorbonos More articles by this author Ari Goldberg More articles by this author Gopal N. Gupta More articles by this author Expand All Advertisement Loading ...

Analysis of the correlations between the severity of lung involvement and olfactory psychophysical scores in coronavirus disease 2019 (COVID-19) patients.

Analysis of the correlations between the severity of lung involvement and olfactory psychophysical scores in coronavirus disease 2019 (COVID-19) patients.

Endovascular Coil Embolization of a Posterior Communicating Artery Aneurysm: 2-Dimensional Operative Video.

Since the International Subarachnoid Aneurysm Trial,1 endovascular treatment has been the favored treatment for appropriate ruptured intracranial aneurysms. While our endovascular technology has advanced to allow us to treat the majority of intracranial aneurysms, simple coil embolization is still the most common modality. This video demonstrates the fundamentals of aneurysm catheterization and coiling for safe treatment. In addition, the set-up and devices are detailed. This video is to add to the library of basic techniques that will aid a large number of practitioners. This patient consented to endovascular treatment. The video demonstrates endovascular coil embolization of a posterior communicating artery aneurysm in a 76-yr-old female who presented with a subarachnoid hemorrhage. Image of biplane suite in video used courtesy of Siemens Medical Solutions USA, Inc. Illustration at 5:12 reprinted from Yasargil MG, et al, Microneurosurgery IV B, p. 9, Thieme, New York, 1995.

Critical Obstetric Patients During the Coronavirus Disease 2019 Pandemic: Operationalizing an Obstetric Intensive Care Unit.

Critical Obstetric Patients During the Coronavirus Disease 2019 Pandemic: Operationalizing an Obstetric Intensive Care Unit.

A 2-Phase Merge Filter Approach to Computer-Aided Detection of Breast Tumors on 3-Dimensional Ultrasound Imaging.

The role of image analysis in 3-dimensional (3D) automated breast ultrasound (ABUS) images is increasingly important because of its widespread use as a screening tool in whole-breast examinations. However, reviewing a large number of images acquired from ABUS is time-consuming and sometimes error prone. The aim of this study, therefore, was to develop an efficient computer-aided detection (CADe) algorithm to assist the review process. The proposed CADe algorithm consisted of 4 major steps. First, initial tumor candidates were formed by extracting and merging hypoechoic square cells on 2-dimensional (2D) transverse images. Second, a feature-based classifier was then constructed using 2D features to filter out nontumor candidates. Third, the remaining 2D candidates were merged longitudinally into 3D masses. Finally, a 3D feature-based classifier was used to further filter out nontumor masses to obtain the final detected masses. The proposed method was validated with 176 passes of breast images acquired by an Acuson S2000 automated breast volume scanner (Siemens Medical Solutions USA, Inc., Malvern, PA), including 44 normal passes and 132 abnormal passes containing 162 proven lesions (79 benign and 83 malignant). The proposed CADe system could achieve overall sensitivity of 100% and 90% with 6.71 and 5.14 false-positives (FPs) per pass, respectively. Our results also showed that the average number of FPs per normal pass (7.16) was more than the number of FPs per abnormal pass (6.56) at 100% sensitivity. The proposed CADe system has a great potential for becoming a good companion tool with ABUS imaging by ensuring high sensitivity with a relatively small number of FPs.

Semiautomatically Quantified Tumor Volume Using 68Ga-PSMA-11 PET as a Biomarker for Survival in Patients with Advanced Prostate Cancer.

Prostate-specific membrane antigen (PSMA)-targeting PET imaging is becoming the reference standard for prostate cancer staging, especially in advanced disease. Yet, the implications of PSMA PET-derived whole-body tumor volume for overall survival are poorly elucidated to date. This might be because semiautomated quantification of whole-body tumor volume as a PSMA PET biomarker is an unmet clinical challenge. Therefore, in the present study we propose and evaluate a software that enables the semiautomated quantification of PSMA PET biomarkers such as whole-body tumor volume. Methods: The proposed quantification is implemented as a research prototype. PSMA-accumulating foci were automatically segmented by a percental threshold (50% of local SUVmax). Neural networks were trained to segment organs in PET/CT acquisitions (training CTs: 8,632, validation CTs: 53). Thereby, PSMA foci within organs of physiologic PSMA uptake were semiautomatically excluded from the analysis. Pretherapeutic PSMA PET/CTs of 40 consecutive patients treated with 177Lu-PSMA-617 were evaluated in this analysis. The whole-body tumor volume (PSMATV50), SUVmax, SUVmean, and other whole-body imaging biomarkers were calculated for each patient. Semiautomatically derived results were compared with manual readings in a subcohort (by 1 nuclear medicine physician). Additionally, an interobserver evaluation of the semiautomated approach was performed in a subcohort (by 2 nuclear medicine physicians). Results: Manually and semiautomatically derived PSMA metrics were highly correlated (PSMATV50: R2 = 1.000, P < 0.001; SUVmax: R2 = 0.988, P < 0.001). The interobserver agreement of the semiautomated workflow was also high (PSMATV50: R2 = 1.000, P < 0.001, interclass correlation coefficient = 1.000; SUVmax: R2 = 0.988, P < 0.001, interclass correlation coefficient = 0.997). PSMATV50 (ml) was a significant predictor of overall survival (hazard ratio: 1.004; 95% confidence interval: 1.001-1.006, P = 0.002) and remained so in a multivariate regression including other biomarkers (hazard ratio: 1.004; 95% confidence interval: 1.001-1.006 P = 0.004). Conclusion: PSMATV50 is a promising PSMA PET biomarker that is reproducible and easily quantified by the proposed semiautomated software. Moreover, PSMATV50 is a significant predictor of overall survival in patients with advanced prostate cancer who receive 177Lu-PSMA-617 therapy.

The results of standard echocardiography and use of Velocity Vector Imaging technology after surgical revascularization in patients with coronary artery disease

The aim of the study was to assess the impact of surgical revascularization on left ventricular function using standard echocardiographic study and Velocity Vector Imaging technology. Materials and methods. 40 patients with ischemic heart disease were examined before and 12 days, 6, 12 and 24 months after coronary artery bypass grafting (CABG). A standard echocardiographic (EchoCG) study was performed on ultrasound scanner Acuson Х 300 (Siemens, USA) with a 5–1 MHz sector multifrequency sensor. For objective assessment of myocardial function, the analysis of left ventricular (LV) deformation and rotational properties was performed using Syngo VVI (Siemens Medical Solutions USA Inc., США) in 720 LV segments. Results. Standard EchoCG showed a stable systolic, diastolic and contractile LV function during 2 years of follow-up. The study of global values of strain (S) and strain rate (SR) showed a decrease in longitudinal S 6 months after CABG in the right coronary artery (RCA) area in the group of patients with complaints compared to those who had no complaints (p = 0.004), in addition, in this zone there was a tendency to a difference in longitudinal SR between these two groups (p = 0.07). In anterior descending artery area was a tendency to decreased strain of longitudinal fibers (p = 0.06) during the same period of observation. 1 year after CABG, strain decreased in patients with complaints (p = 0.04) in the circumference artery area only in circular fibers. Positive dynamics were noted in the diastolic function of left ventricular fibers and rotation indices. Conclusion. The use of Velocity Vector Imaging after coronary bypass surgery shows a change in the function of myocardial fibers in the areas of coronary arteries, which is important in patients complaining of angina pain.

Ultrasound Elastography to Quantify Liver Disease Severity in Autosomal Recessive Polycystic Kidney Disease

To evaluate the diagnostic accuracy of ultrasound elastography with acoustic radiation force impulse (ARFI) to detect congenital hepatic fibrosis and portal hypertension in children with autosomal recessive polycystic kidney disease (ARPKD). Cross-sectional study of 25 children with ARPKD and 24 healthy controls. Ultrasound ARFI elastography (Acuson S3000, Siemens Medical Solutions USA, Inc, Malvern, Pennsylvania) was performed to measure shear wave speed (SWS) in the right and left liver lobes and the spleen. Liver and spleen SWS were compared in controls vs ARPKD, and ARPKD without vs with portal hypertension. Linear correlations between liver and spleen SWS, spleen length, and platelet counts were analyzed. Receiver operating characteristic analysis was used to evaluate diagnostic accuracy of ultrasound ARFI elastography. Participants with ARPKD had significantly higher median liver and spleen SWS than controls. At a proposed SWS cut-off value of 1.56m/s, the left liver lobe had the highest sensitivity (92%) and specificity (96%) for distinguishing participants with ARPKD from controls (receiver operating characteristic area 0.92; 95% CI 0.82-1.00). Participants with ARPKD with portal hypertension (splenomegaly and low platelet counts) had significantly higher median liver and spleen stiffness than those without portal hypertension. The left liver lobe also had the highest sensitivity and specificity for distinguishing subjects with ARPKD with portal hypertension. Ultrasound ARFI elastography of the liver and spleen, particularly of the left liver lobe, is a usefulnoninvasive biomarker to detect and quantify liver fibrosis and portal hypertension in children with ARPKD.

Surgical Splenectomy Alters Red Cell Rheology in Patients with Sickle Cell Disease

Background: Many patients with sickle cell disease (SCD) require a surgical splenectomy for repeat splenic sequestration or hypersplenism, resulting in worsening anemia and/or thrombocytopenia, or abdominal discomfort. Higher rates of thrombosis, pain crises and acute chest syndrome (ACS) have been reported following surgical splenectomy, although the reasons for this are not known. We hypothesize that this clinical worsening post-splenectomy is due to hemorheological changes; studies of the effects of surgical splenectomy on hemorheology in non-SCD animal models found significant reductions in red cell deformability and increase in whole blood viscosity, or blood thickness, following splenectomy. Understanding the impact of surgical splenectomy on blood rheology is especially relevant for patients with SCD, who have many clinical complications as a result of their high whole blood viscosity for their given hemoglobin levels, and low hematocrit-to-viscosity ratio (HVR), a measure of oxygen carrying capacity. Another important measure of SCD rheology is percent dense red blood cells (%DRBC), red cells with a density>1.11 mg/mL; they are typically the result of cellular dehydration, and are less deformable and more likely to sickle. We therefore sought to use our existing longitudinal rheology data, including measures of viscosity and %DRBC, to evaluate the impact of surgical splenectomy on our pediatric patients with SCD.Methods: We identified seven pediatric patients with multiple measurements of whole blood viscosity and %DRBC, collected before and after surgical splenectomy between November 2013 and April 2018 from SCD patients at Texas Children's Hospital on an IRB approved protocol. The cohort included 4 female and 3 male patients, ages 3-12 years old. Whole blood viscosity was measured using a cone and plate viscometer (DV3T Rheometer, AMETEK Brookfield, Middleboro, MA, USA) at 37 degrees Celsius within 4 hours of sample collection in an EDTA vacutainer tube. CBC data including %DRBC was measured on an ADVIA 120 Hematology System (Siemens Medical Solutions USA, Inc., Malvern, PA, USA). Samples collected 1 month before or after an emergency department visit or within 3 months of a packed red blood cell transfusion were omitted from analysis.Results: We found a significant rise in %DRBC following splenectomy (p=0.01). There was a significant increase in whole blood viscosity at 45 s-1 and 225 s-1 (p=0.006 and p=0.004, respectively) and a decline in hematocrit-to-viscosity ratio (HVR) at 45 s-1 and 225 s-1 (p=0.03 and p=0.03, respectively) (Table 1). Hemoglobin and hematocrit did not significantly change after splenectomy (p=0.6 and p=0.5, respectively), suggesting that the rise in viscosity was due to intrinsic changes in red cell rheology. Platelets increased markedly (p<0.00002), a side effect commonly seen following splenectomy, known to contribute to thrombophilia.Conclusion: Overall, the changes in %DRBC, viscosity, and HVR show a worsening of blood rheology following surgical splenectomy with no evidence of a return to baseline 800 days after splenectomy. The increase in viscosity and reduction in HVR in the setting of a rise in %DRBC suggests that the spleen may have played a role in removing these dense or irreversibly sickled cells. Further studies with a larger cohort and long term observation are needed to further elucidate the relationship between worsening rheology and SCD-related complications reported in the literature post-splenectomy. These rheological changes should be considered as part of the decision making for elective splenectomy, monitored post-splenectomy, and addressed therapeutically where possible. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Spontaneous Healing of Avascular Necrosis of the Femoral Head in Sickle Cell Disease

Background. Avascular necrosis (AVN) is a serious complication of sickle cell disease (SCD) that can lead to significant morbidity including chronic pain and physical impairment with treatment depending on the patient's pain severity and functional limitation. Patient age, hemoglobin levels, and abnormal rheology, particularly high blood viscosity, or thickness, and percentage of dense red blood cells, defined as cells >1.11 mg/mL have been identified as risk factors for the development of AVN, but their contributions to the subsequent clinical course has not been described.The natural history of AVN has been described as chronic and progressive without significant surgical or physical therapy based intervention. However, this description was established before widespread MRI use in diagnosis, or hydroxyurea (HU). A new evaluation of the natural history of AVN is needed.Objective: Review the natural history of AVN at our institution in patients for whom repeat imaging is available, and determine if patient demographics, treatment type, and laboratory data, including rheological values, predict of clinical course.Methods. We identified all patients with a diagnosis of AVN with diagnostic and follow-up imaging studies (pelvic X-rays or MRI of the hip), receiving care at Texas Children's Hospital Hematology Center 2006 to 2018, and collected demographic, treatment, rheological and clinical laboratory data. Patient radiographic images at diagnosis and follow up were reviewed and scored by a board certified pediatric radiologist using the Steinberg criteria. Laboratory values for each patient were collected as available from time of diagnosis through to the date of follow up imaging. Longitudinal patient blood samples were collected for rheological measurements under an IRB approved protocol. Whole blood viscosity was measured on a cone and plate viscometer (DV3T Rheometer, AMETEK Brookfield, Middleboro, MA, USA) at 45 and 225 s-1 at 37oC within 4 hours of sample collection in an EDTA vacutainer tube. Percent dense red blood cells (%DRBCs) were measured by an ADVIA 120 Hematology System (Siemens Medical Solutions USA, Inc., Malvern, PA, USA). Statistical analysis comparing groups with and without radiographic improvement was performed using a two-tailed Student's t-test.Results. 16 patients had repeat imaging, allowing for assessment of radiographic improvement (Table1). All were diagnosed via X ray or MRI of the pelvis. Five of 16 patients had resolution or significant radiographic improvement of AVN without orthopedic intervention or prolonged physical therapy, while 11 patients had stable or worsening disease. In the group with radiographic improvement, the mean age was 9.9 years (SD=2.5) and 14.6 years (SD=2.2) in the group without radiographic improvement (p= 0.002). Five patients underwent core decompression with bone marrow aspirate concentrate injection; one progressed to complete femoral head collapse while the rest had stable or worsening disease. Mean hemoglobin (Hb), fetal hemoglobin (HbF), percent DRBCs, whole blood viscosity, and extent of AVN at diagnosis by Steinberg criteria were not statistically different between the patients that showed improvement and those that did not.Conclusions. Our results challenge the paradigm of untreated AVN in SCD as an inexorably progressive disease. Here we present 5 cases of significant radiographic improvement of AVN without surgical or significant physical therapy interventions. Conversely, 5 AVN cases treated with core decompression remained stable or worsened. Given our small cohort, we were unable to establish laboratory or rheological predictors of spontaneous resolution. However, patients in the radiographic improvement group were younger than patients with progressive disease. HU has shown promise in improving vascular complications in SCD patients however more research is needed to delineate its role as a modifier of AVN natural history as it was not correlated with the improved group in our study (all our study patients were on HU either prior to diagnosis or started during the follow up period). Given the findings that significant radiographic improvement is possible with minimal or no intervention, providers should closely weigh the risks and benefits of observation versus surgical intervention, particularly in young patients with SCD. DisclosuresNo relevant conflicts of interest to declare.

Technical Note: Development of a phantom for dosimetric comparison of murine micro-CT protocols with optically stimulated luminescent dosimeters.

This work aims to evaluate the utility and accuracy of a mouse-like phantom and optically stimulated luminescent dosimeters (OSLDs) in measuring dose delivered to the body and lung of mice undergoing micro-CT imaging. A phantom with two cavities for NanoDot OSLDs (Landauer, Inc., Greenwood, IL) was designed and constructed using acrylic to model the mouse body and polyurethane foam to obtain an approximate lung tissue dose. The OSLD dose was compared to ion chamber measurements for the same imaging protocols delivered by a Siemens Inveon micro-CT (Siemens Medical Solutions USA, Inc., Hoffman Estates, IL, USA). A whole body scan, using 80 kV, 0.5 mA and 0.5 mm of aluminum filter, was used to compare results to previously published data. Additionally, dose was measured for the whole body scan without the aluminum filter and two chest protocols (full and half rotation). OSLD dose results agree with chamber measurements within 3%. Average OSLD measurements for the whole body scan without filter were 10.7 ± 0.7 cGy in the abdomen and 11.2 ± 0.7 cGy in the lung. For the full rotation chest protocol, the average dose measured in the lung was 65.8 ± 4.3 cGy and 60.2 ± 3.9 cGy in the abdomen. Average doses were 41.1 ± 2.7 cGy in the lung and 38.2 ± 2.5 cGy in the abdomen for the half rotation chest protocol. The OSLD measurements showed a coefficient of variation under 1.4%. A maximum rotational geometry under-response of 0.86% with respect to exposure at normal incidence to the OSLD was measured. The doses measured were found to be comparable to other studies for the scanner configuration and protocols chosen. The phantom built for this study was found to give reproducible dose measurements with 4% uncertainty. In this way, a robust and convenient method is established for future dose assessment of micro-CT protocols and interinstitutional comparisons.

An extended high-frequency ultrasound protocol for detection of vessel wall inflammation.

The aim of this study was to evaluate an extended protocol of the large vessels using high-frequency duplex ultrasound (DUS) for detection of vessel wall inflammation. Fifty-eight patients performed a DUS examination where arteritis could not be excluded. All DUS examinations were performed using ACUSON S2000 TM ultrasound system (Siemens Medical Solutions USA, Inc.). High-frequency linear transducers were used (18L6 MHz, 9L4MHz) or curve linear for the aortic arch (6C2MHz). Carotid, vertebral, central neck arteries (subclavian, axillary, innominate) arteries, aortic arch and femoral arteries were studied. Circumferential, homogenous wall thickening, with or without a hyperechogenic stripe lining the innermost layer, were regarded as typical signs of arteritis. Intima-media thickness (IMT) was measured in the patients and a normal control group. The latest clinical updated diagnosis was assessed at least 6months after DUS. The DUS findings showed normal vessels (n=14), arteritis and atherosclerosis (n=13), atherosclerosis (n=15) and arteritis (n=16). The latter group had a significant increased IMT in the common femoral artery and the common carotid artery (mean 1·0± SD 0·3mm versus 0·6±0·2mm in the normal group (n=37), P<0·00001, 1·2±0·5mm versus 0·8±0·2mm in the normal group (n=40), P<0·00001). In the groups with sonographic signs implying arteritis (n=29), 20 patients had a clinical diagnosis of arteritis, whereas eight patients had another main diagnosis such as malignancy/other inflammatory or infectious disease complicated by inflammation of the vessel wall. One patient had multiple diagnoses and was not possible to classify. An extended ultrasound protocol for central neck and leg arteries could be of value for diagnosis of arteritis. In case of atypical vessel wall inflammation, other main diagnoses should be considered.

Acoustic Radiation Force Impulse Imaging in Benign and Malignant Breast Lesions.

BackgroundElastography is a promising way to assess tissue differences regarding stiffness or elasticity, which has been historically assessed manually by palpation. Combined with conventional imaging modalities, shear wave elastography can potentially evaluate the stiffness of a breast lesion and consequently help detect malignant breast tumor from benign ones. The aim of this study was to evaluate the diagnostic role of shear wave elastography in breast lesions in the Indian population.Material and methodsFifty patients presenting with breast lesions were included in the study. All the patients were subjected to B-mode ultrasound and elastography using shear wave with Virtual Touch Imaging (VTITM) (Siemens Medical Solutions USA, Inc., PA, USA) and Virtual Touch Quantification (VTQTM) (Siemens Medical Solutions USA, Inc., PA, USA) and the obtained data was analyzed using an appropriate statistical test (independent samples t-test).ResultsIn our study group of 50 patients, 34 were benign and 16 were malignant. VTITM showed a sensitivity of 97% and a specificity of 93% with a positive predictive value (PPV) of 97% for benign lesions. VTITM showed a sensitivity of 87.5 % and a specificity of 100% with a PPV of 100% for malignant lesions. VTQTM showed a sensitivity of 71.4% and a specificity of 100% with a PPV of 100% for benign lesions. VTQTM showed a sensitivity of 100% and a specificity of 100% with a PPV of 76.6% for malignant lesions.ConclusionsVTITM was more reliable as a diagnostic tool compared to VTQTM in benign lesions and both are equally reliable in identifying malignant lesions. Acoustic radiation force impulse (ARFI) plays a significant role as an adjuvant diagnostic tool to B-mode imaging for assessing breast lesions.

Evaluation of the Usefulness of Quantitative Shear Wave Elastography for Differentiating Benign and Malignant Salivary Gland Tumors

Elastography is a technique for assessing hardness and includes both qualitative and quantitative approaches. The utility of quantitative shear wave elastography (SWE) for the differential diagnosis of salivary gland tumors is unclear. Hence, we investigated this by comparing the results of Virtual Touch Quantification (VTQ), a form of quantitative SWE, of different salivary gland tumors. Patients with salivary gland tumors who underwent ultrasonography in our department between July 2014 and April 2017 and had a cytological or histological diagnosis were included. The ultrasonic diagnosis device used was the ACUSON S2000 (Siemens Medical Solutions USA, Inc. Malvern, PA, USA). A solid part of the tumor was selected for measurement with VTQ. For VTQ, the shear wave speed was calculated within a 5-mm square ROI; instances where calculation was impossible are indicated with x.xx. Thus, the feasibility of VTQ measurement and the measured value (m/s) of each tumor were compared. Seventy-one cases were benign tumors (45 Warthin's tumors and 26 pleomorphic adenomas) and 15 cases were malignant tumors. The VTQ measurability ratio and measured value medians were 70.4% and 2.44, respectively, for the benign tumors (82.2% and 2.35 for Warthin's tumor, 50% and 2.76 for pleomorphic adenoma) and 13.3% and 1.58, respectively, for the malignant tumors. VTQ successfully measured most cases of Warthin's tumors, but failed to measure malignant tumors and pleomorphic adenomas. Because of this low rate, the utility of the measured values could not be determined. However, when a measurement was possible, this had the potential to aid in the prediction of benign tumors, especially Warthin's tumor, which can be followed-up with observation.