CT Studies Research Articles

Machine Learning Radiomics Signature for Differentiating Lymphoma versus Benign Splenomegaly on CT.

We aimed to develop and validate a preoperative CT-based radiomics signature for differentiating lymphoma versus benign splenomegaly. We retrospectively analyzed CT studies from 139 patients (age range 26-93 years, 43% female) between 2011 and 2019 with histopathological diagnosis of the spleen (19 lymphoma, 120 benign) and divided them into developing (n = 79) and testing (n = 60) datasets. The volumetric radiomic features were extracted from manual segmentation of the whole spleen on venous-phase CT imaging using PyRadiomics package. LASSO regression was applied for feature selection and development of the radiomic signature, which was interrogated with the complete blood cell count and differential count. All p values < 0.05 were considered to be significant. Seven features were selected for constructing the radiomic signature after feature selection, including first-order statistics (10th percentile and Robust Mean Absolute Deviation), shape-based (Surface Area), and texture features (Correlation, MCC, Small Area Low Gray-level Emphasis and Low Gray-level Zone Emphasis). The radiomic signature achieved an excellent diagnostic accuracy of 97%, sensitivity of 89%, and specificity of 98%, distinguishing lymphoma versus benign splenomegaly in the testing dataset. The radiomic signature significantly correlated with the platelet and segmented neutrophil percentage. CT-based radiomics signature can be useful in distinguishing lymphoma versus benign splenomegaly and can reflect the changes in underlying blood profiles.

The iliac kickstand screw: anatomic CT analysis of screw trajectory and osseous corridor for screw placement

IntroductionThe ‘kickstand screw-rod’ technique has been recently described for correction of coronal malalignment. This technique utilizes powerful ‘construct-to-ilium’ distraction between a fixed multi-screw thoracic construct and the ilium, facilitated by a novel ‘iliac kickstand screw’. The ‘iliac kickstand screw’ traverses a previously undescribed osseous corridor in the ilium.ObjectiveUsing a radiographic CT study, the objective is to describe a large osseous corridor within the ilium to accommodate the novel iliac kickstand screw.Methods50 consecutive patients with pelvic CTs at an academic medical center were queried. Simulated iliac kickstand screw trajectories for the left and right hemipelvis were analyzed with 3D visualization software. Maximal screw lengths and dimensions, and trajectories in the osseous corridor were measured.Results50 patients’ (31 female, 19 male) pelvic CTs were measured with a total of 100 simulated screws. The mean age was 52.4 years and BMI 28.1 ± 7.9. The average length is 119.7 ± 6.6 mm (range 98.7 − 135.3). The narrowest width (maximum potential screw diameter) is 17.8 ± 2.9 mm (coronal) and 20.8 ± 5.3 mm (sagittal). The starting point to the top of the iliac crest is 66.4 mm lateral to midline, and 15.9° caudal in the sagittal and 6.1° lateral in the coronal planes.ConclusionsThe novel iliac kickstand screw traverses a consistent and large osseous corridor within the ilium. The average simulated screw length is 119.7 mm and maximum potential diameter of 17.8 mm. Starting points relative to the iliac crest are identified.

Incidence and Impact of Preoperative Hiatal Hernia in Patients with Esophageal Carcinoma Undergoing Curative Surgical Resection.

Hiatal hernia (HH) and gastroesophageal reflux disease (GERD) are risk factors for esophageal adenocarcinoma. High positive margin rates and poor survival were described among HH patients undergoing esophagectomy. We sought to describe incidence and impact of HH on outcomes following esophagectomy. Patients who underwent esophagectomy 2012-2019 for esophago-junctional carcinoma were included. CT studies were blindly reviewed by two radiologists. A third radiologist reviewed cases of disagreement. Hernias ≥ 3 cm were included in the HH group. Overall, 66 patients (33%) had HH ≥ 3 cm. The no hernia group included 12 patients (6%) with < 3 cm HH and 106 (53%) without HH. Preoperative variables were comparable among groups. Location of anastomosis was similar among cohorts and predominantly cervical (n = 97, 82.2% vs 61, 92.4%, p = 0.113). Postoperatively, HH patients had higher incidence of atrial dysrhythmia (n = 11, 16.7% vs n = 6, 5.1% p = 0.015). Rates of R0 resections were similar (n = 62, 93.9%, vs n = 113, 95.8%, p = 0.724). HH patients had higher rates of signet ring cell histology (n = 14, 21.2% vs n = 9, 7.6% p = 0.025); this was confirmed on subgroup analysis including only adenocarcinoma patients (n = 14, 28.6% vs n = 8, 12.3%, p = 0.042). On Cox regression analysis, HH was not associated with disease-free or overall survival (HR 1.308, p = 0.274 and HR .905, p = 0.722). Patients with preoperative HH had higher rates of postoperative atrial dysrhythmias and signet ring cell features on pathology. In a population with predominant cervical anastomosis, positive margin rates were low and survival comparable among cohorts.

МРТ ВИЗУАЛИЗАЦИЯ ОСЛОЖНЕНИЙ СРЕДНЕЙ ЗОНЫ ЛИЦА У ПАЦИЕНТОВ, ПЕРЕНЕСШИХ COVID-19

Abstract. Introduction. Rhino-orbito-cerebral mucormycosis is an angio-invasive infection caused by filamentous fungi of the Mucoraceae family. Numerous factors were proposed determining mucormycosis against the COVID-19 background. Predisposing factors include uncontrolled diabetes, hematological malignancies, transplantation of solid organs and stem cells, corticosteroids, and weakened immunity. Aim of the study was to investigate the tomographic signs of rhino-cerebral mucormycosis. Materials and Methods. A retrospective study of CT and/or MRI images of 120 patients was conducted, who have been diagnosed with COVID-19 associated with mucormycosis, based on histopathology and/or seeding. Results and Discussion. Imaging findings of rhino-orbito-cerebral mucormycosis associated with COVID-19 using an adapted simplified (three-stage) staging system that can be easily applied to everyday practice and helps standardize and improve communication between radiologists and clinicians. The severity of the disease varies from isolated lesions of the paranasal sinuses to extensive brain damage. Clinical outcomes in patients with COVID-19 with rhino-orbito-cerebral mucormycosis gradually increase depending on the severity of imaging. Conclusions. Early diagnosis of mucormycosis is crucial because visualization is essential at staging the disease and assessing the involvement of deeper structures that may be clinically unmanifest. Although both CT and MRI are useful, contrast-enhanced MRI is the method of choice and helps determine the extent of the disease, especially with respect to the deep spread in the maxillofacial region and brain.

Total Hip Arthroplasty for Low-Grade Developmental Hip Dysplasia Changes the Ipsilateral Knee Alignment on the Axial and Coronal Planes

Background: There is a paucity of data regarding the post-operative influence of total hip arthroplasty (THA) on the axial and coronal alignments of the ipsilateral knee. A CT study was designed to assess the post-THA changes in axial and coronal knee alignments in low-grade dysplastic hips. Methods: Forty Crowe I–II dysplastic hips in 37 patients were assessed: a pre-operative CT scan from the fourth lumbar vertebra to the tibial plateaus was compared to a similar post-operative CT scan performed after a minimum of 2 years after THA. Results: THA implantation caused significant post-operative changes in terms of the rotation height (2 mm lowering; p = 0.003); center of rotation medialization (10 mm medialization; p &lt; 0.001); femoral offset (11 mm increase; p &lt; 0.001); femoral antetorsion (22° internal rotation; p &lt; 0.001), and hip internal rotation (9° internal rotation; p &lt; 0.001). The femoral axis angle deviated in the valgus (5.5° ± 1.1°, p &lt; 0.001) and the mechanical lateral distal femoral angle deviated in the varus (86° ± 2.7°, p = 0.001). The pelvic–tibial alignment changed from 88.2° ± 11.7° to 96° ± 9.3° (p &lt; 0.001). Patellar alignment was not influenced. Conclusions: In conclusion, THA imposes significant changes in low-grade dysplastic hips: all the modifications tend to neutralize the coronal alignment and, mostly, the rotational alignment, without substantial and durable variations of the patellofemoral joint. Large clinical trials should confirm whether radiological changes impact anterior knee pain and patellar stability.

ClotCatcher: a novel natural language model to accurately adjudicate venous thromboembolism from radiology reports

IntroductionAccurate identification of venous thromboembolism (VTE) is critical to develop replicable epidemiological studies and rigorous predictions models. Traditionally, VTE studies have relied on international classification of diseases (ICD) codes which are inaccurate – leading to misclassification bias. Here, we developed ClotCatcher, a novel deep learning model that uses natural language processing to detect VTE from radiology reports.MethodsRadiology reports to detect VTE were obtained from patients admitted to Emory University Hospital (EUH) and Grady Memorial Hospital (GMH). Data augmentation was performed using the Google PEGASUS paraphraser. This data was then used to fine-tune ClotCatcher, a novel deep learning model. ClotCatcher was validated on both the EUH dataset alone and GMH dataset alone.ResultsThe dataset contained 1358 studies from EUH and 915 studies from GMH (n = 2273). The dataset contained 1506 ultrasound studies with 528 (35.1%) studies positive for VTE, and 767 CT studies with 91 (11.9%) positive for VTE. When validated on the EUH dataset, ClotCatcher performed best (AUC = 0.980) when trained on both EUH and GMH dataset without paraphrasing. When validated on the GMH dataset, ClotCatcher performed best (AUC = 0.995) when trained on both EUH and GMH dataset with paraphrasing.ConclusionClotCatcher, a novel deep learning model with data augmentation rapidly and accurately adjudicated the presence of VTE from radiology reports. Applying ClotCatcher to large databases would allow for rapid and accurate adjudication of incident VTE. This would reduce misclassification bias and form the foundation for future studies to estimate individual risk for patient to develop incident VTE.

Imaging of alert patients after non-self-inflicted strangulation: MRI is superior to CT

ObjectiveTo assess the accuracy of CT and MRI reports of alert patients presenting after non-self-inflicted strangulation (NSIS) and evaluate the appropriateness of these imaging modalities in NSIS.Material and methodsThe study was a retrospective analysis of patient characteristics and strangulation details, with a comparison of original radiology reports (ORR) to expert read-outs (EXR) of CT and MRI studies of all NSIS cases seen from 2008 to 2020 at a single centre.ResultsThe study included 116 patients (71% women, p < .001, χ2), with an average age of 33.8 years, mostly presenting after manual strangulation (97%). Most had experienced intimate partner violence (74% of women, p < .001, χ2) or assault by unknown offender (88% of men, p < 0.002 χ2). Overall, 132 imaging studies (67 CT, 51% and 65 MRI, 49%) were reviewed. Potentially dangerous injuries were present in 7%, minor injuries in 22%, and no injuries in 71% of patients. Sensitivity and specificity of ORR were 78% and 97% for MRI and 30% and 98% for CT. Discrepancies between ORR and EXR occurred in 18% of all patients, or 62% of injured patients, with a substantial number of unreported injuries on CT.ConclusionsThe results indicate that MRI is more appropriate than CT for alert patients presenting after non-self-inflicted strangulation and underline the need for radiologists with specialist knowledge to report these cases in order to add value to both patient care and potential future medico-legal investigations.Clinical relevance statementMRI should be preferred over CT for the investigation of strangulation related injuries in alert patients because MRI has a higher accuracy than CT and does not expose this usually young patient population to ionizing radiation.Key Points• Patients presenting after strangulation are often young women with a history of intimate partner violence while men typically present after assault by an unknown offender.• Expert read-outs of CT and MRI revealed potentially dangerous injuries in one of 14 patients.• MRI has a significantly higher sensitivity than CT and appears to be more appropriate for the diagnostic workup of alert patients after strangulation.

Imaging findings and treatment in coccydynia - update of the recent study findings.

Coccydynia is one of the most overlooked symptoms in clinical practice. The diagnosis and radiologic findings of traumatic coccyx can be more easily detected unless it is delayed and postponed. For idiopathic coccydynia, which accounts for one third of cases, patients present with long-standing pain and multiple physician visits. The keywords coccyx, coccydynia, coccygodynia were searched in PubMed, Embase, Scopus databases in the last 5 years. Research articles, reviews and case reports were analyzed. The studies conducted in the last 5 years were presented under the headings of etiology, radiologic assessment, interventional and surgical treatments. The first step is dynamic X-ray of the coccyx in standing and sitting position. In this way, morphologic parameters and hypermobility causing idiopathic coccydynia can be evaluated. Morphologic and morphometric features of the coccyx described in previous CT and MR studies have explained the relationship with coccydynia. The key features are as follows: Type II coccyx morphology, subluxation of the intercoccygeal joint, presence of bony spicules. Knowledge of these definitions as well as the differential diagnosis in this anatomical region will help in reaching the correct diagnosis. The treatment of coccydynia is stepwise like the diagnosis. Conservative treatments are initiated first. Manipulations, ganglion impar block, injections, radiofrequency and shock treatments and finally coccygectomy are treatment methods reported. Radiologists should not overlook this region and should be familiar with the coccyx's morphologic appearance and the sacrococcygeal region's differential diagnosis. · The etiology of coccydynia usually includes trauma, obesity and female sex, special coccyx morphology, and coccygeal hypermobility.. · Coccyx fractures are defined into three groups as flexion type 1, compression type 2, and extension type 3.. · When evaluating coccydynia, the first step is a dynamic X-ray examination of the coccyx in standing and sitting position.. · Hypermobility is defined as more than 25 % posterior subluxation while sitting or more than 25° flexion while sitting.. · More than 35° posterior subluxation is considered significant hypermobility.. · Sukun A, Cankurtaran T, Agildere M et al. Imaging findings and treatment in coccydynia - update of the recent study findings. Fortschr Röntgenstr 2024; 196: 560 - 572.

Esophageal Radiography Interpretation: a Primer for the Gastroenterologist.

Radiological studies can be helpful when evaluating patients with suspect esophageal disorders. From benign strictures to malignancy and motility disorders such as achalasia, imaging modalities play a significant role in diagnosis. This review explores the role of different imaging modalities in the most frequently encountered esophageal pathologies. Conventional barium esophagram has long been considered the primary imaging modality of the esophagus. In the same fashion, a timed barium esophagram is a valuable tool in the evaluation of achalasia and esophagogastric junction outlet obstruction. Over the last few decades there has been an increase in CT and MRI studies, which also play a role in the evaluation of esophageal pathologies. However, not infrequently, these newer imaging techniques can result in incidental esophageal findings. It is important that gastroenterologists appreciate the value of different modalities and recognize key imaging features. The diagnosis and management of esophageal disorders is evolving. A basic understanding of esophageal radiology is essential to any gastroenterologist caring for patients with esophageal complaints.

Abstract 18815: Spectral CT Study to Evaluate Left Atrial Remodeling Using Anatomic and Electron Density Numbers in Patients Scheduled to Undergo Pulmonary Vein Isolation

Introduction: Left atrial (LA) wall remodeling, such as fibrosis and inflammation, may occur in patients with atrial fibrillation (AF) to cause a low voltage AF wave and thickened LA wall. To date, an invasive biopsy has been used to evaluate LA wall remodeling. Hypothesis: Using novel spectral CT with an effective atomic number (EAN) and electron density number (EDN), which are new parameters in addition to CT attenuation, LA anterior wall characteristics can be evaluated. Methods: A total of 13 patients (eight males, mean age 69 years) scheduled for pulmonary vein isolation (PVI) underwent cardiac spectral CT (7500, Philips, Tokyo, Japan). This revealed AF in four patients and a sinus rhythm in nine. From non-contrast, and early and late phase contrast data, EAN and EDN (%EDV) of the LA anterior wall were determined. Results: Mean EANs for the LA anterior wall were 7.35 in patients with AF, and 7.38 in patients with a sinus rhythm, respectively (P=NS), during the non-contrast phase; 8.18 and 8.17, respectively (P=NS), during the early phase; and 8.59 and 8.51, respectively (P=NS) during the late phase. Mean EDNs (%EDW) were 102.7 in patients with AF, and 103,1 in patients with a sinus rhythm, respectively (P=NS) during the non-contrast phase; 102,6 and 103.4, respectively (P=NS) during the early phase; and 103.7 and 103.5, respectively (P=NS) during the late phase. In patients with AF, both LA anterior thickness on CT and LA volume determined by transthoracic echocardiogram had a significant negative correlation with the voltage of AF waves (V2 lead) (R= -0.87 and -0.46, respectively). The EDN, but not EAN, in non-contrast, and early and late phases after contrast material showed a significant negative correlation with the voltage of AF waves (R= -0.74, -0.75, respectively). Conclusions: This is the first study in which characteristics of the LA anterior wall were evaluated by EAN and EDN on spectral CT. As well as LA anterior wall thickening and an enlarged LA volume, the EDN was an indicator of characteristic changes of the LA anterior wall that related to the low voltage of AF waves. This new parameter determined by spectral CT may evaluate characteristics of the LA anterior wall and be a predictor of future occurrence of LA remodeling that is related to the effectiveness of PVI.

Combined Ibrutinib and Venetoclax for First-Line Treatment of Patients with Chronic Lymphocytic Leukemia (CLL): 5-Year Follow-up Data

Background: Ibrutinib (IBR) and venetoclax (VEN) combination is an effective therapy for patients (pts) with CLL. We previously reported results of the first-line cohort of a phase II trial of combined IBR and VEN for high-risk pts with CLL (Jain, NEJM 2019, JAMA Oncology 2021). Here we report updated data for 120 pts (80 pts in the original published cohort and 40 pts in an expansion cohort) with a median follow-up of 61.5 months. Methods: Pts with previously untreated CLL meeting IWCLL treatment criteria were enrolled. All pts had at least one high-risk feature: del(17p), mutated TP53, del(11q), unmutated IGHV, or age ≥65 years. Pts received IBR 420 mg daily for 3 cycles followed by addition of VEN (weekly dose-escalation to 400mg daily). Combined therapy was given for 24 cycles (28 days/cycle). Pts with bone marrow (BM) undetectable MRD (U-MRD) (flow cytometry; sensitivity 10 -4) at 24 cycles of combined therapy discontinued both VEN and IBR; MRD+ pts continued IBR. A trial amendment allowed an additional 12 cycles of combined VEN and IBR for pts who remained BM MRD+ after Cycle 24. Response assessments included BM and CT studies (2008 IWCLL criteria). U-MRD was defined as &amp;lt;0.01%; low MRD+ 0.01% to &amp;lt;1%; high MRD+ ≥1%. Progression-free survival (PFS) was assessed as the time from the start of study drug to CLL progression, Richter transformation, or death from any cause. Blood MRD was monitored every 6 months after active therapy. Results: Between August 2016 and February 2019, a total of 120 pts were enrolled. Median age was 64.5 years (range, 26-88 years). 86% had IGHV-unmutated CLL. 23% had del(17p)/ TP53 mutation. The median follow-up is 61.5 months. Six pts came off study during 1 st 3 cycles of IBR monotherapy; 114 pts initiated VEN. After 12 cycles of the combination, 62/120 (52%) achieved BM U-MRD remission; 43/120 (36%) were BM MRD-positive (low MRD+, n=35; high MRD+, n=8). After 24 cycles of the combination, 77/120 (64%) achieved BM U-MRD remission; 24/120 (20%) were BM MRD+ (low MRD+, n=23; high MRD+, n=1). Overall, 86/120 (72%) achieved BM U-MRD as the best response. One pt had DLBCL transformation and 1 pt had CLL progression during the first 2 year of therapy (details below). The 5-year PFS is 90.1% and 5-year OS is 95.6% (Figure 1). The 5-year PFS for pts with del(17p)/ TP53 mutation (n=27) is 86.1%. Of the 77 pts who were BM U-MRD at the end of cycle 24 of the combination, 73 discontinued all therapy, 4 pts continued IBR per treating physician discretion. Among these 77 pts, with a median follow-up of 40 months post Cycle 24, 22 pts had recurrence of blood MRD (defined as MRD ≥0.01% in 2 consecutive visits). Of the 22 pts with MRD recurrence, 5 pt had CLL progression at a median of 18 months (range, 6-30 months) from MRD recurrence (details below); 16 are being monitored without any active therapy for CLL and without clinical disease progression; 1 pt died from mesothelioma. Among the 55 pts who remain in blood U-MRD remission, 53 remain in long-term follow-up in U-MRD remission; 1 pt had B-PLL transformation and 1 patient died (found unresponsive at home; was off therapy for 2 years). There were 24 pts who were BM MRD+ at the end of cycle 24 of the combination (low MRD+, n=23; high MRD+, n=1). The only pt with high-MRD+ at end of cycle 24 was noted to have Richter transformation at that time. The remaining 23 pts (all low MRD+ in BM, range 0.01-0.95%) continued IBR monotherapy. With a trial amendment, MRD+ pts after Cycle 24 could get 12 additional cycles of VEN; 18/23 pts have resumed VEN. 11/18 (61%) pts achieved U-MRD remission during the third year of combined therapy. Only 2/23 pts are still receiving IBR (remaining pts have d/c IBR; all pts have d/c venetoclax); none of these 23 pts had clinical relapse. A total of 6 pts had CLL progression (1 during the first 2 yr of therapy; remaining 5 during off-therapy phase). 3/6 had evaluation of BTK, PLGG2 and BCL2 mutations at the time of relapse and none were detected. 5 pts have started subsequent therapy (acalabrutinib, n=4; ibrutinib, n=1; all are clinically responding); 1 pt has not yet started therapy. Conclusions: We report long term follow-up of combined IBR and VEN in first-line CLL (n=120) with a 5-year PFS of 90.1%. The 5-year PFS for pts with del(17p)/ TP53 mutation is 86.1%. Retreatment with BTK inhibitor appears effective for pts with disease relapse.

Reducing radiation dose for NN-based COVID-19 detection in helical chest CT using real-time monitored reconstruction.

Computed tomography is a powerful tool for medical examination, which plays a particularly important role in the investigation of acute diseases, such as COVID-19. A growing concern in relation to CT scans is the radiation to which the patients are exposed, and a lot of research is dedicated to methods and approaches to how to reduce the radiation dose in X-ray CT studies. In this paper, we propose a novel scanning protocol based on real-time monitored reconstruction for a helical chest CT using a pre-trained neural network model for COVID-19 detection as an expert. In a simulated study, for the first time, we proposed using per-slice stopping rules based on the COVID-19 detection neural network output to reduce the frequency of projection acquisition for portions of the scanning process. The proposed method allows reducing the total number of X-ray projections necessary for COVID-19 detection, and thus reducing the radiation dose, without a significant decrease in the prediction accuracy. The proposed protocol was evaluated on 163 patients from the COVID-CTset dataset, providing a mean dose reduction of 15.1% while the mean decrease in prediction accuracy amounted to only 1.9% achieving a Pareto improvement over a fixed protocol.

Anatomical cardiac and electrocardiographic axes correlate in both upright and supine positions: an upright/supine CT study

The correlation between the anatomical cardiac and electrocardiographic axes has been discussed for several years. Using upright computed tomography, this study aimed to reveal the relationship between the anatomical cardiac and electrocardiographic axes in both the supine and upright positions. Upright CT and standard supine CT were performed for healthy volunteers, following electrocardiography in both upright and supine position. On CT images, the coordinates of apex, the center of aortic valve (AV) and mitral valve (MV) were recorded, and the vectors and angles were calculated. Subcutaneous and visceral fat volume were semi-automatically calculated in a workstation. From a total 190 volunteers, 41 males were performed electrocardiography and included for this study. The QRS and anatomical axes (AV-apex and MV-apex axis) were significantly correlated in both supine and upright positions, while the angle of the AV-apex to Z axis was the most correlated (supine: r = − 0.54, p = 0.0002, upright: r = − 0.47, p = 0.0020). The anatomical axis moved in the dorsal and caudal directions from the supine to upright position. Multiple regression analysis revealed that the anatomical axis from the AV-apex to the Z-axis was determined according to age, body height, subcutaneous and visceral fat volumes.

Osteoplasty of vertebral bone defects caused by pedicle screw loosening using orthobiological approaches: a pilot study of case series

Objective. To analyze the effectiveness and safety of using an orthobiological product in osteoplasty of bone defects of the vertebrae with simultaneous reosteosynthesis.Material and Methods. The results of screw augmentation technology using thrombogel-enriched allogeneic bone were studied in a retrospective, single-center, non-randomized study, which included 17 patients (10 women, 7 men) with instability of the hardware in the form of screw loosening and osteolysis around screws. Results within 12 months were followed up in 17 patients (100 %). We compared preoperative and postoperative instrumental data, clinical parameters in dynamics.Results. The mean age of the patients was 59 (43–75) years. The distribution of patients, according to the primary pathology, was as follows: 11 patients (64.7 %) had a degenerative-dystrophic pathology of the spine, 4 patients (23.5 %) had a traumatic injury, and 2 patients had a kyphotic deformity on the background of Bechterew’s disease (11.8 %). The mean time from primary to revision surgery was 7.06 months (3.1–12.1), mean CRP was 4.48 (0.5–15.0). When observing patients for 12 months, all patients showed a positive trend in the form of a statistically significant regression of back pain according to VAS from 7.0 (6.0; 7.3) to 1.0 (0.0; 1.0) points (χ2 = 47.9, df 3, р &lt; 0.0001). A positive trend was also noted in the form of a decrease in ODI indicators and an improvement in the quality of life of patients from 63.8 (57.1; 69.1) to 3.0 (2.0; 7.5) at 12 months. When comparing the parameters (VAS and ODI), the obtained differences before/after the operation were statistically significant, while these changes have a pronounced correlation. Postoperative CT studies (3, 6, 12 months) showed no instability of the screws.Conclusion. Osteoplasty of vertebral bone defects and screw augmentation using orthobiological approaches have demonstrated their primary efficacy and safety. Further studies with a large sample size are needed to confirm the obtained results.

Cavitary pulmonary lesion wall thickness, presence of additional nodules, and intralesional contrast enhancement are associated with malignancy in dogs and cats.

To investigate the CT features of cavitary pulmonary lesions and determine their utility to differentiate malignant from benign lesions. This retrospective study included cases from 5 veterinary medical centers between January 1 2010, and December 31, 2020. Inclusion criteria included having a gas-filled cavitary pulmonary lesion on thoracic CT and definitive diagnosis by either cytology or histopathology. Forty-two animals (27 dogs and 15 cats) were included in this study. Medical records systems/imaging databases were searched, and cases meeting inclusion criteria were selected. The CT studies were interpreted by a third-year radiology resident, and findings were reviewed by a board-certified veterinary radiologist. 7 of the 13 lesion characteristics investigated were not statistically associated with the final diagnosis of the lesion, whereas 6 were statistically associated. Those that were associated included the presence of intralesional contrast enhancement, type of intralesional contrast enhancement (heterogenous and homogenous analyzed separately), presence of additional nodules, wall thickness of the lesion at its thickest point, and wall thickness at the thinnest point. Results from the present study showed that thoracic CT imaging of cavitary pulmonary lesions can be used to further refine the list of differential diagnoses. Based on this data set, in lesions that have heterogenous contrast enhancement, additional pulmonary nodules, and wall thickness > 40 mm at their thickest point, it would be reasonable to consider malignant neoplastic disease higher on the list of differentials than other causes.

Do Arch Supports Alter Foot Alignment in Patients with Metatarsalgia? A Weightbearing CT and x-ray Study

Category: Midfoot/Forefoot; Lesser Toes Introduction/Purpose: Arch-support insoles are frequently included in the treatment plans for common foot ailments including metatarsalgia. Literature has demonstrated that insoles with metatarsal and arch support could relieve walking pain and improve patient-reported measures of function in metatarsalgia. The purpose of this study was to examine alterations in foot alignment among metatarsalgia patients who used arch support insoles. Methods: A clinical trial was initiated after the approval by the institutional review board. Patients with metatarsalgia (age: 18-65 y/o) were included after they consented to participate. Individuals with open wounds, feet asymmetry, using assistive device or brace, and those with BMI more than 35 were excluded. Participants underwent weightbearing computed tomography (WBCT), and weight-bearing x-ray of their feet while standing barefoot or on the insoles (Good Feet™, Dr.’s Own, LLC). The radiological measurements on WBCT and X-rays conducted in these patients are shown in Table 1. The Wilcoxon-Signed Rank test was used for comparison of the continuous measurements, and the interobserver reliability was analyzed with Intraclass Correlation Coefficient (ICC). Results: Ten patients with a mean age of 46.9±13.06 years were included in the study. Observed changes on X-rays include decreased 4th-5th intermetatarsal angle (p=0.04), 2nd-4th/2nd-5th metatarsal tangent angles (p=0.003, p=0.001), and 1st metatarsal length on antroposterior (AP) view (p=0.02). Also, 1st metatarsal declination angle (p=0.002), and talo-first metatarsal angle on AP view (p=0.05) were increased. No significant changes on the WBCT were found, except for a decrease in the first metatarsal pronation angle (p=0.02). Conclusion: Arch support insoles can bring about anatomical changes especially in the forefoot area of patients with metatarsalgia. While the causal correlation between these changes and alleviation of the symptoms cannot be proven based on our data, these outcomes can guide future clinical trials comparing different treatment for metatarsalgia to determine contributing factors to the healing process of this condition.

Relative Position of the First Ray and Patient Reported Outcome Measures Following the Modified Lapidus Procedure: a Weightbearing CT Study

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Hallux valgus is a complex three-dimensional deformity, and the modified Lapidus is a commonly used procedure to correct moderate to severe deformities. Shortening and elevation of the first ray are two potential factors that may predispose to increased pressure on the lesser metatarsal heads. However, there is currently no consensus regarding optimal position of the first ray following the modified Lapidus. The purpose of this study is to evaluate the impact of the position of the first ray on patient reported outcome measures. Methods: This retrospective study identified 68 patients (72 feet) from a prospectively collected foot and ankle registry who underwent the modified Lapidus bunionectomy over a 4-year period at a single institution with an average follow-up of 20.3 months (Table 1). Patients were included if they were over 18 years of age, had pre and post-operative weightbearing CTs (WBCT), and pre- and minimum 1-year post-operative PROMIS scores. PROMIS scores from 6 domains including Physical Function, Pain Interference, Pain Intensity, Global Physical Health, Global Mental Health, and Depression were evaluated and compared pre- and post-operatively. Radiographic parameters including 1st metatarsal declination angle (MDA), relative metatarsal length (RML), sesamoid position, metatarsus primus elevatus (MPE), hallux valgus angle (HVA), Intermetarsal angle (IMA), and distance from the metatarsal head and sesamoid from the floor were measured and compared before and after surgery. Paired t- tests were employed to evaluate the significance of pre- to post-operative changes. Results: PROMIS physical function, pain interference, pain intensity, and global physical health improved significantly following the modified Lapidus (all p&lt;.001), however, scores did not show significant correlation with shortening of the first ray. The length of the 1st metatarsal relative to the 2nd decreased by an average of 2.7mm following the procedure when measured on WBCT (p &lt;.001), and 2.6mm when measured on plain radiographs (p &lt;.001). There was no significant change in elevation of the first metatarsal (MPE) relative to the 2nd (3.5mm to 3.47, p&gt;=.9). The distance from the sesamoid to floor increased significantly by 1.42mm and the metatarsal to floor distance increased by 2.22mm (both p&lt;.001). The MDA increased from 20.22 to 21.89 (p &lt;.001). Symptoms of transfer metatarsalgia were noted in 5/72 feet (6.9%). Conclusion: This study revealed that the Lapidus bunionectomy resulted in significantly improved PROMIS scores, however, the scores did not correlate strongly with radiographic parameters for first ray shortening or elevation. The relative shortening of the first ray that occurs with the modified Lapidus procedure is minimal (2.7mm) and does not appear to have a significant adverse impact on patient reported outcome measures. Reduction of the sesamoids under the metatarsal head increased the distance from the metatarsal to floor, but did not result in any significant increase in MPE.

Defining Normal Articular Characteristics of the Primary Joints of the Foot and Ankle: A 3D Hounsfield Algorithm Weight Bearing CT Study

Category: Ankle Arthritis; Hindfoot Introduction/Purpose: To properly treat osteoarthritis-(OA) patients, a grading-system is used to diagnose the stage-of-the- disease. The current gold-standard system, which relies on plain-2D-radiographs, is subjective, categorical, and lacks reliability. Using WBCT-images, 3D-Hounsfield-Unit-(HU) algorithms have been developed to measure the intensity of each image voxel across the joint-space, highlighting transitions between cancellous/subchondral bone and joint-space. The purpose of this study was to analyze and define normal standard values of joint-space-width (JSW) in the four essential joints of the foot-and-ankle (tibiotalar (ankle), subtalar (ST), talonavicular (TN), and first-metatarsophalangeal- (MTP) -joints) using an objective computational WBCT-HU algorithm in healthy non-arthritic feet. We hypothesized that the measurements of JSW and HU distributions across each of the four-essential-joints of the foot-and-ankle would be significantly different from each other, respecting local anatomy and unique functional characteristics of each joint. Methods: Retrospective-comparative-study, we evaluated WBCT-scans of 30 healthy ankle-joints, 28 ST-joints, 26-TN joints, and 30 1st-MTP-joints of control volunteers with no radiographic signs of foot-and-ankle OA. For each-joint, we used dedicated software to define a volume-of-interest (VOI) cube centered on the joint space. Five HU linear search arrays were then defined within this 3D VOI perpendicular to the articular-surface of each-joint, including four projections in each quadrant, and one in the center of the VOI (Figure 1). Image intensity profiles were generated for each search array crossing the transition from cancellous- to-subchondral bone, across the joint-space, back to subchondral-and-cancellous-bone (Figure 2). This profile was used to calculate JSW and to measure HU contrast in the region. Comparisons between the JSW of each joint and within each-joint were accordingly performed using paired t-tests or paired Wilcoxon. Significance was considered for p-values &lt; 0.05. Results: The median-value and 95%-Confidence-Intervals-(CI) for JSW were 4.07mm [CI:3.73–4.20] for the ankle-joint; 4.07mm [3.95–4.44] for the ST-joint; 3.24mm [3.19–3.46] for the TN-joint; and 3.70mm [3.64–4.12] for the 1st-MTP-joint. The TN JSW was significantly narrower than the JSW in the ankle (p=0.0007), ST (p &lt; 0.0002), and 1st-MTP-joints (p=0.0034) (Figure-3). JSW- values were similar across the entire ankle, ST and 1st-MTP-joints. In the TN-joint, the dorsal aspect of the joint was found to be slightly but significantly wider-than the plantar-aspect (p &lt; 0.001). Regarding HU-contrast, we found a progressive increase in the overall contrast from proximal-to-distal (p &lt; 0.001), with a mean HU contrast-value and 95%-CI of respectively 71.8[67.3–76.3] for ankle, 92.4[87.8–97.1] for ST, 84.1[79.2–88.9] for TN, and 101.3[96.9 – 106.8] for 1st-MTP-joints. The only joints with similar HU-contrast were ST and TN. Conclusion: We utilized a novel WBCT-3D-HU measurement algorithm to assess the normal JSW and HU contrast of the four- essential mobile joints of the foot-and-ankle. We found the JSW to be similar (~4mm) in the ankle, ST, and 1st-MTP joints. The TN-joint however, demonstrated a significantly narrower JSW when compared to the other 3 joints. HU-contrast increased progressively from proximal-to-distal, being less prominent in the ankle, similarly increased in TN and ST, and maximum at the 1st-MTP joint. This study's joint characteristic normality data provide a foundation for future-work developing an objective WBCT-based 3D HU-algorithm staging-system for OA-disease-progression in the foot-and-ankle joints.

Association of the superior semicircular canal and tegmen tympani dehiscences and its relationship with the pneumatisation of the temporal bone

PurposeTo analyse the degree of pneumatisation of the temporal bone when there is an association between dehiscence of the superior semicircular canal and dehiscence of the tegmen tympani.Materials and methodsWe analysed a retrospective CT study of 124 selected cases. A single inclusion criterion was applied: the presence of a dehiscence of the tegmen tympani. On the other hand, the degree of temporal pneumatisation was assessed by axial and coronal planes, and has been divided into the following grades O, I, II and III, according to the status and relationship of the mastoid, the bony labyrinth, the petrous segment of the carotid canal and sigmoid sinus.ResultsOf the 124 cases studied, 35 (28.2%) presented both dehiscences. In 26 of the 35 (47.3%), grade II pneumatisation, 4 (14,8%), grade I, and 5 (11,9%) grade III was observed, with a statistically significant relationship (p < 0.001). On the other hand, we did not find a significant relationship when relating both dehiscences in any age or sex group. However, when relating the degree of pneumatisation to sex, among those with grade III pneumatisation, the proportion of men (52.4%) was significantly higher than that of women (47.6%) (p = 0.017).ConclusionWe have detected a statistically significant relationship between the coexistence of grade II pneumatisation and the presence of both dehiscences in the temporal bone.

Navigating the Global IV Contrast Shortage: The Experience of a Comprehensive Cancer Center

In March 2022, a COVID-19 associated lockdown at an intravenous (IV) contrast production facility resulted in global shortages. We report our experience as a comprehensive cancer center navigating the IV contrast shortage through the development of an IV contrast triage team. A triage prioritization system was established to serve as a guideline for ordering clinicians to reduce contrast use (Table 1). The triage team reviewed all requests and made final determination based on patient history, treatment plan, prior imaging, possible alternative modalities, and competing requests. Our institution performed a median of 194 CT studies per day. Contrast utilization as a percentage of all CTs ordered was approximately 80% prior to the shortage, nadired at 9% during peak shortage, and has since returned to pre-shortage levels. While most requests for contrast were changed to non-contrast by the ordering clinician, 132 requests were reviewed by the triage team. Fifty studies (38%) were approved by the team for contrast administration, 56 (42%) were recommended to be performed without contrast, 15 (11%) for a change in modality, and 11 (8%) were felt suitable for delay. There was overall general concordance between the recommendations of the triage team and studies conducted without significant distributional differences (χ2 = 4.004, two-tailed p = 0.2610). We did not note any instances of patient harm associated with the lack of contrast or from the utilization of an alternative imaging modality. The concept of resilience involves the development of system-based practices that allow for sustained operations during periods of sudden change, or loss of critical supplies. The effort to optimally allocate limited supply of contrast was an extensive effort across the organization including from senior leadership, IT, radiology, nursing, physicians, and APPs. Defaulting to an automatic cancelation of contrast requests, followed by review from an interdisciplinary triage team was effective in safely reducing contrast utilization. Decisions made by the team appeared to be sound without any known patient harm.