Surgical Confirmation Research Articles

Application of a combined clinical prediction model based on enhanced T1-weighted image(T1WI) full volume histogram in peripheral nerve invasion (PNI) and lymphatic vessel invasion (LVI) in rectal cancer.

This study aims to use a combined clinical prediction model based on enhanced T1-weighted image(T1WI) full volume histogram to predict preoperative peripheral nerve invasion (PNI) and lymphatic vessel invasion (LVI) in rectal cancer. We included a total of 68 PNI patients and 80 LVI patients who underwent surgical resection and pathological confirmation of rectal cancer. According to the PNI/LVI status, patients were divided into PNI positive group (n = 39), the PNI negative group (n = 29), LVI positive group (n = 48), and the LVI negative group (n = 32). External validation included a total of 42 patients with nerve and vascular invasion in patients with surgically resected and pathologically confirmed rectal cancer at another healthcare facility, with a PNI positive group (n = 32) and a PNI-negative group (n = 10) as well as an LVI positive group (n = 35) and LVI-negative group (n = 7). All patients underwent 3.0T magnetic resonance T1WI enhanced scanning. We use Firevoxel software to delineate the region of interest (ROI), extract histogram parameters, and perform univariate analysis, LASSO regression, and multivariate logistic regression analysis in sequence to screen for the best predictive factors. Then, we constructed a clinical prediction model and plotted it into a column chart for personalized prediction. Finally, we evaluate the performance and clinical practicality of the model based on the area under curve (AUC), calibration curve, and decision curve. Multivariate logistic regression analysis found that variance and the 75th percentile were independent risk factors for PNI, while maximum and variance were independent risk factors for LVI. The clinical prediction model constructed based on the above factors has an AUC of 0.734 (95% CI: 0.591-0.878) for PNI in the training set and 0.731 (95% CI: 0.509-0.952) in the validation set; The training set AUC of LVI is 0.701 (95% CI: 0.561-0.841), and the validation set AUC is 0.685 (95% CI: 0.439-0.932). External validation showed an AUC of 0.722 (95% CI: 0.565-0.878) for PNI; and an AUC of 0.706 (95% CI: 0.481-0.931) for LVI. This study indicates that the combination of enhanced T1WI full volume histogram and clinical prediction model can be used to predict the perineural and lymphovascular invasion status of rectal cancer before surgery, providing valuable reference information for clinical diagnosis.

Quantitative parameters of HRCT target scan to predict the risk of lung adenocarcinoma based on the detection of lung ground-glass nodules.

To explore the value of high-resolution computed tomography (HRCT) in the differential diagnosis of benign and malignant ground-glass nodules (GGNs), and to provide a theoretical basis for the clinical application of HRCT. A total of 208 patients with GGN who had been clinically confirmed by surgical pathology and clinical confirmation were collected, and HRCT target scanning technology was used to scan and collect general information of patients, and observe the distribution of GGN, GGN size, GGN cross-sectional area, diameter, transverse diameter, solid composition, relationship with bronchi, and relationship with blood vessels and other indicators. Multivariate regression analysis and risk factor prediction are performed. The differences were statistically significant in multivariate regression analysis, such as nodule location, maximum diameter, maximum cross-sectional area, GGN status, nodule boundary and relationship with blood vessels (P < 0.05). The results of ROC curve showed that the AUC value of nodule site and nodule boundary was greater than 0.5, and the nodule boundary AUC value was 0.676, which was more sensitive to predict whether GGN deteriorated to lung adenocarcinoma (LUAD). Nodule site and nodule boundary are effective risk predictors for LUAD in patients with GGN, and nodule boundary is the most valuable independent predictor.

DIAGNOSTIC ACCURACY AND SAFETY OF ULTRASONOGRAPHY FOR INTESTINAL MALROTATION IN THE PEDIATRIC POPULATION

Intestinal malrotation is a critical condition in pediatric patients that requires accurate and timely diagnosis. Ultrasonography is a non-invasive imaging modality frequently used to diagnose this condition. Objective: To evaluate ultrasonography's diagnostic accuracy and safety for detecting intestinal malrotation in pediatric patients. Methods: This retrospective study was conducted at Lahore General Hospital from January 2023 to January 2024. The study included children who underwent ultrasound for suspected malrotation during this period. Ultrasounds were performed by pediatric sonographers and interpreted by radiologists. The ultrasound examination was deemed indeterminate if normal anatomy was not delineated or the diagnosis was not confirmed. Data were analyzed to determine the sensitivity and specificity of ultrasonography in diagnosing intestinal malrotation. Results: Ultrasound examinations were performed on 230 patients for suspected malrotation. The mean age of the participants was 1.4 years. Among these, 61.7% (142) were neonates, with 36% (51/142) presenting on the first day of life. 218 (94.7%) patients had normal ultrasound findings, with no false-negative results reported. Malrotation was diagnosed through ultrasound in 7 (3%) patients, two of whom had associated malrotation. Five out of these seven patients were neonates. No false-positive results were reported after surgical confirmation. Additionally, 5 (2.17%) patients had indeterminate ultrasound findings. The sensitivity and specificity of ultrasonography for diagnosing intestinal malrotation were 100%. Conclusion: The study concludes that ultrasonography is a safe, accurate, and effective diagnostic tool for intestinal malrotation in pediatric patients. It is a feasible option for clinical practice due to its high diagnostic accuracy and non-invasive nature.

Endometriosis, Pain, and Related Psychological Disorders: Unveiling the Interplay among the Microbiome, Inflammation, and Oxidative Stress as a Common Thread.

Endometriosis (EM), a chronic condition in endometrial tissue outside the uterus, affects around 10% of reproductive-age women, significantly affecting fertility. Its prevalence remains elusive due to the surgical confirmation needed for diagnosis. Manifesting with a range of symptoms, including dysmenorrhea, dyschezia, dysuria, dyspareunia, fatigue, and gastrointestinal discomfort, EM significantly impairs quality of life due to severe chronic pelvic pain (CPP). Psychological manifestations, notably depression and anxiety, frequently accompany the physical symptoms, with CPP serving as a key mediator. Pain stems from endometrial lesions, involving oxidative stress, neuroinflammation, angiogenesis, and sensitization processes. Microbial dysbiosis appears to be crucial in the inflammatory mechanisms underlying EM and associated CPP, as well as psychological symptoms. In this scenario, dietary interventions and nutritional supplements could help manage EM symptoms by targeting inflammation, oxidative stress, and the microbiome. Our manuscript starts by delving into the complex relationship between EM pain and psychological comorbidities. It subsequently addresses the emerging roles of the microbiome, inflammation, and oxidative stress as common links among these abovementioned conditions. Furthermore, the review explores how dietary and nutritional interventions may influence the composition and function of the microbiome, reduce inflammation and oxidative stress, alleviate pain, and potentially affect EM-associated psychological disorders.

Ultrasound-based radiomics nomogram for distinguishing invasive breast cancer (IBC) from invasive breast cancer with intraductal component (IBC-IC)

ObjectiveThe objective was to devise a nomogram integrating radiomics features, sonographic characteristics, and immunologic indices to distinguish between IBC and IBC-IC. MethodsThe preoperative ultrasonography (US) findings and pathological data from 244 BCE patients (115 IBC-IC and 129 IBC) diagnosed with IDC through surgical confirmation were retrospectively gathered. The study utilized the BI-RADS lexicon from the ACR to interpret the findings. 1125 radiomics features were derived from the regions of breast lesions, coupled with pathological data, to establish a predictive model employing the LASSO technique. The model's performance was examined by the AUC, along with sensitivity, and specificity measures, to evaluate its effectiveness in differentiating between the two groups of subjects. ResultsFour prognostic models for IDC-IC were developed, comprising a conventional ultrasound (CUS) signature, pathology signature nomogram, radiomics signature, and combined signature. The combined model exhibited the highest diagnostic efficacy, achieving the AUC of 0.893, sensitivity of 0.875, and specificity of 0.835 in the training set, and 0.835, 0.800, and 0.789 in the testing set. ConclusionThe combined model, integrating CUS, pathology information, and radiomics features derived from CUS, exhibited a notable capacity for preoperatively distinguish IDC-IC. This capability holds promise for guiding personalized surgical strategies for BC individuals undergoing breast-conserving surgery (BCS).

Abstract PO2-23-04: Magnetic Seeds, used to Locate the Metastatic Axillary Lymph Node placed before Neoadjuvant Chemotherapy for Breast Cancer Treatment, do not interfere the pre-surgical MRI Breast response assessment

Abstract Background: Axillary management in clinically node-positive patients who converted to ycN0 after neoadjuvant chemotherapy (NAC) for breast cancer (BC) remains under research with the aim of de-escalation of axillary lymph node dissection (ALND). A magnetic seed is one of the several positive lymph nodes marking techniques used in targeted axillary dissection (TAD) for patients with cN1 breast cancer undergoing neoadjuvant systemic therapy. It has been criticized for its potential masking effect due to the artefact it produces in the MRI sequences used to assess a proper breast response. This study evaluates if the magnetic seeds placed before NAC for guided TAD have influenced in the breast MRI response assessments. Methods: From October 2021 to June 2023, patients with cT0-4 cN1 breast cancer who were candidates for primary systemic treatment were prospectively recruited. Once a breast lesion and axillary node positivity were confirmed, a based hydrogel marker and a magnetic seed, respectively, were placed prior NAC. Once systemic treatment was completed, imaging techniques were used to assess the response, with MRI being the imaging technique of choice to assess breast response and axillary ultrasound the imaging technique of choice to assess axillary response. Surgical pathological confirmation of response in the axilla was by TAD, including sentinel lymph node and magnetic clipped node resection. Results: A total of 43 patients were included and their characteristics are shown in Table 1. In 16 patients (37%) the tumour was located in the upper outer quadrant (UOQ). In this group, the susceptibility artefact produced by the magnetic seed in the MRI created a black hole obscuring the axilla with a mean diameter of 69 mm (range: 57-76 mm). In no case did the halo interfere with the correct MRI visualisation of the breast marker. By MRI, the mean distance of the artifact halo from the breast marker or residual breast lesion was 40 mm (range: 13-79 mm). Overall, complete radiological response (ycCR) was reported in 20 patients (46%), breast only in 21 (49%) and axilla only in 38 (88%) patients. In 5 patients, preoperative axillary ultrasound revealed residual axillary disease, confirmed by FNA, lead to direct ALND. In the remaining 38 patients the axillary TAD assessment was completed. In all cases, the magnetic clipped node was successfully surgically removed. Pathological complete response (pCR) was confirmed in 9 (21%), breast only in 11 (26%) and axilla only in 13 (30%) patients. MRI diagnostic performance in detecting residual breast disease after NAC was not altered by the magnetic clipped node artifact when comparing the tumour location in the UOQ to the other quadrants (AUC 0.764 vs. 0.702; p=0.698). Conclusions: Surgical axillary staging remains the most reliable method for assessing the axillary response after NAC. Target axillary dissection guided by magnetic seed placed before NAC is an effective and accurate technique. The artifact generated in the MRI does not interfere with the pre-surgical breast response assessment after neoadjuvant systemic treatment. Table 1: Patients and tumor characteristics Citation Format: Martin Espinosa-Bravo, Joaquin Rivero Deniz, Clara Morales Comas, Javier de la Torre Fernandez de Vega, Irene Vives Rosello, Enrica Esposito, Vicente Peg Camara, María De Les Neus Rus Calafell, Ignacio Miranda Gomez, Christian Siso Raber. Magnetic Seeds, used to Locate the Metastatic Axillary Lymph Node placed before Neoadjuvant Chemotherapy for Breast Cancer Treatment, do not interfere the pre-surgical MRI Breast response assessment [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-23-04.

Transthoracic echocardiographic Doppler metrics in evaluating bioprosthetic tricuspid valve dysfunction.

There is currently limited information on the utility of transthoracic echocardiography (TTE)-derived Doppler parameters for assessing bioprosthetic tricuspid valve (BTV) dysfunction. Our study aimed to establish the precision and appropriate reference ranges for routinely collected transthoracic Doppler parameters in the assessment of BTV dysfunction. We retrospectively evaluated 100 BTV patients who underwent TTE. Based on redo surgical confirmation or more than 2 repeat TTE or transesophageal echocardiography (TEE) examinations, patients were allocated to normal (n=61), regurgitant (n=24), or stenotic (n=15) BTV group. Univariate and multivariate binary logistic regression were performed to identify TTE Doppler parameters that detected BTV dysfunction. The VTI ratio (VTITV/VTILVOT) was the most accurate Doppler parameter for detecting BTV dysfunction, with a ratio of>2.8 showing 84.6% sensitivity and 90.2% specificity. VTI ratio>3.2, mean gradient (MGTV)>6.2mmHg and pressure half-time>218ms detected significant BTV stenosis, with sensitivities of 100%, 93.3% and 93.3% and specificities of 82.4%, 75.3% and 87.1%, respectively. After multivariate analysis, the VTI ratio>2.8 (OR=9.00, 95% CI=2.13-41.61, p=.003) and MGTV>5.1mmHg (OR=6.50, 95% CI=1.69-27.78, p=.008) were the independent associations of BTV dysfunction. With these cutoff values, 75.0%-92.2% of normal and 62.5%-96.0% of dysfunctional BTV were identified. Doppler parameters from TTE can accurately identify BTV dysfunction, particularly with VTI ratio>2.8 and MGTV>5.1mmHg, to assess the need for additional testing with TEE.

Advances in approaches to diagnose endometriosis

Endometriosis is a common, underdiagnosed, systemic inflammatory, and endocrine pain disorder that impacts the quality of life of millions of persons with a uterus globally. It is associated with chronic pelvic pain and an increased risk of subfertility. It has also been associated with cardiovascular disease, depression, thyroid and autoimmune disorders, ovarian and breast cancers, and poor pregnancy outcomes. Treatment of endometriosis-related pain and infertility can be medical and/or surgical, although misdiagnosis due to symptoms that overlap with other conditions and reliance on definitive diagnosis by histologic confirmation of endometriosis at surgery have contributed to a prolonged diagnosis-to-treatment timeline. A paradigm shift in endometriosis diagnosis is underway, with greater reliance on clinical and family history, physical examination, and imaging, without surgical confirmation, and then proceeding with medical and/or surgical therapies, although any one diagnostic approach alone is insufficient. Although there are no validated, specific molecular biomarkers for endometriosis, recent candidates have promise for diagnosing the disease and facilitating symptom management. This review presents current and evolving approaches to diagnose endometriosis with the goal of expediting the diagnosis-to-treatment timeframe, so patients can have confidence in a diagnosis for their symptoms, expectations set about disease management across the lifespan, and a patient-centered treatment plan promptly initiated. To provide context, the review begins with a summary of disease characteristics, followed by genetic and environmental risks for developing endometriosis, the central role of estrogen and inflammation in the pathophysiology of pain and infertility relevant to the disease and biomarker discovery, and nonsurgical approaches that are increasingly being acknowledged by professional organizations across the globe to be of value in the diagnosis of this enigmatic disease with diverse manifestations.

A rare case of dysplastic cerebellar gangliocytoma - Lhermitte Duclos Disease

Lhermitte–Duclos disease (LDD), also known as dysplastic cerebellar gangliocytoma, is an uncommon hamartomatous lesion found in the cerebellar cortex. First described by French physicians Lhermitte and Duclos in 1920, this condition involves enlarged cerebellar folia containing abnormal ganglion cells. Clinical manifestations typically include headaches, visual disturbances, and cerebellar dysfunction. While imaging techniques like computed tomography (CT) scans may indicate the presence of mass lesions, magnetic resonance imaging (MRI) is crucial for accurate delineation of the lesion's boundaries and characterization of tissue involvement. Surgical intervention, typically in the form of respective surgery, remains the cornerstone of treatment for LDD. Despite advancements in imaging technologies and surgical techniques, the management of LDD remains fraught with complexities. The prognosis can be variable, and in some cases, despite appropriate therapeutic interventions guided by MRI-assisted surgical planning and confirmation through CT screening, the outcome may be unfavorable, as observed in this instance with the demise of the 50-year-old male patient. Further research and a deeper understanding of the pathophysiology underlying LDD are imperative to enhance diagnostic accuracy, refine treatment modalities, and potentially improve patient outcomes. This case underscores the challenges in managing this rare neurological condition and highlights the need for continued exploration into more effective therapeutic avenues.

Improved detection of air-filled lesions using computed tomography in dogs with recurrent spontaneous pneumothorax through reduction of pulmonary atelectasis via positive pressure ventilation.

Spontaneous pneumothorax in dogs is predominantly caused by the rupture of air-filled lesions, such as bullae or blebs. The efficacy of Computed Tomography (CT) in detecting these lesions has been deemed limited due to its reportedly low sensitivity. This retrospective, cross-sectional study investigates the utility of CT in eight dogs diagnosed with recurrent pneumothorax, all of which had surgical confirmation of the cause of the pneumothorax. Thoracic radiographs were obtained before and the day following the CT studies. Initially, a CT study was conducted without positive pressure ventilation (pre-PPV CT). Subsequent CT studies were performed post-evacuation of pneumothorax and with positive pressure ventilation of 15 cmH2O until lung atelectasis was resolved (post-PPV CT). The pre-PPV CT and post-PPV CT images were anonymized and reviewed by two board-certified radiologists. The presence and morphology of air-filled lesions were evaluated on all images. Surgical findings were recorded and compared to the CT findings. Air-filled lesions were detected in 5 out of 8 dogs in the pre-PPV CT studies and in all 8 dogs in the post-PPV CT studies. The CT findings of air-filled lesions were consistent with surgical findings. None of the dogs showed increased severity of pneumothorax in radiographs taken the day following the CT studies. The study concludes that the resolution of lung atelectasis by evacuation of pneumothorax and positive pressure ventilation during CT studies is feasible and enhances the detection of air-filled lesions in dogs with recurrent spontaneous pneumothorax. This could potentially aid in improving surgical planning.

Diagnostic Accuracy of MRI in Detecting the Perineural Spread of Head and Neck Tumors: A Systematic Review and Meta-Analysis.

The purpose of this study was to review the diagnostic accuracy of MRI in detecting perineural spreading (PNS) of head and neck tumors using histopathological or surgical evidence from the afflicted nerve as the reference standard. Previous studies in the English language published in the last 30 years were searched from PubMed and Embase databases. We included studies that used magnetic resonance imaging (MRI) (with and without contrast enhancement) to detect PNS, as well as the histological or surgical confirmation of PNS, and that reported the exact numbers of patients required for assessing diagnostic accuracy. The outcome measures were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Heterogeneity was assessed with the Higgins inconsistency test (I2). P-values smaller than 0.05 were considered statistically significant. A total of 11 retrospective studies were found, reporting 319 nerve samples from 245 patients. Meta-analytic estimates and their 95% confidence intervals were as follows: sensitivity 0.85 (0.70-0.95), specificity 0.85 (0.80-0.89), PPV 0.86 (0.70-0.94), and NPV 0.85 (0.71-0.93). We found statistically significant heterogeneity for sensitivity (I2 = 72%, p = 0.003) and PPV (I2 = 70%, p = 0.038), but not for NPV (I2 = 65%, p = 0.119) or specificity (I2 = 12%, p = 0.842). The most frequent MRI features of PNS were nerve enlargement and enhancement. Squamous cell carcinoma and adenoid cystic carcinoma were the most common tumor types, and the facial and trigeminal nerves were the most commonly affected nerves in PNS. Only a few studies provided examples of false MRI diagnoses. MRI demonstrated high diagnostic accuracy in depicting PNS of cranial nerves, yet this statement was based on scarce and heterogeneous evidence.

Comparison of Time to Pregnancy in In Vitro Fertilisation between Endometriosis and Nonendometriosis.

This study is to compare the time to pregnancy (TTP) between patients with endometriosis and nonendometriosis undergoing in vitro fertilisation (IVF).Material and Methods.This is an observational retrospective cohort study. We included 291 patients (53 with endometriosis and 238 without endometriosis) achieving biochemical pregnancy, whether singleton or multifetal (serum beta-hCG >5 mIU/mL), between 1st January 2014 and 31st March 2020. We excluded patients with incomplete case notes and those declining participation. Time to pregnancy is the interval between the time when infertility was established to the date of confirmed biochemical pregnancy, expressed in months. Endometriosis diagnosis includes any form of endometriosis through surgical confirmation. A statistical analysis was done through the Mann-Whitney U test. Time to pregnancy was assessed through the Kaplan-Meier test. A p value <0.05 is considered statistically significant. Endometriosis patients had a shorter infertility duration (4 years vs. 5 years, p=0.024). Both groups had similar median age and body mass index at presentation. There was no significant difference in the TTP between endometriosis and nonendometriosis groups (57.7 vs. 70.9 months, p=0.060), further confirmed by a Cox regression test incorporating confounders (IVF protocol (OR: 1.482, 95% CI 0.667-3.292, and p=0.334) and type of the cycle (OR 1.071, 95% CI 0.803-1.430, and p=0.640)). The endometriosis group reached the maximum cumulative pregnancy rate at around 169 months postinfertility diagnosis, whilst the nonendometriosis group at around 255 months postinfertility diagnosis. Time to pregnancy between endometriosis and nonendometriosis is not significantly different. However, infertility among patients with endometriosis tends to be shorter.

Double aortic arch: a comparison of fetal cardiovascular magnetic resonance, postnatal computed tomography and surgical findings

In double aortic arch (DAA), one of the arches can demonstrate atretic portions postnatally, leading to diagnostic uncertainty due to overlap with isolated right aortic arch (RAA) variants. The main objective of this study is to demonstrate the morphological evolution of different DAA phenotypes from prenatal to postnatal life using three-dimensional (3D) fetal cardiac magnetic resonance (CMR) imaging and postnatal computed tomography (CT)/CMR imaging. Three-dimensional fetal CMR was undertaken in fetuses with suspected DAA over a 6-year period (January 2016-January 2022). All cases with surgical confirmation of DAA were retrospectively studied and morphology on fetal CMR was compared to postnatal CT/CMR and surgical findings. Thirty-four fetuses with surgically confirmed DAA underwent fetal CMR. The RAA was dominant in 32/34 (94%). Postnatal CT/CMR was undertaken at a median age of 3.3months (interquartile range 2.0-3.9) demonstrating DAA with patency of both arches in 10/34 (29%), with 7 showing signs of coarctation of the left aortic arch (LAA). The LAA isthmus was not present on CT/CMR in 22/34 (65%), and the transverse arch between left carotid and left subclavian artery was not present in 2 cases. Fetal CMR provides novel insights into perinatal evolution of DAA. The smaller LAA can develop coarctation or atresia related to postnatal constriction of the arterial duct, making diagnosis of DAA challenging with contrast-enhanced CT/CMR. This highlights the potentially important role for prenatal 3D vascular imaging and might improve the interpretation of postnatal imaging.

Rate of Missed Intracranial Colloid Cysts on MRI and CT.

Intracranial colloid cysts of the third ventricle are rare; however, they may be symptomatic. They can create a mass effect on the foramina of Monro, resulting in acute hydrocephalus. Colloid cysts are detectable on CT and MRI but are commonly missed. In this paper, we investigate the rate of missed colloid cysts on MRI and/or CT imaging within our multihospital metropolitan medical group. A retrospective, institutional review board-approved search of the network-wide picture archiving and communication system (PACS) from January 1, 2010, to October 31, 2020, was performed to identify reports including a "colloid cyst" in MRI brain or CT head imaging. Results without imaging and/or surgical confirmation of intracranial colloid cysts were excluded, rendering 229 cases. A PACS review of these cases was performed by two neuroradiologists to determine instances where the cyst had previously been imaged but not diagnosed on either CT or MRI. Two hundred twenty-nine subjects had confirmed colloid cysts through imaging and/or surgical reports. Of these, 46 had prior imaging depicting a colloid cyst either on CT and/or MRI without mention on the interpretative report, resulting in a non-detection rate of 20.1%. Intracranial colloid cysts can be missed at a considerably high rate, which is concerning given their clinically unpredictable nature and ability to cause significant morbidity and mortality. As such, it is important to take a proactive approach to searching for these cysts as part of a regular imaging search pattern and to continue to determine new methods of increasing detection sensitivity.

Pulmonary Artery Intimal Sarcoma Mimicking Right Ventricular Outflow Tract Thrombus

A 72-year-old man presented with breathlessness and a systolic murmur. Extensive diagnostic work-up revealed a rare pulmonary artery intimal sarcoma mimicking a right ventricular outflow tract thrombus and impacting a cardiac pacemaker lead. Surgical resection, pathology confirmation, and management strategies are discussed, highlighting the challenges of treating this rare malignancy.

Value of Non-Contrast-Enhanced Vessel Wall MR Imaging in Assessing Vascular Invasion of Retroperitoneal Tumors.

Due to their location and growth patterns, retroperitoneal tumors often involve the surrounding blood vessels. Clinical decisions on a proper treatment depend on the information on this condition. Evaluation of blood vessels using non-contrast-enhanced vessel wall MRI may provide noninvasive assessment of the extent of tumor invasion to assist clinical decision-making. To investigate the performance and potential of non-contrast-enhanced vessel wall MRI in evaluating the degree of vessel wall invasion of retroperitoneal tumors. Prospective. Thirty-seven participants (mean age: 60.59 ± 11.77 years, 59% male) with retroperitoneal tumors close to vessels based on their diagnostic computer tomography. 3 T; vessel wall MRI sequences: two-dimensional T2-weighted MultiVane XD turbo spin-echo (2D-T2-MVXD-TSE) and three-dimensional T1-weighted motion sensitized driven equilibrium fat suppression turbo spin-echo (3D-T1-MSDE-TSE) sequences; conventional MRI sequences: T2-weighted fat suppression turbo spin-echo (T2-FS-TSE), T2-weighted turbo spin-echo (T2-TSE), modified Dixon T1-weighted fast field echo (T1-mDixon-FFE), and diffusion-weighted echo planar imaging (DWI-EPI) sequences. All patients underwent preoperative imaging using both non-contrast conventional and vessel wall MRI sequences. Images obtained from conventional and vessel wall MRI sequences were evaluated independently by three junior radiologists (3 and 2 years of experience in reading MRI) and reviewed by one senior radiologist (25 years of experience in reading MRI) to assess the degree of vessel wall invasion. MRI were validated results from the clinical standard diagnosis based on surgical confirmation or histopathological reports. Interobserver agreement was determined based on the reports from three readers with similar years of experiences. Intraobserver variability was assessed based on categorizing and recategorizing the vessels of 37 patients 1 month apart. Intra-class correlation efficient (ICC), Chi-square test, McNemar test, area under the receiver-operating characteristic curve (AUC), Delong test, P < 0.05 was considered significant. The accuracy of vessel wall MRI (91.96%, 95% CI: 85.43-95.71; 103 of 112) in detecting the degree of vessel wall invasion was significantly higher than that of conventional MRI (75%, 95% CI: 66.24-82.10; 84 of 112). The interobserver variability or reproducibility in categorization of the degree of vascular wall invasion was good in evaluating images from conventional and vessel wall MRI sequences (ICC = 0.821, 95% CI: 0.765-0.867 and ICC = 0.881, 95% CI: 0.842-0.913, respectively). Diagnosis of vessel wall invasion of retroperitoneal tumors and assessment of its severity can be improved by using non-contrast-enhanced vessel wall MRI. 1 TECHNICAL EFFICACY: Stage 3.

Initial skin necrosis presentation at emergency room was associated with fulminant clinical course and mortality in patients with Vibrio necrotizing fasciitis

Necrotizing fasciitis (NF) is a life-threatening infection. Skin necrosis is an important skin sign of NF. The purposes of this study was to investigate the initial skin conditions of Vibrio NF patients between emergency room (ER) to preoperative status, to compare the clinical and laboratory risk indicators of the skin necrosis group and non-skin necrosis group when they arrived at ER, and to evaluate whether initial cutaneous necrosis related to fulminant course and higher fatalities. From 2015 to 2019, seventy-two Vibrio NF patients with surgical confirmation were enrolled. We identified 25 patients for inclusion in the skin necrosis group and 47 patients for inclusion in the non-skin necrosis group due to the appearance of skin lesion at ER. Seven patients died, resulting in a mortality rate of 9.7%. Six patients of skin necrosis group and one patient of non-skin necrosis group died, which revealed the skin necrosis group had a significantly higher mortality rate than the non-skin necrosis group. All the patients in the skin necrosis group and 30 patients of non-skin necrosis group developed serous or hemorrhagic bullous lesions before operation (p = 0.0003). The skin necrosis group had a significantly higher incidence of APACHE score, postoperative intubation, Intensive care unit stay, septic shock, leukopenia, higher counts of banded leukocytes, elevated C-reactive protein (CRP), and lower serum albumin level. Vibrio NF patients presenting skin necrosis at ER were significantly associated with fulminant clinical courses and higher mortality. Physicians should alert the appearance of skin necrosis at ER to early suspect NF and treat aggressively by those clinical and laboratory risk indicators, such as elevated APACHE score, shock, leukopenia, higher banded leukocytes, elevated CRP, and hypoalbuminia.

A Comparison of Retrospective ECG-Gated CT and Surgical or Angiographical Findings in Acute Aortic Syndrome.

The best cardiac phases in retrospective ECG-gated CT for detecting an intimal tear (IT) in aortic dissection (AD) and an ulcer-like projection (ULP) in an intramural hematoma (IMH) have not been established. This study aimed to compare the detection accuracy of diastolic-phase and systolic-phase ECG-gated CT for IT in AD and ULP in IMH, with subsequent surgical or angiographical confirmation as the reference standard.In total, 81 patients (67.6 ± 11.8 years; 41 men) who underwent emergency ECG-gated CT and subsequent open surgery or thoracic endovascular aortic repair for AD (n = 52) or IMH (n = 29) were included. The accuracies of detecting IT and ULP were compared among only diastolic-phase, only systolic-phase, and both diastolic-phase and systolic-phase methods of retrospective ECG-gated CT; surgical or angiographical findings were used as the reference standard. The detection accuracy for IT and ULP using only diastolic-phase, only systolic-phase, and both diastolic-phase and systolic-phase methods of ECG-gated CT was 93% [95% CI: 87-97], 94% [95% CI: 88-97], and 95% [95% CI: 90-97], respectively. There were no significant differences in detection accuracy among the 3 acquisition methods (P = 0.55). Similarly, there were no significant differences in the accuracy of detecting IT in AD (P = 0.55) and ULP in IMH (P > 0.99) among only diastolic-phase, only systolic-phase, and both diastolic- and systolic-phase ECG-gated CT.Retrospective ECG-gated CT for detecting IT in AD and ULP in IMH yields highly accurate findings. There were no significant differences seen among only diastolic-phase, only systolic-phase, and both diastolic-phase and systolic-phase ECG-gated CT.

Paraurethral fibroadenoma of the vulva: a clinical case

Fibroadenoma of the vulva is a benign fibroepithelial tumor that is extremely rare. We present a rare clinical case of a 49-year-old woman with a large slow-growing paraurethral fibroadenoma of the vulva, confirmed by histological examination.This observation describes a rare pathology that contributed to urination disorders, which required surgical treatment and confirmation of the benign process by immunohistochemical examination.

The emerging role of MRI neurography in the diagnosis of chronic inguinal pain.

Chronic pain is a frequent and notable complication after inguinal hernia repair, it has been extensively studied, butits management and diagnosis are still difficult. The cause of chronic pain following inguinal hernia surgery isusually multifactorial. This case series highlights the utility of MRI neurography (MRN) in evaluating the damage toinguinal nerves after a hernia repair, with surgical confirmation of the preoperative imaging findings. A retrospective review was performed on patients who underwent inguinal mesh removal and triple denervation of the groin. Inclusion criteria included MRI neurography. All patients underwent surgical exploration of the inguinal canal for partial or complete mesh removal and triple denervation of the groin by the same senior surgeon. A total of nine patients who underwent triple denervation were included in this case series. MRN was then performed on 100% of patients. The postoperative mean VAS score adjusted for all patients was 1.6 (SD p), resulting in a 7.5 score difference compared to the preoperative VAS score (p). Since chronic groin pain can be a severely debilitating condition, diagnosis, and treatment become imperative. MRN can detect direct and indirect signs of neuropathy even in the absence of a detectable compressive causeaids in management and diagnosis by finding the precise site of injury, and grading nerve injury to aid pre-operativeassessment for the nerve surgeon. Thus, it is a valuable diagnostic tool to help with the diagnosis of nerve injuriesin the setting of post-inguinal hernia groin pain.