Ultrasound Magnetic Resonance Research Articles

SequenceMorph: A Unified Unsupervised Learning Framework for Motion Tracking on Cardiac Image Sequences.

Modern medical imaging techniques, such as ultrasound (US) and cardiac magnetic resonance (MR) imaging, have enabled the evaluation of myocardial deformation directly from an image sequence. While many traditional cardiac motion tracking methods have been developed for the automated estimation of the myocardial wall deformation, they are not widely used in clinical diagnosis, due to their lack of accuracy and efficiency. In this paper, we propose a novel deep learning-based fully unsupervised method, SequenceMorph, for in vivo motion tracking in cardiac image sequences. In our method, we introduce the concept of motion decomposition and recomposition. We first estimate the inter-frame (INF) motion field between any two consecutive frames, by a bi-directional generative diffeomorphic registration neural network. Using this result, we then estimate the Lagrangian motion field between the reference frame and any other frame, through a differentiable composition layer. Our framework can be extended to incorporate another registration network, to further reduce the accumulated errors introduced in the INF motion tracking step, and to refine the Lagrangian motion estimation. By utilizing temporal information to perform reasonable estimations of spatio-temporal motion fields, this novel method provides a useful solution for image sequence motion tracking. Our method has been applied to US (echocardiographic) and cardiac MR (untagged and tagged cine) image sequences; the results show that SequenceMorph is significantly superior to conventional motion tracking methods, in terms of the cardiac motion tracking accuracy and inference efficiency.

Echogenicity of Brain Structures in Huntington's Disease Patients Evaluated by Transcranial Sonography - Magnetic Resonance Fusion Imaging using Virtual Navigator and Digital Image Analysis.

Transcranial sonography (TCS) magnetic resonance (MR) fusion imaging and digital image analysis are useful tools for the evaluation of various brain pathologies. This study aimed to compare the echogenicity of predefined brain structures in Huntington's disease (HD) patients and healthy controls by TCS-MR fusion imaging using Virtual Navigator and digitized image analysis. The echogenicity of the caudate nucleus (CN), substantia nigra (SN), lentiform nucleus (LN), insula, and brainstem raphe (BR) evaluated by TCS-MR fusion imaging using digitized image analysis was compared between 21 HD patients and 23 healthy controls. The cutoff values of echogenicity indices for the CN, LN, insula, and BR with optimal sensitivity and specificity were calculated using receiver operating characteristic analysis. The mean echogenicity indices for the CN (67.0±22.6 vs. 37.9±7.6, p<0.0001), LN (110.7±23.6 vs. 59.7±11.1, p<0.0001), and insula (121.7±39.1 vs. 70.8±23.0, p<0.0001) were significantly higher in HD patients than in healthy controls. In contrast, BR echogenicity (24.8±5.3 vs. 30.1±5.3, p<0.001) was lower in HD patients than in healthy controls. The area under the curve was 90.9%, 95.5%, 84.1%, and 81.8% for the CN, LN, insula, and BR, respectively. The sensitivity and specificity were 86% and 96%, respectively, for the CN and 90% and 100%, respectively, for the LN. Increased CN, LN, and insula echogenicity and decreased BR echogenicity are typical findings in HD patients. The high sensitivity and specificity of the CN and LN hyperechogenicity in TCS-MR fusion imaging make them promising diagnostic markers for HD.

Sural nerve: imaging anatomy and pathology.

High resolution ultrasound (US) and magnetic resonance (MR) neurography are both imaging modalities that are commonly used for assessing peripheral nerves including the sural nerve (SN). The SN is a cutaneous sensory nerve which innervates the lateral ankle and foot to the base of the fifth metatarsal. It is formed by contributing nerves from the tibial and common peroneal nerves with six patterns and multiple subtypes described in literature. In addition to the SN being a cutaneous sensory nerve, the superficial location enables the nerve to be easily biopsied and harvested for a nerve graft, as well as increasing the susceptibility to traumatic injury. As with any peripheral nerves, pathologies such as peripheral nerve sheath tumors and neuropathies can also affect the SN. By utilizing a high frequency probe in US and high-resolution MR neurography, the SN can be easily identified even with the multiple variations given the standard distal course. US and MRI are also useful in determining pathology of the SN given the specific image findings that are seen with peripheral nerves. In this review, we evaluate the normal imaging anatomy of the SN and discuss common pathologies identified on imaging.

P-312 Effect on pregnancy outcomes of depot GnRH agonist pre-treatment before frozen-thawed embryo transfer cycles in patients with adenomyosis

Abstract Study question Is there any difference between using or not using depot GnRH agonist pre-treatment on pregnancy outcomes in patients with adenomyosis before frozen-thawed embryo transfer cycles? Summary answer GnRH agonist pre-treatment before frozen-thawed embryo transfer has no effect on pregnancy outcomes in adenomyosis patients. What is known already Uterine adenomyosis negatively affects implantation and clinical pregnancy rates and also increases the risk of early pregnancy loss. Increased inflammatory markers and increased myometrial peristalsis are thought to decrease the rate of implantation. Depot GnRH agonist pre-treatment is thought to increase implantation rate by both decreasing myometrial contractility and reducing inflammatory marker production. Study design, size, duration This retrospective cohort study was conducted at ART and Reproductive Genetics Centre, Memorial Sisli Hospital, Istanbul, Turkey. Patients with adenomyosis undergoing a FET cycle between 2011 and 2021 were evaluated. Patients between 25-45 years old with good and top-quality blastocysts were included and preimplantation genetic diagnosis (PGD) was applied to patients who were &amp;gt;37 years old. A total of 144 frozen embryo transfer cycles were examined. Participants/materials, setting, methods Diagnosis of adenomyosis was made using transvaginal ultrasound and/or pelvic magnetic resonance imaging which revealed an asymmetrically thickening between the anterior and posterior uterine walls, focal adenomyosis, myometrial cysts and irregular/interrupted junctional zone of the endometrium. 65 patients in the study group (Group I) who received depot GnRH agonist pre-treatment for minimum 2 and maximum 6 months and 79 patients without GnRH agonist pre-treatment (Group 2) were evaluated. Main results and the role of chance There was no significant difference in patient characteristics such as age, endometrial thickness on embryo transfer day, BMI, infertility duration, and anti mullerian hormone levels between groups 1 and 2. Endometrial preparation was done using artificial cycle in the depot agonist group, whereas both artificial and modified natural cycle were used in patients without depot GnRH agonist pre-treatment.The pregnancy rate was 53.8%(n = 35) in group 1 and 54.4%(n = 43) in group 2. The clinical pregnancy loss rate was 20% (n = 9) in group 1 and 15.7% (n = 6)in group 2. The live birth rate was 40% (n = 26) in group I and 39.2. (n = 31) in group II. There were no statistically significant differences in pregnancy rates, clinical pregnancy losses, and live birth rates between the groups. Limitations, reasons for caution The limitation of the study is its retrospective nature. Wider implications of the findings The lack of any statistically significant differences in pregnancy outcomes in this study suggests the need for further evaluation of the value/effectiveness of GnRHa treatment in adenomyosis patients before embryo transfer cycles. Trial registration number not applicable

Abstract 2470: Comparison of H-scan ultrasound and diffusion-weighted magnetic resonance imaging of head and neck cancer undergoing neoadjuvant chemotherapy

Abstract Introduction: The use of ultrasound (US) for tumor tissue characterization remains an exciting prospect. The purpose of this research project was to introduce a 3-dimensional (3-D) H-scan US imaging system, which links information in the backscattered US signals to various-sized tissue structures in volume space, and evaluate use for monitoring early response of head and neck cancer to neoadjuvant chemotherapy. Methods: Studies were conducted using female mice (N = 20) implanted in the mammary fat pad with 1 million breast cancer cells (MDA-MB-231). Once tumors reached about 0.8 cm in size, animals were divided into three groups so that mean tumor size in each were comparable. Animals underwent H-scan US and diffusion-weighted magnetic resonance imaging (DW-MRI) at baseline and again at days 1, 3, and 7. After baseline imaging, animals were administered neoadjuvant treatment injections, namely: (1) 0.3 mg sterile saline (control), (2) 5 mg/kg of cisplatin, or (3) 25 mg/kg cisplatin. In vivo US imaging was performed using a Vevo 3100 system (FUJIFILM VisualSonics Inc) equipped with an MX201 linear array transducer. Volume acquisitions contained 400 frames of US image data spaced 50 μm apart. To generate the H-scan US images, Gaussian-weighted Hermite polynomial filters were convolved with the radiofrequency (RF) data to measure the relative strength of the backscattered US signals. In short, the lower frequency signals were assigned to a red (R) channel and the higher frequency components to a blue (B) channel. The unfiltered original RF signal was assigned to the green (G) channel to complete the RGB colormap. Animals were also imaged using a preclinical MRI scanner (BioSpec 3T, Bruker) using a DW-MRI sequence for generation of apparent diffusion coefficient (ADC) maps as a measure of intratumoral water diffusion. After the last day of imaging, animals were euthanized and tumor tissue excised for ex vivo analysis. Results: In vivo results demonstrated that 3-D H-scan US imaging was considerably more sensitive to tumor changes after neoadjuvant treatment as compared to B-scan US. While there was no difference at baseline (p &amp;gt; 0.60), H-scan US images from the cisplatin treated tumors exhibited increased intensity at day 7 (15.6 ± 1.9% and 17.2 ± 3.2% for low and high dosed groups, respectively; p &amp;lt; 0.05) indicating a decrease in aggregate US scatterer size. Furthermore, longitudinal trends found using H-scan US imaging matched those from DW-MRI (p &amp;lt; 0.05). Collectively, these observations were attributed to cancer cell nuclear condensation and apoptotic activity as confirmed by histological analysis. Conclusions: 3-D H-scan US imaging is a promising new tool for monitoring cancer response to neoadjuvant therapy. In vivo results matched those found using DW-MRI, which is an established modality for assessing anticancer treatment using apoptosis-inducing drugs. Citation Format: Haowei Tai, Ryan Margolis, Junjie Li, Brian Trinh, Jane Song, Kenneth Hoyt. Comparison of H-scan ultrasound and diffusion-weighted magnetic resonance imaging of head and neck cancer undergoing neoadjuvant chemotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2470.

Should asymptomatic small anteriorly located midline prostatic cyst in young adults be treated surgically or conservatively? A case report and review of the literature

Abstract Background Prostatic cysts are uncommon, typically asymptomatic and discovered by chance during imaging. Prostatic cysts in the midline are less prevalent and primarily seen in the posterior aspect of the prostate. Case presentation We describe a case of a 32-year-old man with a complaint of left loin pain and a little sensation of pelvic discomfort. Ultrasound was done revealing small pelvic cystic structure related to urinary bladder base and neck with possibility to be prostatic in origin. Transrectal ultrasound and pelvic magnetic resonance imaging were done and showed an anteriorly located midline prostatic cyst protruding into the bladder lumen, with no communication with the urethra on conventional ascending urethrogram. Conclusion The rare relationship between the cyst, bladder neck, and prostate make this case to some extent unique and further interesting. To our best knowledge, this is the eighth documented case in the literature to describe an anteriorly located midline intraprostatic cyst projecting at the bladder neck and base with illustration of different plans of treatment.

A comparative study of transperineal software-assisted magnetic resonance/ultrasound fusion biopsy and transrectal cognitive fusion biopsy of the prostate

BackgroundThe advantages and disadvantages of transperineal and transrectal biopsies remain controversial in the era of prostate targeted biopsy. In this study, we compared the cancer detection and complication rates of transperineal magnetic resonance/ultrasound (MR/US) fusion biopsy and transrectal cognitive fusion biopsy of the prostate.MethodsThis was a comparative study of two prospectively collected cohorts. Men with clinically suspected prostate cancer and prostate imaging reporting and data system (PI-RADS) score ≥ 3 lesions on multi-parametric magnetic resonance imaging (mpMRI) were enrolled. They underwent either transperineal software fusion biopsy or transrectal cognitive fusion biopsy and systematic biopsy. The detection rates of any prostate cancer and clinically significant prostate cancer (csPC, defined as Gleason score ≥ 3 + 4) and the complication rates between both groups were analysed.ResultsNinety-two and 85 patients underwent transperineal software fusion and transrectal cognitive fusion biopsies, respectively. The detection rate for any prostate cancer was similar between both groups (60.8% vs. 56.4%, p = 0.659). In terms of csPC detection, transperineal fusion biopsy outperformed transrectal fusion biopsy (52.2% vs. 36.5%, p = 0.036). In multivariate regression analysis, age, PI-RADS score > 3, and transperineal route were significant predictors of csPC. Meanwhile, transperineal biopsy resulted in a higher rate of urinary retention than transrectal biopsy (18.5% vs. 4.7%, p = 0.009). No serious infectious complications were noted, although a patient developed sepsis after transrectal biopsy.ConclusionsTransperineal software fusion biopsy provided a higher csPC detection rate than transrectal cognitive fusion biopsy and carried minimal risk for infectious complications in patients with MRI-visible prostate lesions.

Amoebiasis in Pregnancy: A Review and Update of the Literature

Amoebiasis in Pregnancy: A Review and Update of the Literature

Transient ultrasound elastography and magnetic resonance elastography for the diagnosis of oesophageal varices in patients with chronic liver disease or portal vein thrombosis

Transient ultrasound elastography and magnetic resonance elastography for the diagnosis of oesophageal varices in patients with chronic liver disease or portal vein thrombosis

Che cos’è l’ematocolpo?

Hematocolpos is a term given to a blood-filled dilated vagina due to menstrual blood. When there is concurrent uterine distention, the term hematometrocolpos is used. These conditions are mostly in the setting of an anatomical obstruction, usually an imperforate hymen. Usually, clinical presentation may be characterized by primary amenhorrea, recurrent abdominal or pelvic pain, urinary retention and dys-uria or constipation. Imaging techniques such as trans-abdominal ultrasound and nuclear magnetic res-onance are respectively the exam of choice and the “gold standard” exam for diagnosing hematocolpos. The paper reports the case of a 12-year-old girl with a sacral pain present for a month, not associated with other symptoms with a diagnosis of hematocolpos that became evident to the magnetic resonance.

Deep Learning-Based Registration of MR and Treatment Planning Ultrasound Images for HDR Prostate Brachytherapy

Propagation of contours from high-quality magnetic resonance (MR) images to treatment planning ultrasound (US) images with severe needle artifacts is a challenging task, which can greatly aid the organ or intraprostatic lesion contouring in high dose rate (HDR) prostate brachytherapy. In this study, a deep learning approach was developed to automatize this registration procedure for HDR brachytherapy practice.With the approval from the institutional review board, the MR and US images with manual prostate contours were collected from our clinical database and processed to construct the deep learning dataset. A deep learning framework based on the weakly-supervised strategy was proposed for the registration of prostate MR images and US images after the needle insertion, which consisted of two segmentation networks and a deformable registration network. Specifically, two 3D V-Net was trained for the prostate segmentation on the MR and US images separately, to generate the weak supervision labels automatically for the registration network training. Besides the image pair, the corresponding prostate probability maps from the segmentation were further fed to the registration network to improve the registration accuracy, and the deformation matrix was the output. A random augmentation method was designed to alleviate the map overfitting problem during the network training. The overlap between the deformed and fixed prostate contours was analyzed to evaluate the registration accuracy.Clinical data from 121, 104 and 63 patient cases were collected and utilized for the MR and US image segmentation networks, and the registration network learning, respectively. The mean DSC, center-of-mass (COM) distance, Hausdorff distance (HD) and averaged symmetric surface distance (ASSD) results for the registration of prostate contours were 0.87 ± 0.05, 1.70 ± 0.89 mm, 7.21 ± 2.07 mm, 1.61 ± 0.64 mm, respectively. By providing the prostate probability map from the segmentation to the registration network, as well as applying the random map augmentation method, the evaluation results of the four metrics were all improved, such as an increase of DSC from 0.83 ± 0.08 to 0.86 ± 0.06 and from 0.86 ± 0.06 to 0.87 ± 0.05, respectively.This study first worked on the deep learning-based registration about the treatment planning US image for HDR prostate brachytherapy. A novel segmentation-based registration framework was proposed for this multi-modality registration problem, which not only largely saved the labor work on the data preparation, but also improved the registration accuracy. The evaluation results showed the potential of this approach in HDR brachytherapy to automatize current clinical procedures.

Deep Learning Improves Speed and Accuracy of Prostate Gland Segmentations on Magnetic Resonance Imaging for Targeted Biopsy.

Purpose:Targeted biopsy improves prostate cancer diagnosis. Accurate prostate segmentation on magnetic resonance imaging (MRI) is critical for accurate biopsy. Manual gland segmentation is tedious and time-consuming. We sought to develop a deep learning model to rapidly and accurately segment the prostate on MRI and to implement it as part of routine magnetic resonance-ultrasound fusion biopsy in the clinic.Materials and Methods:A total of 905 subjects underwent multiparametric MRI at 29 institutions, followed by magnetic resonance-ultrasound fusion biopsy at 1 institution. A urologic oncology expert segmented the prostate on axial T2-weighted MRI scans. We trained a deep learning model, ProGNet, on 805 cases. We retrospectively tested ProGNet on 100 independent internal and 56 external cases. We prospectively implemented ProGNet as part of the fusion biopsy procedure for 11 patients. We compared ProGNet performance to 2 deep learning networks (U-Net and holistically-nested edge detector) and radiology technicians. The Dice similarity coefficient (DSC) was used to measure overlap with expert segmentations. DSCs were compared using paired t-tests.Results:ProGNet (DSC=0.92) outperformed U-Net (DSC=0.85, p <0.0001), holistically-nested edge detector (DSC=0.80, p <0.0001), and radiology technicians (DSC=0.89, p <0.0001) in the retrospective internal test set. In the prospective cohort, ProGNet (DSC=0.93) outperformed radiology technicians (DSC=0.90, p <0.0001). ProGNet took just 35 seconds per case (vs 10 minutes for radiology technicians) to yield a clinically utilizable segmentation file.Conclusions:This is the first study to employ a deep learning model for prostate gland segmentation for targeted biopsy in routine urological clinical practice, while reporting results and releasing the code online. Prospective and retrospective evaluations revealed increased speed and accuracy.

Prognostic value of electroencephalography in hypoxic-ischemic encephalopathy

Background: Hypoxic-ischemic encephalopathy (HIE) is one of the main causes of neurodevelopmental disorders. We developed a model that has diagnostic and prognostic value in predicting the neurodevelopmental outcomes in newborns with HIE. HIE staging allows us to start therapeutic interventions early in newborns with suspected encephalopathy.&#x0D; Methods: This was a retrospective study in a cohort of 58 full-term neonates with clinical suspicion of HIE. We assessed electroclinical variables at birth [etiology of hypoxia, neonatal seizures, HIE stages based on Sarnat criteria, use of therapeutic hypothermia, neuroimaging tests and electroencephalography (EEG) findings] and two years of follow up (EEG findings, development of epilepsy, the presence of cognitive deficits, behavioral issues, language problems, visual or hearing disturbances, and cerebral palsy).&#x0D; Results: There was a high electro-clinical correlation to severe HIE (88.8%) and moderate HIE (50%). There was a considerable proportion of patients affected by mild HIE, based on clinical examination, who presented with an abnormal EEG (32.3%). There is a relationship between the onset of neonatal seizures, epilepsy, and severe HIE diagnosed with EEG (88.9%). A higher percentage of patients with moderate and severe HIE, based on EEG findings, present abnormal results in cranial ultrasound and cerebral magnetic resonance imaging (62.5%). At two years of age, functional neurodevelopment disturbances were observed most frequently in patients affected with severe and moderate HIE based on EEG.&#x0D; Conclusions: This study shows a model with diagnostic and prognostic value in predicting newborns' neurodevelopmental outcomes with suspected HIE. This knowledge allows us to assess the role of performing serial EEG in patients with suspected HIE and the relevance of EEG findings in the prognosis of neurodevelopmental disorders.

Magnetic resonance imaging versus computed tomography and ultrasound for the diagnosis of female pelvic pathology.

We sought to determine the diagnostic accuracy of magnetic resonance (MR) imaging compared with computed tomography (CT) and ultrasound (US) when evaluating for five common pelvic pathologies among women presenting to the emergency department (ED) with right lower quadrant abdominal pain. This prospective, single-center study was conducted at an academic ED as a sub-analysis of a direct comparison of the diagnostic accuracy of CT and MR in the evaluation of appendicitis. Patients were eligible for participation in the parent study if they were at least 12 years old and had a CT performed for evaluation of possible appendicitis. In the current study, only female patients who also underwent pelvic US were included. Three radiologists independently interpreted each MR examination specifically for the presence of pelvic pathology, knowing that patients had initially undergone imaging evaluation for possible appendicitis. The determination of an independent expert panel of two radiologists and one emergency physician based on surgical pathology, comprehensive chart review, clinical information, and follow-up phone calls served as the reference standard. Test characteristics of MR, CT, and US were calculated based on this; the main outcome measure was the summary sensitivity and specificity of MR versus CT and US. Forty-one participants were included with a mean age of 27.6 ± 10.8 years. The MR consensus interpretation had an overall sensitivity and specificity of 57.1% (CI 38.8-75.5%) and 97.2% (CI 94.7-99.6%) respectively, for detecting any of the five pelvic pathologies. By comparison, CT exhibited sensitivity and specificity of 66.7% (CI 50.0-83.5%) and 98.3% (CI 96.4-100.0%) while it was 64.3% (CI 46.5-82.0%) and 97.7% (CI 95.6-99.9%) for US, respectively. No significant differences were identified when comparing these modalities. Overall, Fleiss' kappa interrater reliability value for MR interpretation was 0.75, corresponding to substantial agreement between the three readers. In women who might otherwise undergo multiple imaging tests to evaluate gastrointestinal versus pelvic pathologies, our data suggest that MR may be an acceptable first-line imaging test.

Clinical application of MRI diagnostics in BCC operations of the medial eye canthus – a case study

Basal cell carcinoma (BCC) is the most common malignant skin neoplasm. Imaging modalities, such as ultrasound and contrast-enhanced magnetic resonance imaging are valuable in diagnosing and staging BCC. This case report aims to demonstrate contrast-enhanced magnetic resonance imaging features in the pre-operative assessment of BCC infiltrate tissues in the medial periorbital area. MRI results are presented alongside intraoperative assessment and histopathology examination results.

Prevalence and Association of Occult Spinal Dysraphism with Anorectal Malformation

Background: Anorectal malformation (ARM) is associated with occult spinal dysraphism (OSD). The guideline for screening for OSD in patients with ARM is still controversial. Objective: 1) To evaluate the prevalence of OSD in each type of ARM and to elucidate which types of ARM should be screened for underlying OSD. 2) To compare the methods used in radiologic screening for OSD, such as plain lumbosacral X-ray, spinal ultrasound (U/S), and spinal magnetic resonance imaging (MRI). Materials and Methods: The medical records of all patients with ARM treated at Siriraj Hospital between 2006 and 2016 were reviewed. Spinal dysraphism screening with lumbosacral X-ray, U/S, or MRI were performed depending on the surgeon’s request. Associated urinary tract anomalies were noted. Data of the surgical treatments, outcomes, and complications of treatments were collected. Results: Among the 204 ARM patients treated, 150 patients were screened for OSD, involving 150 lumbosacral X-ray, 65 U/S, and 39 MRI. The prevalence of OSD (n=33) in all types of ARM was 16.2%. The higher types of ARM had higher prevalence of OSD, except for vestibular fistula (20.5%). The prevalence of OSD in cloaca malformation, rectobladder neck fistula, rectoprostatic urethral fistula, rectobulbar urethral fistula, and perineal fistula were 28.6%, 33.3%, 16.7%, 12.5%, and 9.8%, respectively. Lumbosacral X-ray had a sensitivity of 51.7% and was not a good screening method. Sixteen of 65 U/S revealed OSD (24.6%). Tethered cord and syringomyelia were noted in nine and seven, respectively. Spinal MRI (n=39) revealed 27 OSD (69.2%) comprising 16 tethered cords, 12 spinal lipoma, and 10 syringomyelia. ARM associated with KUB anomalies had a statistically significant correlation with OSD. In 33 OSD, 17 patients (51.1%) were operated on. Fourteen received untethering spinal cord, while five had intradural lipoma excised. Conclusion: Patients with ARM had a high prevalence of OSD and should be screened for. U/S is the first-line method. MRI is strongly recommended in cloaca malformation, rectobladder neck fistula, rectoprostatic urethral fistula, vestibular fistula, and all ARM associated with KUB anomalies. Other types of ARM should be screened by MRI if feasible. Keywords: Spinal dysraphism, Tethered cord, Anorectal malformation

Acute cholestasis as uncommon onset of Kawasaki disease: a case report

BackgroundKawasaki disease (KD) or mucocutaneous lymph node syndrome is a vasculitis that mostly occurs in young children. Adult-onset KD (AKD) is rare and often misdiagnosed. Here we report a rare case of KD with cholestasis as principal symptom.Case presentationA 43-year-old caucasian man was admitted to our hospital for high fever, lack of appetite related to nausea and vomiting, headache and significant malaise. Physical examination highlighted fever, increasing jaundice, bilateral laterocervical lymph nodes, erythema of the palms, and strikingly red lips and conjunctiva. The clinical course was complicated by arterial hypotension, tachycardia, decreasing haemoglobin, increasing acute phase reactants tests, and multiorgan failure. Due to cardiovascular instability the patient was admitted to the local Intensive Care Unit. Chest X-ray, abdominal ultrasound, chest and abdominal CT and Colangio Magnetic Resonance were normal. Jaundice was investigated and infections, autoimmune diseases or drugs adverse reactions, were excluded. Also coronary artery computed tomography was carried out excluding coronary artery aneurysms. Broad-spectrum antibiotics were not effective. After exclusion other possible conditions, diagnosis of KD was set. He was treated with high doses of corticosteroids and acetylsalicylic acid and clinical conditions as well as laboratory exams improved.ConclusionsThis report dealing with an adult onset of atypical KD may be of benefit to physicians of various specialties, including primary care doctors, hospital internists, intensivists and gastroenterologists due to its peculiarities. It demonstrates that a case of prolonged fever unresponsive to antibiotics and related to cholestatic jaundice, oedema or erythema of the extremity associated with desquamation of feet and hands, and red eyes, may suggest atypical form of KD.

Multidetector spiral computed tomography–venography in outpatient phlebological practice

Duplex ultrasound scanning (DUS) and magnetic resonance imaging are sometimes insufficient to meet our clinical needs due to specifics of given pathology and intrinsic technical limitations of these methods. This study aims to assess the need for multispiral computed tomography–venography (CT-venography) and to evaluate its diagnostic capabilities for various disorders in primary ambulatory patients in phlebology practice.Material and Methods. From January, 2017 to December,2019, a total of 10,112 patients sought initial consultation of a phlebologist. Upon examination, the physician assigned patients to one of the proposed categories using dedicated software. Analysis of these categories demonstrated the following pattern of morbidity: 2,167 patients (21.4%) had chronic venous disorders of class С0S-1 (CEAP classification); 4,460 patients (44.1%) had varicose veins of class C2-3 (CEAP classification); 351 patients (3.5%) had varicose veins of class C4-6; 570 patients (5.6%) had other diseases including post-thrombotic syndrome, acute thrombosis, thrombophlebitis, and venous malformations; and 2,564 patients (25.4%) were suffering from non-venous disorders. DUS was performed in all cases.Results. The study demonstrated that 260 patients required CT-venography constituting 2.6% of the total number of patients who came to the clinic in the indicated period. The direct venography with contrast medium injection through the peripheral veins was used in 156 cases (60%). Patients did not have any significant complications, such as acute kidney injury or worsening of chronic renal failure, severe allergic reactions to the contrast agent, or problems with the puncture site of peripheral veins.Conclusions: 1) CT-venography allowed to achieve the accurate three-dimensional imaging of the venous system, providing, in some cases, the necessary information for finding solutions on optimal management. 2) The need for CT-venography may occur in 2.6% of patients in ambulatory phlebology practice. 3) CT-venography is useful for diagnosing angiodysplasias, postthrombotic and non-thrombotic lesions, complicated varicose veins, especially in recurrence, and in some cases of acute deep vein thrombosis. 4) DUS is mandatory for hemodynamic assessment in all patients before CT-venography.

Magnetic resonance imaging changes of brain injured survivors of multiple pregnancy complicated by single intrauterine fetal demise

Background. Multiple pregnancy has increased risks for complications. The incidence of fetal anomalies in multiple pregnancies is also significantly higher than in single pregnancies. The syndrome of death of one fetus in multiple pregnancies is often combined with an increase in perinatal morbidity and mortality of second fetuses. Objective. To investigate and categorize the range of the surviving fetal brain damage by prenatal magnetic resonance imaging in case of single intrauterine fetal death of monochorionic twin. Design and methods. Seventeen patients with a monochorionic multiple pregnancy which complicated by single intrauterine fetal demise were included in retrospective study. All cotwins underwent ultrasound neurosonography and magnetic resonance imaging. Results. The were no structural pathological changes in 8 cases (47,1 %), while 4 (23,5 %) had only isolated moderate ventriculomegaly. In 5 cases (29,4 %) surviving fetuses from monochorionic diam-niotic twins had structural and morphological brain abnormalities. Conclusion. Brain injuries of the surviving co-twin after single intrauterine fetal demise in monochorionic pregnancy are mostly ischemic and manifest as periventricular leukomalacia in combination with ventriculomegaly.

Anabolic steroid-induced myositis and osteitis. Case report through a radiologic approach

Introduction: Myositis is a rare complication of extra-articular anabolic steroid injections, while osteitis has not been reported as an adverse effect from this cause. This case report provides information about imaging findings of these two entities.Case presentation: A 37-year-old male, bodybuilder, presented pain and edema in the left gluteal region, associated with functional limitation, 5 days after receiving an intramuscular anabolic steroid injection (stanozolol). The man underwent an ultrasound scan and magnetic resonance imaging of the pelvis with contrast, which allowed making the diagnosis of myositis of the left gluteus maximus and osteitis of the iliac bone. The patient was treated with piperacillin-tazobactam and vancomycin for 10 days, without complications. No surgical management was required.Conclusion: Myositis is a rare complication of anabolic steroid injections and the pathophysiological mechanism of this substance is unknown. Osteitis, on the other hand, is an even rarer complication and, to the best of our knowledge, this isthe first known case associated with this cause. Given the findings, the myositis reported herein has an infectious nature; however, further studies are required to demonstrate the actual causal association.