Underwent Computed Tomography Examination Research Articles

Medication of the cervical spinal nerves for the treatment of equine cervical radiculopathy

SummaryBackgroundSeveral perineural injection techniques have been described to medicate the cervical spinal nerves of horses with suspected radiculopathy due to lesions at the intervertebral foramen (IVF). The technique and outcome have never been described in live, standing horses with suspected clinical disease.ObjectivesTo assess the safety and efficacy of medication of the ventral rami of the cervical spinal nerves (VRCSNs) for the treatment of cervical radiculopathy in horses.Study designCase series.MethodsHorses that underwent ultrasound‐guided perineural injection of the VRCSNs following radiographic and/or computed tomography (CT) evaluation of the cervical spine were included. Perineural injection with corticosteroids was performed using a standardised technique under ultrasound guidance as previously described. Outcome data were collected by clinical record review and unstructured follow‐up telephone conversations.ResultsForty‐seven injections of the VRCSNs were performed in 12 horses with only two self‐limiting adverse reactions noted. All horses that underwent CT examination had at least one site of IVF narrowing with the foramina at the C6/C7 articulation most frequently affected. Nine horses improved following medication of the VRCSNs with eight returning to their previous levels of exercise. All seven horses that underwent CT of the cervical spine had an initial improvement in clinical signs. Six horses were in full work and still performing at their intended level of exercise at a median of 21.5 months post injection.Main limitationsLack of definitive diagnosis of spinal nerve compression without histopathology of the spinal nerves which is not possible in the live horse.ConclusionsMedication of the VRCSNs is a safe treatment option which may provide benefit to horses with suspected spinal nerve compression but should be reserved for horses that have undergone a detailed clinical examination and CT evaluation of the cervical spine.

Computed tomography of the equine caudal spine and pelvis: Technique, image quality and anatomical variation in 56 clinical cases (2018-2023).

Cross-sectional imaging improves the diagnostic accuracy of complex anatomical regions. Computed tomography (CT) of the pelvis and caudal spine in a large group of live horses and ponies has not been previously reported. To describe the procedure for acquiring CT images of horses' caudal spine/pelvis under general anaesthesia (GA) and to detail the image quality, artefacts and anatomical variations in this region. Retrospective case series. Horses with CT of the caudal spine/pelvis were included. Horses under 6 months and CT examination performed post-mortem were excluded. Protocols, image quality, region of interest, anatomical features and morbidities were analysed. Fifty-six horses (8 months to 20 years, 85-680 kg) met the inclusion criteria. GA ranged from 10 to 60 min (mean: 30, median: 32). There were no adverse events recorded in any of the horses associated with the procedure. Images of all horses were considered of diagnostic quality. Anatomical variations were common and included the location of diverging (widest) interspinous space, the presence of spina bifida in the lumbar and sacral spine, the shape of the last lumbar vertebra and the location of intertransverse joints in terms of where they were present and the degree of fusion/modelling. Not all horses underwent CT examination of the same regions, the upper size limit of horses is unknown and will vary depending on bore size and table infrastructure. Image noise, particularly in large horses and beam hardening artefacts from hardware and pelvis degraded image quality. Images were of insufficient quality in large horses for soft tissue interpretation. CT of the caudal spine and pelvis in live horses with wide-bore CT machines and modified patient infrastructure was safe and produced diagnostic images.

Foreign body-intestinal canal angle guides management of ingested foreign bodies in the lower gastrointestinal tract.

Determining whether prompt surgery is required for patient with ingested foreign bodies is clinically important. To evaluate the potential value of computed tomography (CT) in guiding the selection of surgical treatment for patients with ingested foreign bodies in the lower gastrointestinal tract. Between January 2014 and December 2023, we analyzed the data of 58 patients (median age: 65.4years; range, 31-96years) with ingested foreign bodies in the lower gastrointestinal tract who underwent CT examinations. Patients were treated either conservatively (35 cases) or surgically (23 cases). The angle between the long axis of the foreign body and the intestinal canal (FB-IC angle) was measured. CT findings and clinical variables were evaluated to identify potential indicators for surgical treatment through univariate and multivariate logistic regression analyses. Univariate analysis revealed the FB-IC angle (P = 0.002), presence of free peritoneal gas (P = 0.002), white blood cell count (P = 0.018), and neutrophil count (P = 0.007) as significant factors associated with surgical treatment. Multivariate analysis demonstrated that the FB-IC angle (odds ratio, 1.033; P = 0.045) and the presence of free peritoneal gas (odds ratio, 41.335; P = 0.002) are independent indicators for surgical management. The FB-IC angle showed an area under the receiver operating characteristic curve of 0.755, with a cutoff value of 51.25 degrees. The FB-IC angle and presence of free peritoneal gas serve as potential predictive imaging markers for surgical intervention.

Deep learning-based automatic pipeline system for predicting lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma using computed tomography: A multi-center study.

The assessment of lateral lymph node metastasis (LLNM) in patients with papillary thyroid carcinoma (PTC) holds great significance. This study aims to develop and evaluate a deep learning-based automatic pipeline system (DLAPS) for diagnosing LLNM in PTC using computed tomography (CT). A total of 1,266 lateral lymph nodes (LLNs) from 519 PTC patients who underwent CT examinations from January 2019 to November 2022 were included and divided into training and validation set, internal test set, pooled external test set, and prospective test set. The DLAPS consists of an auto-segmentation network based on RefineNet model and a classification network based on ensemble model (ResNet, Xception, and DenseNet). The performance of the DLAPS was compared with that of manually segmented DL models, the clinical model, and Node Reporting and Data System (Node-RADS). The improvement of radiologists' diagnostic performance under the DLAPS-assisted strategy was explored. In addition, bulk RNA-sequencing was conducted based on 12 LLNs to reveal the underlying biological basis of the DLAPS. The DLAPS yielded good performance with area under the receiver operating characteristic curve (AUC) of 0.872, 0.910, and 0.822 in the internal, pooled external, and prospective test sets, respectively. The DLAPS significantly outperformed clinical models (AUC 0.731, P<0.001) and Node-RADS (AUC 0.602, P<0.001) in the internal test set. Moreover, the performance of the DLAPS was comparable to that of the manually segmented deep learning (DL) model with AUCs ranging 0.814-0.901 in three test sets. Furthermore, the DLAPS-assisted strategy improved the performance of radiologists and enhanced inter-observer consistency. In clinical situations, the rate of unnecessary LLN dissection decreased from 33.33% to 7.32%. Furthermore, the DLAPS was associated with the cell-cell conjunction in the microenvironment. Using CT images from PTC patients, the DLAPS could effectively segment and classify LLNs non-invasively, and this system had a good generalization ability and clinical applicability.

The predictive role of computed tomography with oral contrast in the successful management of adhesive small bowel obstruction

Background Adhesive small bowel obstruction (SBO) stands out as one of the most frequent and clinically significant complications following abdominal surgery. The present study aimed to investigate the role of computed tomography (CT) with oral contrast media in guiding treatment and predicting the success of conservative treatment in patients presenting with adhesive SBO. Patients and methods This is a prospective study that was conducted on adult patients who were clinically and radiologically proven to have SBO and had a history of at least one previous abdominal surgical intervention. The included patients underwent CT examination of the abdomen and pelvis with oral contrast. Patients who had the oral contrast seen reaching the right colon were admitted and completed conservative management. Surgical intervention was indicated in patients who showed failure of treatment with oral contrast. Results This study included 70 patients, of whom 29 (41.4%) had contrast in the right colon during CT examination after the first oral contrast administration. The remaining patients (n=41, 58.6%) indicated a second oral contrast CT study after 24 h. Sixteen (22.9%) patients had nonresolving obstructions and underwent surgical intervention. Overall, 52 (74.3%) patients were successfully treated with oral contrast studies, with no subsequent morbidity. Significant predictors for surgical intervention were a history of more than one previous surgical intervention (OR=6.08, CI: 1.75–21.14, P=0.005) and nonpassage of contrast to the right colon in the CT study (OR=0.099, CI: 0.029–0.341, P&lt;0.001). Conclusion This study highlights the clinical relevance of CT with oral contrast studies in guiding management. A history of multiple previous surgeries and nonpassage of the oral contrast to the right colon emerged as a significant predictor for surgical intervention.

Glenoid segmentation from computed tomography scans based on a 2-stage deep learning model for glenoid bone loss evaluation.

The best-fitting circle drawn by computed tomography (CT) reconstruction of the en face view of the glenoid bone to measure the bone defect is widely used in clinical application. However, there are still some limitations in practical application, which can prevent the achievement of accurate measurements. This study aimed to accurately and automatically segment the glenoid from CT scans based on a 2-stage deep learning model and to quantitatively measure the glenoid bone defect. Patients who were referred to our institution between June 2018 and February 2022 were retrospectively reviewed. The dislocation group consisted of 237 patients with a history of ≥2 unilateral shoulder dislocations within 2 years. The control group consisted of 248 individuals with no history of shoulder dislocation, shoulder developmental deformity, or other disease that may lead to abnormal morphology of the glenoid. All patients underwent CT examination with a 1-mm slice thickness and a 1-mm increment, including complete imaging of the bilateral glenoid. A residual neural network (ResNet) location model and a U-Net bone segmentation model were constructed to develop an automated segmentation model for the glenoid from CT scans. The data set was randomly divided into training (201 of 248) and test (47 of 248) data sets of control-group data and training (190 of 237) and test (47 of 237) data sets of dislocation-group data. The accuracy of the stage 1 (glenoid location) model, the mean intersection-over-union value of the stage 2 (glenoid segmentation) model, and the glenoid volume error were used to assess the performance of the model. The R2 value and Lin concordance correlation coefficient were used to assess the correlation between the prediction and the gold standard. A total of 73,805 images were obtained after the labeling process, and each image was composed of CT images of the glenoid and its corresponding mask. The average overall accuracy of stage 1 was 99.28%; the average mean intersection-over-union value of stage 2 was 0.96. The average glenoid volume error between the predicted and true values was 9.33%. The R2 values of the predicted and true values of glenoid volume and glenoid bone loss (GBL) were 0.87 and 0.91, respectively. The Lin concordance correlation coefficient value of the predicted and true values of glenoid volume and GBL were 0.93 and 0.95, respectively. The 2-stage model in this study showed a good performance in glenoid bone segmentation from CT scans and could quantitatively measure GBL, providing a data reference for subsequent clinical treatment.

Risk of hematological malignancies from CT radiation exposure in children, adolescents and young adults

Over one million European children undergo computed tomography (CT) scans annually. Although moderate- to high-dose ionizing radiation exposure is an established risk factor for hematological malignancies, risks at CT examination dose levels remain uncertain. Here we followed up a multinational cohort (EPI-CT) of 948,174 individuals who underwent CT examinations before age 22 years in nine European countries. Radiation doses to the active bone marrow were estimated on the basis of body part scanned, patient characteristics, time period and inferred CT technical parameters. We found an association between cumulative dose and risk of all hematological malignancies, with an excess relative risk of 1.96 (95% confidence interval 1.10 to 3.12) per 100 mGy (790 cases). Similar estimates were obtained for lymphoid and myeloid malignancies. Results suggest that for every 10,000 children examined today (mean dose 8 mGy), 1–2 persons are expected to develop a hematological malignancy attributable to radiation exposure in the subsequent 12 years. Our results strengthen the body of evidence of increased cancer risk at low radiation doses and highlight the need for continued justification of pediatric CT examinations and optimization of doses.

Retrospective study of an incisional hernia after laparoscopic colectomy for colorectal cancer

PurposeThis study aimed to examine the incidence of incisional hernia (IH) in elective laparoscopic colorectal surgery (LC) using regulated computed tomography (CT) images at intervals every 6 months.MethodsWe retrospectively examined the diagnosis of IH in patients who underwent LC for colorectal cancer at Kansai Medical University Hospital from January 2014 to August 2018. The diagnosis of IH was defined as loss of continuity of the fascia in the axial CT images.Results470 patients were included in the analysis. IH was diagnosed in 47 cases at 1 year after LC. The IH size was 7.8 cm2 [1.3–55.6]. In total, 38 patients with IH underwent CT examination 6 months after LC, and 37 were already diagnosed with IH. The IH size was 4.1 cm2 [0–58.9]. The IH size increased in 17 cases between 6 months and 1 year postoperatively, and in 1 case, a new IH occurred. 47%(18/38) of them continued to grow until 1 year after LC. A multivariate analysis was performed on the risk of IH occurrence. SSI was most significantly associated with IH occurrence (OR:5.28 [2.14–13.05], p = 0.0003).ConclusionIH occurred in 10% and 7.9% at 1 year and 6 months after LC. By examining CT images taken for the postoperative surveillance of colorectal cancer, we were able to investigate the occurrence of IH in detail.

The influence of early adoption of nonenhanced computed tomography on management of patients with pyogenic liver abscess.

A pyogenic liver abscess (PLA) is an infectious disease with high in-hospital mortality. It has no specific symptoms and is difficult to be diagnosed early in the emergency department. Ultrasound is commonly used to detect PLA lesions of PLA, but its sensitivity can be affected by lesion size, location, and clinician experience. Therefore, early diagnosis and prompt treatment (especially abscess drainage) are crucial for better patient outcomes and should be prioritized by clinical physicians. We conducted a retrospective study to compare the effect of early and late (i.e., receiving CT scanning within 48 h and >48 h after admission) adoption of nonenhanced computed tomography (CT) scanning regarding the hospitalization days and interval between admission and drainage of patients with PLA. This study included 76 hospitalized patients with PLA in the Department of Digestive Disease of Xiamen Chang Gung Hospital in China who underwent CT examinations from 2014 to 2021. We conducted CT scans on 56 patients within 48 h of admission and on 20 patients more than 48 h after admission. The early CT group had a significantly shorter hospitalization length compared with the late CT group (15.0 days vs. 20.5 days; P = 0.035). Besides, the median time to initiate drainage after admission was also significantly shorter in the early CT group than in the late CT group (1.0 days vs. 4.5 days; P < 0.001). Early CT scanning within 48 h of admission may aid in early PLA diagnosis and benefit disease recovery, as revealed by our findings.

Predictive factors and diagnostic significance of CT findings for anastomotic leak after gastric cancer surgery: A retrospective analysis

AbstractBackgroundAnastomotic leak following radical gastrectomy poses a significant risk to patients. Despite previous studies, effective methods for diagnosing anastomotic leaks after gastric cancer surgery remain elusive. In this study, we aimed to assess the overall burden of anastomotic leaks and investigate diagnostic factors, particularly radiological signs on postoperative computed tomography (CT), that may facilitate early detection.MethodsWe included a total of 70 gastric cancer patients who underwent curative gastrectomy and underwent CT examination post‐surgery. Among them, 35 patients with anastomotic leak were matched with 35 patients without anastomotic leak. We compared the rates of various types of postoperative complications between the two groups and conducted univariate and multivariate analyses to identify predictive variables for postoperative diagnosis.ResultsPatients with anastomotic leaks experienced significantly longer postoperative hospital stays and higher overall expenditures (p &lt; 0.001). Logistic regression analysis revealed that extraluminal gas at the anastomosis site, fever (T ≥ 38.5°C), and neutrophilia (NE ≥ 78%) on postoperative days 4–7 were independent diagnostic factors for anastomotic leaks (p &lt; 0.05).ConclusionsThe diagnostic factors identified in this study offer valuable insights into early detection of anastomotic leaks. We recommend early CT examination for patients exhibiting consistent fever and neutrophilia between postoperative days 4 and 7 following gastric cancer surgery.

CT Radiomics-Based Nomogram for Predicting the Lateral Neck Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Prospective Multicenter Study

This study is based on multicenter cohorts and aims to utilize computed tomography (CT) images to construct a radiomics nomogram for predicting the lateral neck lymph node (LNLN) metastasis in the papillary thyroid carcinoma (PTC) and further explore the biological basis under its prediction. In the multicenter study, 1213 lymph nodes from 409 patients with PTC who underwent CT examinations and received open surgery and lateral neck dissection were included. A prospective test cohort was used in validating the model. Radiomics features were extracted from the CT images of each patient's LNLNs. Selectkbest, maximum relevance and minimum redundancy and the least absolute shrinkage and selection operator (LASSO) algorithm were used in reducing the dimensionality of radiomics features in the training cohort. Then, a radiomics signature (Rad-score) was calculated as the sum of each feature multiplied by the nonzero coefficient from LASSO. A nomogram was generated using the clinical risk factors of the patients and Rad-score. The nomograms' performance was analyzed in terms of accuracy, sensitivity, specificity, confusion matrix, receiver operating characteristic curves, and areas under the receiver operating characteristic curve (AUCs). The clinical usefulness of the nomogram was evaluated by decision curve analysis. Moreover, three radiologists with different working experiences and nomogram were compared to one another. Whole transcriptomics sequencing was performed in 14 tumor samples; the correlation of biological functions and high and low LNLN samples predicted by the nomogram was further investigated. A total of 29 radiomics features were used in constructing the Rad-score. Rad-score and clinical risk factors (age, tumor diameter, location and number of suspected tumors) compose the nomogram. The nomogram exhibited good discrimination performance of the nomogram for predicting LNLN metastasis in the training cohort (AUC, 0.866), internal test cohort (0.845), external test cohort (0.725), and prospective test cohort (0.808) and showed diagnostic capability comparable to senior radiologists, significantly outperforming junior radiologists (p<0.05). Functional enrichment analysis suggested that the nomogram can reflect the ribosome-related structures of cytoplasmic translation in patients with PTC. Our radiomics nomogram provides a noninvasive method that incorporates radiomics features and clinical risk factors for predicting LNLN metastasis in patients with PTC.

Morphological classification and clinical significance of medial malleolus based on computed tomography three-dimensional reconstruction.

Internal malleolus fractures and postoperative functional limitations are serious complications of deltoid ligament repair, reconstruction, while studies on conducting beak. Anatomical structure classification of medial malleolus at home and abroad is reported rarely. Hence, this morphological study is mainly designed to investigate the anatomical morphological classification and clinical significance of medial malleolus based on computed tomography (CT) three-dimensional reconstruction. From October 2018 to January 2021, 373 patients who underwent CT examination of malleolus medialis joint in the Jiang'an Hospital of Traditional Chinese Medicine were observed. The medial malleolus was observed and classified; then, geometric parameters were measured according to different medial malleolus types. According to the results of 373 cases, medial malleolus can be divided into four types: omega type (66%), radical sign type (16%), inverted triangle type (14%), and wave type (4%). There are four main shapes: omega, inverted triangle, radical sign, and wave in the medial malleolus of all normal ankles. The measurement of medial malleolus parameters according to medial malleolus in different shapes was of importance to guide smooth operation of medial malleolus fixation and deltoid ligament reconstruction and epidemiological.

The use of artificial intelligence and deep learning reconstruction in urological computed tomography: Dose reduction at ghost level

Abstract Objective: The objective of the study is to demonstrate that with the use of artificial intelligence (AI) in computed tomography (CT), radiation doses of CT kidney-ureter-bladder (KUB) and CT urogram (CTU) can be reduced to less than that of X-ray KUB and CT KUB, respectively, while maintaining the good image quality. Materials and Methods: We reviewed all CT KUBs (n = 121) performed in September 2019 and all CTUs (n = 74) performed in December 2019 at our institution. The dose length product (DLP) of all CT KUBs and each individual phase of CTU were recorded. DLP of each scan done with new scanner (Canon Aquilion One Genesis with AiCE [CAOG]) which uses AI and deep learning reconstruction (DLR) were compared against traditional non-AI scanner (GE OPTIMA 660 [GEO-660]). We also compared DLPs of both scanners against the United Kingdom, National Diagnostic Reference Levels (NDRL) for CT. Results: One hundred and twenty-one patient’s CT KUBs and 74 patient’s CTUs were reviewed. For CT KUB group, the mean DLP of 81/121 scans done using AI/DLR scanner (CAOG) was 77.8 mGy cm (1.16 mSv), while the mean DLP of 40/121 CT KUB done with GEO-660 was 317.1 mGy cm (4.75 mSv). For CTU group, the mean DLP for 46/74 scans done using AI/DLR scanner (CAOG) was 401.9 mGy cm (6 mSv), compared to mean DLP of 1352.6 mGy cm (20.2 mSv) from GEO-660. Conclusion: We propose that CT scanners using AI/DLR method have the potential of reducing radiation doses of CT KUB and CTU to such an extent that it heralds the extinction of plain film XR KUB for follow-up of urinary tract stones. To the best of our knowledge, this is the first study comparing CT KUB and CTU doses from new scanners utilizing AI/DLR technology with traditional scanners using hybrid iterative reconstruction technology. Moreover, we have shown that this technology can markedly reduce the cumulative radiation burden in all urological patients undergoing CT examinations, whether this is CT KUB or CTU.

Anatomic characteristics of primary acquired nasolacrimal duct obstruction: a comparative computed tomography study.

Studies of local anatomic characteristics of primary acquired nasolacrimal duct obstruction (PANDO) are important for understanding the etiology of PANDO and guiding surgical treatment. The purpose of this study was to review computed tomography (CT) scans to identify the anatomic differences in the obstructed and unobstructed sides of PANDO patients as well as in control patients in a Chinese population. In this retrospective comparative observational study, the CT scans of 126 PANDO patients were reviewed. A total of 76 patients who underwent CT examinations for eyeball atrophy or an intraocular foreign body but had a healthy lacrimal drainage system and orbit structure were enrolled as controls. The nasolacrimal canal (NLC) widths, lacrimal sac fossa structures, and nasal abnormalities in the obstructed and unobstructed sides in patients and both sides in controls were evaluated. Both obstructed and unobstructed sides in PANDO patients showed significant differences to the sides of controls in NLC width (obstructed: 3.91±0.90 mm, unobstructed: 3.86±0.83 mm, control: 4.31±0.95 mm; obstructed and control: P<0.01, unobstructed and control: P<0.01, respectively), ethmoid sinusitis (26%, 28%, 16%; P=0.03 and P=0.03, respectively), osteomeatal complex opacification (18%, 14%, 7%; P<0.01 and P=0.04, respectively), and agger nasi cell opacification (22%, 20%, 9%; P<0.01 and P<0.01, respectively). However, although no significant differences (all P>0.05) were found between the obstructed and unobstructed sides of unilateral PANDO patients in these characteristics, there were correlations (r=0.714, 0.209, 0.376, and 0.112; P<0.01, P=0.03, P<0.01, P=0.24, respectively). We also found expanded lacrimal sac fossa width (6.45±1.01 mm) and decreased frontal process proportion (45.9%±15.4%) only in the obstructed sides of PANDO patients compared to the lacrimal sac fossa width in controls (6.08±1.16 mm, P<0.01) and the frontal process proportion in controls (49.9%±15.4%, P=0.03). There was no difference in the positional relationship of the uncinate process (UP) with the lacrimal fossa between patients and controls. A narrow NLC and nasal inflammation are associated with PANDO, while an expanded lacrimal sac fossa and a decreased frontal process proportion could be pathological changes. The healthy sides of unilateral PANDO patients might have a high risk of developing an obstruction. We also found an increased probability of the UP overlapping the lower lacrimal sac fossa in an Asian population compared to the published European data.

Multimodal Imaging in Rhinoorbitocerebral Mucormycosis Associated with Type 2 Diabetes After COVID-19.

This case series analyzed the appropriateness of computed tomography (CT) and magnetic resonance imaging (MRI) for visualization of rhinoorbitocerebral mucormycosis (ROCM) patterns associated with type 2 diabetes (T2D) post-recovery from coronavirus disease 2019 (COVID-19). The study included 24 patients with invasive ROCM after having recovered from COVID-19. All patients underwent CT examinations and microbiological and histological verification; 5 patients underwent MRI. The CT and MRI patterns noted in our patients revealed involvement of skull orbits, paranasal sinuses, large arteries, and optic nerves, with intracranial spread and involvement of the cranial base bones. Using brain scan protocol for CT provided better soft-tissue resolution. We found that extending the MRI protocol by T2-sequence with fat suppression or STIR was better for periantral fat and muscle evaluations. Computed tomography of the paranasal sinuses is the method of choice for suspected fungal infections, particularly mucormycosis. However, MRI is recommended if there is suspicion of orbital, vascular, or intracranial complications, including cavernous sinus extension. The combination of both CT and MRI enables determination of soft tissue invasion and bony destruction, thereby facilitating the choice of an optimal ROCM treatment strategy. Invasive fungal infections are extremely rare in Europe; most of the related data are provided from India and Middle Eastern or African nations. Hence, this study is notable in its use of only diagnosed ROCM cases in Russia.

Thorax radiotherapy using 18F-positron emission tomography/computed tomography-guided precision radiotherapy is a prognostic factor for survival in patients with extracranial oligometastatic non-small cell lung cancer:A two-center propensity score-matched analysis.

This retrospective study compared positron emission tomography (PET)/computed tomography (CT) and CT in the treatment of extracranial oligometastatic non-small-cell lung cancer (NSCLC) and explored the impact of thorax radiotherapy (TRT) on patient survival. We reviewed the medical records of Chinese patients with stage IV extracranial oligometastatic NSCLC who underwent PET/CT or CT at two centers. Propensity score matching (PSM) was used to control differences in patient characteristics between the maintenance chemotherapy alone and TRT plus maintenance chemotherapy groups. We analyzed 192 eligible patients. The median survival time was better in patients who received PET/CT than in those who only received CT (n = 192, 16 months vs. 6 months, p<0.001). Subgroup analysis showed the median survival time was significantly longer in the TRT plus maintenance group than in the chemotherapy alone group in patients who underwent PET/CT examinations (n = 94, 25 months vs. 11 months, p<0.001). However, there was no statistical difference in survival between both groups in patients who underwent CT examinations (n = 98, 8 months vs. 5 months, p = 0.180). A multifactorial analysis revealed a more favorable prognosis in patients who underwent PET/CT evaluation (HR: 0.343, 95% CI: 0.250-0.471, p <0.001) and TRT (HR: 0.624, 95% CI: 0.464-0.840, p = 0.002), than in those who did not. PSM was consistent with these results. PET/CT-guided TRT is associated with improved clinical outcomes in patients with stage IV extracranial oligometastatic NSCLC.

Posterior wall blowout on computed tomography after anterior cruciate ligament reconstruction

BackgroundDuring anterior cruciate ligament (ACL) reconstruction, even when a posterior wall of the femoral bone tunnel is identified, computed tomography (CT) occasionally demonstrates a breach of the posterior femoral cortex of the femoral bone tunnel, i.e., posterior wall blowout, after ACL reconstruction (posterior wall blowout-like phenomenon). This study aimed to investigate the influence of the posterior wall blowout-like phenomenon on clinical outcomes after ACL reconstruction using hamstring tendon. MethodsA total of 105 patients who underwent CT examination two weeks after ACL reconstruction were enrolled. A cortical suspension device was used for femoral side fixation in all cases. Posterior wall was identified in all cases during the surgery. The side-to-side difference in anterior knee laxity, pivot shift test, Lysholm knee score, the International Knee Documentation Committee (IKDC) subjective form, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were evaluated one year after the surgery. A second CT examination was performed 6–12 months after the surgery, if a posterior wall blowout-like phenomenon was identified in the first CT examination. ResultsTwo weeks after the surgery, 16 of the 105 patients showed a posterior wall blowout-like phenomenon. Twelve of the 16 cases demonstrated a regenerated posterior femoral cortex of the femoral bone tunnel on their second CT images. There were no significant differences between the posterior wall blowout-like phenomenon group and the normal posterior wall group in terms of a side-to-side difference in anterior knee laxity (0.4 ± 1.5 mm and 0.1 ± 1.6 mm, respectively), pivot shift test, Lysholm knee score, IKDC score, and KOOS at one year after surgery. The length and diameter of the femoral bone tunnel were not significantly different between the two groups. ConclusionsPosterior wall blowout-like phenomenon after ACL reconstruction using a cortical suspension device did not negatively influence clinical outcomes. Level of evidenceIII – retrospective comparative clinical study.

Predicting Survival for Hepatic Arterial Infusion Chemotherapy of Unresectable Colorectal Liver Metastases: Radiomics Analysis of Pretreatment Computed Tomography.

ObjectiveHepatic arterial infusion chemotherapy (HAIC) is an effective treatment for advanced unresectable colorectal cancer liver metastases (CRLM). This study was conducted to predict the efficacy of HAIC in patients with unresectable CRLM by radiomics methods based on pretreatment computed tomography (CT) examinations and clinical data.Materials and MethodsA total of 63 patients were included in this study (41 in the training group and 22 in the validation group). All these patients underwent CT examination before HAIC. During the follow-up period, CT scans and laboratory examinations were performed regularly. Eighty-five radiological features were extracted from the regions of interest (ROIs) of CT images using the PyRadiomics program. The t-test and correlation were applied to select features. These features were analyzed using LASSO-Cox regression, and a linear model was developed to predict overall survival (OS).ResultsAfter reducing features by t-test and correlation test, seven features remained. After LASSO-Cox cross-validation, four features remained at λ = 0.232. They were gray level co-occurrence matrix (GLCM), gray level run length matrix (GLRLM), neighborhood gray tone difference matrix (NGTDM), and the location of the primary tumor. The C-index was 0.758 in the training group and 0.743 in the test group. Nomograms predicting 1-, 2-, and 3-year survival were established.ConclusionOur study demonstrates that a radiomics approach based on pretreatment CT texture analysis has the ability to predict early the outcome of HAIC in patients with advanced unresectable colorectal cancer with a high degree of accuracy and feasibility.

Retrospective analysis of dose delivered to the uterus during CT examination in pregnant women

PurposeThe purpose of this study was to analyze the dose to the uterus (UD) calculated for pregnant women per computed tomography (CT) acquisition and per CT examination in our Institution. Materials and methodsConsecutive pregnant women who underwent CT examination from June 2014 to February 2022 and for whom UD calculation was performed by a medical physicist were retrospectively included. UDs were computed per CT acquisition using the CT Expo 2.4 software and were summed up to obtain the total UD per CT examination. The CTDIvol and dose-length product (DLP) values were retrieved from the dose report and compared with those calculated by the software. ResultsA total of 256 pregnant women with a mean age of 29.4 ± 5.5 (SD) years (range: 18–48) at 24.5 ± 10.4 (SD) weeks of amenorrhea (range: 1–40) were included. UDs were computed for 339 CT acquisitions. The CTDIvol and DLP computed by the software were significantly greater than those retrieved from the dose reports (P < 0.05). The greatest UDs were reported for the abdomen-pelvis (10.93 ± 5.74 [SD] mGy; range: 1.2–24.1), chest-abdomen-pelvis (9.79 ± 7.09 [SD] mGy; range: 3.9–22.1), pelvis (18.50 ± 17.96 [SD] mGy; range: 5.8–31.2) and lumbar spine (10.24 ± 11.38 [SD] mGy; range: 2.3–29.6) CT examinations. The total UDs per CT examination were > 20 mGy for 10 pregnant women and the maximum total UD was 52.3 mGy. ConclusionGreatest UDs during CT examinations are observed when the pelvis is directly exposed to X-rays. With current dose levels and in optimized practices, UDs per CT acquisition and CT examination are always below 100 mGy. UD calculations cannot be performed for CT examinations that do not directly expose the pelvis (i.e., those < 1 mGy).

CT in the Differentiation of Gliomas from Brain Metastases: The Radiomics Analysis of the Peritumoral Zone.

Due to their similar imaging features, high-grade gliomas (HGGs) and solitary brain metastases (BMs) can be easily misclassified. The peritumoral zone (PZ) of HGGs develops neoplastic cell infiltration, while in BMs the PZ contains pure vasogenic edema. As the two PZs cannot be differentiated macroscopically, this study investigated whether computed tomography (CT)-based texture analysis (TA) of the PZ can reflect the histological difference between the two entities. Thirty-six patients with solitary brain tumors (HGGs, n = 17; BMs, n = 19) that underwent CT examinations were retrospectively included in this pilot study. TA of the PZ was analyzed using dedicated software (MaZda version 5). Univariate, multivariate, and receiver operating characteristics analyses were used to identify the best-suited parameters for distinguishing between the two groups. Seven texture parameters were able to differentiate between HGGs and BMs with variable sensitivity (56.67–96.67%) and specificity (69.23–100%) rates. Their combined ability successfully identified HGGs with 77.9–99.2% sensitivity and 75.3–100% specificity. In conclusion, the CT-based TA can be a useful tool for differentiating between primary and secondary malignancies. The TA features indicate a more heterogenous content of the HGGs’ PZ, possibly due to the local infiltration of neoplastic cells.