Nurse practitioners' use of diagnostic imaging: A scoping review.

AIM: To explore the nature and extent of peer-reviewed literature related to the use of diagnostic imaging by nurse practitioners (NPs) to inform future practice and research. BACKGROUND: Nurse practitioners undertake advanced assessment, diagnosis, and management of patients, including requesting and interpretation of diagnostic imaging. It is unclear what evidence exists related to the quality use of radiological investigations by NPs in recent years. DESIGN: A scoping review based on the steps suggested by the Joanna Briggs Institute. METHODS: A structured review of the databases Medline, CINAHL and Embase was undertaken using the keywords and MESH terms 'nurse practitioner', 'medical imaging', 'diagnostic imaging', 'scan' and 'radiography'. Only English language articles were included, and no date limit was applied. Database review was completed on 30 May 2021. RESULTS: Eight themes were identified-country and clinical context, requesting diagnostic imaging, performing diagnostic imaging, image-guided interventions, interpreting diagnostic imaging, training education and knowledge, impact on resource usage and comparison with medical practitioners. There were more studies across a greater breadth of clinical specialties and imaging modalities in the United States than in other countries. Nurse practitioner practice is frequently benchmarked against that of medical colleagues. There is a paucity of studies focusing on educational preparation and the lack of relevant university curricula for NPs around diagnostic imaging. CONCLUSION: There are significant gaps in the evidence outside of the United States across several of the identified themes. Further studies are needed to explore NP access to and use of diagnostic imaging and to understand the barriers and facilitators to this. RELEVANCE TO CLINICAL PRACTICE: Studies from four countries were included in this review. The evidence suggests that, where studied, nurse practitioners (NPs) can safely and appropriately request and interpret plain x-rays in the emergency and minor injuries setting. Further research is needed to evaluate the educational needs of NPs in relation to diagnostic imaging and their use of advanced imaging techniques, particularly outside of the United States. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Correlation of maximal nasal septal deviation with deviation at the maxillary insertion.

PURPOSE: It is unclear if septal deviation at the insertion points to the nasal cavity is associated with the overall septal deviation. This study aimed to assess septal deviation at the cribriform plate (CP) and maxillary crest (MC) using CT scans and to see if there was any correlation with overall septal deviation. METHODS: All consecutive CT sinus scans between January 2020 and December 2021 were retrospectively reviewed. Patients were excluded if they had a history of head, nasal or facial trauma, or any previous nasal surgical procedure. Angles between the septum and MC and the septum and CP as well as maximal angle of septal deviation (MSD) were measured. RESULTS: A total of 70 scans were included in the final analysis. The mean MSD was 8.14°. The mean septal deviation was 0.89° at the CP and 2.02° at the MC. The correlation coefficient between the deviation at the CP and MSD was 0.025 and between the deviation at the MC and MSD was 0.321. CONCLUSION: Our data reveal a positive correlation between septal deviation at the floor of the nose and overall septal deviation; this was not observed at the septal deviation at the roof. This could be explained due to the inherent tilt in the cribriform plate or by earlier ossification and fixation of the septum during its development at its insertion to the roof, thereby allowing further growth and potential for deviation of the lower part of the septum and its insertion to the floor.

The association between diabetes and abdominal aortic aneurysms in men: results of two Danish screening studies, a systematic review, and a meta-analysis of population-based screening studies.

BACKGROUND: A paradoxical protective effect of diabetes on the development and progression of abdominal aortic aneurysms (AAA) has been known for years. This study aimed to investigate whether the protective role of diabetes on AAAs has evolved over the years. METHODS: A cross-sectional study, a systematic review and meta-analysis. This study was based on two large, population-based, randomised screening trials of men aged 65-74; VIVA (2008-2011) and DANCAVAS (2014-2018), including measurement of the abdominal aorta by ultrasound or CT, respectively. Analyses were performed using multiple logistic regressions to estimate the odds ratios (ORs) for AAAs in men with diabetes compared to those not having diabetes. Moreover, a systematic review and meta-analysis of population-based screening studies of AAAs to visualise a potential change of the association between diabetes and AAAs. Studies reporting only on women or Asian populations were excluded. RESULTS: In VIVA, the prevalence of AAA was 3.3%, crude OR for AAA in men with diabetes 1.04 (95% confidence interval, CI, 0.80-1.34), and adjusted OR 0.64 (CI 0.48-0.84). In DANCAVAS, the prevalence of AAA was 4.2%, crude OR 1.44 (CI 1.11-1.87), and adjusted OR 0.78 (CI 0.59-1.04). Twenty-three studies were identified for the meta-analysis (N = 224 766). The overall crude OR was 0.90 (CI 0.77-1.05) before 2000 and 1.16 (CI 1.03-1.30) after 1999. The overall adjusted OR was 0.63 (CI 0.59-0.69) before 2000 and 0.69 (CI 0.57-0.84) after 1999. CONCLUSION: Both the crude and adjusted OR showed a statistically non-significant trend towards an increased risk of AAA by the presence of diabetes. If this represents an actual trend, it could be due to a change in the diabetes population. TRIAL REGISTRATION: DANCAVAS: Current Controlled Trials: ISRCTN12157806. VIVA: ClinicalTrials.gov NCT00662480.

Radiological analysis of orbital lymphoma histological subtypes.

PURPOSE: To characterise the radiological features of orbital lymphoma subtypes. METHODS: This was a multicentre, retrospective study to analyse radiological and clinical characteristics of orbital lymphoma by histological subtype across two sites within Australia and the United States. RESULTS: A total of eighty-eight patients were included. The most common subtypes were extranodal marginal zone lymphoma [EMZL] (48, 54.5%), follicular lymphoma [FL] (16, 18.2%), and diffuse large B-cell lymphoma [DLBCL] (15, 17.0%). Clinically, significant associations were found between DLBCL and vision change (p < .01), pain (p < .01), extraocular movement limitation (p = .01), and optic neuropathy (p = .01). Radiologically, there was no significant difference between the individual histopathological sub-groups with respect to bone destruction (p = .30), optic nerve involvement (p = .30) and diffuse appearance (p = .84). However, if categorised as either aggressive or indolent, aggressive lymphoma subtypes were significantly more likely to demonstrate globe indentation radiologically than indolent subtypes (Odds Ratio = 5.5, 95% CI: 1.3, 23.3; p = .02). CONCLUSIONS: DLBCL was significantly associated with vision change, pain, extraocular movement limitation and optic neuropathy clinically. Aggressive lymphoma subtypes were significantly more likely to demonstrate globe indentation radiologically. Otherwise, there were no significant differences between lymphoma subtypes and radiological findings on MRI and CT.

Alveolar ridge preservation with guided bone regeneration or socket seal technique. A randomised, single-blind controlled clinical trial.

OBJECTIVES: To compare radiographic bone changes, following alveolar ridge preservation (ARP) using Guided Bone Regeneration (GBR), a Socket Seal (SS) technique or unassisted socket healing (Control). MATERIAL AND METHODS: Patients requiring a single rooted tooth extraction in the anterior maxilla, were randomly allocated into: GBR, SS and Control groups (n= 14/). Cone Beam Computed Tomography (CBCT) images were recorded post-extraction and at 4 months, the mid-buccal and mid-palatal alveolar ridge heights (BARH/PARH) were measured. The alveolar ridge width, cross-sectional socket and alveolar-process area changes, implant placement feasibility, requirement for bone augmentation and post-surgical complications were also recorded. RESULTS: BARH and PARH was found to increase with the SS (0.65 mm ± 1.1/0.65 mm ± 1.42) techniques, stabilise with GBR (0.07 mm ± 0.83/0.86 mm ±1.37) and decrease in the Control (-0.52 mm ± 0.8/-0.43 mm ± 0.83). Statistically significance was found when comparing the GBR and SS BARH (p = .04/.005) and GBR PARH (p = .02) against the Control. GBR recorded the smallest reduction in alveolar ridge width (-2.17 mm ± 0.84), when compared to the Control (-2.3 mm ± 1.11) (p = .89). A mid-socket cross-sectional area reduction of 4% (-2.27 mm2  ± 11.89), 1% (-0.88 mm2  ± 15.48) and 13% (-6.93 mm2  ± 8.22) was found with GBR, SS and Control groups (GBR vs. Control p = .01). The equivalent alveolar process area reduction was 8% (-7.36 mm2  ± 10.45), 6% (-7 mm2  ± 18.97) and 11% (-11.32 mm2  ± 10.92). All groups supported implant placement, with bone dehiscence noted in 57% (n = 4), 64%(n = 7) and 85%(n = 12) of GBR, SS and Control cases (GBR vs. Control p = .03). GBR had a higher risk of swelling and mucosal colour change, with SS associated with graft sequestration and matrix breakdown. CONCLUSION: GBR ARP was found to be more effective at reducing radiographic bone dimensional changes following tooth extraction.

Magnetic resonance imaging accuracy before surgery in children with retropharyngeal abscesses.

AIMS: Retropharyngeal abscess (RPA) is a deep neck infection occurring in childhood. The gold standard technique for diagnosis is computerised tomography (CT) with a contrast medium. The aim of this study is to answer the question of whether magnetic resonance imaging (MRI) can be an alternative in diagnosing RPA and predicting pus drainage at surgery. METHODS: This is a retrospective study conducted at the paediatric emergency department of a tertiary level children hospital. The medical records of 31 children admitted to the Otorhinolaryngology and Paediatric ward, with a suspected diagnosis of RPA, were reviewed. The primary study outcome was the diagnostic accuracy of CT and MRI in predicting the amount of pus during surgery. RESULTS: Twenty-two patients (71%) underwent surgery. Among them, 18 had imaging before surgery. Eleven patients evaluated with CT scan underwent surgery: four had non-significant purulent drainage, three of them were reported to have a significant fluid collection (negative predictive value 66% and positive predictive value of 55%). Nine patients evaluated with MRI underwent surgery: four cases had non-significant purulent drainage, three of them showed a significant fluid collection at MRI (negative predictive value of 60%; positive predictive value of 56%). CONCLUSION: MRI and CT scans showed similar accuracy in predicting successful pus drainage during surgery; therefore, it could be a valid alternative in the diagnosis of RPA in children.

Liver nodules after the Fontan operation: role of the computerised tomography scan.

Currently, there is an increasing prevalence of liver nodules in patients following the Fontan operation. The appropriate non-invasive modalities have been applied to assess a diagnosis of Fontan-associated liver disease. The aims of this study were to determine the prevalence and associated factors for the presence of liver nodules using CT scan. A cross-sectional study of 34 patients older than 15 years of age was recruited. Ultrasound upper abdomen, ultrasound liver elastography, and CT scan of the upper abdomen were performed after the Fontan operation. The median age of patients was 20 years (range 14-36 years). The median age at the Fontan operation was 7 years (range 5-17 years) and the duration after the Fontan operation was 12 years (range 4-22 years). The prevalence of liver nodules was 62% as detected by CT scans. Hepatic vein pressure in patients with liver nodules was significantly higher than in those without liver nodules. Hepatic vein pressure above 13 mmHg was a factor associated with liver nodules. There was little agreement between the ultrasound of the upper abdomen and CT scan of the upper abdomen in the evaluation of liver nodules. Hepatic pressure was the only associated factor for the occurrence of liver nodules in patients following the Fontan operation. The prevalence of liver nodules was very high after the Fontan operation. The upper abdomen CT scan should be performed for the surveillance of liver nodules in every Fontan patient over the age of 15 years.

Integration of a vertebral fracture identification service into a fracture liaison service: a quality improvement project.

Integration of a vertebral fracture identification service into a Fracture Liaison Service is possible. Almost one-fifth of computerised tomography scans performed identified an individual with a fracture. This increase in workload needs to be considered by any FLS that wants to utilise such a service. INTRODUCTION: This service improvement project aimed to improve detection of incidental vertebral fractures on routine imaging. It embedded a vertebral fracture identification service (Optasia Medical, OM) on routine computerised tomography (CT) scans performed in this hospital as part of its Fracture Liaison Service (FLS). METHODS: The service was integrated into the hospital's CT workstream. Scans of patients aged ≥ 50 years for 3 months were prospectively retrieved, alongside their clinical history and the CT report. Fractures were identified via OM's machine learning algorithm and cross-checked by the OM radiologist. Fractures identified were then added as an addendum to the original CT report and the hospital FLS informed. The FLS made recommendations based on an agreed algorithm. RESULTS: In total, 4461 patients with CT scans were retrieved over the 3-month period of which 850 patients had vertebra fractures identified (19.1%). Only 49% had the fractures described on hospital radiology report. On average, 61 patients were identified each week with a median of two fractures. Thirty-six percent were identified by the FLS for further action and recommendations were made to either primary care or the community osteoporosis team within 3 months of fracture detection. Of the 64% not identified for further action, almost half was because the CT was part of cancer assessment or treatment. The remaining were due to a combination of only ≤ 2 mild fractures; already known to a bone health specialist; in the terminal stages of any chronic illness; significant dependency for activities of daily living; or a life expectancy of less than 12 months CONCLUSION: It was feasible to integrate a commercial vertebral fracture identification service into the daily working of a FLS. There was a significant increase in workload which needs to be considered by any future FLS planning to incorporate such a service into their clinical practice.

Twelve tips for interpreting abdominal CT scans.

BACKGROUND: Abdominal computerised tomography (CT) scans are a crucial tool in the diagnosis and management of the acute abdomen. Currently, medical students are not widely and extensively trained in the interpretation of abdominal scans. AIM: We aim to provide advice about interpreting abdominal CT scans. METHODS: We used the critical reflection of our experiences, both in clinical practice and in teaching, alongside advice from the literature to develop these tips. RESULTS: Twelve tips following the '4As, 3Bs, 2Cs and 1D' approach are presented to assist doctors and medical students with interpreting abdominal CT scans. CONCLUSION: The early identification of pathology on CT scans has been demonstrated to improve patient outcomes in certain cases, while a formal radiologist's report is awaited. Following a systematic approach, such as the one we presented here, may aid trainees in looking at abdominal CT scans.

Imaging features of primary breast sarcoma: A case report.

Primary breast sarcoma (PBS) is a rare group of non-epithelial tumours arising from connective tissue of the breast. We report the case of a 55-year-old female who presented with rapidly increasing mass in the left breast. The mammogram showed a large high density mass occupying the whole of the left breast, while Doppler ultrasound showed a mass of increased vascularity. Diagnosis was confirmed by histopathology of ultrasound-guided biopsy. Although there are no pathognomonic imaging features of PBS, presence of a solitary large mass showing rapid growth, with circumscribed or indistinct margins without axillary lymph node involvement should raise the suspicion of sarcoma and prompt biopsy to ensure early diagnosis and treatment; particularly considering the aggressive nature of these sarcomas.

A multi-label classification model for full slice brain computerised tomography image.

BACKGROUND: Screening of the brain computerised tomography (CT) images is a primary method currently used for initial detection of patients with brain trauma or other conditions. In recent years, deep learning technique has shown remarkable advantages in the clinical practice. Researchers have attempted to use deep learning methods to detect brain diseases from CT images. Methods often used to detect diseases choose images with visible lesions from full-slice brain CT scans, which need to be labelled by doctors. This is an inaccurate method because doctors detect brain disease from a full sequence scan of CT images and one patient may have multiple concurrent conditions in practice. The method cannot take into account the dependencies between the slices and the causal relationships among various brain diseases. Moreover, labelling images slice by slice spends much time and expense. Detecting multiple diseases from full slice brain CT images is, therefore, an important research subject with practical implications. RESULTS: In this paper, we propose a model called the slice dependencies learning model (SDLM). It learns image features from a series of variable length brain CT images and slice dependencies between different slices in a set of images to predict abnormalities. The model is necessary to only label the disease reflected in the full-slice brain scan. We use the CQ500 dataset to evaluate our proposed model, which contains 1194 full sets of CT scans from a total of 491 subjects. Each set of data from one subject contains scans with one to eight different slice thicknesses and various diseases that are captured in a range of 30 to 396 slices in a set. The evaluation results present that the precision is 67.57%, the recall is 61.04%, the F1 score is 0.6412, and the areas under the receiver operating characteristic curves (AUCs) is 0.8934. CONCLUSION: The proposed model is a new architecture that uses a full-slice brain CT scan for multi-label classification, unlike the traditional methods which only classify the brain images at the slice level. It has great potential for application to multi-label detection problems, especially with regard to the brain CT images.

Chest imaging in paediatric pulmonary TB.

Tuberculosis (TB) remains a significant cause of death from an infectious disease worldwide. The diagnosis of pulmonary TB in children is often challenging as children present with non-specific clinical symptoms, have difficulties providing specimens and have a low bacillary load. Radiological imaging supports a clinical diagnosis of pulmonary TB in children, can assess response to treatment and evaluate complications of TB. However, radiological signs on plain radiographs are often non-specific and inter-observer variability in the interpretation contribute to the difficulties in radiological interpretation and diagnosis. The goal of this review is to discuss the advantages and features of cross-sectional imaging such as ultrasound, Computed tomography (CT) and Magnetic resonance imaging (MRI) in diagnosing pulmonary TB (PTB) and its complications in children.

Repair of alveolar cleft bone defects by bone collagen particles combined with human umbilical cord mesenchymal stem cells in rabbit.

BACKGROUND: Alveolar cleft is a type of cleft lip and palate that seriously affects the physical and mental health of patients. In this study, a model of the alveolar cleft phenotype was established in rabbits to evaluate the effect of bone collagen particles combined with human umbilical cord mesenchymal stem cells (HUC-MSCs) on the repair of alveolar cleft bone defects. METHODS: A model of alveolar clefts in rabbits was established by removing the incisors on the left side of the upper jaw bone collagen particles combined with HUC-MSCs that were then implanted in the defect area. Blood biochemical analysis was performed 3 months after surgery. Skull tissues were harvested for gross observation, and micro-focus computerised tomography (micro-CT) analysis. Tissues were harvested for histological and immunohistochemical staining. The experiments were repeated 6 months after surgery. RESULTS: Bone collagen particles and HUC-MSCs showed good biocompatibility. Bone collagen particles combined with HUC-MSCs were markedly better at inducing bone repair and regeneration than bone collagen particles alone. CONCLUSIONS: Combining HUC-MSCs with bone collagen particles provides a simple, rapid and suitable method to fill a bone defect site and treat of alveolar cleft bone defects.

New horizons in iron deficiency anaemia in older adults.

Iron deficiency anaemia (IDA) is common in older adults and associated with a range of adverse outcomes. Differentiating iron deficiency from other causes of anaemia is important to ensure appropriate investigations and treatment. It is possible to make the diagnosis reliably using simple blood tests. Clinical evaluation and assessment are required to help determine the underlying cause and to initiate appropriate investigations. IDA in men and post-menopausal females is most commonly due to occult gastrointestinal blood loss until proven otherwise, although there is a spectrum of underlying causative pathologies. Investigation decisions should take account of the wishes of the patient and their competing comorbidities, individualising the approach. Management involves supplementation using oral or intravenous (IV) iron then consideration of treatment of the underlying cause of deficiency. Future research areas are outlined including the role of Hepcidin and serum soluble transferrin receptor measurement, quantitative faecal immunochemical testing, alternative dosing regimens and the potential role of IV iron preparations.

Bone SPECT/CT has excellent sensitivity and specificity for diagnosis of loosening and patellofemoral problems after total knee arthroplasty.

PURPOSE: The primary purpose of this retrospective study with prospectively collected data was to evaluate the clinical value of SPECT/CT, in particular its impact on clinical diagnosis and patient management, in patients with pain, stiffness, or swelling after primary total knee arthroplasty (TKA). The secondary purpose was to determine the sensitivity and the specificity of SPECT/CT for different pathologies such as loosening and patellofemoral overloading. METHODS: A retrospective analysis was carried out on 214 knees in 202 consecutive patients (mean age 69 ± 11 years) with persistent or recurrent knee pain after TKA. All patients underwent clinical examination, standardised radiographs, and 99mTc-hydroxymethane diphosphonate (HDP) SPECT/CT as part of a routine diagnostic algorithm. The diagnoses before and after SPECT/CT and final treatment were recorded. TKA component position was routinely measured on 3D-reconstructed images. Intensity and anatomical distribution of bone tracer uptake were determined. RESULTS: SPECT/CT changed the clinical diagnosis and final treatment in 139/214 (65%) knees. In 117 (54.7%) out of 214 patients, revision surgery was proposed following SPECT/CT. Early onset of pain was significantly (p = 0.011) correlated with tibiofemoral stress pattern in SPECT/CT. A total of 86 knees (40.2%) were surgically revised using semi-constrained or fully constrained TKA. In 35 patients, a secondary patellar resurfacing was performed. SPECT/CT showed the clinical diagnosis to be incorrect for suspicion of tibial component loosening in 56 patients (26.2%), femoral component loosening in 53 patients (24.8%), and patellofemoral overloading/progressive patellofemoral osteoarthritis in 26 patients (12.1%) and provided different underlying causes of persistent knee pain after TKA. Likewise, SPECT/CT identified tibial component loosening in 8 patients (3.7%), femoral component loosening in 4 patients (1.9%), and patellofemoral OA in 71 patients (33.2%) without prior clinical suspected diagnosis. The sensitivity and specificity of SPECT/CT for detection of patellofemoral OA was 96.5% and 96.2%, respectively. The sensitivity and specificity for detection of tibial component loosening was 96.0% and 100%, respectively. The sensitivity and specificity for detection of femoral component loosening was 95.0% and 100%, respectively. CONCLUSION: The diagnostic benefits of SPECT/CT in the challenging and complex cohort of patients with pain after primary TKA have been proven. The excellent sensitivity and specificity for detection of tibial or femoral component loosening and diagnosis of patellofemoral OA have been surgically confirmed. Due to the benefits in establishing the correct diagnosis, SPECT/CT should be implemented as part of the routine diagnostic algorithm for patients with pain after primary TKA. LEVEL OF EVIDENCE: II.

Extent of anterior clinoidectomy for clipping of carotid-ophthalmic aneurysms predicted on three-dimensional computerised tomography angiography.

AIM OF STUDY: We aimed to verify the value of computerised tomography angiography (CTA) on predicting the extent of anterior clinoidectomy that is optimal for particular carotid-ophthalmic aneurysms (COAs). CLINICAL RATIONALE FOR STUDY: The anterior clinoid process (ACP) often impedes the complex microsurgery of COA. Complete removal of the ACP ensures safe clipping; however, it also may increase the risk of severe complications. The probability of performing a successful partial anterior clinoidectomy could be evaluated by preoperative CTA. MATERIALS AND METHODS: 28 patients with either a ruptured (n=4) or unruptured COA were included in this prospective, single-centre, observational study. One aneurysm was giant, two were large, and the rest were smaller. Successful aneurysm clipping was the aim in all cases. The anterior clinoidectomy was preoperatively planned on multiplanar three-dimensional reconstructions of CTA images (3D-CTA) which resembled the typical view of a frontotemporal craniotomy. Finally, the predicted clinoidectomy was compared to the extent of the actual clinoidectomy. RESULTS: 21 aneurysms (75%) projected superolateral or superior. The ACP was completely and selectively resected in 25% (7 of 28) and 67.9% of patients (19 of 28) respectively. Optic nerve (ON) unroofing was always performed in the case of total anterior clinoidectomy, but accompanied only 8 of 19 selective clinoidectomies (p = 0.03). The extent of the actual clinoidectomy was predicted by the 3D-CTA-based preoperative planning in 17 of 27 cases (63.0%). Particularly, prediction of the osteotomy was correct in 85.7% of complete, 62.5% of selective lateral, and 57.1% of medial clinoidectomy. None of the radiological and clinical factors determined the correlation between the planned and the actual extent of ACP removal. There was one incomplete occlusion among 23 obtained follow-up CTAs. CONCLUSIONS: The predictive value of 3D-CTA on the extent of anterior clinoidectomy still remains unsatisfactory; it is limited by the individual variability of COA and its surrounding structures. CLINICAL IMPLICATIONS: Currently, the role of 3D-CTA planning is restricted to educational purposes only.

Computerised tomography scan in multi-drug-resistant versus extensively drug-resistant tuberculosis.

PURPOSE: Multi-drug-resistant tuberculosis (MDR-TB) is simultaneously resistant to isoniazid and rifampin. Of course, this germ may also be resistant to other anti-tuberculosis drugs. Patients with extensively drug-resistant tuberculosis (XDR-TB) are also resistant to all types of fluoroquinolone and at least one of the three injectable medications: amikacin, clarithromycin, or kanamycin, in addition to isoniazid and rifampin. Therefore, the main objective of the current study was to evaluate and compare the computed tomography (CT) scan findings of MDR-TB and XDR-TB patients. MATERIAL AND METHODS: In this comparative descriptive cross-sectional study 45 consecutive TB patients who referred to Masih Daneshvari Hospital, Tehran, Iran from 2013 to 2019 were enrolled. TB was diagnosed based on sputum smear and sensitive molecular and microbial tests. Patients were divided into two groups (MDR-TB and XDR-TB) based on two types of drug resistance. CT scan findings were compared for cavitary, parenchymal, and non-parenchymal disorders. The early diagnostic values of these factors were also calculated. RESULTS: Findings related to cavitary lesions including the pattern, number, size of the largest cavity, maximum thickness of the cavity, lung involvement, number of lobes involved, and the air-fluid levels in the two patient groups were similar (p > 0.05). Parenchymal findings of the lung also included fewer and more nodules of 10 mm in the MDR-TB and XDR-TB groups, respectively. Tree-in-bud, ground-glass-opacity, bronchiectasis, cicatricial emphysema, and lobar atelectasis were similar in the two patient groups (p > 0.05). Findings outside the parenchymal lung, including mediastinal lymphadenopathy and pericardial effusion, showed no statistically significant difference between the MDR-TB and XDR-TB groups (p > 0.05). Parenchymal calcification was more common in the XDR group than in the MDR group (64.7% and 28.6%, respectively) with a significant difference (p = 0.01). CONCLUSIONS: CT scan findings in patients with XDR-TB are similar to those of patients with MDR-TB for cavitary, parenchymal, and non-parenchymal lung characteristics. However, patients with XDR-TB tend to have more parenchymal calcification and left-sided plural effusion. CT characteristics overlap between XDR-TB and those with MDR-TB. It can be concluded that CT scan features are not sensitive to the diagnosis.

Multimodality imaging of coronavirus disease 2019 (COVID-19): a pictorial essay.

The coronavirus disease 19 (COVID-19) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or new coronavirus 2019 (2019-nCoV) is now a global pandemic with attendant morbidity, mortality, and socioeconomic disruption. Its features have been described on plain chest radiography, chest computed tomography (CT), chest ultrasonography, brain CT, brain magnetic resonance imaging, and fluorodeoxyglucose-positron emission tomography. Based on current evidence, imaging plays an ancillary role in the management of those with severe illness. This essay illustrates the imaging manifestations of COVID-19 pictorially.

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults.

Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn's disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn's disease, including patients, their families and friends.

Three-dimensional computed tomography analysis of frontoethmoidal cells: A critical evaluation of the International Frontal Sinus Anatomy Classification (IFAC).

OBJECTIVES: Two major classifications of frontoethmoidal cells, Lee and Kuhn and the IFAC (International Frontal Sinus Anatomy Classification), distinguish anterior, posterior and medial cells. The European anatomical position paper includes also lateral cells. According to the IFAC, anterior cells push the frontal sinus drainage pathway (FSDP) medially, posteriorly or posteromedially. Posterior cells push the FSDP anteriorly. The only medial cell, pushing the FSDP laterally is the frontal septal cell, which is attached to or located in the interfrontal sinus septum. The aim of this study was to verify the IFAC and characterise cells, which are inconsistent with this classification. DESIGN: A radioanatomic analysis. SETTING: Tertiary university hospital. PARTICIPANTS: One hundred and three Caucasian adult patients with no inflammatory changes in paranasal sinuses CT. MAIN OUTCOMES MEASURE: Results of assessment of multiplanar reconstruction of thin slice CT. RESULTS: Two types of cells that cannot be classified using the IFAC were found: (a) Lateral cells extending between the skull base and the anterior buttress, pushing the FSDP anteromedially or medially, present in 34 (16.5%) of the sides, (b) Paramedian cells: medially based, not adjacent to the interfrontal septum, pushing the FSDP laterally and posteriorly, present in 33 (16%) of sides. Suprabulla cells and suprabulla frontal cells were found to push the FSDP in directions other than anterior 28% and 31% of the time respectively. CONCLUSIONS: Neglecting lateral and paramedian cells may lead to inconsistent results between radioanatomical studies and impede communication between surgeons. They should be included in existing classifications of frontoethmoidal cells.