Imaging Findings on Head Computed Tomography Scans in Victims of Intimate Partner Violence.

OBJECTIVE: The aim of the study is to analyze the imaging findings and injury patterns seen on head computed tomography (CT) examinations performed on survivors of intimate partner violence (IPV). METHODS: An institutional review board-approved retrospective analysis of 668 patients reporting IPV to our institution's violence intervention and prevention program between January 2013 and June 2018 identified 40 unique patients with radiological findings visible on head CT. All injuries visible on head CT were analyzed based on the anatomic location and injury type. Demographics, IPV screening at the time of injury, concomitant, prior, and subsequent injuries to the index head injury were also recorded. RESULTS: Our study cohort had 36 women and 4 men with a mean age at presentation of 43 ± 13 years (mean ± SD), 91 unique injuries with 57 (62.6%) isolated soft tissue injuries, 4 (3.2%) fractures, 13 (14.3%) intra-axial, and 17 (18.7%) extra-axial injuries. Soft tissue injuries and intra-axial injuries occurred most commonly in the frontal region (45.6% and 38.5%), followed by the parietal region (22.8% and 23.1%), while most extra-axial injuries were subdural hematomas (41.2%). Left-sided injuries accounted for 49% (45/91) with 29/91 right-sided (32%) and 17/91 bilateral (19%) injuries. The IPV screening occurred in 44% of injury visits (22/50). Concomitant injuries were seen in 14/50 injury visits (28%), most commonly being in the lower extremity (6/14, 42.9% [% of visits with concomitant injuries]) followed by the upper extremity (5/14, 35.7%), while 52% of visits (26/50) were preceded by prior injuries and 68% of events (34/50) were followed by subsequent injuries. CONCLUSIONS: Isolated soft tissue swelling is the most common manifestation of IPV on head CT scans with frontoparietal region being the most common site. Synchronous and metachronous injuries are frequent.

Incidence and characteristics of spinal injuries in the victims of intimate partner violence (IPV).

PURPOSE: To describe the incidence and patterns of the spinal injuries in the victims of physical IPV. MATERIALS AND METHODS: With institutional review board (IRB) approval, we retrospectively reviewed patients referred to our institution's domestic violence intervention and prevention program with a diagnosis directly related to physical abuse between January 2013 and June 2018. Electronic health records and radiology reports were reviewed for all patients. RESULTS: A total of 21/688 (3%) IPV patients with 41 vertebral injuries were identified. The study population comprised of 19/21 (90%) females. Median age of the included patients was 43 years with a range of 21-72 years. All vertebral injuries were AO type A spinal injuries. Upper lumbar spine (L1 and L2) was the most common level of injury followed by upper to mid-thoracic spine. The reported mechanism of the injury was IPV in 8/21 (38.0%), fall in 8/21(38.0%), and incidental in 5/21 (24.0%). Ten out of 21 (48%) patients had concomitant injuries, most commonly to the craniofacial region 5/21 (23%). Psychiatry history was positive in 17/21 (81%), and substance abuse was positive in 15/21 (71%) of the patients. CONCLUSION: Incidence of spinal injuries is relatively low in IPV with morphologic AO type A injury being the most common type of injury and the upper lumbar spine being the most common level of injury.

COVID Lessons Continue: Postvaccination Somatostatin Receptor-Positive Axillary Nodes on DOTATATE Imaging.

ABSTRACT: COVID vaccination has begun in most of the countries. Older population and high-risk groups are prioritized for vaccination. Postvaccination imaging in cancer patients may show effects of the immune response to the vaccine. As such, it is important to know the timing and laterality of the vaccination as the reactive lymph nodes in the ipsilateral axilla can be seen on the imaging. We present a case of DOTATATE-avid nonpathologically enlarged lymph nodes in ipsilateral axilla and linear tracer uptake in the deltoid muscle on a patient imaged for a recent diagnosis of rectal neuroendocrine neoplasm.

Imaging Biomarkers of Hypothyroidism on Lung Cancer Screening CT.

PURPOSE: To assess the feasibility of attenuation and size measurement of the thyroid gland as an imaging biomarker for hypothyroidism in patients undergoing lung cancer screening (LCS) with low dose CT. MATERIALS AND METHODS: With institutional review board (IRB) approval, we retrospectively reviewed all patients with LCS CT between September 1, 2016 and March 31, 2020, who had at least 1 thyroid-stimulating hormone (TSH) test within 90 days of the patient's most recent screening CT. Hypothyroid patients were identified through billing diagnosis and/or elevated TSH or those on treatment with thyroxine; normal patients were identified as those without a diagnosis of hypothyroidism and normal TSH. For each hypothyroid patient, an age- and sex-matched normal control was included. The diameters and attenuation of both lobes of the thyroid gland were measured for each case; patients in whom the thyroid gland could not be seen to measure were excluded. RESULTS: A total of 304 patients were included. The areas under the receiver operating characteristic curve for size and attenuation of the left lobe were 0.774 (95% confidence interval [CI] 0.714-0.825) and 0.812 (95% CI 0.759-0.861), respectively; and for the right lobe were 0.776 (95% CI 0.719-0.827) and 0.794 (95% CI 0.740-0.847), respectively. We developed a decision tree algorithm to predict hypothyroidism combining the minimum size and attenuation of either lobe of the thyroid gland, with sensitivity, specificity, and accuracy of 76%, 87%, and 82%, respectively. CONCLUSION: Size and attenuation of the thyroid gland can be used to identify potential hypothyroid patients undergoing LCS.

Malignant peritoneal mesothelioma: correlation between CT imaging features and histologic subtypes.

PURPOSE: To identify correlation between CT imaging features and histologic subtypes of Malignant Peritoneal Mesothelioma (MPM). METHODS: This was a retrospective single-center study of 51 consecutive patients with the diagnosis of Malignant Peritoneal Mesothelioma (MPM). The tumors were classified into pure epithelioid type and those with sarcomatoid component (pure sarcomatoid and biphasic type). Imaging features of these subtypes were compared for extent and type of peritoneal thickening, omental thickening, abdominal visceral infiltration, abdominal wall infiltration, and loco-regional and distant metastases. Fisher's Exact test was used to correlate the association of imaging features with histology types followed by multivariate analysis using logistic regression test. RESULTS: 32 males and 19 females with a median age of 63 years (range 35-86 years) were included in the study. 41/51 (80%) were epithelioid histology type and 10/51 (20%) had sarcomatoid component (3 pure sarcomatoid type, 7 biphasic type). Abdominal visceral infiltration was seen more commonly in cases of MPM with sarcomatoid component (p = 0.001). Sarcomatoid type also had a frequent association with metastases (p = 0.001) and discrete masses (p = 0.01). Epithelioid type was commonly associated with ascites (p = 0.04). On multivariate analysis, most significant correlation was identified between the sarcomatoid type and imaging features of metastases (p = 0.001) and visceral infiltration (p = 0.019). CONCLUSION: Sarcomatoid type of MPM showed significant correlation with more aggressive imaging features of metastases and visceral infiltration as compared to epithelioid type.

CT-guided Core-Needle Biopsy of the Lung Is Safe and More Effective than Fine-Needle Aspiration Biopsy in Patients with Hematologic Malignancies.

PURPOSE: To evaluate the safety and diagnostic yield of CT-guided core-needle biopsy (CNB) versus fine-needle aspiration biopsy (FNAB) of lung nodules and masses in patients with hematologic malignancies (HMs). MATERIALS AND METHODS: With institutional review board approval, 166 patients were retrospectively reviewed between 2007 and 2017 who were diagnosed with leukemia, lymphoma, or myelodysplastic syndromes (with or without hematopoietic stem cell transplant) and who underwent CT-guided FNAB and/or CNB of the lung. Patient medical records, pathologic reports, and interventional biopsy reports were reviewed. RESULTS: In the study period, 166 patients underwent percutaneous CT-guided lung biopsy; 36% (60 of 166) of the procedures included CNB (CNB + FNAB and CNB only), whereas 64% (106 of 166) were FNAB only. In the CNB group, FNAB was also performed for 92% (55 of 60) of the patients before CNB; 13% (eight of 60) of patients in the CNB group were nondiagnostic versus 45% (48 of 106) of FNAB only (P < .0001). There was no statistically significant difference in the pulmonary complication rates, with 1.7% of CNB and 1.9% of FNAB only requiring chest tube placement (P = .7), 5% of CNB and 2.8% of FNAB only developing hemoptysis (P = .4), and 5% of CNB and 2% of FNAB only developing hemothorax (P = .3). A change in clinical management was observed in 51% of patients with diagnostic biopsies compared with 21% of patients with nondiagnostic biopsies (P = .0002). CONCLUSION: CT-guided CNB is an effective technique for performing lung biopsy in patients with HMs with higher diagnostic yield compared with FNAB, and a higher, although not a statistically significant, increased risk of bleeding complications and pneumothorax.© RSNA, 2019See also the commentary by Elicker in this issue.

Multiple hypertrophic relapsing remitting cranial neuropathies as an initial presentation of primary CNS lymphoma without any brain or spinal cord lesion.

Cranial nerve thickening as an initial isolated presentation of CNS lymphoma is rare. Once an extremely rare neoplasm, primary lymphoma of the central nervous system (CNS) now ranks only next to meningiomas and low-grade astrocytomas in prevalence. Multiple cranial nerve thickening can be a feature of primary CNS lymphoma. Here we report a case of a 45-year-old immunocompetent female who presented with relapsing remitting multiple cranial nerve thickening as an initial feature of primary CNS lymphoma without any other brain or spinal cord lesions.