Association between dental restorations and artefacts on head magnetic resonance images in paediatric patients.

BACKGROUND: Magnetic resonance imaging (MRI) has become an important diagnostic tool for paediatric patients. The association between dental restorations and MRI artefacts/distortions, however, is unclear. AIM: To investigate the association between dental restorations and artefacts in head MRI in children. DESIGN: This retrospective analysis included patients who underwent head MRI and dental examination at Ramathibodi Hospital from January 2015 to March 2021. From dental records and dental radiographs, a dentist reviewed the amount and type of restorative materials used. Two radiologists examined the MRI scans in five sequences for the presence of distortions and quantified the magnitude and grading of any artefacts. RESULTS: Ninety-four patients aged 3-15 years were included. Twenty-four patients who received preformed metal crowns (PMCs) had MRI distortions. Subjects with no restorations or with tooth-coloured material or amalgam restorations or both did not exhibit distortions. The number of PMCs was related to the size of an artefact. Almost all distortions were confined to the oral cavity and maxillary sinus and did not affect the diagnostic brain area. CONCLUSION: Among the commonly used dental restorative materials for children, only PMCs were associated with artefacts on head MRI scans.

Diagnostic value of contrast-enhanced 3D FLAIR sequence in acute optic neuritis.

PURPOSE: Contrast-enhanced fluid-attenuated inversion recovery (FLAIR) sequence of the brain has the potential for detecting optic nerve abnormality. This study aimed to compare the diagnostic value of whole-brain contrast-enhanced three-dimensional FLAIR with fat suppression (CE 3D FLAIR FS) sequence in detecting acute optic neuritis to dedicated orbit MRI and clinical diagnosis. MATERIALS AND METHODS: Twenty-two patients with acute optic neuritis who underwent whole-brain CE-3D-FLAIR FS and dedicated orbit MRI were retrospectively included. The hypersignal FLAIR of the optic nerve on whole-brain CE-3D-FLAIR FS, enhancement, and hypersignal T2W on orbit images were assessed. The optic nerve to frontal white matter signal intensity ratio on CE-FLAIR FS was calculated as maximum signal intensity ratio (SIR) and mean SIR. RESULTS: Twenty-six hypersignals of optic nerves were found on CE-FLAIR FS from 30 pathologic nerves. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CE FLAIR FS brain and dedicated orbital images for diagnosing acute optic neuritis were 77%, 93%, 96%, 65%, and 82% and 83%, 93%, 96%, 72%, and 86%, respectively. Optic nerve to frontal white matter SIR of the affected optic nerves was higher than that of normal optic nerves. Using a cutoff maximum SIR of 1.24 and cutoff mean SIR of 1.16, the sensitivity, specificity, PPV, NPV, and accuracy were 93%, 86%, 93%, 80%, and 89% and 93%, 86%, 93%, 86%, and 91%, respectively. CONCLUSION: The hypersignal of the optic nerve on whole-brain CE 3D FLAIR FS sequence has qualitative and quantitative diagnostic potential in patients with acute optic neuritis.

Applications of Artificial Intelligence in the Radiology Roundtrip: Process Streamlining, Workflow Optimization, and Beyond.

There are many impactful applications of artificial intelligence (AI) in the electronic radiology roundtrip and the patient's journey through the healthcare system that go beyond diagnostic applications. These tools have the potential to improve quality and safety, optimize workflow, increase efficiency, and increase patient satisfaction. In this article, we review the role of AI for process improvement and workflow enhancement which includes applications beginning from the time of order entry, scan acquisition, applications supporting the image interpretation task, and applications supporting tasks after image interpretation such as result communication. These non-diagnostic workflow and process optimization tasks are an important part of the arsenal of potential AI tools that can streamline day to day clinical practice and patient care.

Intravoxel incoherent motion for differentiating residual/recurrent tumor from post-treatment change in patients with high-grade glioma.

PURPOSE: To investigate the diagnostic value of f derived from IVIM technique and to correlate it with rCBV derived from DSC for the differentiation of residual/recurrent tumor from post-treatment change in patients with high-grade glioma. MATERIALS AND METHODS: Patients who underwent MR imaging with IVIM and DSC studies for evaluation of high-grade glioma after standard treatment were enrolled in this retrospective study. For qualitative analysis, the f and rCBV maps were interpreted as hypoperfused or hyperperfused in each parameter. Quantitative analysis was performed using ROI analysis in f and rCBV parameters. The lesions were divided into residual/recurrent tumor and post-treatment change groups. RESULTS: Nineteen patients with high-grade glioma were included. In qualitative analysis, the f-map shows higher sensitivity (100.0%) than rCBV map (92.3%), while the rCBV map shows higher specificity (100.0%) than the f-map (83.3%). In quantitative analysis, the optimal cutoff values of 1.19 for f and 1.06 for rCBV are shown to provide high diagnostic value with high sensitivity (91.7%) for both parameters but slightly higher specificity of rCBV (85.7%) than f (71.4%). The correlation between f and rCBV was good with ICC of 0.810. CONCLUSION: The f value measured by IVIM technique, non-contrast perfusion technique, has high diagnostic performance and potential to be an alternative method to CBV measured by DSC for differentiation between residual/recurrent tumor and post-treatment change in patients with high-grade glioma.

Dual-Energy Computed Tomography-Derived Iodine Density and Spectral Attenuation Analysis for Differentiation of Inverted Papilloma and Sinonasal Squamous Cell Carcinoma/Lymphoma.

OBJECTIVE: This study aimed to assess the value of dual-energy computed tomography for differentiation of inverted papilloma from squamous cell carcinoma (SCC)/lymphoma. METHODS: Twenty-eight patients with pathologically diagnosed inverted papilloma or SCC/lymphoma underwent contrast-enhanced dual-energy computed tomography. Qualitative features (laterality, location, enhancement pattern, border, necrosis, hemorrhage, calcification, bone destruction, pterygopalatine fossa extension, adjacent invasion, and perineural spreading) and quantitative features (iodine density and spectral attenuation curve slope) were analyzed. Optimal cutoff thresholds of diagnostic efficacy were generated. RESULTS: Fifteen patients had inverted papilloma, and 13 had malignancy (5 SCC and 8 lymphoma). Computed tomography findings of bilateral lesions, sphenoid sinus involvement, pterygopalatine fossa extension, and adjacent invasion were significantly associated with SCC/lymphoma. The iodine density was significantly higher in SCC/lymphoma (2.46 ± 0.22 mg/mL) than in inverted papilloma (1.42 ± 0.46 mg/mL; P = 0.001). An iodine density threshold of 1.74 mg/mL had a sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of 92.3%, 86.7%, 92.9%, 85.7%, and 90.3%, respectively. The spectral attenuation curve slope was significantly higher in SCC/lymphoma (4.35 ± 0.27 HU/keV) than in inverted papilloma (2.72 ± 0.88 HU/keV; P = 0.001). A spectral attenuation curve slope threshold of 3.34 HU/keV had a sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of 92.3%, 86.7%, 92.9%, 85.7%, and 90.8%, respectively. CONCLUSIONS: Squamous cell carcinoma/lymphoma had a significantly higher iodine density and spectral attenuation curve slope than inverted papilloma. Using optimal quantitative measurement thresholds provides high diagnostic efficacy.

Report of clinical presentations and two novel mutations in patients with Wiskott-Aldrich syndrome/X-linked Thrombocytopenia.

Wiskott-Aldrich syndrome (WAS)/X-linked thrombocytopenia (XLT) is a rare X-linked disease characterized by thrombocytopenia, eczema, and recurrent infection. In addition, WAS/XLT increases incidence of autoimmune diseases and malignancies. We reported 7 male patients, 2 with WAS and 5 with XLT, from 6 different families. Two novel mutations, p.Gly387GlufsTer58 and p.Ala134Asp, were identified in patients with WAS. Both patients had severe clinical phenotypes compatible with classic WAS and developed lethal outcomes with intracranial hemorrhage. Other than that, one patient with XLT developed pineoblastoma.

Superior Ophthalmic Vein Embolism Following Forehead Augmentation with Autologous Fat Injection.

BACKGROUND: Facial rejuvenation and reconstruction with autologous fat injection are a common and effective procedure used worldwide. Most surgeons and patients are satisfied with the favorable outcomes. However, catastrophic complications from arterial and venous occlusion resulting in visual loss and stroke may occur. CASE PRESENTATION: We herein report a case of isolated venous occlusion from fat embolism. The patient developed acute painful proptosis and blurred vision of her right eye while undergoing an esthetic autologous fat injection into her forehead. Based on her clinical manifestations and radiologic findings, the patient was diagnosed with superior ophthalmic vein occlusion. Symptomatic and supportive treatments were given. Spontaneous clinical improvement occurred without secondary complications. Therefore, the initially planned endovascular therapy with transfemoral transvenous embolectomy of the right superior ophthalmic vein was canceled. CONCLUSIONS: Facial augmentation with autologous fat injection can cause superior ophthalmic vein embolism. Surgeons should therefore perform this procedure very cautiously. Prompt ophthalmological evaluation and proper management are important for improving clinical outcomes. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Role of Quantitative Spectral CT Analysis for Differentiation of Orbital Lymphoma and Other Orbital Lymphoproliferative Disease.

PURPOSE: To investigate the value of quantitative parameters from spectral computed tomography for the differentiation of orbital lymphoma from other lymphoproliferative disease, including idiopathic orbital inflammatory disease (IOID) and IgG4-related disease (IgG4-RD). METHODS: Patients with orbital masses who underwent pre-treatment contrast-enhanced spectral CT were enrolled in this retrospective study. The subjects were divided into lymphoma and other orbital lymphoproliferative disease groups. Qualitative imaging features (margin, location, enhancement pattern, cranial nerves, soft tissue, and bone involvement) were reviewed. Quantitative parameters (iodine density and spectral attenuation curve slope) derived from spectral CT were measured. RESULTS: Eleven patients had orbital lymphoma and 11 had other orbital lymphoproliferative diseases (idiopathic orbital inflammatory disease (IOID), n = 5; IgG4-related disease (IgG4-RD), n = 6). Qualitative analysis showed no significant difference between the two groups. There was significantly higher iodine density in orbital lymphoma (1.24 ±â€¯0.24 mg/ml) than in IOID/IgG4-RD (0.83 ±â€¯0.23 mg/ml; P = 0.001). An iodine density threshold of 1.0 mg/ml gave sensitivity, specificity, and accuracy of 81.8%, with an area under the curve of 0.876 (P = 0.0003). Orbital lymphoma had a significantly higher iodine spectral attenuation curve slope (2.44 ±â€¯0.51 HU/keV) than IOID/IgG4-RD (1.66 ±â€¯0.47 HU/keV; P = 0.001). A threshold of 1.99 HU/keV for the spectral attenuation curve slope of 40-70 keV gave sensitivity, specificity, and accuracy of 81.8%, with an area under the curve of 0.884 (P = 0.0002). CONCLUSIONS: Quantitative spectral CT parameters can help differentiate orbital lymphoma from other orbital lymphoproliferative disease, with lymphoma having a significantly higher iodine density value and spectral attenuation curve slope than IOID/IgG4-RD.

Correlation between optic nerve sheath diameter measured on imaging with acute pathologies found on computed tomography of trauma patients.

PURPOSE: To evaluate the correlation between optic nerve sheath diameter (ONSD) measurement with signs of increased intracranial pressure (ICP) found on computed tomography (CT) in trauma patients. MATERIALS AND METHODS: 271 consecutive head CT trauma scans performed at our trauma center were retrospectively reviewed for ONSD and CT findings. Measurement of ONSD was made at CT and, when available, with ultrasonography (US). Imaging signs of increased ICP were assessed. Association between ONSD and signs of ICP were analyzed. RESULTS: The mean ONSD on axial CT images, optic-nerve axial plane and US was 4.70 ± 0.59 mm, 4.78 ± 0.59 mm, and 3.16 ± 0.50 mm, respectively. The ONSD measured at CT was significantly higher than that measured by US(p < 0.01). No difference of ONSD measured at CT between axial and optic-nerve axial planes. Patients with CT evidence of increased ICP had significantly higher ONSD than those without imaging abnormalities (p = 0.0001-0.0064). The ONSD cutoff points for suggesting increased ICP were 4.8 mm (60.5 % sensitivity, 61.2 % specificity, 20.4 % PPV, 90.4 % NPV) at CT and 3.15 mm (97.4 % sensitivity, 13.8 % specificity, 15.7 % PPV, 97 % NPV) at US. CONCLUSION: There was a significant association between ONSD and imaging signs of increased ICP in CT with a high NPV. No difference of ONSD measurement at CT between normal and optic-nerve axial planes was observed, whereas there was a significant difference between diameter obtained at CT and US.