A case of fulminant myocarditis with full recovery after a 38-h sustained asystole.

Key Clinical Message: Even if cardiac rhythm deteriorated to asystole in the clinical course of fulminant myocarditis, cardiac function may recover, and the patient may be discharged without brain damage, if circulation could be maintained by appropriate mechanical cardiac supports. Abstract: A 69-year-old man was diagnosed with fulminant myocarditis with circulatory collapse. His cardiac rhythm deteriorated to asystole on the second day; however, circulatory status was maintained through extracorporeal membrane oxygenation and intra-aortic balloon pumping. After 38 h-lasting asystole, his heart resumed beating. He was discharged without neurological deficits on Day 25.

Surgical strategy for airway management and bleeding control in penetrating neck injury in zone II: A case report.

We report the case of a 33-year-old man with a self-inflicted neck wound with severe hypopharynx injury, and hemorrhagic shock, which was well managed by a trauma surgeon trained in esophageal surgery. Training in cervical lymph node dissection for esophageal cancer could be useful in the management of penetrating neck injuries.

Metabolic changes induced by dapagliflozin, an SGLT2 inhibitor, in Japanese patients with type 2 diabetes treated by oral anti-diabetic agents: A randomized, clinical trial.

AIM: We aimed to determine whether SGLT2 inhibitor dapagliflozin treatment affects body composition and amino acid (AA) metabolism. METHODS: Fifty-two overweight patients treated by oral antidiabetic agents were randomly assigned to dapagliflozin (Dapa) or a standard treatment (Con) and followed for 24 weeks. The primary outcome was the change in body mass (BM) between baseline and week 24. Body composition, intrahepatic triglyceride (IHTG) content, and plasma AA concentrations were examined as secondary outcomes. RESULTS: The change in BM was significantly larger in the Dapa than in the Con group, with a difference in the mean change of -1.72 kg (95 %CI: -2.85, -0.59; P = 0.004) between the groups. Total fat mass was reduced by dapagliflozin treatment, but fat-free mass was maintained. IHTG content was significantly reduced in the Dapa than in the Con (P = 0.033). Changes in AAs showed small differences between the groups, but only serine concentrations were significantly reduced in the Dapa. Intra-group analysis showed that positive associations were observed between changes in branched chain AA concentrations and body composition only in the Dapa. CONCLUSIONS: Dapagliflozin treatment causes a reduction in BM mainly by reducing fat mass. AA metabolism shows subtle changes with dapagliflozin treatment.

18F-fluorodeoxyglucose uptake in advanced gastric cancer correlates with histopathological subtypes and volume of tumor stroma.

PURPOSE: The aim of this study was to investigate the correlation between preoperative 18F-fluorodeoxyglucose (FDG) uptake and histological subtypes, amount of tumor stroma in advanced gastric cancer (GC), and clinical outcomes. METHODS: We evaluated 56 patients (male/female, 42:14; mean age, 69 years) with advanced GC who underwent surgical resection at our institution and positron emission tomography-computed tomography with 18F-FDG prior to surgery. We used the maximum standardized uptake value (SUVmax) of the tumor and the tumor-to-liver ratio (TLR) of the SUVmax for the analysis. The SUVmax and TLR correlated with histological subtypes, immunohistochemistry (IHC) for CD34, and recurrence-free survival (RFS). Tumor stroma in GC was evaluated by CD34 expression. GCs were classified according to the Lauren and World Health Organization (WHO) classifications. RESULTS: The average FDG uptakes (SUVmax) were 4.17% and 14.04% in diffuse and intestinal type GCs, respectively, according to the Lauren classification, and 4.17%, 13.87%, 7.70%, 9.71%, and 19.45% in the poorly cohesive, tubular, mucinous, and papillary adenocarcinomas, respectively, according to the WHO classification. The FDG uptake in diffuse type was significantly lower than that in the intestinal type (p = 0.000). The SUVmax and TLR of the CD34(+) group (mean SUVmax, 5.50; TLR, 1.56) were significantly lower than those of the CD34(-) group (mean SUVmax, 14.09; TLR, 4.09). RFS was not associated with TLR or CD34 expression. CONCLUSION: GC, which has abundant tumor stroma characterized by high CD34 expression on IHC, shows low FDG uptake.

The impact of lactate clearance on outcomes according to infection sites in patients with sepsis: a retrospective observational study.

Whether lactate clearance (LC) influences outcomes differently depending on the infection site in sepsis cases is not fully elucidated. Herein, we analyzed LC's clinical utility as a predictor of patient outcomes according to infection site. This retrospective study, conducted at two tertiary emergency critical care medical centers in Japan, included patients with sepsis or septic shock. The associations between infection site (lungs vs. other organs) and in-hospital mortality and ventilator-free days (VFDs) were evaluated using univariable and multivariate analyses. We assessed LC's ability to predict in-hospital mortality using the area under the receiver operating characteristic curve. Among 369 patients with sepsis, infection sites were as follows: lungs, 186 (50.4%); urinary tract, 45 (12.2%); abdomen, 102 (27.6%); and other, 36 (9.8%). Patients were divided into a pneumonia group or non-pneumonia group depending on their infection site. The pneumonia group displayed a higher in-hospital mortality than the non-pneumonia group (24.2% vs. 15.8%, p = 0.051). In the multivariate analysis, lower LC was associated with higher in-hospital mortality [adjusted odds ratio (AOR), 0.97; 95% confidence interval (CI) 0.96-0.98; p < 0.001] and fewer VFD [adjusted difference p value (AD), - 1.23; 95% CI - 2.42 to - 0.09; p = 0.025] in the non-pneumonia group. Conversely, LC did not affect in-hospital mortality (AOR 0.99; 95% CI 0.99-1.00; p = 0.134) and VFD (AD - 0.08; 95% CI - 2.06 to 1.91; p = 0.854) in the pneumonia group. Given the differences in the impact of LC on outcomes between the pneumonia and non-pneumonia groups, this study suggests that optimal treatment strategies might improve outcomes. Further studies are warranted to validate our results and develop optimal therapeutic strategies for sepsis patients.

The impact of blood type on the mortality of patients with severe abdominal trauma: a multicenter observational study.

Few studies have investigated the relationship between blood type and trauma outcomes according to the type of injury. We conducted a retrospective multicenter observational study in twelve emergency hospitals in Japan. Patients with isolated severe abdominal injury (abbreviated injury scale for the abdomen ≥ 3 and that for other organs < 3) that occurred between 2008 and 2018 were divided into four groups according to blood type. The association between blood type and mortality, ventilator-free days (VFD), and total transfusion volume were evaluated using univariate and multivariate regression models. A total of 920 patients were included, and were divided based on their blood type: O, 288 (31%); A, 345 (38%); B, 186 (20%); and AB, 101 (11%). Patients with type O had a higher in-hospital mortality rate than those of other blood types (22% vs. 13%, p < 0.001). This association was observed in multivariate analysis (adjusted odds ratio [95% confidence interval] = 1.48 [1.25-2.26], p = 0.012). Furthermore, type O was associated with significantly higher cause-specific mortalities, fewer VFD, and larger transfusion volumes. Blood type O was associated with significantly higher mortality and larger transfusion volumes in patients with isolated severe abdominal trauma.

Increased 18F-FDG accumulation in less-affected lung area in patients with non-small cell lung cancer and postoperative acute exacerbation of interstitial lung disease.

PURPOSE: To investigate whether or not 18F-FDG accumulation in normal or less-affected lung fields increased in non-small cell lung cancer (NSCLC) patients with postoperative acute exacerbation (PAE) of interstitial lung disease (ILD) MATERIAL AND METHODS: Thirty-six NSCLC patients with ILD and 50 patients without ILD (non-ILD patients) underwent pre-operative 18F-FDG-PET/CT at 2 institutions. Volume-of-interest (VOI) was placed to measure the mean standardized uptake value (SUVmean) in normal or less-affected lung fields at pre-defined 12 areas on ventral and dorsal locations of both lungs. SUVtissue fraction (TF) was defined as corrected SUVmean by using TF and mean computed tomography density on PET/CT. Harmonized SUVmean (hSUVmean) and SUVTF (hSUVTF) were calculated based on results of phantom study, which was performed to optimize the measured SUV difference among 2 institutions. Both the h-SUVmean and the h-SUVTF were compared between 8 patients with PAE of ILD (PAE group) or remaining 28 patients without PAE of ILD (non-PAE group) and non-ILD patients in each of the 12 areas. RESULTS: The hSUVmean in PAE group was higher in 9 out of 12 locations as compared with non-ILD patients, whereas the hSUVmean was mostly similar between non-PAE group and non-ILD patients. In contrast, the hSUVTF in non-PAE group was similar to that in PAE group, and higher than in non-ILD patients in most locations. CONCLUSION: 18F-FDG-PET/CT demonstrated increased SUVmean along with elevated SUVTF in normal or less-affected lung fields for NSCLC patients with PAE of ILD, which may reflect regional invisible fibrosis and inflammatory change.

The Online Attention Game for Digital Identity Education: An Exploratory Study.

Ill-considered postings by young social media users hungry for attention have recently garnered headlines. Imprudent online posts distort the posters' digital identity, which refers to one's online image as perceived by others. Online attention-seeking behaviour may result in digital identities that are separate from a person's true nature, which can lead to social and mental harm. To mitigate these impacts, effective educational material is needed to help non-technical users understand the risks and consequences of thoughtless, attention-seeking online behaviour. This study takes the first step towards fulfilling this educational need by developing the Online Attention Game (OAG), which is played in a laboratory or classroom setting (OAG-CS) or remotely (OAG-R). It replicates the online competition involved in seeking other social media users' attention. Through five OAG games (two OAG-CS games with students, two OAG-CS games with researchers, and one OAG-R game with researchers), we confirmed the tendencies and characteristics of young university students' and adult researchers' online posting behaviour. Through carrying out the OAG-R successfully, we ensured the OAG was useful for digital identity education even at the difficult time of the COVID-19 pandemic.

Histologic Distribution and Characteristics on MR Imaging of Ultrasmall Superparamagnetic Iron Oxide in Ethyl-nitrosourea-induced Endogenous Rat Glioma.

PURPOSE: (1) To evaluate the enhancement patterns of an ultrasmall superparamagnetic iron oxide contrast agent (USPIO-CA) compared with those of a gadolinium-based contrast agent (Gd-BCA). (2) To compare the histologic distribution of USPIO-related iron particles (USPIO-IPs) with the USPIO-enhancement area in the early vascular and in the cellular imaging phase (E- and L-phase, respectively) after intravenous CA administration. METHODS: We performed USPIO-enhanced MRI of N-ethyl-N-nitrosourea (ENU)-induced endogenous rat glioma, including spin-echo (SE) T1-weighted images (T1WIs) and gradient-recalled-echo (GRE) T2-weighted images (T2WIs), before and at 3-6 h after USPIO-CA administration for E-phase images. For L-phase images, MRI was performed at 16-19 and 62-69 h after administration. Two observers determined the USPIO-enhancement area on E-phase images and Gd-enhancement areas. We compared the USPIO-enhancement size (USPIO-ES) and Gd-ES on SE T1WIs, and the hypo-intense USPIO-ES on GRE T2WIs and Gd-ES using the Wilcoxon signed-rank test. In addition, two raters visually evaluated the correspondence between the histologic distribution of USPIO-IPs and the USPIO-enhancement area on corresponding GRE T2WIs at each phase using a 3-rating scale. RESULTS: Significantly smaller hyper-intense, hypo-intense and combined hyper-/hypo-intense areas were observed on USPIO-enhanced SE T1WIs compared with Gd-enhanced images (all P < 0.001). The hypo-intense USPIO-ES on GRE T2WIs was significantly smaller than the Gd-ES (P = 0.001). The distribution of USPIO-IPs on histopathological specimen and USPIO-enhancement on GRE T2WIs exhibited poor agreement in 5 of 9 tumors with enhancement from rats sacrificed early. The distribution of microglia containing USPIO-IPs corresponded with the pattern of USPIO-enhancement in the 2 tumors with late enhancement. CONCLUSION: The enhancement pattern and size of USPIO-CA in a rat glioma model were statistically different from those of Gd-BCA. Our histological data suggests that USPIO-enhanced MRI offers vascular bed imaging in E-phase and might depict the intra-tumoral distribution of immune effector cells in L-phase.

Usability of the lateral decubitus position on four-dimensional ultra-low-dose computed tomography for the detection of localized pleural adhesion in the pulmonary apical region.

BACKGROUND: Localized pleural adhesion (LPA) evaluation in the apical region is difficult even with four-dimensional ultra-low-dose computed tomography (4D-ULDCT) in the supine position due to smaller pleural movements. PURPOSE: To assess usability of 4D-ULDCT in the lateral decubitus (LD) position for LPA detection in the apical region. MATERIAL AND METHODS: Forty-seven patients underwent 4D-ULDCT of a single respiration cycle with 16-cm coverage of body axis in supine and LD positions with the affected lung uppermost. Intraoperative thoracoscopic findings confirmed LPA presence. A pleural point and a corresponding point on costal outer edge were placed in identical axial planes at end-inspiration. Pleuro-chest wall distance between two points (PCD) was calculated at each respiratory phase. In the affected lung, average change in amount of PCD (PCDACA) was compared between patients with and without LPA in total and two sub-groups (non-COPD and COPD, non-emphysematous and emphysematous patients) in supine and non-dependent (ND) LD positions. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal thresholds in PCDACA for differentiating patients with LPA from those without. RESULTS: In COPD/emphysematous patients and total population, PCDACA with LPA was smaller than in those without in the supine and NDLD positions for overall, lateral, and dorsal regions. For the lateral region in COPD patients, area under ROC curve (AUC) increased from supine (0.64) to NDLD position (0.81). For the dorsal region in emphysematous patients, AUC increased from supine (0.76) to NDLD position (0.96). CONCLUSION: 4D-ULDCT in LD position may be useful for LPA detection in apical regions for COPD and/or emphysematous patients.

Planned Versus On-Demand Relaparotomy Strategy in Initial Surgery for Non-occlusive Mesenteric Ischemia.

BACKGROUND: There has been insufficient evidence regarding a treatment strategy for patients with non-occlusive mesenteric ischemia (NOMI) due to the lack of large-scale studies. We aimed to evaluate the clinical benefit of strategic planned relaparotomy in patients with NOMI using detailed perioperative information. METHODS: We conducted a multicenter retrospective cohort study that included NOMI patients who underwent laparotomy. In-hospital mortality, 28-day mortality, incidence of total adverse events, ventilator-free days, and intensive care unit (ICU)-free days were compared between groups experiencing the planned and on-demand relaparotomy strategies. Analyses were performed using a multivariate mixed effects model and a propensity score matching model after adjusting for pre-operative, intra-operative, and hospital-related confounders. RESULTS: A total of 181 patients from 17 hospitals were included, of whom 107 (59.1%) were treated using the planned relaparotomy strategy. The multivariate mixed effects regression model indicated no significant differences for in-hospital mortality (61 patients [57.0%] in the planned relaparotomy group vs. 28 patients [37.8%] in the on-demand relaparotomy group; adjusted odds ratio [95% confidence interval] = 1.94 [0.78-4.80]), as well as in 28-day mortality, adverse events, and ICU-free days. Significant reduction in ventilator-free days was observed in the planned relaparotomy group. Propensity score matching analysis of 61 matched pairs with comparable patient severity did not show superiority of the planned relaparotomy strategy. CONCLUSIONS: The planned relaparotomy strategy, compared with on-demand relaparotomy strategy, did not show clinical benefits after the initial surgery of patients with NOMI. Further studies estimating potential subpopulations who may benefit from this strategy are required.

Preoperative assessment of localized pleural adhesion: Utility of software-assisted analysis on dynamic-ventilation computed tomography.

PURPOSE: To assess the usefulness of software analysis using dynamic-ventilation CT for localized pleural adhesion (LPA). MATERIALS AND METHODS: Fifty-one patients scheduled to undergo surgery underwent both dynamic-ventilation CT and static chest CT as preoperative assessments. Five observers independently evaluated the presence and severity of LPA on a three-point scale (non, mild, and severe LPA) for 9 pleural regions (upper, middle, and lower pleural aspects on ventral, lateral, and dorsal areas) on the chest CT by three different methods by observing images from: static high-resolution CT (static image); dynamic-ventilation CT (movie image), and dynamic-ventilation CT while referring to the adhesion map (movie image with color map), which was created using research software to visualize movement differences between the lung surface and chest wall. The presence and severity of LPA was confirmed by intraoperative thoracoscopic findings. Parameters of diagnostic accuracy for LPA presence and severity were assessed among the three methods using Wilcoxon signed rank test in total and for each of the three pleural aspects. RESULTS: Mild and severe LPA were confirmed in 14 and 8 patients. Movie image with color map had higher sensitivity (56.9 ±â€¯10.7 %) and negative predictive value (NPV) (91.4 ±â€¯1.7 %) in LPA detection than both movie image and static image. Additionally, for severe LPA, detection sensitivity was the highest with movie image with color map (82.5 ±â€¯6.1 %), followed by movie image (58.8 ±â€¯17.0 %) and static image (38.8 ±â€¯13.9 %). For LPA severity, movie image with color map was similar to movie image and superior to static image in accuracy as well as underestimation and overestimation, with a mean value of 80.2 %. CONCLUSION: Software-assisted dynamic-ventilation CT may be a useful novel imaging approach to improve the detection performance of LPA.

Optimization of pulse sequences in ultrafast magnetic resonance imaging for the diagnosis of acute abdominal pain caused by gastrointestinal disease.

BACKGROUND: Magnetic resonance imaging (MRI) is widely used to diagnose acute abdominal pain; however, it remains unclear which pulse sequence has priority in acute abdominal pain. PURPOSE: To investigate the diagnostic accuracy of MRI and to assess the conspicuity of each pulse sequence for the diagnosis of acute abdominal pain due to gastrointestinal diseases. MATERIAL AND METHODS: We retrospectively enrolled 60 patients with acute abdominal pain who underwent MRI for axial and coronal T2-weighted (T2W) imaging, fat-suppressed (FS)-T2W imaging, and true-fast imaging with steady-state precession (True-FISP) and axial T1-weighted (T1W) imaging and investigated the diagnosis with endoscopy, surgery, histopathology, computed tomography, and clinical follow-up as standard references. Two radiologists determined the diagnosis with MRI and rated scores of the respective sequences in assessing intraluminal, intramural, and extramural abnormality using a 5-point scale after one month. Diagnostic accuracy was calculated and scores were compared by Wilcoxon-signed rank test with Bonferroni correction. RESULTS: Diagnostic accuracy was 90.0% and 93.3% for readers 1 and 2, respectively. Regarding intraluminal abnormality, T2W, FS-T2W, and True-FISP imaging were superior to T1W imaging in both readers. FS-T2W imaging was superior to True-FISP in reader 2 (P < 0.0083). For intramural findings, there was no significant difference in reader 1, whereas T2W, FS-T2W, and True-FISP imaging were superior to T1W imaging in reader 2 (P < 0.0083). For extramural findings, FS-T2W imaging was superior to T2W, T1W, and True-FISP imaging in both readers (P < 0.0083). CONCLUSION: T2W and FS-T2W imaging are pivotal pulse sequences and should be obtained before T1W and True-FISP imaging.

Age-related differences in the impact of coagulopathy in patients with isolated traumatic brain injury: An observational cohort study.

BACKGROUND: Although age and coagulopathy are well-known predictors of poor outcome after traumatic brain injury (TBI), the interaction effect of these two predictors remains unclear. OBJECTIVES: We assessed age-related differences in the impact of coagulopathy on the outcome following isolated TBI. METHODS: We conducted a retrospective observational study in two tertiary emergency critical care medical centers in Japan from 2013 to 2018. A total of 1036 patients with isolated TBI (head Abbreviated Injury Scale ≥ 3 and other Abbreviated Injury Scale < 3) were selected and divided into the nonelderly (n = 501, 16-64 years) and elderly group (n = 535, age ≥65 years). We further evaluated the impact of coagulopathy (international normalized ratio, >1.2) on the outcomes (Glasgow Outcome Scale-Extended [GOS-E] scores, in-hospital mortality, and ventilation-free days) in both groups using univariate and multivariate models. Further, we conducted an age-based assessment of the impact of TBI-associated coagulopathy on GOS-E using a generalized additive model. RESULTS: The multivariate model showed a significant association of age and TBI-associated coagulopathy with lower GOS-E scores, in-hospital mortality, and shorter ventilation-free days in the nonelderly group; however, significant impact of coagulopathy was not observed for all the outcomes in the elderly group. There was a decrease in the correlation degree between coagulopathy and GOS-E scores decreased with those older than 65 years. CONCLUSION: There was a low impact of coagulopathy on functional and survival outcomes in geriatric patients with isolated TBI. LEVEL OF EVIDENCE: Therapeutic study, Level IV.

Evaluation of manual chest compressions according to the updated cardiopulmonary resuscitation guidelines and the impact of feedback devices in an educational resuscitation course.

BACKGROUND: The cardiopulmonary resuscitation guidelines revised in 2015 recommend target chest compression rate (CCR) and chest compression depth (CCD) of 100-120 compressions per minute (cpm) and 5-6 cm, respectively. We hypothesized that the new guidelines are harder to comply with, even with proper feedback. METHODS: This prospective observational study using data collected from the participants of an Immediate Cardiac Life Support course included the evaluation of chest compressions using performance data from a feedback device after the completion of the course. Participants completed chest compressions for 1 min and were provided with feedback, after which they performed another cycle of CC. Primary outcome measures were CCR and CCD as well as the correct CCR percentage and CCD percentage for pre and post feedback. RESULTS: The study included a total of 88 participants. The median pre-CCR was 112.5 cpm (interquartile range [IQR] 108-116 cpm), and the median correct pre-CCR percentage was 96% (IQR 82.5-99.5%). After the feedback, there was a slight increase in the correct CCR percentage (99% [IQR 92.5-100%]). Conversely, the median pre-CCD was 5.4 cm (IQR 4.9-5.8 cm), and the median pre-correct CCD percentage was 66% (IQR 18.5-90%). The increase in the median post-correct CCD percentage to 72% (IQR 27-94%) observed after the feedback was not statistically significant (P = 0.361). CONCLUSIONS: Compliance with the new guidelines for chest compressions, especially those regarding the CCD, might be difficult. However, whether the changes in guidelines affect outcomes in actual clinical settings is uncertain and requires further investigation.

Difference of computed tomographic characteristic findings between gastric and intestinal gastrointestinal stromal tumors.

PURPOSE: We aimed to compare the computed tomography (CT) imaging differences between gastric and intestinal gastrointestinal stromal tumors (GISTs). MATERIALS AND METHODS: Thirty-eight patients with 38 gastric GISTs and 27 with 31 intestinal GISTs were enrolled. Tumors were classified as small (< 5 cm) or large (≥ 5 cm). Qualitative and quantitative CT imaging characteristics on non-contrast and contrast-enhanced CT were evaluated by two radiologists independently and statistically compared. RESULTS: Early venous return and higher CT number of the draining vein in the arterial phase were more frequent in small-sized intestinal GISTs than in small-sized gastric GISTs (p < 0.001). Small-sized intestinal GISTs demonstrated a wash-out pattern, whereas small-sized gastric GISTs showed a plateau pattern. Contrast enhancement was higher in small-sized intestinal GISTs than in small-sized gastric GISTs (p < 0.001). CT number was inversely proportional to the diameter of intestinal GISTs in both arterial and venous phases but not to that of gastric GISTs. CONCLUSION: Strong enhancement with wash-out pattern and early venous return are characteristic findings of small-sized intestinal GISTs. Radiologists should be aware that CT findings of GISTs have a wide spectrum and may differ according to size and site of origin.

Peripheral bronchial luminal conspicuity on dynamic-ventilation computed tomography: association with radiation doses and temporal resolution by using an ex vivo porcine lung phantom.

BACKGROUND: It is still unclear which image reconstruction algorithm is appropriate for peripheral bronchial luminal conspicuity (PBLC) on dynamic-ventilation computed tomography (DVCT). PURPOSE: To assess the influence of radiation doses and temporal resolution (TR) on the association between movement velocity (MV) and PBLC on DVCT. MATERIAL AND METHODS: An ex vivo porcine lung phantom with simulated respiratory movement was scanned by 320-row CT at 240 mA and 10 mA. Peak and dip CT density and luminal area adjusted by values at end-inspiration (CTDpeak and CTDdip, luminal area ratio [LAR]) for PBLC and MVs were measured and visual scores (VS) were obtained at 12 measurement points on 13 frame images obtained at half and full reconstructions (TR 340 and 190 ms) during expiration. Size-specific dose estimate (SSDE) was applied to presume radiation dose. VS, CTDpeak, CTDdip, LAR, and their cross-correlation coefficients with MV (CCC) were compared among four methods with combinations of two reconstruction algorithms and two doses. RESULTS: The dose at 10 mA was presumed as 26 mA by SSDE for standard proportion adults. VS, CTDdip, CTDpeak, and LAR with half reconstruction at 10 mA (2.52 ± 0.59, 1.016 ± 0.221, 0.948 ± 0.103, and 0.990 ± 0.527) were similar to those at 240 mA except for VS, and different from those with full reconstruction at both doses (2.24 ± 0.85, 0.830 ± 0.209, 0.986 ± 0.065, and 1.012 ± 0.438 at 240 mA) (P < 0.05). CCC for CTDdip with half reconstruction (-0.024 ± 0.552) at 10 mA was higher compared with full reconstruction (-0.503 ± 0.291) (P < 0.05). CONCLUSION: PBLC with half reconstruction at 10 mA was comparable to that at 240 mA and better than those with full reconstruction on DVCT.

MR Imaging-based Evaluation of Mesenteric Ischemia Caused by Strangulated Small Bowel Obstruction and Mesenteric Venous Occlusion: An Experimental Study Using Rabbits.

PURPOSE: This study assessed the MRI findings of strangulated small bowel obstruction (SBO) and mesenteric venous occlusion (MVO) in a rabbit model using 3T MRI. MATERIALS AND METHODS: Twenty rabbits were included in this study. The strangulated SBO and MVO models were generated via surgical procedures in nine rabbits, and sham surgery was performed in two rabbits. The success of generating the models was confirmed via angiographic, macroscopic, and microscopic findings after the surgical procedure. MRI was performed before and 30 min after inducing mesenteric ischemia. T1-weighted images (T1WIs), T2-weighted images (T2WIs), and fat-suppressed T2WIs (FS-T2WIs) were obtained using the BLADE technique, and fat-suppressed T1WIs (FS-T1WIs) were obtained. The signal intensities of the affected bowel before and after the surgical procedures were visually categorized as high, iso, and low intense compared with the findings for the normal bowel wall on all sequences. Bowel wall thickness was measured, and the signal intensity ratio (SI ratio) was calculated using the signal intensities of the bowel wall and psoas muscle. RESULTS: Angiographic, macroscopic, and microscopic findings confirmed that all surgical procedures were successful. The ischemic bowel wall was thicker than the normal bowel. The bowel wall was thicker in the MVO model (3.17 ± 0.55 mm) than in the strangulated SBO model (2.26 ± 0.46 mm). The signal intensity and SI ratio of the bowel wall were significantly higher after the procedure than before the procedure on all sequences in both models. The mesentery adjacent to the ischemic bowel loop exhibited a high signal intensity in all animals on FS-T2WIs. CONCLUSION: Non-contrast MRI can be used to evaluate mesenteric ischemia caused by strangulated SBO and MVO. FS-T2WIs represented the best modality for depicting the high signal intensity in the bowel wall and mesentery caused by ischemia.