Fully automated 3D machine learning model for HPV status characterization in oropharyngeal squamous cell carcinomas based on CT images.

BACKGROUND: Human papillomavirus (HPV) status plays a major role in predicting oropharyngeal squamous cell carcinoma (OPSCC) survival. This study assesses the accuracy of a fully automated 3D convolutional neural network (CNN) in predicting HPV status using CT images. METHODS: Pretreatment CT images from OPSCC patients were used to train a 3D DenseNet-121 model to predict HPV-p16 status. Performance was evaluated by the ROC Curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F1 score. RESULTS: The network achieved a mean AUC of 0.80 ± 0.06. The best-preforming fold had a sensitivity of 0.86 and specificity of 0.92 at the Youden's index. The PPV, NPV, and F1 scores are 0.97, 0.71, and 0.82, respectively. CONCLUSIONS: A fully automated CNN can characterize the HPV status of OPSCC patients with high sensitivity and specificity. Further refinement of this algorithm has the potential to provide a non-invasive tool to guide clinical management.

Maze-solving in a plasma system based on functional analogies to reinforcement-learning model.

Maze-solving is a classical mathematical task, and is recently analogously achieved using various eccentric media and devices, such as living tissues, chemotaxis, and memristors. Plasma generated in a labyrinth of narrow channels can also play a role as a route finder to the exit. In this study, we experimentally observe the function of maze-route findings in a plasma system based on a mixed discharge scheme of direct-current (DC) volume mode and alternative-current (AC) surface dielectric-barrier discharge, and computationally generalize this function in a reinforcement-learning model. In our plasma system, we install two electrodes at the entry and the exit in a square lattice configuration of narrow channels whose cross section is 1×1 mm2 with the total length around ten centimeters. Visible emissions in low-pressure Ar gas are observed after plasma ignition, and the plasma starting from a given entry location reaches the exit as the discharge voltage increases, whose route converging level is quantified by Shannon entropy. A similar short-path route is reproduced in a reinforcement-learning model in which electric potentials through the discharge voltage is replaced by rewards with positive and negative sign or polarity. The model is not rigorous numerical representation of plasma simulation, but it shares common points with the experiments along with a rough sketch of underlying processes (charges in experiments and rewards in modelling). This finding indicates that a plasma-channel network works in an analog computing function similar to a reinforcement-learning algorithm slightly modified in this study.

Imaging approach to ingested foreign bodies in the neck.

Foreign body ingestion is a common clinical occurrence worldwide, with high morbidity in the pediatric population and in adult patients with intentional attempts. Coins and button battery ingestions are more common among children. Bone impaction and swallowed dentures are usually seen in older adults. While most ingested foreign bodies pass through the gastrointestinal tract spontaneously with no complications, some require endoscopic and/or surgical intervention. Complications such as pharyngoesophageal ulceration, perforation, stricture, and deep neck infection can develop without timely diagnosis and management. The purpose of this article is to familiarize radiologists with the imaging approach to assess for characteristics and impacted locations of ingested foreign bodies in the neck.

Differential Assessment of Internal Jugular Vein Stenosis in Patients Undergoing CT and MRI with Contrast.

OBJECTIVE: Internal Jugular Vein Stenosis (IJVS) is hypothesized to play a role in the pathogenesis of diverse neurological diseases. We sought to evaluate differences in IJVS assessment between CT and MRI in a retrospective patient cohort. METHODS: We included consecutive patients who had both MRI of the brain and CT of the head and neck with contrast from 1 June 2021 to 30 June 2022 within the same admission. The degree of IJVS was categorized into five grades (0-IV). RESULTS: A total of 35 patients with a total of 70 internal jugular (IJ) veins were included in our analysis. There was fair intermodality agreement in stenosis grades (κ = 0.220, 95% C.I. = [0.029, 0.410]), though categorical stenosis grades were significantly discordant between imaging modalities, with higher grades more frequent in MRI (χ2 = 27.378, p = 0.002). On CT-based imaging, Grade III or IV stenoses were noted in 17/70 (24.2%) IJs, whereas on MRI-based imaging, Grade III or IV stenoses were found in 40/70 (57.1%) IJs. Among veins with Grade I-IV IJVS, MRI stenosis estimates were significantly higher than CT stenosis estimates (77.0%, 95% C.I. [35.9-55.2%] vs. 45.6%, 95% C.I. [35.9-55.2%], p < 0.001). CONCLUSION: MRI with contrast overestimates the degree of IJVS compared to CT with contrast. Consideration of this discrepancy should be considered in diagnosis and treatment planning in patients with potential IJVS-related symptoms.

Rapid expansion of a left atrial myxoma caused by acute multiple internal hemorrhages: a case report and literature review.

BACKGROUND: Left atrial myxoma is the most common benign tumor, with the growth rate remaining unknown because specific symptoms do not present until the tumor grows to a certain size. Early surgical management is performed in most cases once it is detected by physicians. Despite cardiac myxomas commonly being perceived as slow-growing tumors, rapid enlargement of myxomas has been reported. CASE PRESENTATION: A 64-year-old woman was referred to our hospital with a diagnosis of a left atrial tumor. The pointed tumor changed morphologically in a few hours, and her respiratory condition, which had been normal at admission, suddenly deteriorated. Emergent surgery was performed, and the diagnosis was myxoma with multiple intratumor massive hematomas. The patient recovered uneventfully and was discharged on postoperative day 12 without any complications. CONCLUSIONS: We report an extremely rare case of left atrial myxoma rapidly expanded due to acute multiple hemorrhages within itself. Massive internal hemorrhage alters the size, shape, and fragility of the tumor. We should recognize the potential risk of internal hemorrhage that may lead to acute deterioration of the so-called "slow-growing benign" tumors, such as myxomas.

Using Texture Analysis of Neck Computed Tomography Images to Differentiate Primary Hyperparathyroidism From Normal Controls.

OBJECTIVE: To investigate the utility of texture analysis in detecting osseous changes associated with hyperparathyroidism on neck CT examinations compared with control patients and to explore the best regions in the head and neck to evaluate changes in the trabecular architecture secondary to hyperparathyroidism. METHODS: Patients with hyperparathyroidism who underwent a 4D CT of the neck with contrast were included in this study. Age-matched control patients with no history of hyperparathyroidism who underwent a contrast-enhanced neck CT were also included. Mandibular condyles, bilateral mandibular bodies, the body of the C4 vertebra, the manubrium of the sternum, and bilateral clavicular heads were selected for analysis, and oval-shaped regions of interest were manually placed. These segmented areas were imported into an in-house developed texture analysis program, and 41 texture analysis features were extracted. A mixed linear regression model was used to compare differences in the texture analysis features contoured at each of the osseous structures between patients with hyperparathyroidism and age-matched control patients. RESULTS: A total of 30 patients with hyperparathyroidism and 30 age-matched control patients were included in this study. Statistically significant differences in texture features between patients with hyperparathyroidism and control patients in all 8 investigated osseous regions. The sternum showed the greatest number of texture features with statistically significant differences between these groups. CONCLUSIONS: Some CT texture features demonstrated statistically significant differences between patients with hyperparathyroidism and control patients. The results suggest that texture features may discriminate changes in the osseous architecture of the head and neck in patients with hyperparathyroidism.

Comparing accuracy of machine learning approaches to identifying parathyroid adenomas: Lessons and new directions.

PURPOSE: The purpose of this investigation is to understand the accuracy of machine learning techniques to detect biopsy-proven adenomas from similar appearing lymph nodes and factors that influence accuracy by comparing support vector machine (SVM) and bidirectional Long short-term memory (Bi-LSTM) analyses. This will provide greater insight into how these tools could integrate multidimensional data and aid the detection of parathyroid adenomas consistently and accurately. METHODS: Ninety-nine patients were identified; 93 4D-CTs of patients with pathology-proven parathyroid adenomas were reviewed; 94 parathyroid adenomas and 112 lymph nodes were analyzed. A 2D slice through the lesions in each phase was used to perform sequence classification with ResNet50 as the pre-trained network to construct the Bi-LSTM model, and the mean enhancement curves were used to form an SVM model. The model characteristics and accuracy were calculated for the training and validation data sets. RESULTS: On the training data, the area under the curve (AUC) of the Bi-LSTM was 0.99, while the SVM was 0.95 and statistically significant on the DeLong test. The overall accuracy of the Bi-LSTM on the validation data set was 92 %, while the SVM was 88 %. The accuracy for parathyroid adenomas specifically was 93 % for the Bi-LSTM and 83 % for the SVM model. CONCLUSION: Enhancement characteristics are a distinguishing feature that accurately identifies parathyroid adenomas alone. The Bi-LSTM performs statistically better in identifying parathyroid adenomas than the SVM analysis when using both morphologic and enhancement information to distinguish between parathyroid adenomas and lymph nodes. SUMMARY STATEMENT: The Bi-LSTM more accurately identifies parathyroid adenomas than the SVM analysis, which uses both morphologic and enhancement information to distinguish between parathyroid adenomas and lymph nodes, performs statistically better.

Multiparametric machine learning algorithm for human papillomavirus status and survival prediction in oropharyngeal cancer patients.

BACKGROUND: Human papillomavirus (HPV) status influences prognosis in oropharyngeal cancer (OPC). Identifying high-risk patients are critical to improving treatment. We aim to provide a noninvasive opportunity for managing OPC patients by training multiple machine learning pipelines to determine the best model for characterizing HPV status and survival. METHODS: Multi-parametric algorithms were designed using a 492 OPC patient database. HPV status incorporated age, sex, smoking/drinking habits, cancer subsite, TNM, and AJCC 7th edition staging. Survival considered HPV model inputs plus HPV status. Patients were split 4:1 training: testing. Algorithm efficacy was assessed through accuracy and area under the receiver operator characteristic curve (AUC). RESULTS: From 31 HPV status models, ensemble yielded 0.83 AUC and 78.7% accuracy. From 38 survival models, ensemble yielded 0.91 AUC and 87.7% accuracy. CONCLUSION: Results reinforce artificial intelligence's potential to use tumor imaging and patient characterizations for HPV status and outcome prediction. Utilizing these algorithms can optimize clinical guidance and patient care noninvasively.

Effects of Astaxanthin, Lutein, and Zeaxanthin on Eye-Hand Coordination and Smooth-Pursuit Eye Movement after Visual Display Terminal Operation in Healthy Subjects: A Randomized, Double-Blind Placebo-Controlled Intergroup Trial.

(1) Background: The impairment of eye-hand coordination and smooth-pursuit eye movement caused by visual display terminal (VDT) operation is thought to impair daily living activities, for which no effective methods are currently known. On the other hand, various food ingredients, including astaxanthin, lutein, and zeaxanthin, are known to help improve the eye health of VDT operators. This study aimed to test the hypothesis that the combination of astaxanthin, lutein, and zeaxanthin can prevent the impairment of eye-hand coordination and smooth-pursuit eye movement caused by VDT operation. (2) Methods: We conducted a randomized, placebo-controlled, parallel-group clinical trial. Healthy subjects who regularly worked with VDTs were randomly assigned to the active and placebo groups. All of the subjects took soft capsules containing 6 mg of astaxanthin, 10 mg of lutein, and 2 mg of zeaxanthin or placebo soft capsules once daily for eight weeks. We evaluated the eye-hand coordination, smooth-pursuit eye movements, and macular pigment optical density (MPOD) at 0, two, four, and eight weeks after soft-capsule intake. (3) Results: The active group showed significantly improved eye-hand coordination after VDT operation at eight weeks. However, there was no clear improvement in the effect of the supplementation on smooth-pursuit eye movements. The active group also showed a significant increase in MPOD levels. (4) Conclusions: Consumption of a supplement containing astaxanthin, lutein, and zeaxanthin mitigates the decline of eye-hand coordination after VDT operation.

Fear generalization and behavioral responses to multiple dangers.

Animals often exhibit consistent-individual differences (CIDs) in boldness/fearfulness, typically studied in the context of predation risk. We focus here on fear generalization, where fear of one danger (e.g., predators) is correlated with fear of other dangers (e.g., humans, pathogens, moving vehicles, or fire). We discuss why fear generalization should be ecologically important, and why we expect fear to correlate across disparate dangers. CIDs in fear are well studied for some dangers in some taxa (e.g., human fear of pathogens), but not well studied for most dangers. Fear of some dangers has been found to correlate with general fearfulness, but some cases where we might expect correlated fears (e.g., between fear of humans, familiar predators, and exotic predators) are surprisingly understudied.

Investigation of mechanisms underlying a light approaching behavior in a house gecko by comparative and learning experiments.

Nocturnal predators of many taxa are known to come to artificial light at night for foraging on clumped food resources. Both innate and acquired light preferences seem to be possible mechanisms of light approaching behavior although empirical tests are lacking in most nocturnal predators. Here, using a Japanese gecko Gekko japonicus, we investigated whether geckos have a light preference and how foraging experiences under the light reinforce light approaching tendency. In a comparative experiment, there was no difference in light approaching behavior between urban and suburban geckos irrespective of their original light habitats. In an associative learning experiment, geckos did not significantly change light approaching behavior even after repeated opportunities to forage crickets near a lamp in the laboratory setting. These results imply that light approaching behavior of Japanese geckos may not be easily reinforced by foraging experiences under the light. Although we often witness geckos coming to artificial light at night, our findings may not suggest their light preference. Geckos may approach the light-up foraging spot based on other cues relating to the artificial light environment.

Synthesis of Electromagnetic Wave-Absorbing Co-Ni Alloys and Co-Ni Core-Shell Structured Nanoparticles.

Co-Ni alloy nanoparticles, a potential candidate for microwave absorption material, were successfully synthesized by tuning the reduction timing of Co and Ni ions by introducing oleylamine as a complexing agent and 1-heptanol as a reducing solvent. The formation mechanism elucidated using time-resolved sampling and in situ X-ray absorption spectroscopy (XAS) and ultraviolet-visible (UV-vis) spectrophotometry measurements suggested that the delay in the reduction of Co ions via complexation with oleylamine facilitated the co-reduction of Co with Ni ions and led to the formation of Co-Ni alloys. The successful synthesis of Co-Ni alloys experimentally confirmed the differences in magnetic properties between alloy and core-shell structured Co50Ni50 particles. Further, the syntheses of Co-Ni alloys with different compositions were also possible using the above technique. In addition, the microwave absorption properties were measured using the free-space method utilizing a vector network analyzer of Co50Ni50─polyethylene composite with different sheet thicknesses. A reflection loss (RL) value of -25.7 dB at 13.6 GHz for the alloy structure was more significant than the core-shell counterpart. The above values are high compared to results reported in the past. The validity of the measurements was confirmed by utilizing the parameter retrieval method to extract permittivity and permeability from the scattering parameter (S) and recalculation of the RL as a function of frequency.

Primary Multiparametric Quantitative Brain MRI: State-of-the-Art Relaxometric and Proton Density Mapping Techniques.

This review on brain multiparametric quantitative MRI (MP-qMRI) focuses on the primary subset of quantitative MRI (qMRI) parameters that represent the mobile ("free") and bound ("motion-restricted") proton pools. Such primary parameters are the proton densities, relaxation times, and magnetization transfer parameters. Diffusion qMRI is also included because of its wide implementation in complete clinical MP-qMRI application. MP-qMRI advances were reviewed over the past 2 decades, with substantial progress observed toward accelerating image acquisition and increasing mapping accuracy. Areas that need further investigation and refinement are identified as follows: (a) the biologic underpinnings of qMRI parameter values and their changes with age and/or disease and (b) the theoretical limitations implicitly built into most qMRI mapping algorithms that do not distinguish between the different spatial scales of voxels versus spin packets, the central physical object of the Bloch theory. With rapidly improving image processing techniques and continuous advances in computer hardware, MP-qMRI has the potential for implementation in a wide range of clinical applications. Currently, three emerging MP-qMRI applications are synthetic MRI, macrostructural qMRI, and microstructural tissue modeling.

Quantitative MRI Characterization of the Extremely Preterm Brain at Adolescence: Atypical versus Neurotypical Developmental Pathways.

Background Extremely preterm (EP) birth is associated with higher risks of perinatal white matter (WM) injury, potentially causing abnormal neurologic and neurocognitive outcomes. MRI biomarkers distinguishing individuals with and without neurologic disorder guide research on EP birth antecedents, clinical correlates, and prognoses. Purpose To compare multiparametric quantitative MRI (qMRI) parameters of EP-born adolescents with autism spectrum disorder, cerebral palsy, epilepsy, or cognitive impairment (ie, atypically developing) with those without (ie, neurotypically developing), characterizing sex-stratified brain development. Materials and Methods This prospective multicenter study included individuals aged 14-16 years born EP (Extremely Low Gestational Age Newborns-Environmental Influences on Child Health Outcomes Study, or ELGAN-ECHO). Participants underwent 3.0-T MRI evaluation from 2017 to 2019. qMRI outcomes were compared for atypically versus neurotypically developing adolescents and for girls versus boys. Sex-stratified multiple regression models were used to examine associations between spatial entropy density (SEd) and T1, T2, and cerebrospinal fluid (CSF)-normalized proton density (nPD), and between CSF volume and T2. Interaction terms modeled differences in slopes between atypically versus neurotypically developing adolescents. Results A total of 368 adolescents were classified as 116 atypically (66 boys) and 252 neurotypically developing (125 boys) participants. Atypically versus neurotypically developing girls had lower nPD (mean, 557 10 × percent unit [pu] ± 46 [SD] vs 573 10 × pu ± 43; P = .04), while atypically versus neurotypically developing boys had longer T1 (814 msec ± 57 vs 789 msec ± 82; P = .01). Atypically developing girls versus boys had lower nPD and shorter T2 (eg, in WM, 557 10 × pu ± 46 vs 580 10 × pu ± 39 for nPD [P = .006] and 86 msec ± 3 vs 88 msec ± 4 for T2 [P = .003]). Atypically versus neurotypically developing boys had a more moderate negative association between T1 and SEd (slope, -32.0 msec per kB/cm3 [95% CI: -49.8, -14.2] vs -62.3 msec per kB/cm3 [95% CI: -79.7, -45.0]; P = .03). Conclusion Atypically developing participants showed sexual dimorphisms in the cerebrospinal fluid-normalized proton density (nPD) and T2 of both white matter (WM) and gray matter. Atypically versus neurotypically developing girls had lower WM nPD, while atypically versus neurotypically developing boys had longer WM T1 and more moderate T1 associations with microstructural organization in WM. © RSNA, 2022 Online supplemental material is available for this article.

Optimization of Culture Conditions for the Generation of Canine CD20-CAR-T Cells for Adoptive Immunotherapy.

BACKGROUND/AIM: Chimeric antigen receptor (CAR) T cell therapy targeting CD20 has the potential to become a promising novel treatment for canine B cell lymphoid malignancy. However, the optimal approach for producing potent CAR-T cells with favorable phenotype for dogs remains unknown. In this study, we assessed several culture conditions and their effects on the phenotypic characteristics of CD20-CAR-T cells. MATERIALS AND METHODS: Canine CAR-T cells were generated by incubating with several mitogens in the presence or absence of Akt inhibitor. Gene transduction efficiency and phenotypic characteristics were determined by flow cytometry. RESULTS: Comparison of several kinds of mitogens revealed that stimulation with phytohemagglutinin has high transduction efficacy, whereas stimulation with concanavalin A was superior in memory T cell formation. Akt inhibition at the initial stage of CAR-T production tended to enhance transduction efficiency and memory T cell formation. CONCLUSION: This study provides a significant insight into the understanding of the ex vivo expansion of canine T cells in adoptive immunotherapy.

Normal Variants of the Oral and Maxillofacial Region: Mimics and Pitfalls.

A normal variant is defined as an incidental, often asymptomatic, imaging finding that mimics a true pathologic condition. Given the complex anatomy and wide variety of normal variants in the oral and maxillofacial region, a thorough understanding of commonly encountered normal variants in this region is essential to avoid misinterpretation and unnecessary further imaging or interventions. Moreover, familiarity with normal variants that are known to become symptomatic at times is necessary to facilitate further workup and guide the treatment plan. Intraoral radiography and panoramic radiography, which are unique to oral and maxillofacial radiology, provide two-dimensional (2D) images. Hence, the overlapping of structures or the displacement of the tomographic layer on images can confuse radiologists. It is crucial to understand the principle of 2D imaging to avoid being confused by ghost images or optical illusions. In addition, understanding the normal development of the maxillofacial region is essential when interpreting maxillofacial images in children or young adults because the anatomy may be quite different from that of mature adults. Knowledge of changes in the jaw bone marrow and each tissue's growth rate is essential. It is also necessary to know when the tooth germ begins to calcify and the tooth erupts for diagnostic imaging of the maxillofacial region. The authors describe imaging findings and clinical manifestations of common normal variants in the oral and maxillofacial region, divided into four parts: the maxilla, mandible, tooth, and temporomandibular joint, and discuss the imaging approach used to differentiate normal variants from true pathologic conditions. Online supplemental material is available for this article. ©RSNA, 2022.

A tissue-engineered, decellularized, connective tissue membrane for allogeneic arterial patch implantation.

BACKGROUND: We have previously applied in vivo tissue-engineered vascular grafts constructed in patients' subcutaneous spaces. However, since the formation of these vascular grafts depends on host health, their application is challenging in patients with suppressed regenerative ability. Therefore, the allogeneic implantation of grafts from healthy donors needs to be evaluated. This study aimed to fabricate allogeneic cardiovascular grafts in animals. MATERIALS AND METHODS: Silicone rod molds were implanted into subcutaneous pouches in dogs; the implants, along with surrounding connective tissues, were harvested after four weeks. Tubular connective tissues were decellularized and stored before they were cut open, trimmed to elliptical sheets, and implanted into the common carotid arteries of another dog as vascular patches (n = 6); these were resected and histologically evaluated at 1, 2, and 4 weeks after implantation. RESULTS: No aneurysmal changes were observed by echocardiography. Histologically, we observed neointima formation on the luminal graft surface and graft wall cell infiltration. At 2 and 4 weeks after implantation, α-SMA-positive cells were observed in the neointima and graft wall. At 4 weeks after implantation, the endothelial lining was observed at the grafts' luminal surfaces. CONCLUSION: Our data suggest that decellularized connective tissue membranes can be prepared and stored for later use as allogeneic cardiovascular grafts.

Quantitative assessment of the maxillary sinusitis using computed tomography texture analysis: odontogenic vs non-odontogenic etiology.

OBJECTIVES: The purpose of this study was to investigate computed tomography (CT) texture features of mucosal thickening of maxillary sinus mucosa to differentiate odontogenic maxillary sinusitis (OMS) from non-odontogenic maxillary sinusitis (NOMS). METHODS: Eighteen OMS patients and age- and gender-matched 18 NOMS patients who underwent sinus CT were retrospectively reviewed. OMS patients were identified by histopathological examination of tissues excised at surgery combined with CT imaging findings. Patients with mucosal thickening in the maxillary sinus without apical periodontitis or advanced periodontal bone loss near the maxillary sinus on CT were defined as NOMS. Patients with thin mucosal thickening (< 10 mm), cyst, tumor, post-operative deformity, severe metal artifact precluding visualization of the maxillary sinus, and age younger than 20 years were excluded. CT texture features of the mucosal thickening were analyzed using an in-house developed Matlab-based texture analysis program. Forty-five texture features were extracted from each segmented volume. The results were tested with the Mann-Whitney U test. RESULTS: Six histogram features (mean, median, standard deviation, entropy, geometric mean, harmonic mean) and two gray-level co-occurrence matrix features (entropy, correlation) showed significant differences between OMS and NOMS patients. CONCLUSIONS: CT texture analysis revealed the quantitative differences between OMS and NOMS. The texture features can serve as a quantitative indicator of maxillary sinusitis to differentiate between OMS and NOMS and help prevent incorrect treatment choices.

Urgency of Esophageal Foreign Body Removal: Differentiation Between Coins and Button Cell Batteries.

OBJECTIVE: Coin-shaped button battery foreign bodies have a similar initial presentation to coin ingestion, but delayed retrieval of a battery from the esophagus can have devastating consequences. Variations in timing of retrieval for children with ingestion of coin foreign bodies have been reported. The study assesses the sensitivity and specificity of conventional and digital radiographs to differentiate button batteries from coin foreign bodies. STUDY DESIGN: 3B case control study. STUDY SETTING: Tertiary academic medical center. METHODS: A radiographic study of the 12 most common commercially available button batteries and 66 coins of varying international origins was performed. Foreign bodies were placed at the cervical esophagus of a cadaver, and anteroposterior (AP) and lateral conventional radiographs of the neck were obtained. Digital AP and lateral radiographs of standalone coins and batteries were also obtained. Images were blindly read by 2 otolaryngologists and 2 radiologists. Statistical analysis was performed to determine accuracy in identifying coins vs batteries. RESULTS: Using conventional radiographs to identify button batteries yielded a sensitivity of 0.88 and a specificity of 0.92 (positive predictive value [PPV] = 0.75, negative predictive value [NPV] = 0.97). Digital radiography yielded an overall sensitivity of 0.98 and specificity of 0.97 (PPV = 0.87, NPV = 0.99). Features of button batteries were only seen on AP conventional radiographs using reverse contrast. CONCLUSIONS: Neither conventional nor digital radiographic imaging had perfect accuracy in identifying coins vs batteries. Features of common disc batteries were identified, which may aid in diagnosis. With potential devastating consequences from retained battery in the esophagus, emergent removal of any possible disc battery foreign body should be considered.