Solitary Metastasis of Colon Adenocarcinoma Mimicking Colloid Cyst of the Third Ventricle.

Metastatic lesions to the choroid plexus, although far less common than colloid cysts, can present very similarly both symptomatically and radiographically. Choroid plexus metastases are most common in the lateral ventricles, however, when they occur in the third and fourth ventricles they may cause obstructive hydrocephalus typical of a colloid cyst lesion. Renal cell carcinoma is the most common primary cancer, but many rare primaries have been reported. When patients are presenting with symptoms typical of colloid cysts it is important to consider past oncological history and if past medical history is significant for cancer using MR spectroscopy may be valuable in distinguishing between cystic and metastatic lesions.

Metastatic Renal Cell Carcinoma to the Cerebrum in a Patient With Lynch Syndrome: A Case Report.

Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome is an autosomal-dominant genetic disorder of DNA mismatch repair associated with many forms of cancer, especially colorectal and including renal cell. In this report, we present a case of a patient with a known history of HNPCC whose first presentation of renal cell carcinoma (RCC) was associated with a symptomatic intracranial lesion. After intracranial imaging, resection, and pathologic examination, the lesion was revealed to be of RCC origin. Further imaging revealed primary RCC. HNPCC may present with neurologic symptoms prior to the diagnosis of primary cancer, and lower levels of suspicion for intracranial lesions may be required to properly treat this patient population.

The Role of Computed Tomography and Real-Time Polymerase Chain Reaction in the Diagnosis and Prognostication of COVID-19.

With the rapid spread of coronavirus disease 2019 (COVID-19) starting in early 2020, there has been much interest in the applicability of radiologic imaging in managing affected patients. From the initial screening to addressing the extent of pulmonary involvement, CT scans provide great value to hospitals overwhelmed by an influx of patients, including those with suspected COVID-19. Because CTs come at a high financial cost, lower cost real-time polymerase chain reaction (RT-PCR) COVID-19 tests are critical due to their ability to identify asymptomatic carriers and properly handle patients during the ongoing pandemic. However, unlike RT-PCR, CT scans can also provide insight into the progression of the virus. The signs of acute COVID-19 infection include unique patterns of ground-glass opacities (GGO) with vascular thickening, enabling radiologists to diagnose COVID-19 with a high specificity. Additionally, there may be a significant value in the use of CT scans in predicting the outcomes.

Predicting in-hospital mortality after traumatic brain injury: External validation of CRASH-basic and IMPACT-core in the national trauma data bank.

BACKGROUND: Traumatic brain injury (TBI) prognostic prediction models offer value to individualized treatment planning, systematic outcome assessments and clinical research design but require continuous external validation to ensure generalizability to different settings. The Corticosteroid Randomization After Significant Head Injury (CRASH) and International Mission on Prognosis and Analysis on Clinical Trials in TBI (IMPACT) models are widely available but lack robust assessments of performance in a current national sample of patients. The purpose of this study is to assess the performance of the CRASH-Basic and IMPACT-Core models in predicting in-hospital mortality using a nationwide retrospective cohort from the National Trauma Data Bank (NTDB). METHODS: The 2016 NTDB was used to analyze an adult cohort with moderate-severe TBI (Glasgow Coma Scale [GCS] ≤ 12, head Abbreviated Injury Scale of 2-6). Observed in-hospital mortality or discharge to hospice was compared to the CRASH-Basic and IMPACT-Core models' predicted probability of 14-day or 6-month mortality, respectively. Performance measures included discrimination (area under the receiver operating characteristic curve [AUC]) and calibration (calibration plots and Brier scores). Further sensitivity analysis included patients with GCS ≤ 14 and considered patients discharged to hospice to be alive at 14-days. RESULTS: A total of 26,228 patients were included in this study. Both models demonstrated good ability in differentiating between patients who died and those who survived, with IMPACT demonstrating a marginally greater AUC (0.863; 95% CI: 0.858 - 0.867) than CRASH (0.858; 0.854 - 0.863); p < 0.001. On calibration, IMPACT overpredicted at lower scores and underpredicted at higher scores but had good calibration-in-the-large (indicating no systemic over/underprediction), while CRASH consistently underpredicted mortality. Brier scores were similar (0.152 for IMPACT, 0.162 for CRASH; p < 0.001). Both models showed slight improvement in performance when including patients with GCS ≤ 14. CONCLUSION: Both CRASH-Basic and IMPACT-Core accurately predict in-hospital mortality following moderate-severe TBI, and IMPACT-Core performs well beyond its original GCS cut-off of 12, indicating potential utility for mild TBI (GCS 13-15). By demonstrating validity in the NTDB, these models appear generalizable to new data and offer value to current practice in diverse settings as well as to large-scale research design.