Electrodiagnostic and Advanced Neuroimaging Characterization for Successful Treatment of Spinal Extradural Arachnoid Cyst.

BACKGROUND: Spinal extradural arachnoid cysts are relatively uncommon. Rarely, large cysts presented with spinal cord compression requiring surgical intervention. CASE DESCRIPTION: We report a patient with a progressively enlarging spinal extradural arachnoid cyst causing worsening right S1 radiculopathy and gastrocnemius muscle atrophy. Electromyography and nerve conduction studies revealed an S1 motor radiculopathy. Serial magnetic resonance imaging findings confirmed enlargement of the small cyst originating from the sacral thecal sac on the right while 2 smaller cysts on the left remained stable. Dynamic computed tomography myelogram revealed connection to the thecal sac behind the right S1 nerve root. We performed a right hemilaminectomy from L5 to S2, exposed the cyst pedicle ligated it, and marsupialized the cyst. After surgery, the patient showed clinical and electrodiagnostic improvement. CONCLUSION: This case illustrates the principles of timely surgical intervention after advanced diagnostic imaging and electrodiagnostic testing to improve neurologic function and minimize complications.

Exploring the Usability of Mobile Apps Supporting Radiologists' Training in Diagnostic Decision Making.

PURPOSE: The objective of this study was to conduct a usability evaluation of mobile apps for supporting education and training in radiologic diagnostic decision-making processes. METHODS: Of 381 mobile apps available at two major stores (Google Play and iTunes), eight iOS apps were selected for laboratory-based usability tests. Six staff radiologists completed eight app-specific task sets, using a think-aloud strategy. The triangular methods approach included quantitative performance measures, System Usability Scale (SUS), and qualitative thematic analysis using heuristic usability principles of usability issues. RESULTS: Overall, radiologists achieved higher than 70% success, with favorable SUS scores, in completing the tasks for seven of the eight apps. However, task success rate and SUS score had a weak relation (r = 0.23), indicating that the perceived usability may not reflect the holistic usability of the app. Task analysis and self-report revealed 108 usability issues, which were condensed to 55 unique issues and categorized by nine usability themes and mapped to ten usability heuristics. Nonintuitive functionality (eg, nonintuitive or misleading labels) was the most frequent theme observed, leading to inefficient navigation. These usability findings were consistent with the 13 improvements the radiologists suggested. CONCLUSIONS: This study demonstrates the feasibility of usability evaluation of radiology mobile apps and suggests potential improvements in the development of radiology mobile apps. This study also suggests that proficiency with mobile devices may not be equivalent to being an expert user, proficient in using the apps.

Efficacy, safety, and potential biomarkers of sunitinib monotherapy in advanced hepatocellular carcinoma: a phase II study.

PURPOSE: To assess the safety and efficacy of sunitinib in patients with advanced hepatocellular carcinoma (HCC) and explore biomarkers for sunitinib response. PATIENTS AND METHODS: We conducted a multidisciplinary phase II study of sunitinib, an antivascular endothelial growth factor receptor tyrosine kinase inhibitor, in advanced HCC. Patients received sunitinib 37.5 mg/d for 4 weeks followed by 2 weeks of rest per cycle. The primary end point was progression-free survival (PFS). We used functional magnetic resonance imaging to evaluate vascular changes in HCC after sunitinib treatment. Circulating molecular and cellular biomarkers were evaluated before and at six time points after sunitinib treatment. RESULTS: Thirty-four patients were enrolled. The objective response rate was 2.9%, and 50% of patients had stable disease. Median PFS was 3.9 months (95% CI, 2.6 to 6.9 months), and overall survival was 9.8 months (95% CI, 7.4 months to not available). Grade 3 or 4 toxicities included leukopenia/neutropenia, thrombocytopenia, elevation of aminotransferases, and fatigue. Sunitinib rapidly decreased vessel leakiness, and this effect was more pronounced in patients with delayed progression. When evaluated early (at baseline and day 14) as well as over three cycles of treatment, higher levels of inflammatory molecules (eg, interleukin-6, stromal-derived factor 1alpha, soluble c-KIT) and circulating progenitor cells were associated with a poor outcome. CONCLUSION: Sunitinib shows evidence of modest antitumor activity in advanced HCC with manageable adverse effects. Rapid changes in tumor vascular permeability and circulating inflammatory biomarkers are potential determinants of response and resistance to sunitinib in HCC. Our study suggests that control of inflammation might be critical for improving treatment outcome in advanced HCC.

Gray-scale and color Doppler sonographic findings in a case of subacute granulomatous thyroiditis mimicking thyroid carcinoma.

Subacute granulomatous thyroiditis is a common disease of unknown cause and is usually self-limiting, with complete resolution of symptoms occurring spontaneously or after steroidal treatment. We report a case of subacute granulomatous thyroiditis in a 62-year-old woman whose clinical presentation was consistent with thyroid carcinoma. Gray-scale and color Doppler sonography revealed marked enlargement of the left lobe of the thyroid and markedly hypoechoic, ill-defined focal areas in both lobes. No flow was noted on color Doppler sonographic examination. Fine-needle aspiration of the thyroid was performed, and histopathologic examination of the specimen confirmed the diagnosis of subacute granulomatous thyroiditis. The patient received prednisolone therapy (20 mg/day) for 2 weeks and recovered well. This case report is the first to describe the gray-scale and color Doppler sonographic appearances of subacute granulomatous thyroiditis. This disease should be included in the differential diagnosis of patients with clinical signs and symptoms of thyroid carcinoma. Histopathologic examination is necessary to confirm the diagnosis.