Radiomics nomogram based on MRI water imaging identifying symptomatic nerves of patients with primary trigeminal neuralgia: A preliminary study.

The study proposes a combined nomogram based on radiomics features from magnetic resonance neurohydrography and clinical features to identify symptomatic nerves in patients with primary trigeminal neuralgia. We retrospectively analyzed 140 patients with clinically confirmed trigeminal neuralgia. Out of these, 24 patients constituted the external validation set, while the remaining 116 patients contributed a total of 231 nerves, comprising 118 symptomatic nerves, and 113 normal nerves. Radiomics features were extracted from the MRI water imaging (t2-mix3d-tra-spair). Radiomics feature selection was performed using L1 regularization-based regression, while clinical feature selection utilized univariate analysis and multivariate logistic regression. Subsequently, radiomics, clinical, and combined models were developed by using multivariate logistic regression, and a nomogram of the combined model was drawn. The performance of nomogram in discriminating symptomatic nerves was assessed through the area under the curve (AUC) of receiver operating characteristics, accuracy, and calibration curves. Clinical applications of the nomogram were further evaluated using decision curve analysis. Five clinical factors and 13 radiomics signatures were ultimately selected to establish predictive models. The AUCs in the training and validation cohorts were 0.77 (0.70-0.84) and 0.82 (0.72-0.92) with the radiomics model, 0.69 (0.61-0.77) and 0.66 (0.53-0.79) with the clinical model, 0.80 (0.74-0.87), and 0.85 (0.76-0.94) with the combined model, respectively. In the external validation set, the AUCs for the clinical, radiomics, and combined models were 0.70 (0.60-0.79), 0.78 (0.65-0.91), and 0.81 (0.70-0.93), respectively. The calibration curve demonstrated that the nomogram exhibited good predictive ability. Moreover, The decision curve analysis curve indicated shows that the combined model holds high clinical application value. The integrated model, combines radiomics features from magnetic resonance neurohydrography with clinical factors, proves to be effective in identify symptomatic nerves in trigeminal neuralgia. The diagnostic efficacy of the combined model was notably superior to that of the model constructed solely from conventional clinical features.

The CT-guided percutaneous drainage of pancreatic pseudocyst accompanied by pseudoaneurysm: A case report.

RATIONALE: This case report discusses the CT-guided percutaneous drainage of a pancreatic pseudocyst accompanied by a pseudoaneurysm. Pancreatic pseudocysts can erode the peripancreatic artery and produce pseudoaneurysms. This is rare, but it can be life-threatening. PATIENT CONCERNS: The case presented involves a 58-year-old female who was diagnosed with pancreatic cancer and underwent surgical treatment. She presented with hematochezia, dizziness, and hypodynamic findings with no obvious cause. Imaging revealed a pancreatic pseudocyst and small arterial aneurysms. To reduce the risk of aneurysm rupture, the patient underwent transcatheter arterial coil embolization. Three days later, CT-guided catheter drainage was performed to reduce the erosion of the arterial wall caused by pancreatic fluid. DIAGNOSES: The contrast-enhanced-CT imaging showed a round, slightly high-density lesion in the cyst, suggesting the presence of a pseudoaneurysm. INTERVENTIONS: The patient was sent for another transcatheter arterial embolization with coils and n-butyl-2-cyanoacrylate. OUTCOMES: After receiving the transcatheter arterial embolization, the patient had no serious bleeding or other complications. LESSONS: Early detection and accurate assessment of pseudoaneurysms are essential for appropriate management. This case shows that contrast-enhanced CT is necessary before CT-guided percutaneous drainage of pancreatic pseudocysts. It also shows that, due to the many complications that pancreatic pseudocysts may cause, appropriate treatment of pseudocysts complicated with pseudoaneurysm has important clinical significance.