Correlation Between Volume and Pressure of Intracranial Space With Craniectomy Surface Area and Brain Herniation: A Phantom-Based Study.

There are proponents of decompressive craniectomy (DC) and its various modifications who claim reasonable clinical outcomes for each of them. Clinical outcome in cases of traumatic brain injury, managed conservatively or aided by different surgical techniques, depends on multiple factors, which vary widely among patients and have complex interplay, making it difficult to compare one case with another in absolute terms. This forms the basis of the perceived necessity to have a standard model to study, compare, and strategize in this field. We designed a phantom-based model and present the findings of the study aimed at establishing a correlation of the volume of intracranial space and changes in intracranial pressure (ICP) with surface area of the craniectomy defect created during DC and brain herniation volume. A roughly hemispherical radio-opaque container was scanned on a 128-slice computed tomography scanner. Craniectomies of different sizes and shapes were marked on the walls of the phantom. Two spherical sacs of stretchable materials were subsequently placed inside the phantom, fixed to three-way connectors, filled with water, and connected with transducers. The terminals of the transducer cables were coupled with the display monitor through a signal amplifier and processor module. Parts of the wall of the phantom were removed to let portions of the sac herniate through the defect, simulating a DC. Volume measurements using AW volume share 7® software were done. Resection of a 12.7 × 11.5 cm part of the wall resulted in a 10-cm-diameter defect in the wall. Volume differential of 35 mL created a midline shift of 5 mm to the side with lesser volume. When measuring pressure in two stretchable sacs contained inside the phantom, there always remained a pressure differential ranging from 1 to 2 mm Hg in different recordings, even with sacs on both sides containing an equal volume of fluids. Creating a circular wall defect of 10 cm in diameter with an intracavitary pressure of 35 mm Hg on the ipsilateral sac and 33 mm on the contralateral sac recorded with intact walls, resulted in a true volume expansion of 48.411 cm3. The herniation resulted in a reduction of pressure in both sacs, with the pressure recorded as 25 mm in the ipsilateral sac and 24 mm in the contralateral sac. The findings closely matched those of the other model-based studies. Refinement of the materials used is likely to provide a valid platform to study cranial volume, ICP, craniectomy size, and brain prolapse volume in real time. The model will help in pre-operatively choosing the most appropriate technique between a classical DC, a hinge craniotomy, and an expansive cranioplasty technique in cases of refractory raised ICP.

Diagnosis and treatment of epiploic appendagitis in a Middle Eastern country: An observational retrospective analysis of 156 cases.

BACKGROUND: Epiploic appendagitis (EPA) is an uncommon emergency surgical condition that causes acute abdominal pain, rendering a list of differential diagnoses. Therefore, careful examination and imaging tools are required. EPA is a self-limiting condition that can be resolved in 1-2 weeks and rarely needs surgical intervention. Its low incidence makes EPA less well-known among the public and some medical professionals, and it is frequently under-diagnosed. We aimed to explore the incidence, clinical presentation, modalities of imaging to diagnose and options for treating EPA. METHODS: An observational retrospective analysis was conducted between 2016 and 2022 at a tertiary hospital in an Arab Middle Eastern country. RESULTS: There were 156 EPA cases diagnosed over six years, with a mean age of 33 years. Males represented 82% of the cohort. The entire cohort was treated non-operatively except for eight patients who had surgical intervention using open or laparoscopic surgery. The diagnosis was made by a computerized tomographic scan (CT). However, plain X-ray, abdominal ultrasound, and magnetic resonance imaging (MRI) were performed initially in a few selected cases to rule out other conditions. No specific blood test indicated EPA; however, a histopathology examination was diagnostic. No mortality was reported in the study cohort. CONCLUSION: This is the most extensive study analyzing EPA patients from the Middle East. EPA is a rare and mostly self-limiting acute abdominal disorder; however, early ultrasound and CT scan can pick it up quickly after a high index of suspicion.

Case report: Poorly differentiated breast carcinoma presenting as a breast abscess.

We report a case of 31-year-old female with no past medical history who presented with sudden onset discharging skin ulcer in left inframammary fold with erythema and swelling immediately after she came back from holiday for which she presented to the breast one stop clinic and underwent ultrasound-guided aspiration of the detected cystic lesion in the left breast with impression of breast abscess. Afterwards, as the result of cytology reporting as C5, ultrasound-guided Core-Needle Biopsy was performed, which confirmed poorly differentiated carcinoma of breast. Furthermore, similar necrotizing masses were found in axillary lymph nodes and Liver. The final diagnosis was concluded as poorly differentiated breast carcinoma with metastasis to axillary lymph nodes and the liver. This case reports a very uncommon presentation of breast carcinoma in a young patient with no past medical history, presenting with cystic necrotizing mass which is extremely rare in breast cancer. At the time of presentation, carcinoma had spread to the liver and axillary nodes.

Quantitative CT scan and response to pronation in COVID-19 ARDS.

Background: The use of the prone position (PP) has been widespread during the COVID-19 pandemic. While it has demonstrated benefits, including improved oxygenation and lung aeration, the factors influencing the response in terms of gas exchange to PP remain unclear. In particular, the association between baseline quantitative Computed Tomography (qCT) scan results and gas exchange response to PP in intubated, mechanically ventilated subjects with COVID-19 ARDS is unknown. The present study aimed to compare baseline qCT results between subjects responding to PP in terms of oxygenation or carbon dioxide (CO2) clearance and those who did not.Methods: This was a single-center, retrospective observational study, including critically ill, intubated, mechanically ventilated subjects with COVID-19 related acute respiratory distress syndrome admitted to the ICUs of Niguarda Hospital between March 2020 and November 2021. Blood-gas samples were collected before and after PP. Subjects in whom the PaO2/FiO2 increase was ≥ 20 mmHg after PP were defined as Oxygen responders (Oxy-R). CO2-responders (CO2R) were defined when the ventilatory ratio (VR) decreased during PP. Automated qCT analyses were performed to obtain tissue mass and density of the lungs.Results: One hundred twenty-five subjects were enrolled, of which 116 (93%) were Oxy-R and 51 (41%) CO2R. No difference in qCT characteristics and oxygen were observed between Oxy-R and Oxygen Non Responders (Tissue mass 1532 ±396 vs. 1654 ±304 g, p= .28; density -544±109 vs. -562±58 HU, p= .42). Similar findings were observed when dividing the population according to CO2 response (Tissue mass 1551±412 vs. 1534±377 g, p= .89; density -545±123 vs. -546±94 HU, p= .99).Conclusions: Most COVID-19 related ARDS subjects improve their oxygenation at the first pronation cycle. The study suggests that baseline qCT scan data are not associated with the response to PP in oxygenation or CO2 in mechanically ventilated COVID-19 related ARDS subjects.

COVID-19 diagnostic prediction on chest CT scan images using hybrid quantum-classical convolutional neural network.

Notwithstanding the extensive research efforts directed towards devising a dependable approach for the diagnosis of coronavirus disease 2019 (COVID-19), the inherent complexity and capriciousness of the virus continue to pose a formidable challenge to the precise identification of affected individuals. In light of this predicament, it is essential to devise a model for COVID-19 prediction utilizing chest computed tomography (CT) scans. To this end, we present a hybrid quantum-classical convolutional neural network (HQCNN) model, which is founded on stochastic quantum circuits that can discern COVID-19 patients from chest CT images. Two publicly available chest CT image datasets were employed to evaluate the performance of our model. The experimental outcomes evinced diagnostic accuracies of 99.39% and 97.91%, along with precisions of 99.19% and 98.52%, respectively. These findings are indicative of the fact that the proposed model surpasses recently published works in terms of performance, thus providing a superior ability to precisely predict COVID-19 positive instances.Communicated by Ramaswamy H. Sarma.

Effect of a Single-Session Mindfulness-Based Swinging Technique (MBST) Intervention on Emotional Distress in Cancer Patients Undergoing PET-CT Scan: A Randomized Controlled Trial.

Introduction: Undergoing complex diagnostic investigation of positron emission tomography-computed tomography (PET-CT) scans is associated with high levels of distress, fear, and anxiety in oncological patients. This study evaluated the effects of a single 20-min session of an innovative mindfulness-based swinging technique (MBST) intervention on emotional distress in cancer patients scheduled for PET-CT scans. Material and Methods: Adult cancer patients undergoing PET-CT scans (n = 57) were assigned to the intervention group (n = 27) or the control group (n = 30). The emotion thermometer (ET) was used to measure distress, anxiety, depression, anger, and need for help at baseline and after the PET-CT scan. Participants in the intervention group received a 5-min psycho-education followed by listening to an audio recording of the MBST intervention just before their PET-CT scan. The session included mindfulness-based visualization, imaginary swinging activity, and synchronized breathing. The control group participants received brief 5-min counseling. Results: There was a statistically significant reduction in distress (p < 0.001), anxiety (p < 0.001), depression (p < 0.001), anger (p = 0.002), and need for help (p < 0.001) in the intervention group compared with the control group. Safety: None of the participants reported adverse events caused by the MBST intervention. The intervention was well accepted by the participants. However, n = 3 participants could not complete the intervention due to mind wandering, inability to focus, difficulty complying with the guided instructions, falling asleep, and physical discomfort unrelated to the intervention. Conclusion: The findings suggest the potential role of MBST intervention in mitigating emotional distress in patients undergoing complex diagnostic imaging procedures. Integrating this with conventional care in nuclear medicine settings can provide patient-centered care that addresses their unmet requirements. There is a need for further validation with a larger sample size. Clinical Trial Registration Number: CTRI/2023/04/051243 (Registered prospectively on 03/04/2023).

Therapeutic effect of curcumin nanoemulsion on cystic echinococcosis in BALB/c mice: a computerized tomography (CT) scan and histopathologic study evaluation.

BACKGROUND: This study aimed to determine the therapeutic efficacy of curcumin nanoemulsion (CUR-NE) in mice infected with Echinococcus granulosus sensu stricto protoscoleces. METHODS: Forty-two inbred BALB/c mice were divided into seven groups of six animals each. Six groups were inoculated intra-peritoneally with 1500 viable E. granulosus protoscoleces, followed for six months and used as infected groups. The infected groups were named as: CEI1 to CEI6 accordingly. The 7th group was not inoculated and was named cystic echinococcosis noninfected group (CENI7). CEI1 and CEI2 groups received 40 mg/kg/day and 20 mg/kg/day curcumin nanoemulsion (CUR-NE), respectively. CEI3 received nanoemulsion without curcumin (NE-no CUR), CEI4 received curcumin suspension (CUR-S) 40 mg/kg/day, CEI5 received albendazole 150 mg/kg/day and CEI6 received sterile phosphate-buffered saline (PBS). CENI7 group received CUR-NE 40 mg/kg/day. Drugs administration was started after six months post-inoculations of protoscoleces and continued for 60 days in all groups. The secondary CE cyst area was evaluated by computed tomography (CT) scan for each mouse before treatment and on the days 30 and 60 post-treatment. The CT scan measurement results were compared before and after treatment. After the euthanasia of the mice on the 60th day, the cyst area was also measured after autopsy and, the histopathological changes of the secondary cysts for each group were observed. The therapeutic efficacy of CUR-NE in infected groups was evaluated by two methods: CT scan and autopsied cyst measurements. RESULTS: Septal calcification in three groups of infected mice (CEI1, CEI2, and CEI4) was revealed by CT scan. The therapeutic efficacy of CUR-NE 40 mg/kg/day (CEI1 group) was 24.6 ± 26.89% by CT scan measurement and 55.16 ± 32.37% by autopsied cysts measurements. The extensive destructive effects of CUR-NE 40 mg/kg/day (CEI1 group) on the wall layers of secondary CE cysts were confirmed by histopathology. CONCLUSION: The current study demonstrated a significant therapeutic effect of CUR-NE (40 mg/kg/day) on secondary CE cysts in BALB/c mice. An apparent septal calcification of several cysts revealed by CT scan and the destructive effect on CE cysts observed in histopathology are two critical key factors that suggest curcumin nanoemulsion could be a potential treatment for cystic echinococcosis.

Segmentation and classification of lungs CT-scan for detecting COVID-19 abnormalities by deep learning technique: U-Net model.

Background: Artificial intelligence (AI) techniques have been ascertained useful in the analysis and description of infectious areas in radiological images promptly. Our aim in this study was to design a web-based application for detecting and labeling infected tissues on CT (computed tomography) lung images of patients based on the deep learning (DL) method as a type of AI. Materials and Methods: The U-Net architecture, one of the DL networks, is used as a hybrid model with pre-trained densely connected convolutional network 121 (DenseNet121) architecture for the segmentation process. The proposed model was constructed on 1031 persons' CT-scan images from Ibn Sina Hospital of Iran in 2021 and some publicly available datasets. The network was trained using 6000 slices, validated on 1000 slices images, and tested against the 150 slices. Accuracy, sensitivity, specificity, and area under the receiver operating characteristics (ROC) curve (AUC) were calculated to evaluate model performance. Results: The results indicate the acceptable ability of the U-Net-DenseNet121 model in detecting COVID-19 abnormality (accuracy = 0.88 and AUC = 0.96 for thresholds of 0.13 and accuracy = 0.88 and AUC = 0.90 for thresholds of 0.2). Based on this model, we developed the "Imaging-Tech" web-based application for use at hospitals and clinics to make our project's output more practical and attractive in the market. Conclusion: We designed a DL-based model for the segmentation of COVID-19 CT scan images and, based on this model, constructed a web-based application that, according to the results, is a reliable detector for infected tissue in lung CT-scans. The availability of such tools would aid in automating, prioritizing, fastening, and broadening the treatment of COVID-19 patients globally.

Outcome prediction of cardiac arrest with automatically computed gray-white matter ratio on computed tomography images.

BACKGROUND: This study aimed to develop an automated method to measure the gray-white matter ratio (GWR) from brain computed tomography (CT) scans of patients with out-of-hospital cardiac arrest (OHCA) and assess its significance in predicting early-stage neurological outcomes. METHODS: Patients with OHCA who underwent brain CT imaging within 12 h of return of spontaneous circulation were enrolled in this retrospective study. The primary outcome endpoint measure was a favorable neurological outcome, defined as cerebral performance category 1 or 2 at hospital discharge. We proposed an automated method comprising image registration, K-means segmentation, segmentation refinement, and GWR calculation to measure the GWR for each CT scan. The K-means segmentation and segmentation refinement was employed to refine the segmentations within regions of interest (ROIs), consequently enhancing GWR calculation accuracy through more precise segmentations. RESULTS: Overall, 443 patients were divided into derivation N=265, 60% and validation N=178, 40% sets, based on age and sex. The ROI Hounsfield unit values derived from the automated method showed a strong correlation with those obtained from the manual method. Regarding outcome prediction, the automated method significantly outperformed the manual method in GWR calculation (AUC 0.79 vs. 0.70) across the entire dataset. The automated method also demonstrated superior performance across sensitivity, specificity, and positive and negative predictive values using the cutoff value determined from the derivation set. Moreover, GWR was an independent predictor of outcomes in logistic regression analysis. Incorporating the GWR with other clinical and resuscitation variables significantly enhanced the performance of prediction models compared to those without the GWR. CONCLUSIONS: Automated measurement of the GWR from non-contrast brain CT images offers valuable insights for predicting neurological outcomes during the early post-cardiac arrest period.

Structural Lung Disease and Clinical Phenotype in Bronchiectasis Patients: The EMBARC CT Study.

RATIONALE: Chest computed tomography -scans (CTs) are essential to diagnose and monitor bronchiectasis (BE). To date, little quantitative data is available about the nature and extent of structural lung abnormalities (SLA) on CTs of BE patients. OBJECTIVES: to investigate SLA on CTs of patients with bronchiectasis and the relationship of SLAs to clinical features using the European Bronchiectasis Registry (EMBARC) Methods: CTs from BE patients included in the EMBARC registry were analyzed using the validated Bronchiectasis Scoring Technique for CT (BEST-CT). BEST-CT subscores are expressed as % of total lung volume. Scored items are: atelectasis/consolidation (%ATCON), bronchiectasis with and without mucus plugging (%BEMP, %BEwMP), airway wall thickening (%AWT), mucus plugging (%MP), ground-glass opacities (%GGO), bullae (%BUL), airways and parenchyma (%A,%P). Four composite scores were calculated: Total BE (%TBE=%BEMP+%BEwMP), total MP (%TMP=%BEMP+%MP), total inflammatory changes (%TinF=%ATCON+%BEMP+%MP+%GGO) and total disease (%DIS= all but %A & %P).¬ Measurments and Main Results: CTs of 524 BE patients were analyzed. Mean (range) of subscores were: %TBE 4.6 (2.3-7.7), %TMP 4.2 (1.2-8.1), %TinF 8.3 (3.5-16.7) and %DIS 14.9 (9.1-25.9). BE associated with primary ciliary dyskinesia was associated with more SLA, while COPD was associated with less SLA. Lower FEV1, longer disease duration, Pseudomonas aeruginosa and NTM infection, and severe exacerbations were all independently associated with worse SLA. CONCLUSION: Patients with bronchiectasis have highly heterogeneous type and extent of structural lung abnormalities. Strong relationships between radiological disease and clinical features suggest CT analysis may be a useful tool for clinical phenotyping.

Atrial fibrillation and preexisting cognitive impairment in ischemic stroke patients: Dijon Stroke Registry.

BACKGROUND: Atrial Fibrillation (AF) is a common cause of ischemic stroke (IS), and is associated with cognitive impairment in the general population. We aimed to compare the prevalence of preexisting cognitive impairment between IS patients with and without AF, and to assess whether prior brain damage could contribute to the observed differences. METHODS: Patients with acute IS were prospectively identified from the population-based Dijon Stroke Registry, France. Patients who had a CT-scan as brain imaging modality were included in this analysis to assess the presence of preexisting leukoaraiosis, old vascular brain lesions, and cerebral atrophy. Characteristics of patients including prior-to-stroke cognitive status (normal cognition, mild cognitive impairment (MCI), or dementia) were compared between those with and without AF. RESULTS: Among 916 IS patients, 288 (31.4 %) had AF, of whom 88 had newly diagnosed AF. AF patients had more frequent prior MCI (17.8 % versus 10.2 %) or dementia (22.4 % versus 13.1 %) (p = 0.001), vascular risk factors, and preexisting brain damage. In unadjusted model, preexisting cognitive impairment was associated with AF (OR=2.24; 95 % CI: 1.49-3.37, p < 0.001 for MCI; OR=2.20; 95 % CI: 1.52-3.18, p < 0.001 for dementia). After adjustment for clinical and imaging variables, preexisting mild cognitive impairment (OR=1.87; 95 % CI: 1.06-3.32, p = 0.032) and dementia (OR=1.98; 95 % CI: 1.15-3.40, p = 0.013) were independently associated with AF. CONCLUSION: AF is a common condition in IS patients and is associated with preexisting cognitive impairment. Brain lesions visible on imaging did not seem to fully account for this association that may involve other mechanisms yet to be elucidated.

Transcatheter Aortic Valve Replacement for Sutureless Bioprosthetic Valve Tilting Resulting in Severe Paravalvular Leak.

Severe paravalvular leak (PVL) may be complicated by heart failure and haemolysis. PVL management is challenging, especially when the gap is large. We describe a case of PVL due to tilting of a sutureless biological prosthesis successfully treated by transcatheter aortic valve replacement (TAV-in-SAV).

Surgical Proposition of a Slow-Growing Calvarial Exostosis in a Female Patient With a Congenital Iris Cyst of the Anterior Chamber and Mandibular Tori.

We present an unusual case of a woman in her early 50s with a slow-growing calvarial exostosis. Exostoses are bony spurs or osteomas extending outward beyond a bone's surface and may be benign or malignant. Calvarial exostoses are a less common bone tumor that can occur in the population. We present a case of a rare, slow-growing calvarial exostosis with a combination of mandibular tori and a congenital iris cyst. We discuss differentials of this exostosis and different syndromes that may cause it such as hereditary multiple exostoses and Gardner syndrome. The current article aims to spread awareness of this atypical presentation of exostoses and present our institution's surgical proposition for removing a calvarial exostosis to obtain a further histological analysis of its composition. As these masses may commonly be benign, a definitive diagnosis cannot be made through imaging alone to rule out more threatening conditions. We have addressed radiological findings and diagnostic and treatment options offered to the patient. The patient decided not to move forward with removing the mass and would continue to monitor and return should she notice any unusual or acute changes.

Total Muscle Area and Visceral Adipose Tissue Measurements for Frailty Assessment in TAVR Patients.

Background: Transcatheter aortic valve replacement (TAVR) is a treatment option for severe aortic valve stenosis. Pre-TAVR assessments, extending beyond anatomy, include evaluating frailty. Potential frailty parameters in pre-TAVR computed tomography (CT) scans are not fully explored but could contribute to a comprehensive frailty assessment. The primary objective was to investigate the impact of total muscle area (TMA) and visceral adipose tissue (VAT) as frailty parameters on 5-year all-cause mortality in patients undergoing TAVR. Methods: Between 01/2017 and 12/2018, consecutive TAVR patients undergoing CT scans enabling TMA and VAT measurements were included. Results: A total of 500 patients qualified for combined TMA and VAT analysis. Age was not associated with a higher risk of 5-year mortality (HR 1.02, 95% CI: 0.998-1.049; p = 0.069). Body surface area normalized TMA (nTMA) was significantly associated with 5-year, all-cause mortality (HR 0.927, 95% CI: 0.927-0.997; p = 0.033), while VAT had no effect (HR 1.002, 95% CI: 0.99-1.015; p = 0.7). The effect of nTMA on 5-year, all-cause mortality was gender dependent: the protective effect of higher nTMA was found in male patients (pinteraction: sex × nTMA = 0.007). Conclusions: Normalized total muscle area derived from a routine CT scan before transcatheter aortic valve replacement complements frailty assessment in patients undergoing TAVR.

Traumatic fractures in an early 19th century museum skeleton suggest the homicide of an old Munich character: the history of "Finessensepperl" (Finesse Joseph).

The well preserved skeleton of Joseph Huber, a very well-known historical character of the 19th century Munich, also nicknamed "Finessen-Sepperl", is the starting point of the reconstruction of life and death of this historical individual. He was known as a postilion d´amour (love's messenger) of the Royal Bavarian capital with numerous comments and anecdotes and a few biographical sketches that indicate he remained well until the last few years of his life where requests for his duties lessened. The skeleton shows a small-sized male individual with almost complete loss of teeth, but otherwise very well-mineralized bone, having suffered from three episodes of trauma - an old-healed incomplete femoral neck fracture leading to severe osteoarthrosis, a clavicle fracture of the medial third with a few weeks old callus formation, and fresh serial rib fractures along with severe skull trauma with fractures of the os temporale and petrosum, presumably leading to intracranial bleeding and finally death. The type and distribution of these latter two injuries are in agreement with a murderous attack - which was retrospectively reported several years after his death, while the old-healed femoral neck fracture may have caused reduction in Joseph´s walking activities but not reduced requests for his services. Paleopathology not only identifies the terminal decline, but also previous diseases of this Old Bavarian character and thereby completes his story.

Association Between Soft Tissue Measures From Computed Tomography and Upper Airway Collapsibility on Drug-Induced Sleep Endoscopy.

OBJECTIVE: Positive airway pressure (PAP) titration during drug-induced sleep endoscopy (DISE) provides objective measures of upper airway collapsibility. While skeletal measurements relate to collapsibility measures on DISE, the influence of soft tissue dimensions on upper airway collapsibility is not known. We analyzed the relationship of measures of upper airway soft tissue volumes, specifically soft palate, pharyngeal lateral walls, and tongue, with metrics of collapsibility. STUDY DESIGN: Cross-sectional analysis from a prospective cohort. SETTING: Academic medical center. METHODS: Patients seeking PAP alternative therapies for obstructive sleep apnea (OSA) underwent standardized supine computed tomography (CT) acquisition and DISE protocols. The CT analysis primarily focused on soft tissue volumes and, secondarily, on airway and skeletal volumetric measures. DISE with PAP administration (DISE-PAP) enabled the determination of the pressure at which inspiratory airflow first commenced (pharyngeal critical pressure, PcritA) and the pressure at which inspiratory flow limitation was abolished (pharyngeal opening pressure, PhOP). Both unadjusted and adjusted correlation analyses were performed to understand the relationship between upper airway anatomy and either PcritA or PhOP. RESULTS: One hundred thirty-nine subjects completed both CT and DISE-PAP. On average, patients were male (70.5%), white (84.2%), middle-aged (56.6 ± 13.5 years), and overweight (29.6 ± 4.7 kg/m2), with moderate-severe apnea-hypopnea index (29.7 ± 21.3 events/h). Adjusted for age, sex, body mass index, and skeletal volumes, soft palate, and lateral pharyngeal wall volumes were not associated with PhOP or PcritA, but a larger tongue was associated with more positive PhOP (⍴ = 0.20, P = .02), and more positive PcritA (⍴ = 0.16, P = .07). Exploratory analyses revealed smaller minimum cross-sectional retropalatal area and intramandibular volume were also associated with increased collapsibility measures. CONCLUSION: After controlling for clinical factors and skeletal volume, greater tongue volume was associated with more severe collapsibility during DISE. These results, in concert with previous work, suggest that greater tongue volume in a smaller skeletal dimensions contribute to the severity of airway collapsibility, a key driver of OSA pathogenesis.

Grading of Gliomas by Contrast-Enhanced CT Radiomics Features.

Background: Gliomas, as Central Nervous System (CNS) tumors, are greatly common with 80% of malignancy. Treatment methods for gliomas, such as surgery, radiation therapy, and chemotherapy depend on the grade, size, location, and the patient's age. Objective: This study aimed to quantify glioma based on the radiomics analysis and classify its grade into High-grade Glioma (HGG) or Low-grade Glioma (LGG) by various machine-learning methods using contrast-enhanced brain Computerized Tomography (CT) scans. Material and Methods: This retrospective study involved acquiring and segmenting data, selecting and extracting features, classifying, analyzing, and evaluating classifiers. The study included a total of 62 patients (31 with LGG and 31 with HGG). The tumors were segmented by an experienced CT-scan technologist with 3D slicer software. A total of 14 shape features, 18 histogram-based features, and 75 texture-based features were computed. The Area Under the Curve (AUC) and Receiver Operating Characteristic Curve (ROC) were used to evaluate and compare classification models. Results: A total of 13 out of 107 features were selected to differentiate between LGGs and HGGs and to perform various classifier algorithms with different cross-validations. The best classifier algorithm was linear-discriminant with 93.5% accuracy, 96.77% sensitivity, 90.3% specificity, and 0.98% AUC in the differentiation of LGGs and HGGs. Conclusion: The proposed method can identify LGG and HGG with 93.5% accuracy, 96.77% sensitivity, 90.3% specificity, and 0.98% AUC, leading to the best treatment for glioma patients by using CT scans based on radiomics analysis.

CT Scan Data Analysis in Malformations of Cortical Development.

Malformations of cortical development (MCDs) are a diverse group of disorders that result from abnormal neuronal migration, proliferation, and differentiation during brain development. Head computed tomography (CT) has limited use in the diagnosis of MCDs and should be reserved for selected cases with specific indications or when magnetic resonance imaging is not available or contraindicated. CT can detect brain calcifications associated with MCDs, thus helping in the differential diagnosis between acquired and genetic MCDs or in the identification of different genetic patterns. Moreover, CT can provide high-resolution images of the skull and bones, thus identifying associated malformations, such as craniosynostosis, inner and middle ear malformations, and vertebral anomalies. In this chapter, we review the CT scan technique, data analysis, and indications in the investigation of MCDs.

Comparing fluorodeoxyglucose positron emission tomography with computed tomography in staging for nodal and distant metastasis in urothelial/bladder cancer.

Objectives: We aim to assess the clinical value of 18F-fluorodeoxyglucose positron (18F-FDG-PET) scan in detecting nodal and distant metastasis compared with computed tomography (CT) scan in patients with urothelial carcinoma or bladder cancer, aiming to improve staging accuracy and thereby better prognosticate and determine therapy. Methods: A retrospective review of 75 patients with invasive bladder cancer (≥T1) who were staged with both CT and 18F-FDG-PET within an 8-week interval was performed for the period between 2015 and 2020. Seventy-two per cent (54/75) had formal pelvic lymph node (LN) dissection or biopsy of lesions suspicious for metastases. FDG-PET definitions for positive sites were assessed depending on SUV Max (nodes with SUVmax >4 at any size, SUV > 2 for lymph nodes >8 mm, or any SUV if the lymph node was >10 mm on axial images). For CT scanning, enlarged LN by RECIST 1.1 criteria (>10 mm) as well as qualitative findings suggesting metastasis were considered positive. The analysis was based on the comparison of CT and 18F-FDG-PET findings to histopathology results from LN dissection or biopsies. Results: Sensitivity, specificity, positive predictive values (PPV) and negative predictive value (NPV) of CT versus FDG-PET for detecting metastasis, in patients who underwent pelvic LN dissection or biopsy of lesions suspicious of metastases, were 46.6% (95% CI: 21%-70%) versus 60% (95% CI: 32%-84%), 100% (95% CI: 91%-100%) versus 83.78% (95% CI: 69%-94%), 100% (95% CI: 63%-100%) versus 60% (95% CI: 32%-84%), and 82.2% (95% CI: 68%-92%) versus 83.78% (95% CI: 69%-94%), respectively. 7/75 (9.3%) patients avoided cystectomy due to 18F-FDG-PET features of metastases that were not detected by CT. Conclusion: FDG-PET may be more sensitive than CT for metastases in the staging of bladder cancer, which resulted in significant avoidance of aggressive local management in cases with occult metastasis.

A Case of Pheochromocytoma With Coagulation Necrosis Due to Hypertensive Crisis Aggravated by Contrast-Enhanced CT Scan and Negative 123I-Metaiodobenzylguanidine (MIBG) Scintigraphy.

123I-metaiodobenzylguanidine (123I-MIBG) scintigraphy is a highly sensitive and specific imaging test for the diagnosis of pheochromocytoma. Typical pheochromocytomas are positive on 123I-MIBG scintigraphy; however, cases of paragangliomas eliciting negative results have been reported. We encountered a case of hypertensive crisis resulting in extensive coagulative necrosis of a pheochromocytoma and negative findings on 123I-MIBG scintigraphy. A 50-year-old Japanese female presented with an acute onset of vomiting, epigastralgia, and abdominal pain. Immediately after contrast-enhanced CT, the patient developed respiratory failure and was intubated. The CT scan revealed a 5-cm left adrenal mass, and a pheochromocytoma crisis was suspected. The patient's condition stabilized following phentolamine administration. Regarding the assessment for pheochromocytoma, plasma metanephrine levels were not markedly increased, and 123I-MIBG scintigraphy was negative. However, a histological examination of the left adrenal mass revealed extensive coagulative necrosis of the entire adrenal mass, comprising trabecular and alveolar growth of large polygonal cells that were immunopositive for chromogranin A/synaptophysin, thereby suggesting a diagnosis of pheochromocytoma. There have been three reported cases of 123I-MIBG scintigraphy-negative pheochromocytomas because of pure avascular necrosis without hemorrhage or rupture. To the best of our knowledge, this is the first reported case of massive tumor necrosis due to hypertensive crisis exacerbated after contrast-enhanced CT imaging. In conclusion, pheochromocytoma cannot be ruled out even with negative findings on 123I-MIBG scintigraphy. Accordingly, clinical judgment must be made based on a comprehensive assessment of the clinical course and pathological diagnosis, especially for cases involving a hypertensive crisis.