[Brain Abscess].

Although the prognosis of brain abscesses has historically improved, the mortality rate still ranges from 5 to 32%, with ventricular perforation reaching 50% and 85-100% in fungal brain abscesses. The characteristic finding of ring-like enhancement by contrast-enhanced imaging is non-specific, and DWI, SWI and MR spectroscopy are very useful in differentiating brain abcesses from necrotizing brain tumors. Brain abscesses show apparent diffusion restriction on the DWI/apparent diffusion coefficient(ADC) map, whereas necrotizing brain tumors often show a weak diffusion restriction. The "dual rim sign" on SWI is also a highly specific finding of brain abscess.

CD45RA-Foxp3high regulatory T cells have a negative impact on the clinical outcome of head and neck squamous cell carcinoma.

BACKGROUND: Although regulatory T cells (Tregs) are thought to play an important role in immune suppression, their clinical significance in head and neck squamous cell carcinoma (HNSCC) is unclear. A recent study reported Tregs could be divided into functional subsets based on the expression of CD45RA and Foxp3. METHOD: The frequency of circulating Treg subsets was analyzed in patients with HNSCC and compared with the frequency in patients with benign tumors. The association of Treg subsets with the frequency of lymphocyte subsets, status of progression, clinical course, and prognosis were also examined. RESULTS: The frequency of CD4+Foxp3+ Tregs was comparable between HNSCC patients and age-matched benign tumor patients; however, CD45RA-Foxp3high Tregs were significantly increased in HNSCC patients, in particular those with advanced stage tumors. The high frequency of CD45RA-Foxp3high Tregs correlated with a poor prognosis and the low frequency of CD45RA-Foxp3high Tregs before treatment showed a better clinical outcome, even in patients with advanced stage tumors. CD45RA-Foxp3high Treg numbers were decreased after intensive treatments; however, Treg numbers recovered in the early stages of recurrent cases, even before the clinical manifestation. CONCLUSION: CD45RA-Foxp3high Tregs are associated with the clinical course of HNSCC and might be a new target for treatment and an early marker of tumor recurrence in HNSCC patients.

Classification and characterization of Japanese consumers' beef preferences by external preference mapping.

BACKGROUND: Over the past few decades, beef producers in Japan have improved marbling in their beef products. It was recently reported that marbling is not well correlated with palatability as rated by Japanese consumers. This study sought to identify the consumer segments in Japan that prefer sensory characteristics of beef other than high marbling. RESULTS: Three Wagyu beef, one Holstein beef and two lean imported beef longissimus samples were subjected to a descriptive sensory test, physicochemical analysis and a consumer (n = 307) preference test. According to consumer classification and external preference mapping, four consumer segments were identified as 'gradual high-fat likers', 'moderate-fat and distinctive taste likers', 'Wagyu likers' and 'distinctive texture likers'. Although the major trend of Japanese consumers' beef preference was 'marbling liking', 16.9% of the consumers preferred beef samples that had moderate marbling and distinctive taste. The consumers' attitudes expressed in a questionnaire survey were in good agreement with the preference for marbling among the 'moderate-fat and distinctive taste likers'. CONCLUSION: These results indicate that moderately marbled beef is a potent category in the Japanese beef market. © 2017 Society of Chemical Industry.

Stand-alone anchored cage versus cage with plating for single-level anterior cervical discectomy and fusion: a prospective, randomized, controlled study with a 2-year follow-up.

To avoid complications associated with plating in anterior cervical discectomy and fusion (ACDF), stand-alone anchored PEEK cage was developed and favourable outcomes with a low rate of dysphasia have been described. The objective of this study was to compare the clinical and radiological outcomes of ACDF using a standalone anchored PEEK cage (PREVAIL; Medtronic Sofamor Danek, Memphis, TN) with those of a PEEK cage with plating in a prospective randomized manner. Fifty patients with single-level cervical radiculopathy were randomly assigned to a PREVAIL or a PEEK cage with plating. Following 3, 6, 12, and 24 months, clinical and radiological outcomes were assessed. The mean surgical time for the patients with a PREVAIL was significantly shorter than that for those with a PEEK cage with plating. The clinical outcomes evaluated by visual analogue scale for pain and the Odom's criteria were comparable between both the groups. Both the groups demonstrated the high fusion rate (92% in PREVAIL; 96% in PEEK cage with plating). The subsidence rate and the improvement of cervical alignment were comparable between both the groups. The incidence of adjacent-level ossification was significantly lower for patients with a PREVAIL than that for those with a PEEK cage with plating. The rate of dysphasia graded by the method of Bazaz and measurement of prevertebral soft tissue swelling indicated no significant differences between both the groups. Our prospective randomized study confirmed that stand-alone anchored PEEK cage is a valid alternative to plating in ACDF with a low rate of adjacent-level ossification. However, the potential to reduce the incidence of dysphasia was not confirmed.

Comparison of fusion rates following transforaminal lumbar interbody fusion using polyetheretherketone cages or titanium cages with transpedicular instrumentation.

PURPOSE: Compared to titanium cage, polyetheretherketone (PEEK) cage with pedicle screw fixation has been increasingly used in transforaminal lumbar interbody fusion (TLIF). However, there is insufficient evidence supporting the superiority of PEEK cages over titanium cages as optimal TLIF spacers. The aim of this study was to compare the clinical and radiographic outcomes of patients at a 2-year follow-up after undergoing instrumented TLIF in which either a PEEK cage or a titanium cage was implanted. MATERIALS AND METHODS: We retrospectively analyzed prospectively collected 48 patients who underwent single-level TLIF in which the first 23 patients received a titanium cage and the 25 patients received a PEEK cage. Patient demographics, clinical outcomes, and radiographic imaging were studied. RESULTS: Improvement of clinical outcomes was comparable between the two groups. Based on the criteria using computed tomography, 96 % in the Titanium group and 64 % in the PEEK group showed fusion at 12 months. At 24 months, fusion rate in the Titanium group was increased to 100 %, while PEEK group showed 76 % of fusion rate. In the PEEK group, vertebral osteolysis was noted in 60 % of the cases with nonunion. This abnormal finding was not observed in the Titanium group. Vertebral osteolysis was significantly associated with nonunion. CONCLUSIONS: The superiority of PEEK cages over titanium cages for bony fusion was not demonstrated. Additionally, we found unfavorable radiographic findings in the cases with a PEEK cage, which may lead to nonunion. Improvement in biocompatibility of a PEEK cage will be needed to increase the fusion rate.

Three-dimensional fast imaging employing steady-state acquisition MRI and its diagnostic value for lumbar foraminal stenosis.

The aim of this study was to evaluate the usefulness of three-dimensional (3D) fast imaging employing steady-state acquisition (3D FIESTA) in the diagnosis of lumbar foraminal stenosis (LFS). Fifteen patients with LFS and 10 healthy volunteers were studied. All patients met the following criteria: (1) single L5 radiculopathy without compressive lesion in the spinal canal, (2) pain reproduction during provocative radiculography, and (3) improvement of symptoms after surgery. We retrospectively compared the symptomatic nerve roots to the asymptomatic nerve roots on fast spin-echo (FSE) T1 sagittal, FSE T2 axial and reconstituted 3D FIESTA images. The κ values for interobserver agreement in determining the presence of LFS were 0.525 for FSE T1 sagittal images, 0.735 for FSE T2 axial images, 0.750 for 3D FIESTA sagittal, 0.733 for axial images, and 0.953 for coronal images. The sensitivities and specificities were 60 and 86 % for FSE T1 sagittal images, 27 and 91 % for FSE T2 axial images, 60 and 97 % for 3D FIESTA sagittal images, 60 and 94 % for 3D FIESTA axial images, and 100 and 97 % for 3D FIESTA coronal images, respectively. 3D FIESTA can provide more reliable and additional information for the running course of lumbar nerve root, compared with conventional magnetic resonance imaging. Particularly, use of 3D FIESTA coronal images enables accurate diagnosis for LFS.

Improvements in pincer nail deformity occur earlier and last longer when acetylcysteine gel is added to an overcurvature-correcting device: Results of a phase 3, multicenter, randomized, vehicle-controlled, investigator-blinded study.

Acetylcysteine (AC) destabilizes keratin and softens nails, reducing the time needed to correct pincer nail deformity with an overcurvature-correcting device. The objective of this phase 3, multicenter, randomized, investigator-blinded study was to evaluate the early and sustained therapeutic effectiveness and safety of 10% AC gel plus an overcurvature-correcting device to treat pincer nails. Patients aged 12 years and older with hallux pincer nail were fitted with an overcurvature-correcting device for 7 days, with a 24-h application of AC gel (n = 40) or vehicle (n = 39) on day 1. The primary end point (achievement of a distal narrowed nail width ratio ≥70% on day 8) was met by 47.5% in the 10% AC group and 25.6% in the vehicle group (difference 21.9%; p = 0.0439). Secondary end points showed a greater tendency towards improvement with 10% AC. The nail correction effect was maintained for at least 12 weeks in the majority of AC-treated patients, although the study duration was insufficient to assess the long-term probability of recurrence. No AC-related adverse events were reported. In conclusion, a single application of 10% AC gel combined with short-term device use facilitated earlier correction of pincer nails compared with the device alone, with improvements maintained after device removal.

Efficacy and safety of topical acetylcysteine combined with the use of an overcurvature-correcting device in patients with pincer nail deformity: a randomized, vehicle-controlled, investigator-blinded study.

BACKGROUND: While pincer nails may be treated using overcurvature-correcting devices, it takes several months to achieve successful outcomes. Nail-softening drugs may reduce the treatment duration required. OBJECTIVE: To evaluate the efficacy and safety of treatment with acetylcysteine (AC) gel added to an overcurvature-correcting device, and define the optimal AC concentration. METHODS: In this investigator-blinded study, 70 patients with hallux pincer nail were fitted with an overcurvature-correcting device for 7 days and were randomly assigned to receive a single 24-h administration of a gel containing 10%, 20% or 30% AC or vehicle. Nail improvement was objectively evaluated by calculating the distal narrowed nail width (dNNW) ratio. RESULTS: All three AC concentrations plus device showed earlier sustained improvement of pincer nails versus vehicle plus device. There was no observable correlation between AC concentration and effectiveness. No clinically problematic adverse events were observed at any AC concentration, and we recommended AC gel at a concentration of 10%. CONCLUSIONS: By adding AC gel application to an overcurvature-correcting device, early and sustained reductions in transverse curvature were produced compared with using a device alone (vehicle control). The dNNW ratio used in this study was an appropriate objective index for evaluating therapeutic effects.

Comparison of CT findings of coronavirus disease 2019 (COVID-19) pneumonia caused by different major variants.

PURPOSE: To explore the CT findings and pneumonnia progression pattern of the Alpha and Delta variants of SARS-CoV-2 by comparing them with the pre-existing wild type. METHOD: In this retrospective comparative study, a total of 392 patients with COVID-19 were included: 118 patients with wild type (70 men, 56.8 ± 20.7 years), 137 with Alpha variant (93 men, 49.4 ± 17.0 years), and 137 with Delta variant (94 men, 45.4 ± 12.4). Chest CT evaluation included opacities and repairing changes as well as lesion distribution and laterality. Chest CT severity score was also calculated. These parameters were statistically compared across the variants. RESULTS: Ground glass opacity (GGO) with consolidation and repairing changes were more frequent in the order of Delta variant, Alpha variant, and wild type throughout the disease course. Delta variant showed GGO with consolidation more conspicuously than did the other two on days 1-4 (vs. wild type, Bonferroni corrected p = 0.01; vs. Alpha variant, Bonferroni corrected p = 0.003) and days 5-8 (vs. wild type, Bonferroni corrected p < 0.001; vs. Alpha variant, Bonferroni corrected-p = 0.003). Total lung CT severity scores of Delta variant were higher than those of wild type on days 1-4 and 5-8 (Bonferroni corrected p = 0.01 and Bonferroni corrected p = 0.005, respectively) and that of Alpha variant on days 1-4 (Bonferroni corrected p = 0.002). There was no difference in the CT findings between wild type and Alpha variant. CONCLUSIONS: Pneumonia progression of Delta variant may be more rapid and severe in the early stage than in the other two.

The role of chest imaging in the diagnosis, management, and monitoring of coronavirus disease 2019 (COVID-19).

Coronavirus disease 2019 (COVID-19) pandemic has posed a major public health crisis all over the world. The role of chest imaging, especially computed tomography (CT), has evolved during the pandemic paralleling the accumulation of scientific evidence. In the early stage of the pandemic, the performance of chest imaging for COVID-19 has widely been debated especially in the context of comparison to real-time reverse transcription polymerase chain reaction. Current evidence is against the use of chest imaging for routine screening of COVID-19 contrary to the initial expectations. It still has an integral role to play, however, in its work up and staging, especially when assessing complications or disease progression. Chest CT is gold standard imaging modality for COVID-19 pneumonia; in some situations, chest X-ray or ultrasound may be an effective alternative. The most important role of radiologists in this context is to be able to identify those patients at greatest risk of imminent clinical decompensation by learning to stratify cases of COVID-19 on the basis of radiologic imaging in the most efficient and timely fashion possible. The present availability of multiple and more refined CT grading systems and classification is now making this task easier and thereby contributing to the recent improvements achieved in COVID-19 treatment and outcomes. In this article, evidence of chest imaging regarding diagnosis, management and monitoring of COVID-19 will be chronologically reviewed.

CT angiography covering both cervical and cerebral arteries using high iodine concentration contrast material with dose reduction on a 16 multidetector-row system.

INTRODUCTION: Our aim was to examine the feasibility of a computed tomographic angiography (CTA) protocol using a reduced dose of high-concentration contrast material on a 16 multidetector-row system to visualize both cervical and cerebral arteries in one session. METHODS: In 31 consecutive patients, we performed CTA covering the cervical and cerebral arteries. The patients were assigned to one of three groups: group A, 100 mL of 300 mgI/mL; group B, 80 mL of 370 mgI/mL; and group C, 60 mL of 370 mgI/mL followed by a 30-mL saline flush. Arterial enhancements were quantified by measuring attenuation values of the common carotid artery, internal jugular vein, proximal middle cerebral artery (MCA), basilar artery, and straight sinus on source images. Visualizations of the carotid bifurcation and arteries continuing to the circle of Willis were rated on a three-point grading scale on CTA images for qualitative assessment. RESULTS: There were no statistically significant differences in attenuation of all the target vessels among the three groups, with the one exception being a lower attenuation of the MCA in group C than in groups A and B (P < 0.01). Neither were there any significant differences noted among the three groups on the visual assessment. CONCLUSION: Use of a reduced dose of high iodine concentration contrast material may provide an equal degree of image quality for CTA covering the craniocervical region on a 16 multidetector-row system.

A case of incidentally detected IgG4-related sclerosing disease involving inflammatory abdominal aortic aneurysm and autoimmune pancreatitis.

A 59-year-old asymptomatic man was incidentally found to have a periaortic mass and an elevated serum amylase level during his medical check-up. Additional findings, such as infiltration of immunoglobulin G4 (IgG4)-producing plasma cells in the mass lesion, elevation of serum IgG4 (1000 mg/dl), and pancreatic duct narrowing as evidenced on a magnetic resonance cholangiopancreatography scan, confirmed the diagnosis as retroperitoneal fibrosis complicated with autoimmune pancreatitis. The patient responded favorably to steroid treatment before the appearance of symptoms.

Erratum: Chest CT Findings in Cases from the Cruise Ship "Diamond Princess" with Coronavirus Disease 2019 (COVID-19).

[This corrects the article DOI: 10.1148/ryct.2020200110.].

Chest CT Findings in Cases from the Cruise Ship Diamond Princess with Coronavirus Disease (COVID-19).

PURPOSE: To evaluate the chest CT findings in an environmentally homogeneous cohort from the cruise ship Diamond Princess with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: This retrospective study comprised 104 cases (mean age, 62 years ± 16 [standard deviation], range, 25-93 years) with COVID-19 confirmed with reverse-transcription polymerase change reaction findings. CT images were reviewed, and the CT severity score was calculated for each lobe and the entire lung. CT findings were compared between asymptomatic and symptomatic cases. RESULTS: Of 104 cases, 76 (73%) were asymptomatic, 41 (54%) of which had lung opacities on CT. Twenty-eight (27%) cases were symptomatic, 22 (79%) of which had abnormal CT findings. Symptomatic cases showed lung opacities and airway abnormalities on CT more frequently than asymptomatic cases [lung opacity; 22 (79%) vs 41 (54%), airway abnormalities; 14 (50%) vs 15 (20%)]. Asymptomatic cases showed more ground-glass opacity (GGO) over consolidation (83%), while symptomatic cases more frequently showed consolidation over GGO (41%). The CT severity score was higher in symptomatic cases than asymptomatic cases, particularly in the lower lobes [symptomatic vs asymptomatic cases; right lower lobe: 2 ± 1 (0-4) vs 1 ± 1 (0-4); left lower lobe: 2 ± 1 (0-4) vs 1 ± 1 (0-3); total score: 7 ± 5 (1-17) vs 4 ± 2 (1-11)]. CONCLUSION: This study documented a high incidence of subclinical CT changes in cases with COVID-19. Compared with symptomatic cases, asymptomatic cases showed more GGO over consolidation and milder extension of disease on CT.An earlier incorrect version appeared online. This article was corrected on April 8, 2020.© RSNA, 2020.

Comparison of Chest CT Grading Systems in Coronavirus Disease 2019 (COVID-19) Pneumonia.

PURPOSE: To compare the performance and interobserver agreement of the COVID-19 Reporting and Data System (CO-RADS), the COVID-19 imaging reporting and data system (COVID-RADS), the RSNA expert consensus statement, and the British Society of Thoracic Imaging (BSTI) guidance statement. MATERIALS AND METHODS: In this case-control study, total of 100 symptomatic patients suspected of having COVID-19 were included: 50 patients with COVID-19 (59±17 years, 38 men) and 50 patients without COVID-19 (65±24 years, 30 men). Eight radiologists independently scored chest CT images of the cohort according to each reporting system. The area under the receiver operating characteristic curves (AUC) and interobserver agreements were calculated and statistically compared across the systems. RESULTS: A total of 800 observations were made for each system. The level of suspicion of COVID-19 correlated with the RT-PCR positive rate except for the "negative for pneumonia" classifications in all the systems (Spearman's coefficient: ρ=1.0, P=<.001 for all the systems). Average AUCs were as follows: CO-RADS, 0.84 (95% confidence interval, 0.83-0.85): COVID-RADS, 0.80 (0.78-0.81): the RSNA statement, 0.81 (0.79-0.82): and the BSTI statement, 0.84 (0.812-0.86). Average Cohen's kappa across observers was 0.62 (95% confidence interval, 0.58-0.66), 0.63 (0.58-0.68), 0.63 (0.57-0.69), and 0.61 (0.58-0.64) for CO-RADS, COVID-RADS, the RSNA statement and the BSTI statement, respectively. CO-RADS and the BSTI statement outperformed COVID-RADS and the RSNA statement in diagnostic performance (P=.<.05 for all the comparison). CONCLUSIONS: CO-RADS, COVID-RADS, the RSNA statement and the BSTI statement provided reasonable performances and interobserver agreements in reporting CT findings of COVID-19.

Achilles tendon after percutaneous surgical repair: serial MRI observation of uncomplicated healing.

OBJECTIVE: The purpose of this study was to prospectively explore the MRI features of normal healing of the expected residual tendon gap in the Achilles tendon after percutaneous surgical repair. SUBJECTS AND METHODS: MR images of the Achilles tendon were obtained approximately 4, 8, and 12 weeks after surgery. Assessment of MR images was focused on the presence of residual tendon gap and gap length, Achilles tendon contour, and contrast enhancement in the ruptured area. Cases of open surgical repair were used for comparison. We attempted to statistically compare the timing of tendon gap disappearance within the percutaneous surgical repair group and between the percutaneous and open surgical repair groups. RESULTS: A total of 30 tendons repaired with percutaneous surgical technique and 10 repaired with open surgical technique were evaluated. At the first, second, and third MRI sessions of the percutaneous surgical repair group, a residual gap was found in 100%, 80%, and none of the tendons on T1-weighted images and in 87%, 63%, and none of the tendons on T2-weighted images. Achilles tendon contour was visualized in 30%, 90%, and 100% of the tendons on T1-weighted images and 90%, 100%, and 100% of the tendons on T2-weighted images. Intratendinous enhancement was present in 100%, 73%, and 7% of the tendons in the percutaneous surgical repair group. Ring-shaped peritendinous enhancement was recognized at the third session in all subjects. A significantly longer time was required for tendon gap disappearance after percutaneous than after open surgical repair. CONCLUSION: The time course of the MR findings in the ruptured Achilles tendon after percutaneous surgical repair appears to reflect regular healing.

Neurography of the spinal nerve roots by diffusion tensor scanning applying motion-probing gradients in six directions.

PURPOSE: Diffusion-weighted (DW) magnetic resonance (MR) imaging of the nerve roots and peripheral nerves has been reported. We applied a sequence similar to brain diffusion tensor (DT) tractography to such a technique and assessed its feasibility. METHODS: On a 1.5-T MR system, we acquired DW images in the axial plane using a single-shot echo-planar short tau inversion-recovery (STIR)-based sequence. Motion-probing gradients (MPGs) were applied in 6 directions with a b-value of 500 s/mm(2). For postprocessing, we performed maximum-intensity projection to reconstruct the images. We obtained cervical spine images from 3 volunteers and 8 patients and thoracolumbar spine images from 3 volunteers and 6 patients. On the source images of the cervical spine obtained from the volunteers, we compared the signal-to-noise ratios (SNRs) of the neural structures between images obtained applying MPG in 6 directions and in 3 directions. We visually assessed the nerve roots and proximal portions of the contiguous peripheral nerves in the images from volunteers and patients. RESULTS: The SNRs were significantly superior in the images obtained with the application of MPGs in 6 directions to those obtained with the application of MPGs in 3 directions (P<0.01). Visual assessment demonstrated the nerve roots as well as the nerve ganglia and the contiguous peripheral nerves up to 3 cm or more from the respective neural foramina in each subject. Image distortion was minimal. CONCLUSIONS: Our technique provides neurographic images of the nerve roots and proximal portions of the contiguous peripheral nerves, and images obtained using our sequence applying MPGs in 6 directions are superior to those obtained in 3 directions.

Comparison of MRI sequences to detect ventriculitis.

OBJECTIVE: The ability of different MRI sequences to depict characteristic findings suggestive of ventriculitis was compared. CONCLUSION: The study comprised 20 brain MRI studies in 13 patients who had a final diagnosis of ventriculitis. Both diffusion-weighted imaging and FLAIR imaging were equally and highly sensitive for detecting intraventricular debris and pus--the most common MRI finding suggestive of ventriculitis. FLAIR imaging was superior to contrast-enhanced T1-weighted imaging for depicting ventricular wall abnormalities--a less common finding that also is suggestive of ventriculitis.

Pre-operative effects of the administration of systemic corticosteroids combined with antibiotics on a lobular capillary hemangioma in the nasal cavity.

Lobular capillary hemangiomas (LCHs), also known as pyogenic granulomas, are benign, rapidly growing hemorrhagic lesions that usually develop in the oral or nasal cavities. In adults, LCHs occur in <5% of all pregnant women. A 30-year-old woman presented with a 4-month history of right-sided nasal obstruction and recurrent epistaxis 2 months post-partum. A fragile, pink-red lobulated tumor existed in the anterior portion of the right inferior turbinate; the biopsy revealed a LCH. Although the patient declined surgery using an external approach, treatment with systemic corticosteroids combined with antibiotics resulted in tumor regression and an endoscopic en bloc resection was possible. No recurrence has been noted to date (>1 year after surgery). Pre-operative treatment with systemic corticosteroids combined with antibiotics may be useful to induce tumor regression and to excise the lesion completely with an endoscopic approach.