Information architecture for a patient-specific dashboard in head and neck tumor boards

Abstract

Purpose

Overcoming the flaws of current data management conditions in head and neck oncology could enable integrated information systems specifically tailored to the needs of medical experts in a tumor board meeting. Clinical dashboards are a promising method to assist various aspects of the decision-making process in such cognitively demanding scenarios. However, in order to provide extensive and intuitive assistance to the participating physicians, the design and development of such a system have to be user-centric. To accomplish this task, conceptual methods need to be performed prior to the technical development and integration stages.

Methods

We have conducted a qualitative survey including eight clinical experts with different levels of expertise in the field of head and neck oncology. According to the principles of information architecture, the survey focused on the identification and causal interconnection of necessary metrics for information assessment in the tumor board.

Results

Based on the feedback by the clinical experts, we have constructed a detailed map of the required information items for a tumor board dashboard in head and neck oncology. Furthermore, we have identified three distinct groups of metrics (patient, disease and therapy metrics) as well as specific recommendations for their structural and graphical implementation.

Conclusion

By using the information architecture, we were able to gather valuable feedback about the requirements and cognitive processes of the tumor board members. Those insights have helped us to develop a dashboard application that closely adapts to the specified needs and characteristics, and thus is primarily user-centric.

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Does Enhancement or Perfusion on Preprocedure CT Predict Outcomes After Embolization of Hepatocellular Carcinoma?

Publication date: Available online 27 March 2018
Source:Academic Radiology
Author(s): Alessandra Borgheresi, Adrian Gonzalez-Aguirre, Karen T. Brown, George I. Getrajdman, Joseph P. Erinjeri, Anne Covey, Hooman Yarmohammadi, Etay Ziv, Constantinos T. Sofocleous, Franz Edward Boas
Rationale and ObjectiveThe objective of this study was to evaluate whether quantitative enhancement or perfusion measurements on preprocedure triphasic computed tomography (CT) can be used to predict response or overall survival after embolization of hepatocellular carcinoma.Materials and MethodsThe institutional review board approved this retrospective review of 63 patients with hepatocellular carcinoma treated with particle embolization between March 2009 and December 2014. Quantitative enhancement and perfusion measurements were performed on the target tumor and the background liver on the triphasic CT performed before treatment. Microvascular invasion (MVI) and degree of differentiation were determined from a core biopsy specimen. Quantitative enhancement and perfusion values were then correlated with pathology (two-tailed t test), response to embolization on modified Response Evaluation Criteria In Solid Tumors (two-tailed t test), and overall survival after embolization (Cox proportional hazards model).ResultsArterial enhancement did not predict immediate response or overall survival after embolization. The degree of differentiation or presence of MVI also did not predict immediate response or overall survival after embolization. However, high hepatic artery coefficient or low portal vein coefficient, both in the tumor (P = .011 and P = .004) and in the background liver (P = .015 and P = .009), were associated with worse survival. Hepatic artery coefficient, both in the tumor (P = .025) and in the background liver (P = .013), were independent predictors of survival in a multivariate model including the Child-Pugh score and the BCLC stage.ConclusionsTumor and liver perfusion parameters estimated from preprocedure triphasic CT were predictive of survival after embolization. Arterial-phase enhancement and histology (degree of differentiation or MVI) did not predict immediate response or overall survival after particle embolization.



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Relationship between Background Parenchymal Enhancement on High-risk Screening MRI and Future Breast Cancer Risk

Publication date: Available online 27 March 2018
Source:Academic Radiology
Author(s): Lars J. Grimm, Ashirbani Saha, Sujata V. Ghate, Connie Kim, Mary Scott Soo, Sora C. Yoon, Maciej A. Mazurowski
Rationale and ObjectivesTo determine if background parenchymal enhancement (BPE) on screening breast magnetic resonance imaging (MRI) in high-risk women correlates with future cancer.Materials and MethodsAll screening breast MRIs (n = 1039) in high-risk women at our institution from August 1, 2004, to July 30, 2013, were identified. Sixty-one patients who subsequently developed breast cancer were matched 1:2 by age and high-risk indication with patients who did not develop breast cancer (n = 122). Five fellowship-trained breast radiologists independently recorded the BPE. The median reader BPE for each case was calculated and compared between the cancer and control cohorts.ResultsCancer cohort patients were high-risk because of a history of radiation therapy (10%, 6 of 61), high-risk lesion (18%, 11 of 61), or breast cancer (30%, 18 of 61); BRCA mutation (18%, 11 of 61); or family history (25%, 15 of 61). Subsequent malignancies were invasive ductal carcinoma (64%, 39 of 61), ductal carcinoma in situ (30%, 18 of 61) and invasive lobular carcinoma (7%, 4of 61). BPE was significantly higher in the cancer cohort than in the control cohort (P = 0.01). Women with mild, moderate, or marked BPE were 2.5 times more likely to develop breast cancer than women with minimal BPE (odds ratio = 2.5, 95% confidence interval: 1.3–4.8, P = .005). There was fair interreader agreement (κ = 0.39).ConclusionsHigh-risk women with greater than minimal BPE at screening MRI have increased risk of future breast cancer.



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Gallbladder Scalloping, Mammillated Caudate Lobe, and Inferior Vena Cava Scalloping

Publication date: Available online 27 March 2018
Source:Academic Radiology
Author(s): Mohammad Amarneh, Ahmed Akhter, M. Zak Rajput, Douglas R. LaBrecque, Monzer Abu-Yousef
PurposeWe aimed to present three new ultrasound signs—gallbladder scalloping, mammillated caudate lobe, and inferior vena cava scalloping—and determine their accuracy in diagnosing liver cirrhosis.Materials and MethodsA total of 201 consecutive patients with a history of chronic liver disease who had undergone ultrasound imaging and liver biopsy were identified. A senior ultrasound radiologist blindly reviewed the ultrasound examinations. Specificity, sensitivity, positive predictive value, and negative predictive value of diagnosing cirrhosis were calculated for all evaluated ultrasound signs and selected combinations of signs, using the liver biopsy results as the reference standard.ResultsOf the 201 patients, 152 (76%) had either pathology-proven cirrhosis or significant fibrosis. Caudate lobe hypertrophy was the most specific (88%) and most positive predictor (90%) for cirrhosis, whereas mammillated caudate lobe was the most sensitive (78%). Inferior vena cava scalloping was the most specific (78%) of the three proposed ultrasound signs. When signs were combined, the presence of either gallbladder scalloping or liver surface nodularity was highly sensitive for cirrhosis (87%), whereas the presence of either gallbladder scalloping or inferior vena cava scalloping with caudate lobe hypertrophy was highly specific (93%).ConclusionsGallbladder scalloping, mammillated caudate lobe, and inferior vena cava scalloping are three novel signs that improve the accuracy of ultrasound in diagnosing cirrhosis.



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Impact of a New Adaptive Statistical Iterative Reconstruction (ASIR)-V Algorithm on Image Quality in Coronary Computed Tomography Angiography

Publication date: Available online 27 March 2018
Source:Academic Radiology
Author(s): Gianluca Pontone, Giuseppe Muscogiuri, Daniele Andreini, Andrea I. Guaricci, Marco Guglielmo, Andrea Baggiano, Fabio Fazzari, Saima Mushtaq, Edoardo Conte, Andrea Annoni, Alberto Formenti, Elisabetta Mancini, Massimo Verdecchia, Alessandro Campari, Chiara Martini, Marco Gatti, Laura Fusini, Lorenzo Bonfanti, Elisa Consiglio, Mark G. Rabbat, Antonio L. Bartorelli, Mauro Pepi
Rationale and objectivesA new postprocessing algorithm named adaptive statistical iterative reconstruction (ASIR)-V has been recently introduced. The aim of this article was to analyze the impact of ASIR-V algorithm on signal, noise, and image quality of coronary computed tomography angiography.Materials and MethodsFifty consecutive patients underwent clinically indicated coronary computed tomography angiography (Revolution CT; GE Healthcare, Milwaukee, WI). Images were reconstructed using filtered back projection and ASIR-V 0%, and a combination of filtered back projection and ASIR-V 20%–80% and ASIR-V 100%. Image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated for left main coronary artery (LM), left anterior descending artery (LAD), left circumflex artery (LCX), and right coronary artery (RCA) and were compared between the different postprocessing algorithms used. Similarly a four-point Likert image quality score of coronary segments was graded for each dataset and compared. A cutoff value of P < .05 was considered statistically significant.ResultsCompared to ASIR-V 0%, ASIR-V 100% demonstrated a significant reduction of image noise in all coronaries (P < .01). Compared to ASIR-V 0%, SNR was significantly higher with ASIR-V 60% in LM (P < .01), LAD (P < .05), LCX (P < .05), and RCA (P < .01). Compared to ASIR-V 0%, CNR for ASIR-V ≥60% was significantly improved in LM (P < .01), LAD (P < .05), and RCA (P < .01), whereas LCX demonstrated a significant improvement with ASIR-V ≥80%. ASIR-V 60% had significantly better Likert image quality scores compared to ASIR-V 0% in segment-, vessel-, and patient-based analyses (P < .01).ConclusionsReconstruction with ASIR-V 60% provides the optimal balance between image noise, SNR, CNR, and image quality.



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The Impact of Interruptions on Chest Radiograph Interpretation

Publication date: Available online 28 March 2018
Source:Academic Radiology
Author(s): Rachel M. Wynn, Jessica L. Howe, Linda C. Kelahan, Allan Fong, Ross W. Filice, Raj M. Ratwani
Rationale and ObjectivesThe objective of this study was to experimentally test the effect of interruptions on image interpretation by comparing reading time and response accuracy of interrupted case reads to uninterrupted case reads in resident and attending radiologists.Materials and MethodsInstitutional review board approval was obtained before participant recruitment from an urban academic health-care system during January 2016–March 2016. Eleven resident and 12 attending radiologists examined 30 chest radiographs, rating their confidence regarding the presence or the absence of a pneumothorax. Ten cases were normal (ie, no pneumothorax present), 10 cases had an unsubtle pneumothorax (ie, readily perceivable by a nonexpert), and 10 cases had a subtle pneumothorax. During three reads of each case type, the participants were interrupted with 30 seconds of a secondary task. The total reading time and the accuracy of interrupted and uninterrupted cases were compared. A mixed-factors analysis of variance was run on reading time and accuracy with experience (resident vs attending) as a between-subjects factor and case type (normal, unsubtle, or subtle) and interruption (interruption vs no interruption) as within-subjects factors.ResultsInterrupted tasks had significantly longer reading times than uninterrupted cases (P = .032). During subtle cases, interruptions reduced accuracy (P = .034), but during normal cases, interruptions increased accuracy (P = .038).ConclusionsInterruptions increased reading times and increased the tendency for a radiologist to conclude that a case is normal for both resident and attending radiologists, demonstrating that interruptions reduce efficiency and introduce patient safety concerns during reads of abnormal cases.



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Incidental Thyroid Nodules in the National Lung Screening Trial

Publication date: Available online 27 March 2018
Source:Academic Radiology
Author(s): Manisha Bahl
Rationale and ObjectivesThere is limited research on the prevalence of incidental thyroid nodules (ITNs) in the United States screening population and on the appropriate evaluation of computed tomography (CT)-detected ITNs. The purpose of this study is to determine the prevalence of ITNs in the National Lung Screening Trial (NLST) and develop a workup strategy for ITNs.Materials and MethodsCT images were obtained for subjects with documented thyroid abnormalities in the CT screening arm of the NLST, subjects diagnosed with thyroid malignancies, and control subjects. Several size thresholds were compared to determine how many nodules would be further evaluated and how many thyroid malignancies would be missed had each threshold been applied at the time of workup.ResultsThyroid nodules were reported in 0.7% (117 of 17,309 subjects). In 663 control subjects without reported thyroid nodules, thyroid nodules were identified in 78 (11.8%). Reported nodules were larger than unreported nodules (21.3 vs 16.9 mm, P = .03). Thyroid malignancies were diagnosed in 0.1% (22 of 17,309). If a 20-mm rather than a 10-mm cutoff were used to determine which nodules should be further evaluated, all malignancies would be detected, but 24 rather than 62 patients would require workup, for a workup reduction rate of 48.7% (38 of 78).ConclusionsLess than 1% of subjects in the NLST had reported ITNs. The true prevalence of ITNs was estimated to be 11.8%, which provides a better approximation of the number of patients who could potentially receive workup. A 20-mm rather than a 10-mm cutoff would reduce the workup rate by almost 50% while still capturing all malignancies.



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t-PA power-pulse spray with rheolytic mechanical thrombectomy using cross-sectional image-guided portal vein access for single setting treatment of subacute superior mesenteric vein thrombosis

Mubin I Syed, Ryan M Gallagher, Rukan S Ahmed, Azim Shaikh, Edward Roberto, Sumeet Patel

Indian Journal of Radiology and Imaging 2018 28(1):93-98

Background: Isolated superior mesenteric vein (SMV) thrombosis is a rare but potentially fatal condition if untreated. Current treatments include transjugular or transhepatic approaches for rheolytic mechanical thrombectomy and subsequent infusions of thrombolytics. Tissue plasminogen activator (t-PA) power-pulse spray can provide benefit in a single setting without thrombolytic infusions. Computed tomography (CT) guidance for portal vein access is underutilized in this setting. Materials and Methods: Case 1 discusses acute SMV thrombosis treated with rheolytic mechanical thrombectomy alone using ultrasound guidance for portal vein access. Case 2 discusses subacute SMV thrombosis treated with the addition of t-PA power-pulse spray to the rheolytic mechanical thrombectomy, using CT guidance for portal vein access. Results: With rheolytic mechanical thrombectomy alone, the patient in Case 1 had significant improvement in abdominal pain. Follow-up CT demonstrated no residual SMV thrombosis and the patient continued to do well in long-term follow-up. With the addition of t-PA power-pulse spray to rheolytic mechanical thrombectomy, the patient in Case 2 with subacute SMV thrombosis dramatically improved postprocedure with resolution of abdominal pain. Follow-up imaging demonstrated patency to the SMV and partial resolution of thrombus. The patient continued to do well at 2-year follow-up. Conclusions: Adding t-PA power-pulse spray to rheolytic mechanical thrombectomy can provide benefit in a single setting versus mechanical thrombectomy alone and prevent the need for subsequent infusions of thrombolytic therapy. CT guidance is a useful alternative of localization for portal vein access via the transhepatic route that is nonoperator-dependent and helpful in the case of obese patients.

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Can MRI diffusion-weighted imaging identify postoperative residual/recurrent soft-tissue sarcomas?

Mai Maher ElDaly, Amr Farouk Ibrahim Moustafa, Suzan Mohamed Samy Abdel-Meguid, Ahmed Mohamed Shokry, Nagui Abd El Wahab

Indian Journal of Radiology and Imaging 2018 28(1):70-77

Purpose: The aim of this study was to evaluate contrast-enhanced magnetic resonance imaging (CE-MRI) and quantitative diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping in the detection of recurrent/residual postoperative soft tissue sarcomas. Materials and Methods: This study included 36 patients; 27 patients had postoperative recurrent/residual soft tissue sarcomas and 9 patients had postoperative and treatment-related changes (inflammation/fibrosis). The DWI was obtained with 3 b values including 0, 400, and 800 s/mm2. Calculation of the ADC value of the lesion was done via placing the region of interest (ROI) to include the largest area of the lesion. ADC values were compared to histopathology. Results: Our results showed that including CE-MRI improved the diagnostic accuracy and sensitivity in recurrence detection compared to conventional non-enhanced sequences. However, it showed low specificity (55.56%) with a high false-positive rate that may lead to an unnecessary biopsy of a mass such as region of postoperative scar tissue. Conclusion: The joint use of gadolinium-enhanced MRI and quantitative DWI with ADC mapping offer added value in the detection of recurrent/residual postoperative soft tissue sarcoma. This combined use increased both the diagnostic sensitivity and specificity with a cut-off average ADC value for detecting nonmyxoid recurrent/residual lesions ≤1.3 × 10−3 mm2/s (100% specificity and 90.48% sensitivity). Our results showed limited value of DWI with ADC mapping in assessing myxoid sarcomatous tumor recurrences.

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Presidential address

K Mohanan

Indian Journal of Radiology and Imaging 2018 28(1):3-5



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Comparing the diagnostic efficacy of full field digital mammography with digital breast tomosynthesis using BIRADS score in a tertiary cancer care hospital

Divya Singla, Arvind K Chaturvedi, Abhinav Aggarwal, SA Rao, Dibyamohan Hazarika, Vivek Mahawar

Indian Journal of Radiology and Imaging 2018 28(1):115-122

Introduction: Breast cancer is one of the leading cancers in females worldwide, and its incidence has been rising at an exponential pace in the last 10 years even in India. Mammography has been the mainstay for detection of breast cancer over decades and has gradually advanced from screen film to full-field digital mammography. Recently, tomosynthesis has evolved as an advanced imaging investigation for early diagnosis of breast lesions in both diagnostic and screening settings. Aim of Study: To compare and evaluate the impact of digital breast tomosynthesis (DBT) compared to full-field digital mammography (FFDM) in the interpretation of BIRADS score in both diagnostic and screening settings. Settings and Design: A 1-year prospective longitudinal study was conducted in the Department of Radio-diagnosis in our institute using Hologic Selenia Dimensions for mammography as well as tomosynthesis. Materials and Methods: One hundred women known or suspected (opportunistic screening) for breast cancer were evaluated either with FFDM alone or both FFDM and DBT. Sensitivity, specificity, positive predictive value, negative predictive value, and P value were used to assess the various diagnostic criteria in our study. Results: Addition of DBT to FFDM results in a statistically significant increase in the sensitivity, specificity, and positive predictive value, and a statistically significant decrease in the false positive rates. Similar results were noted in both diagnostic and screening cases. It was observed that, in most cases, i.e. a total of 47, DBT did not change the BIRADS scoring; however, its addition increased the diagnostic confidence. BIRADS was upgraded and downgraded in 14 and 31 cases, respectively, with the addition of DBT to FFDM. New lesions were seen with addition of DBT to FFDM in 8 cases. Conclusion: Addition of DBT to FFDM results in increase in sensitivity, specificity, positive predictive value, and a statistically significant decrease in false positive rates in both diagnostic and screening cases. As addition of tomosynthesis results in a significant decrease in recall rate, it should be added, at least, in all screening mammography programs.

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Transient global amnesia: Diffusion MRI findings

Tarun P Jain, Ronak Patel, Yash Gawarikar

Indian Journal of Radiology and Imaging 2018 28(1):6-9

Introduction: Aim of this study is to identify and describe the MRI findings in patients with Transient Global Amnesia (TGA), specifically on Diffusion Weighted Imaging (DWI) sequence. Methods: MRI findings in 12 patients with clinical diagnosis of TGA were retrospectively analysed. MRI brain was performed with a 3T scanner on 11 patients and 1.5T scanner on 1 patient. DWI were acquired at B value of 1000 s/mm2 in 4 patients, 2000 s/mm2 in 2 patients and both 1000 and 2000 s/mm2 in 6 patients. Results: There were 7 female and 5 male patients. The mean age was 65.67 years (range 61-74 years). The median time interval between the onset of symptom and MRI scan was 47.5 hours, range 25-114 hours. 11 of the 12 patients showed punctate foci of restricted diffusion in hippocampus (mean size 3.7 mm (range 2-6.5 mm). 10 patients showed foci in left hippocampus. Nine patients showed a single focus, 1 patient showed three foci and 1 patient showed four foci. In 6 patients who had DWI MRI at both B values, scans at B value of 1000 s/mm2 revealed abnormality in 4 patients, while higher B value imaging improved sensitivity in one patient and one patient had a negative scan at both B values. Conclusion: We have highlighted the MRI finding of typical punctate foci of bright signal in hippocampus seen on DWI in patients diagnosed with TGA. Detection on a routine stroke MRI protocol can avoid need for dedicated TGA protocols or repeat scan, improving the workflow.

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Clinicoradiological aspects of pontine tegmental cap dysplasia: Case report of a rare hindbrain malformation

Aanchal Bhayana, Sunil K Bajaj, Ritu N Misra, S Senthil Kumaran

Indian Journal of Radiology and Imaging 2018 28(1):18-21

Malformations involving the brainstem are very rare and present with a varied spectrum of clinical symptoms due to multiple cranial nerve palsies and pyramidal tract involvement. Of these, pontine tegmental cap dysplasia is a very unusual malformation, characterized by ventral pons hypoplasia and an ectopic dorsal band of tissue, projecting into the fourth ventricle, from dorsal pontine tegmentum. A 4-year-old male child, presenting with left facial nerve palsy, revealed hypoplastic ventral pons and an ectopic structure on magnetic resonance imaging (MRI). The ectopic structure was isointense to pons, arose from the left side of dorsal pontine tegmentum, at pontomedullary junction and protruded into the fourth ventricle, impinging upon the left seventh and eighth cranial nerves. Diffusion tensor imaging (DTI) depicted abnormal white matter tracts in ectopic tissue with absent transverse pontine fibres and abnormal middle and superior cerebellar peduncles. The typical MRI appearance, coupled with DTI, helped us reach an accurate diagnosis of pontine tegmental cap dysplasia, in a setting of neurological dysfunction.

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Spontaneous pneumomediastinum, pneumothorax, pneumorrhachis, pneumoretroperitoneum, surgical emphysemaAdult cervical lung herniation: Importance of valsalva manoeuvre in imaging

Bogala Shilpa, Rashmi Sudhir, M V T Krishna Mohan, Veeraiah Koppula

Indian Journal of Radiology and Imaging 2018 28(1):132-133



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Doppler indices of superior thyroid artery in clinically euthyroid adults

Upendra Kumar Joish, Y Kavitha, R Harikiran Reddy, Anitha S Prabhu, M Chetan Kumar, MC Siddharth

Indian Journal of Radiology and Imaging 2018 28(1):10-13

Context: Ultrasonography of thyroid gland is a frequently performed investigation. Many of the diffuse thyroid pathologies are associated with altered vascularity. In view of potential applications and scant available data, there is a need to find normal values of Doppler indices of superior thyroid artery (STA). Aims: To find the normal range of Doppler indices like mean peak systolic velocity (PSV), resistivity index (RI), and pulsatility index (PI) of STA in clinically euthyroid adult individuals. Settings and Design: Prospective cross-sectional observational study. Materials and Methods: A study was done in the Department of Radiodiagnosis of a tertiary care hospital, involving clinically euthyroid adult volunteers. Ultrasonography of the thyroid gland with Doppler of bilateral STAs was performed and mean values of PSV, RI, and PI were calculated. Results: A total of 208 subjects, with a mean age of 37.7 years, underwent Doppler evaluation of STA; 148 of them were women and 60 were men. The mean PSV obtained was 16.94 ± 5.3 cm/s. Mean PI and RI were 0.93 ± 0.31 and 0.5 ± 0.13, respectively. There was no significant difference in the values obtained among both the genders. Conclusion: Mean values of Doppler indices of STA in euthyroid individuals have been found in this study.

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Turf wars in radiology research: “Are the honoraries ready to come out and defend their territory?”

Chander Mohan

Indian Journal of Radiology and Imaging 2018 28(1):1-2



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Hemiagenesis of thyroid with dual thyroid ectopia: A rare case report

Pankaj S Jha, Varsha Rote-Kaginalkar, Prashant Titare, Manoj B Jadhav

Indian Journal of Radiology and Imaging 2018 28(1):14-17

Developmental defects of the thyroid gland are very rare. The common developmental abnormalities are ectopic thyroid, hemiagenesis and agenesis of thyroid gland. These developmental defects may or may not be associated with deranged thyroid function tests. Ultrasonography (USG) is the initial modality of choice for thyroid hemiagenesis but further evaluation by computed tomography (CT) scan or nuclear scan should be done to look for ectopic thyroid tissue rest. Here, we report a rare case of a 9-year-old female having hemiagenesis of the right thyroid lobe and isthmus along with dual ectopic thyroid tissue at prehyoid and infrahyoid regions of the neck presenting as a midline neck swelling and subclinical hypothyroidism.

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Analysis of the time course of changes in imaging findings of small arteries embolized with the N-Butyl cyanoacrylate-lipiodol mixture

Hiroyuki Tokue, Azusa Tokue, Yoshito Tsushima

Indian Journal of Radiology and Imaging 2018 28(1):81-84

Background: There are no reports analyzing imaging findings of arteries embolized with N-butyl cyanoacrylate (NBCA)-Lipiodol. To evaluate the time course of changes in the imaging findings of small arteries embolized with NBCA-Lipiodol. Materials and Methods: Selective transcatheter arterial embolization procedures via the inferior phrenic artery (right IPA, n = 25; left IPA, n = 5) were performed in 30 patients (25 males, 5 females; mean age 63 years, range: 45–78) at our institution. The NBCA-Lipiodol mixture was used as an embolic agent. The ratio of NBCA to Lipiodol was 1:4 (Group-A, n = 16) or 1:8 (Group-B, n = 14).We retrospectively reviewed the computed tomography (CT) findings and outcomes of small arteries embolized with the NBCA-Lipiodol mixture. The residual lipiodol was compared between Group-A and Group-B. The Student's t-test and Chi-square test were used for statistical analyses. In addition, the residual lipiodol rate was calculated using the Kaplan–Meier method and compared using the log-rank test. Results: The mean observation period was 264 ± 84 days (range: 104–425). Lipiodol completely disappeared in 20 arteries (66%) during follow-up. Recanalization of arterial flow was not seen in CT images, even when Lipiodol disappeared. Group-B showed a shorter period of progression to disappearance of Lipiodol than Group-A (P < 0.05). On follow up, the rate of residual Lipiodol in Group-A was higher than that in Group-B (P < 0.05). Conclusion: Residual Lipiodol was expected to gradually disappear. Lipiodol disappeared early when the density of NBCA was low in the NBCA-Lipiodol mixture. Further evaluations of various arteries and ratios of NBCA to Lipiodol are needed.

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Brown fat necrosis with calcifications in the newborn: Risk factors, radiographic findings, and clinical course

Eleza T Golden, Paula Dickson, Stephen Simoneaux

Indian Journal of Radiology and Imaging 2018 28(1):107-110

Objective: To describe the radiographic appearance of subclinical calcified brown fat necrosis and the associated clinical and laboratory findings. Materials and Methods: Picture Archiving and Communications Sytem (PACS) was searched using keywords "soft tissue calcification" and "chest." The clinical record was searched for prior cardiac surgery, bypass, Extracorporeal Membrane Oxygentation (ECMO) and prostaglandin use. Age when calcifications were first detected, location, resolution, and associated laboratory abnormalities were recorded. Results: Nine patients were identified. None had skin lesions. All patients had congenital heart disease and had experienced cardiac/respiratory arrest and/or severe hypotension 1–6 weeks before soft tissue calcifications occurred. Calcifications resolved by 9 weeks to 5 months in 3 patients. The remaining were either deceased or lacked follow-up imaging. Renal ultrasound was performed in all but 1 patient. Nephrocalcinosis was only seen in 1 patient. Conclusion: Brown fat necrosis is subclinical, diagnosed on plain film, and likely self-limited. It occurs in term and preterm infants who have undergone significant systemic stress and carries a poor prognosis.

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Frontal subcutaneous lipoma associated with interhemispheric lipoma, lipomeningocele, and corpus callosal dysgenesis in a young adult: CT and MRI findings

Nidhi Aggarwal, Kushal B Gehlot, Sunil D Kumar, N K Kardam Alsaba Khan

Indian Journal of Radiology and Imaging 2018 28(1):22-26

Intracranial lipomas are rare incidental lesions. Rokitansky first described a corpus callosal lipoma on the posterior part of the corpus callosum in 1856. Since then many cases have been reported. We report the imaging findings of an interhemispheric lipoma extending into subcutaneous plane associated with spinal lipomeningocele and corpus callosal dysgenesis. Computed tomography and magnetic resonance imaging findings are characteristic. All cases have been reported in pediatric age group till now. Such a case in this age group has not been reported earlier.

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Comparison of MDCT, MRI and MRI with diffusion-weighted imaging in evaluation of focal renal lesions: The defender, challenger, and winner!

Ankur Goyal, Raju Sharma, Ashu S Bhalla, Shivanand Gamanagatti, Amlesh Seth

Indian Journal of Radiology and Imaging 2018 28(1):27-36

Purpose: To compare the diagnostic performance of multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), and MRI with diffusion-weighted imaging (DWI) in the characterization of focal renal lesions. We also compared MDCT and MRI in the staging of renal cell carcinoma (RCC). Materials and Methods: One hundred and twenty adult patients underwent MDCT (40-row and 128-row scanners), MRI (at 1.5 T), and DWI (at b-values of 0 and 500 s/mm2) for characterization of 225 renal lesions. There were 65 malignant neoplasms (44 RCCs), 25 benign neoplasms, 25 abscesses, 45 pseudotumors, 15 hemorrhagic cysts, and 50 benign cysts. A composite gold standard including histology, typical imaging criteria, and follow-up imaging was employed. To determine the diagnostic performance of imaging modalities, area-under-curve (AUC) was calculated by receiver-operating-characteristic analysis and compared. Fisher's exact test was used to compare the diagnostic accuracies and confidence levels with MDCT, MRI, and MRI + DWI. Cross-tabulation was used to assess the precision of MDCT and MRI in RCC staging. Results: AUC for MDCT (0.834) and MRI (0.841) in the classification of benign and malignant lesions were within corresponding 95% confidence interval (CI) (P = 0.88) whereas MRI + DWI had significantly better performance (AUC 0.968, P = 0.0002 and 0.0004, respectively). Both CT and MRI had low specificity (66.9% and 68.8%, respectively), which increased substantially with DWI (93.8%) owing to correct diagnosis of pseudotumors. MRI was superior to CT in diagnosing necrotic RCC and hemorrhagic cysts. MRI + DWI had the highest accuracy (94.2%) in assigning the definitive diagnosis and 97.6% lesions were diagnosed with very high confidence, significantly better than CT and MRI. Both CT and MRI had the same accuracy (86.1%) in RCC staging and evaluation of intravascular thrombi. Conclusions: Characterization of renal lesions was most accurate with MRI + DWI. The latter is also the most suitable modality in diagnosing pseudotumors and evaluating patients with renal dysfunction. CT and MRI were equivalent in RCC staging.

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Primary presentation of Jeune's syndrome as gastric motility disorder in an infant: A case report

Amit Katyan, Shabnam Bhandari Grover, Heena Rajani, Deepak Bagga, Neha Antil

Indian Journal of Radiology and Imaging 2018 28(1):65-69

We report a case of a 4-week-old female neonate with Jeune's asphyxiating thoracic dystrophy (JATD) and coexistent situs anomaly, primarily presenting as gastric motility disorder. The child presented with abdominal distension and nonbilious vomiting since birth with failure to thrive. However, skeletal survey revealed JATD. Upper gastrointestinal contrast study showed situs inversus with delayed gastric emptying. Pyloric biopsy and intraoperative antro-duodenal manometry confirmed association of gastric motility disorder. Awareness of the unusual possibility of primary presentation of Jeune syndrome as gastric motility disorder will improve the management approach in such infants.

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Different etiologies of an unusual disease: Colouterine fistula – Report of two cases

Rohit Aggarwal, Venkatraman Indiran, Prabakaran Maduraimuthu

Indian Journal of Radiology and Imaging 2018 28(1):37-40

Colouterine fistula is an extremely rare condition, as the uterus is a thick, muscular organ. Here, we present two different etiologies for this rare condition—diverticulitis and malignancy. A 77-year-old female with colouterine fistula due to diverticulitis presented with complaints of lower abdominal pain localized particularly in the left iliac fossa and fever. Another case was of 73-year-old female with colouterine fistula due to malignancy who presented with abdominal pain, blood in stools, and whitish discharge from vagina. Both cases were evaluated with contrast-enhanced computed tomography (CECT). The presence of air and fluid within the uterus on ultrasound or CT scan, prompts the possibility of colouterine fistula with CECT providing accurate preoperative assessment.

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Emphysematous osteomyelitis: Report of two cases and review of literature

Sachin Khanduri, Meenu Singh, Aakshit Goyal, Simran Singh

Indian Journal of Radiology and Imaging 2018 28(1):78-80

Emphysematous osteomyelitis is a rare condition characterized by the presence of intraosseous gas. A prompt diagnosis is required for this disease to expedite management as it is a potentially fatal condition. Many comorbidities, such as malignancy, diabetes mellitus, alcohol abuse, Crohn's disease, and other etiologies causing immunosuppression, predispose to this condition. The causative organisms are generally anaerobes or members of Enterobacteriaceae family; however, the infection can be mono or polymicrobial. We report two cases affected with emphysematous osteomyelitis due to varied underlying comorbidities. The purpose of this study is to (a) emphasize the importance of computed tomography in diagnosing emphysematous osteomyelitis and (b) to highlight an unusual location of this rare pathology.

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Hernia uteri inguinalis in ovotesticular disorder of sexual differentiation: A rare complication and role of imaging

Janardhana Ponnatapura

Indian Journal of Radiology and Imaging 2018 28(1):41-44

Neonate with ambiguous genitalia can cause great apprehension for the family as well as for healthcare providers. We report a rare complication of delayed diagnosis of hernia uteri inguinalis in ovotesticular disorder of sexual differentiation (DSD) in 20-year-old male patient who presented with pain and swelling in left inguinal region since 1 month. He had a past surgical history of repair of hypospadias 10 years back. On imaging, the left inguinal hernia sac contained nonfunctioning uterus and one ovary in the left scrotal sac and one testis in the right scrotal sac. Further investigation confirmed genotypically female (46XX) with negative sex determining region-Y gene on fluorescence in situ hybridization. The patient was given psychiatric counseling and wished to remain as male. The left inguinal hernia was repaired with excision of nonfunctioning uterus, ovary, and fallopian tube. Hernia uteri inguinalis is rare complication seen in DSD with only three cases being reported worldwide thus far, including our case.

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Ultrasound-guided peripheral nerve interventions for common pain disorders

BP Krishna Prasad, Binu Joy, Vijayakumar A Raghavendra, Ajith Toms, Danny George, Brijesh Ray

Indian Journal of Radiology and Imaging 2018 28(1):85-92

There are a number of common pain disorders that can be managed effectively by injections around or ablation of peripheral nerves. Ultrasound is a universally available imaging tool, is safe, cost-effective, and is excellent in imaging many peripheral nerves and guiding needles to the site of the nerves. This article aims to present an overview of indications and techniques of such procedures that can be effectively performed by a radiologist.

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Utility of ureteric jet: A simple yet useful tool for the evaluation of complex urogenital anomaly

Pranav K Santhalia, Disha Mittal, Arun K Gupta, Manisha Jana

Indian Journal of Radiology and Imaging 2018 28(1):45-48

In infants and young children with suspicion of genitourinary tract anomalies, ultrasonography (USG) is usually the first imaging modality. Advantages of USG are well described. In the evaluation of complex congenital urogenital anomalies, ultrasound examination needs to be tailored according to the clinical suspicion and to yield maximum information. Primary megaureter is a congenital anomaly, which is associated with dilatation of ureter above an adynamic segment at the vesicoureteric junction (VUJ). Two different types are described in the literature: refluxing and obstructive. Absence of ureteric jet on USG in conjunction with vesicoureteric reflux (VUR) on voiding cystourethrogram (VCUG) prompts to the diagnosis of refluxing type of obstructed megaureter. Here we describe a case of duplex moiety with refluxing type of obstructed megaureter, where gray-scale USG and real-time color Doppler evaluation of the ureteric jet established the diagnosis. The aperistaltic segment of lower ureter near the VUJ with an absence of ureteric jet for the same moiety suggested the possibility of an obstructed megaureter. VUR was demonstrated on VCUG; thus, pointing toward a diagnosis of obstructed refluxing megaureter.

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Editorial: British Neuropathological Society and International Society for Forensic and Radiology Imaging Expert Consensus Statement for Post-mortem Neurological Imaging

Publication date: Available online 27 March 2018
Source:Journal of Forensic Radiology and Imaging
Author(s): Owen J. Arthurs, Rick van Rijn




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Dental Post-mortem Computed Tomography for Disaster Victim Identification: A literature review

Publication date: Available online 27 March 2018
Source:Journal of Forensic Radiology and Imaging
Author(s): Elisa Nguyen, Edel Doyle
Over the last decade, post-mortem computed tomography (PMCT) has been increasingly adopted within the forensic setting. The three-dimensional (3D) capability and non-destructive approach of PMCT allows it to have several advantages over conventional x-rays, and as such it may be of potential use within forensic odontology for disaster victim identification (DVI). However, the implementation of dental PMCT can only have a real forensic benefit if its accuracy is comparable to that of conventional post-mortem (PM) dental radiographs; which is currently standard practice. Therefore, the purpose of this review was to evaluate if dental PMCT is as accurate as PM dental radiographs. A review of the current literature has shown the accuracy of dental PMCT to be comparable or similar to that of PM dental radiographs. As a result, there is a potential for dental PMCT to replace conventional PM dental radiographs in the DVI process of Mass Fatality Incidents (MFIs). However, further research is required to establish an international standard protocol for dental PMCT before it can be recognised as a new standard practice within the forensic setting.



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Quantification of Total and Intracellular Sodium Concentration in Primary Prostate Cancer and Adjacent Normal Prostate Tissue With Magnetic Resonance Imaging

Objectives The aim of this study was to measure the tissue sodium concentration (TSC) within tumors and normal prostate in prostate cancer patients, using prostatectomy as pathological criterion standard. Materials and Methods Fifteen patients with biopsy-proven, magnetic resonance imaging (MRI) visible, intermediate- or high-risk prostate cancer underwent a dedicated research sodium MRI, before treatment with radical prostatectomy. All participants signed written informed consent for this institutional review board–approved prospective study. 3 T MRI acquired using a dedicated multinuclear clamshell transmit coil and a bespoke dual-tuned 1H/23Na endorectal receive coil, with intracellular-sodium imaging acquired using inversion recovery sequences; a phantom-based calibration enabled quantitative sodium maps. Regions of interest were defined for normal peripheral zone (PZ) and transition zone (TZ) and tumor regions, referenced from histopathology maps. A 1-way analysis of variance compared normal and tumor tissue, using Tukey test for multiple comparisons. Results Two patients were excluded due to artifact; software error resulted in 1 further intracellular-sodium failure. Fifteen tumors were detected (13 PZ, 2 TZ) in 13 patients: Gleason 3 + 3 (n = 1), 3 + 4 (6), 3 + 5 (2), 4 + 3 (5), 4 + 5 (1). Both mean TSC and intracellular-sodium were significantly higher in normal PZ (39.2 and 17.5 mmol/L, respectively) versus normal TZ (32.9 and 14.7; P

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Real-time inextensible surgical thread simulation

Abstract

Purpose

This paper discusses a real-time simulation method of inextensible surgical thread based on the Cosserat rod theory using position-based dynamics (PBD). The method realizes stable twining and knotting of surgical thread while including inextensibility, bending, twisting and coupling effects.

Methods

The Cosserat rod theory is used to model the nonlinear elastic behavior of surgical thread. The surgical thread model is solved with PBD to achieve a real-time, extremely stable simulation. Due to the one-dimensional linear structure of surgical thread, the direct solution of the distance constraint based on tridiagonal matrix algorithm is used to enhance stretching resistance in every constraint projection iteration. In addition, continuous collision detection and collision response guarantee a large time step and high performance. Furthermore, friction is integrated into the constraint projection process to stabilize the twining of multiple threads and complex contact situations.

Results

Through comparisons with existing methods, the surgical thread maintains constant length under large deformation after applying the direct distance constraint in our method. The twining and knotting of multiple threads correspond to stable solutions to contact and friction forces. A surgical suture scene is also modeled to demonstrate the practicality and simplicity of our method.

Conclusions

Our method achieves stable and fast simulation of inextensible surgical thread. Benefiting from the unified particle framework, the rigid body, elastic rod, and soft body can be simultaneously simulated. The method is appropriate for applications in virtual surgery that require multiple dynamic bodies.

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Quantification of Total and Intracellular Sodium Concentration in Primary Prostate Cancer and Adjacent Normal Prostate Tissue With Magnetic Resonance Imaging

Objectives The aim of this study was to measure the tissue sodium concentration (TSC) within tumors and normal prostate in prostate cancer patients, using prostatectomy as pathological criterion standard. Materials and Methods Fifteen patients with biopsy-proven, magnetic resonance imaging (MRI) visible, intermediate- or high-risk prostate cancer underwent a dedicated research sodium MRI, before treatment with radical prostatectomy. All participants signed written informed consent for this institutional review board–approved prospective study. 3 T MRI acquired using a dedicated multinuclear clamshell transmit coil and a bespoke dual-tuned 1H/23Na endorectal receive coil, with intracellular-sodium imaging acquired using inversion recovery sequences; a phantom-based calibration enabled quantitative sodium maps. Regions of interest were defined for normal peripheral zone (PZ) and transition zone (TZ) and tumor regions, referenced from histopathology maps. A 1-way analysis of variance compared normal and tumor tissue, using Tukey test for multiple comparisons. Results Two patients were excluded due to artifact; software error resulted in 1 further intracellular-sodium failure. Fifteen tumors were detected (13 PZ, 2 TZ) in 13 patients: Gleason 3 + 3 (n = 1), 3 + 4 (6), 3 + 5 (2), 4 + 3 (5), 4 + 5 (1). Both mean TSC and intracellular-sodium were significantly higher in normal PZ (39.2 and 17.5 mmol/L, respectively) versus normal TZ (32.9 and 14.7; P

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Prostate segmentation in transrectal ultrasound using magnetic resonance imaging priors

Abstract

Purpose

In the current standard of care, real-time transrectal ultrasound (TRUS) is commonly used for prostate brachytherapy guidance. As TRUS provides limited soft tissue contrast, segmenting the prostate gland in TRUS images is often challenging and subject to inter-observer and intra-observer variability, especially at the base and apex where the gland boundary is hard to define. Magnetic resonance imaging (MRI) has higher soft tissue contrast allowing the prostate to be contoured easily. In this paper, we aim to show that prostate segmentation in TRUS images informed by MRI priors can improve on prostate segmentation that relies only on TRUS images.

Methods

First, we compare the TRUS-based prostate segmentation used in the treatment of 598 patients with a high-quality MRI prostate atlas and observe inconsistencies at the apex and base. Second, motivated by this finding, we propose an alternative TRUS segmentation technique that is fully automatic and uses MRI priors. The algorithm uses a convolutional neural network to segment the prostate in TRUS images at mid-gland, where the gland boundary can be clearly seen. It then reconstructs the gland boundary at the apex and base with the aid of a statistical shape model built from an MRI atlas of 78 patients.

Results

Compared to the clinical TRUS segmentation, our method achieves similar mid-gland segmentation results in the 598-patient database. For the seven patients who had both TRUS and MRI, our method achieved more accurate segmentation of the base and apex with the MRI segmentation used as ground truth.

Conclusion

Our results suggest that utilizing MRI priors in TRUS prostate segmentation could potentially improve the performance at base and apex.

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A bony defect of the sphenoid air sinus found in male cadaver: a case report.

Related Articles

A bony defect of the sphenoid air sinus found in male cadaver: a case report.

Surg Radiol Anat. 2018 Mar 24;:

Authors: Al-Shouk AAAM

Abstract
The sphenoid sinus one of the posterior group of sinus, considered one of the most difficult sinuses due to its deep location in the skull. The interest in the understanding of the anatomy of the sphenoid sinus increased markedly during the last decades due to the development of endoscopic transsphenoidal approaches to the intracranial structures. The important anatomical relations of the sphenoid sinus make it one of the difficult and challenging structures for the surgeons. In this case report, we present one of the anatomical variations that was found during cadaveric dissection of the head. In this case we found abnormal bony defect in the lateral wall of the sinus, the defect closed just by the lining mucosa of the sinus and the dura from its intracranial side. A point may be of clinical importance to the related nearby structures.

PMID: 29574571 [PubMed - as supplied by publisher]

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The effect of 131I-induced hypothyroidism on the levels of nitric oxide (NO), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), total nitric oxide synthase (NOS) activity, and expression of NOS isoforms in rats.

The effect of 131I-induced hypothyroidism on the levels of nitric oxide (NO), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), total nitric oxide synthase (NOS) activity, and expression of NOS isoforms in rats.

Bosn J Basic Med Sci. 2018 Mar 10;:

Authors: Zhou J, Cheng G, Pang H, Liu Q, Liu Y

Abstract
Accumulating evidence has shown that hypothyroidism affects the cardiovascular system, significantly increasing the incidence of cardiovascular diseases. In the present study we investigated the effect of radioactive iodine (I-131)-induced hypothyroidism on several parameters of vascular function, such as nitric oxide (NO), total nitric oxide synthase (NOS) activity and expression of NOS isoforms, as well as on interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) as indicators of inflammation, in rats. A dose of 150 µCi of 131-I was determined as optimal for establishing the model of hypothyroidism in rats. After administration of 131-I, at the end of month 1, 2, and 4 (n = 3 for each time point), NO, IL-6, and TNF-α in the serum and total NOS activity in the aorta were determined in 150 µCi group, compared to controls. The mRNA and protein expression of endothelial, neuronal, and inducible NOS (eNOS, nNOS, and iNOS) in the rat aorta was also estimated, using quantitative reverse transcription polymerase chain reaction and Western blot, respectively. The levels of IL-6 and TNF-α increased in 150 µCi group; the results were significant at the end of month 2 and 4 for IL-6, and at all time points for TNF-α. The levels of NO decreased significantly at the end of month 2 and 4 in 150 µCi group. The total NOS activity increased significantly in 150 µCi group, at all three time points. Significant changes in the mRNA and protein expression of all three NOS isoforms were observed in 150 µCi group compared to controls. NO, IL-6, TNF-α levels and NOS activity and expression are altered in hypothyroid state, and the underlying mechanism should be further investigated.

PMID: 29579409 [PubMed - as supplied by publisher]

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System for Image-Guided Resection of Non-Palpable Breast Lesions: Proof of Concept.

Related Articles

System for Image-Guided Resection of Non-Palpable Breast Lesions: Proof of Concept.

Med Phys. 2018 Mar 25;:

Authors: Arsenali B, de Jong HWAM, Viergever MA, Gilhuijs KGA

Abstract
PURPOSE: In breast-conserving surgery (BCS), the cancer is sometimes incompletely excised, leading to reduced patient survival. To pursue complete excisions, radioactive seed localization (RSL) may be used to insert an iodine-125 seed into the tumor. The seed is used as a marker for the location of the tumor during surgery. RSL does not, however, show the extent of the tumor. Based on RSL, we pursue to visualize the seed location together with the tumor extent from diagnostic images.
METHODS: A system with two gamma camera heads and two parallel-hole collimators was recently proposed to triangulate the location of an iodine-125 seed during BCS. In the present study, this system was extended with a range camera to visualize a sphere centered on the seed in relation to the breast. This sphere contains the entire tumor and thus defines the target volume for BCS. Physical experiments with acrylic block phantoms (thickness ranging from 3.5 to 6.5 cm) were performed to assess the absolute bias and the precision with which this sphere can be visualized.
RESULTS: When a 6.5 cm thick phantom was used, along the horizontal plane, the target volume was visualized with an absolute bias and a precision of 2.1 mm and 0.8 mm, respectively. Along the vertical axis (i.e., Z-axis), these values were 4.2 mm and 2.8 mm, respectively.
CONCLUSIONS: The proposed system visualizes the target volume with an absolute bias that may be acceptable for BCS. This article is protected by copyright. All rights reserved.

PMID: 29574889 [PubMed - as supplied by publisher]

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Toward a real-time system for temporal enhanced ultrasound-guided prostate biopsy

Abstract

Purpose

We have previously proposed temporal enhanced ultrasound (TeUS) as a new paradigm for tissue characterization. TeUS is based on analyzing a sequence of ultrasound data with deep learning and has been demonstrated to be successful for detection of cancer in ultrasound-guided prostate biopsy. Our aim is to enable the dissemination of this technology to the community for large-scale clinical validation.

Methods

In this paper, we present a unified software framework demonstrating near-real-time analysis of ultrasound data stream using a deep learning solution. The system integrates ultrasound imaging hardware, visualization and a deep learning back-end to build an accessible, flexible and robust platform. A client–server approach is used in order to run computationally expensive algorithms in parallel. We demonstrate the efficacy of the framework using two applications as case studies. First, we show that prostate cancer detection using near-real-time analysis of RF and B-mode TeUS data and deep learning is feasible. Second, we present real-time segmentation of ultrasound prostate data using an integrated deep learning solution.

Results

The system is evaluated for cancer detection accuracy on ultrasound data obtained from a large clinical study with 255 biopsy cores from 157 subjects. It is further assessed with an independent dataset with 21 biopsy targets from six subjects. In the first study, we achieve area under the curve, sensitivity, specificity and accuracy of 0.94, 0.77, 0.94 and 0.92, respectively, for the detection of prostate cancer. In the second study, we achieve an AUC of 0.85.

Conclusion

Our results suggest that TeUS-guided biopsy can be potentially effective for the detection of prostate cancer.

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Radiculomegaly: a case report of this rare dental finding with review of the associated oculo-facio-cardio-dental syndrome.

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Radiculomegaly: a case report of this rare dental finding with review of the associated oculo-facio-cardio-dental syndrome.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Feb 28;:

Authors: Smith MH, Cohen DM, Bhattacharyya I, Islam NM, Kashtwari D

Abstract
BACKGROUND: Radiculomegaly, or root gigantism, is a rare dental abnormality with important clinical implications. It is highly specific for oculo-facio-cardio-dental (OFCD) syndrome, which places dentists at the forefront of diagnosis of this syndrome. Only 1 case of nonsyndromic radiculomegaly has been reported in the literature since the description of OFCD syndrome in 1996. We present the second confirmed, nonsyndromic/nonfamilial case and review the literature for dental treatments in patients with this dental finding.
STUDY DESIGN: A review of the English language literature was performed in PubMed for patients with radiculomegaly or OFCD syndrome. Teeth affected by radiculomegaly, gender, orodental findings, presence of OFCD syndrome, and dental treatment methods were recorded.
RESULTS: Sixty-seven cases of radiculomegaly and 92 cases of OFCD syndrome were found in the literature. Only 1 confirmed case of nonsyndromic/nonfamilial radiculomegaly had been reported previously. Ten reports described dental treatment or treatment plan details, and even fewer included specific methods.
CONCLUSIONS: Because dental anomalies, especially radiculomegaly, are a primary feature of OFCD syndrome, dentists should be aware of the clinical and radiographic features. Radiculomegaly poses a distinct challenge to dentists, and reports of dental therapy provided to these patients are sparse. Early diagnosis of the syndrome may prevent dental challenges and improve prognosis.

PMID: 29574060 [PubMed - as supplied by publisher]

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"Tricyclic antidepressants and appropriate and inappropriate medications in the geriatric population"-comments.

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"Tricyclic antidepressants and appropriate and inappropriate medications in the geriatric population"-comments.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Mar 09;:

Authors: Brown RS

PMID: 29574059 [PubMed - as supplied by publisher]

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Replacing zoledronic acid with denosumab is a risk factor for developing osteonecrosis of the jaw.

Related Articles

Replacing zoledronic acid with denosumab is a risk factor for developing osteonecrosis of the jaw.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Mar 06;:

Authors: Higuchi T, Soga Y, Muro M, Kajizono M, Kitamura Y, Sendo T, Sasaki A

Abstract
OBJECTIVE: Intravenous zoledronic acid (ZA) is often replaced with subcutaneous denosumab in patients with bone metastatic cancer. Despite their different pharmacologic mechanisms of action, both denosumab and ZA are effective in bone metastasis but cause osteonecrosis of the jaw (ONJ) as a side effect. ZA persists in the body almost indefinitely, whereas denosumab does not persist for long periods. This study evaluated the risks of developing ONJ when replacing ZA with denosumab.
STUDY DESIGN: In total, 161 Japanese patients administered ZA for bone metastatic cancer were enrolled in this single-center, retrospective, observational study. The risk of developing ONJ was evaluated by logistic regression analysis using the following factors: age, gender, cancer type, angiogenesis inhibitors, steroids, and replacement of ZA with denosumab.
RESULTS: Seventeen patients (10.6%) developed ONJ. Multiple regression analysis indicated a significant difference in rate of ONJ associated with replacement of ZA with denosumab (odds ratio = 3.81; 95% confidence interval 1.04-13.97; P = .043).
CONCLUSIONS: Replacing ZA with denosumab is a risk factor for the development of ONJ. Both binding of bisphosphonate to bone and receptor activator of nuclear factor-κ B ligand inhibition could additively increase the risk of ONJ. We bring the replacement of ZA with denosumab to the attention of clinical oncologists.

PMID: 29574058 [PubMed - as supplied by publisher]

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A nomogram for classification of temporomandibular joint disk perforation based on magnetic resonance imaging.

Related Articles

A nomogram for classification of temporomandibular joint disk perforation based on magnetic resonance imaging.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Mar 06;:

Authors: Kim JY, Jeon KJ, Kim MG, Park KH, Huh JK

Abstract
OBJECTIVE: The aim of this study was to analyze risk factors and establish a prediction model for temporomandibular joint (TMJ) disk perforation by constructing a nomogram.
STUDY DESIGN: The study included a total of 282 joints in 274 patients. All patients underwent open TMJ surgery after obtaining magnetic resonance imaging (MRI), from 2005 to 2015. The presence or absence of disk perforation was confirmed during the operation. Patients were classified into 2 groups: perforation and nonperforation groups. We investigated demographic data and the characteristics of the disk, joint space, and bone on MRI. A logistic regression analysis was performed to analyze risk factors. A nomogram was constructed and validated internally and externally.
RESULTS: Risk factors for disk perforation were increased age, disk shape (eyeglass or amorphous), low bone marrow signal, abnormal joint space, and 2 or more bony changes in the condyle and fossa. The area under the receiver operating characteristic curve of the nomogram was 0.908 (95% confidence interval [CI] 0.869-0.946) in the internal validation and 0.889 (95% CI 0.804-0.973) in the external validation with good suitability.
CONCLUSIONS: We were able to predict the probability of disk perforation with analyzed risk factors and constructed a nomogram, which may be helpful in proper diagnosis and treatment.

PMID: 29574057 [PubMed - as supplied by publisher]

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Incremental Prognostic Value of Apparent Diffusion Coefficient Histogram Analysis in Head and Neck Squamous Cell Carcinoma

Publication date: Available online 26 March 2018
Source:Academic Radiology
Author(s): Xiaoxia Li, Ying Yuan, Jiliang Ren, Yiqian Shi, Xiaofeng Tao
Rationale and ObjectivesWe aimed to investigate the incremental prognostic value of apparent diffusion coefficient (ADC) histogram analysis in patients with head and neck squamous cell carcinoma (HNSCC) and integrate it into a multivariate prognostic model.Materials and MethodsA retrospective review of magnetic resonance imaging findings was conducted in patients with pathologically confirmed HNSCC between June 2012 and December 2015. For each tumor, six histogram parameters were derived: the 10th, 50th, and 90th percentiles of ADC (ADC10, ADC50, and ADC90); mean ADC values (ADCmean); kurtosis; and skewness. The clinical variables included age, sex, smoking status, tumor volume, and tumor node metastasis stage. The association of these histogram and clinical variables with overall survival (OS) was determined. Further validation of the histogram parameters as independent biomarkers was performed using multivariate Cox proportional hazard models combined with clinical variables, which was compared to the clinical model. Models were assessed with C index and receiver operating characteristic curve analyses for the 12- and 36-month OS.ResultsNinety-six patients were eligible for analysis. Median follow-up was 877 days (range, 54–1516 days). A total of 29 patients died during follow-up (30%). Patients with higher ADC values (ADC10 > 0.958 × 10⁻³ mm²/s, ADC50 > 1.089 × 10⁻³ mm²/s, ADC90 > 1.152 × 10⁻³ mm²/s, ADCmean > 1.047 × 10⁻³ mm²/s) and lower kurtosis (≤0.967) were significant predictors of poor OS (P < .100 for all). After adjusting for sex and tumor node metastasis stage, the ADC90 and kurtosis are both significant predictors of OS with hazard ratios = 1.00 (95% confidence interval: 1.001–1.004) and 0.58 (95% confidence interval: 0.37–0.90), respectively. By adding the ADC parameters into the clinical model, the C index and diagnostic accuracies for the 12- and 36-month OS showed significant improvement.ConclusionsADC histogram analysis has incremental prognostic value in patients with HNSCC and increases the performance of a multivariable prognostic model in addition to clinical variables.



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Exploring the Potential of Undergraduate Radiology Education in the Virtual World Second Life with First-cycle and Second-cycle Medical Students

Publication date: Available online 26 March 2018
Source:Academic Radiology
Author(s): Rocio Lorenzo-Alvarez, Jose Pavia-Molina, Francisco Sendra-Portero
Rationale and ObjectivesVirtual worlds have a remarkable potential for effective teaching and learning, providing immersive, realistic, and engaging online events. Previous studies have explored online education of health professionals in Second Life (SL), the most widely used virtual world, but none of the previous learning experiences were related to radiology. The purpose of this study was to explore the potential use of SL for undergraduate radiology education and the involvement of students in SL learning activities.Materials and MethodsWe delivered a 4-week voluntary undergraduate radiology education program in SL, based on synchronous sessions and asynchronous tasks, with two modalities: introduction to basic radiology for first-cycle (first- to third-year) students and case-based clinical radiology for second-cycle (fourth- to sixth-year) students. Participants completed an evaluation questionnaire about the experiences after the learning program.ResultsForty-six students (20 first-cycle and 26 second-cycle) participated in this study. They found the contents of the course appropriate (mean ≥ 4.53/5), the initiative interesting, and the environment attractive (mean ≥ 4.32/5), and they were willing to participate in future SL experiences (mean ≥ 4.63/5). All students highly rated the organization, the content, the benefit to their medical education, and the professor (mean ≥ 9.05/10).ConclusionOnline radiology education using SL is feasible and well received by medical students of all year groups. The students participated and engaged in this activity very positively and rated the experience highly. The potential of using SL for radiology education includes promising expectations regarding collaborative learning and gamification.



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Radiation Dose Reduction at Low Tube Voltage CCTA Based on the CNR Index

Publication date: Available online 26 March 2018
Source:Academic Radiology
Author(s): Takanori Masuda, Yoshinori Funama, Takeshi Nakaura, Tomoyasu Satou, Tomokazu Okimoto, Yukari Yamashita, Naoyuki Imada, Kazuo Awai
Rationale and ObjectivesWe compared the radiation dose and diagnostic accuracy on 120- and 100-kVp coronary computed tomography angiography (CCTA) scans whose contrast-to-noise ratio (CNR) was the same.Materials and MethodsWe studied 1311 coronary artery segments from 100 patients. For 120-kVp scans, the targeted image level was set at 25 Hounsfield units (HU). For 100-kVp scans, the targeted noise level was set at 30 HU to obtain the same CNR as at 120 kVp. We compared the CNR and the radiation dose on scans acquired at 120 and 100 kVp. Invasive coronary angiography (ICA) images were evaluated by an interventional coronary angiography specialist, and CCTA images were evaluated by a radiologist. Coronary artery disease was defined as a luminal narrowing ≧50% for ICA and CCTA. With ICA considered the gold standard, the diagnostic accuracy (sensitivity, specificity, positive predictive value, and negative predictive value) was analyzed on both 120- and 100-kVp CCTA images. We also compared the diagnostic accuracy for area under the receiver operating characteristic curve of the ICA and CCTA performed at 120 and 100 kVp. Two blinded observers visually evaluated the septal branch.ResultsThe mean dose-length product was 48% lower at 100 kVp than at 120 kVp (P < .01). Under the 120-kVp CCTA protocol, the area under the curve, 95% confidence interval, sensitivity, specificity, positive predictive value, and negative predictive value were 0.94%, 0.91%–0.96%, 94.0%, 93.0%, 82.3%, and 98.1%, respectively; at 100 kVp these values were 0.94%, 0.92%–0.97%, 96.1%, 92.0%, 85.2%, and 98.0%, respectively. Area under the receiver operating characteristic curve analysis revealed no significant difference in diagnostic accuracy between the two protocols (P = .87).ConclusionsAt the same CNR, the 100-kVp CCTA protocol may help to reduce the radiation dose by approximately 50% compared to the 120-kVp protocol without degradation of diagnostic accuracy.



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Toward Augmented Radiologists

Publication date: Available online 26 March 2018
Source:Academic Radiology
Author(s): Shahein H. Tajmir, Tarik K. Alkasab
Radiology practice will be altered by the coming of artificial intelligence, and the process of learning in radiology will be similarly affected. In the short term, radiologists will need to understand the first wave of artificially intelligent tools, how they can help them improve their practice, and be able to effectively supervise their use. Radiology training programs will need to develop curricula to help trainees acquire the knowledge to carry out this new supervisory duty of radiologists. In the longer term, artificially intelligent software assistants could have a transformative effect on the training of residents and fellows, and offer new opportunities to bring learning into the ongoing practice of attending radiologists.



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Subspecialist Reader Reinterpretation of Referred Imaging Studies

Publication date: Available online 27 March 2018
Source:Academic Radiology
Author(s): Mahmoud Al-Hawary




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