scholarly journals Diagnosing necrotizing external otitis on CT and MRI: assessment of pattern of extension

2021 ◽  
Author(s):  
Wilhelmina L. van der Meer ◽  
Jérôme J. Waterval ◽  
Henricus P. M. Kunst ◽  
Cristina Mitea ◽  
Sjoert A. H. Pegge ◽  
...  
Keyword(s):  
Imaging Modality ◽  
External Otitis ◽  
Intracranial Extension ◽  
Disease Extent ◽  
Number Of Patients ◽  
Anterior Extension ◽  
Posterior Extension ◽  
Disease Extension ◽  
Work Up ◽  
Necrotizing External Otitis

Abstract Background and purpose Necrotizing external otitis (NEO) is a serious complication of external otitis. NEO can be classified according to—anterior, medial, posterior, intracranial, and contralateral—extension patterns. Currently there is no consensus on the optimal imaging modality for the identification of disease extension. This study compares NEO extension patterns on MR and CT to evaluate diagnostic comparability. Methods Patients who received a CT and MR within a 3-month interval were retrospectively examined. Involvement of subsites and subsequent spreading patterns were assessed on both modalities by a radiologist in training and by a senior head and neck radiologist. The prevalence of extension patterns on CT and MR were calculated and compared. Results All 21 included NEO cases showed an anterior extension pattern on CT and MR. Contrary to MR, medial extension was not recognized on CT in two out of six patients, and intracranial extension in five out of eight patients. The posterior extension pattern was not recognized on MR. Overall, single anterior extension pattern (62%) is more prevalent than multiple extension patterns (38%). Conclusion All anterior NEO extension pattern were identified on CT as well as MR. However, the medial and intracranial spreading patterns as seen on MR could only be identified on CT in a small number of patients. The posterior spreading pattern can be overlooked on MR. Thus, CT and MR are complimentary for the initial diagnosis and work-up of NEO as to correctly delineate disease extent through the skull base.

Contrast-Enhanced Ultrasound: a Simple and Effective Tool in Defining a Rapid Diagnostic Work-up for Small Nodules Detected in Cirrhotic Patients during Surveillance

2016 ◽  
Vol 25 (2) ◽  
pp. 205-211 ◽  
Author(s):  
Antonio Giorgio ◽  
Luca Montesarchio ◽  
Piero Gatti ◽  
Ferdinando Amendola ◽  
Paolo Matteucci ◽  
...  
Keyword(s):  
Predictive Value ◽  
Imaging Modality ◽  
Dynamic Imaging ◽  
Contrast Enhanced Ultrasound ◽  
Histologic Diagnosis ◽  
Therapeutic Work ◽  
Contrast Enhanced ◽  
Arterial Vascularization ◽  
Cirrhotic Patients ◽  
Work Up

  Background & Aims: Disappearance of portal blood flow and arterial vascularization is the hallmark of hepatocarcinogenesis. The capability of a dynamic imaging modality detecting arterial hypervascularization of small nodules is crucial to promote a rapid diagnostic and therapeutic work-up improving survival. We aimed to evaluate the capability of CEUS to detect arterial vascularization of ≤ 2 cm HCC nodules arising during surveillance so as to shorten the diagnostic and therapeutic work-up. Methods: From October 2009 to September 2014, among 1757 consecutive cirrhotic patients under surveillance with ultrasound (US), 243 patients had new single nodules 7-20 mm; 229/243 had a conclusive histologic diagnosis and comprised the study group. All patients underwent CEUS followed by enhanced MRI and US guided percutaneous 18G needle core biopsy of the nodules. Of the 229 nodules, 27 were hyperechoic, 171 hypoechoic and 31 isoechoic lesions. Results: The histology results revealed that 199/229 nodules were HCC and 30 were benign. Of 199 HCC, CEUS evidenced arterial hypervascularity in 190 nodules (95.5%) (sensitivity 94.48 %, specificity 100%, PPV 100%, NPV 76.92 %). Of the 39 CEUS arterial-unenhanced nodules, 30 were benign and 9 (23%) were well-differentiated HCC. eMRI showed arterial hypervascularity in 199 nodules (86,9%). Of these, only 193 (97%) were histologically HCCs while 6 were benign (sensitivity: 97%, specificity: 80%, PPV: 97%, NPV: 80%). Conclusions: CEUS has a great capability to detect arterial hypervascularity of small HCC. Because only 4.5% of new nodules escape the demonstration of arterial hyervascularity, CEUS must be performed immediately after conventional US to contrast the malignant fate of small lesions arising in a cirrhotic liver.. Abbreviations: CEUS: contrast-enhanced ultrasound; CT: computed tomography; HCC: hepatocellular carcinoma;MRI: magnetic resonance; NPV: negative predictive value; PPV: positive predictive value; US: ultrasonography.

Unusual case of VIII nerve dysfunction on necrotizing external otitis

2020 ◽  
Vol 69 (4) ◽  
Author(s):  
Diogo A. Pereira ◽  
Luís Guedes ◽  
Abílio Leonardo ◽  
Delfim Duarte ◽  
Gustavo Lopes
Keyword(s):  
Unusual Case ◽  
External Otitis ◽  
Nerve Dysfunction ◽  
Necrotizing External Otitis

Pearls and Pitfalls of Contrast-Enhanced Mammography

2019 ◽  
Vol 1 (1) ◽  
pp. 64-72 ◽  
Author(s):  
Jordana Phillips ◽  
Valerie J Fein-Zachary ◽  
Priscilla J Slanetz
Keyword(s):  
Imaging Modality ◽  
Breast Mri ◽  
Successful Implementation ◽  
Newly Diagnosed ◽  
Disease Extent ◽  
Diagnostic Problem Solving ◽  
Contrast Enhanced ◽  
Comparable Performance ◽  
Mri Protocol ◽  
Monitoring Response

Abstract Contrast-enhanced mammography (CEM) is a promising new imaging modality that uses a dual-energy acquisition to provide both morphologic and vascular assessment of breast lesions. Although no official BI-RADS lexicon exists, interpretation entails using the mammographic BI-RADS lexicon in combination with that for breast MRI. CEM has comparable performance to breast MRI, with sensitivity of 93–100% and specificity of 80–94%. Currently FDA approved for diagnostic imaging, this technology can be helpful in determining disease extent in patients with newly diagnosed breast malignancy, monitoring response to neoadjuvant therapy, identifying mammographically occult malignancies, and diagnostic problem-solving. Studies are ongoing about its role in screening, especially in women with dense breasts or at elevated risk. There are some challenges to successful implementation into practice, but overall, patients tolerate the study well, and exam times are less than the full breast MRI protocol.

Ruling out deep venous thrombosis in primary care

2005 ◽  
Vol 94 (07) ◽  
pp. 200-205 ◽  
Author(s):  
Karel G. M. Moons ◽  
Arno W. Hoes ◽  
Ruud Oudega
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Decision Rule ◽  
Cross Sectional ◽  
Diagnostic Decision ◽  
Number Of Patients ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
D Dimer

SummaryIn primary care, the physician has to decide which patients have to be referred for further diagnostic work-up. At present, only in 20% to 30% of the referred patients the diagnosis DVT is confirmed. This puts a burden on both patients and health care budgets. The question arises whether the diagnostic work-up and referral of patients suspected of DVT in primary care could be more efficient. A simple diagnostic decision rule developed in primary care is required to safely exclude the presence of DVT in patients suspected of DVT, without the need for referral. In a cross-sectional study, we investigated the data of 1295 consecutive patients consulting their primary care physician with symptoms suggestive of DVT, to develop and validate a simple diagnostic decision rule to safely exclude the presence of DVT. Independent diagnostic indicators of the presence of DVT were male gender, oral contraceptive use, presence of malignancy, recent surgery, absence of leg trauma, vein distension, calf difference and D-dimer test result. Application of this rule could reduce the number of referrals by at least 23% while only 0·7% of the patients with a DVT would not be referred. We conclude that by using eight simple diagnostic indicators from patient history, physical examination and the result of D-dimer testing, it is possible to safely rule out DVT in a large number of patients in primary care, reducing unnecessary patient burden and health care costs.

Scalp and Calvarial Masses of Infants and Children

Neurosurgery ◽  
1988 ◽  
Vol 22 (6P1-P2) ◽  
pp. 1037-1042 ◽  
Author(s):  
John R. Ruge ◽  
Tadanori Tomita ◽  
Thomas P. Naidich ◽  
Yoon S. Hahn ◽  
David G. McLone
Keyword(s):  
Dura Mater ◽  
Eosinophilic Granuloma ◽  
Infants And Children ◽  
Intracranial Extension ◽  
Sagittal Suture ◽  
Computed Tomographic ◽  
Dermoid Tumor ◽  
Work Up

Abstract Review of 70 children presenting with a solitary nontraumatic lump on the head revealed that 61% ofthe lesions were dermoid tumor, 9% were cephalhematoma deformans, 1% were eosinophilic granuloma, and 4% were occult menin goceles and encephaloceles. Most of the dermoid cysts occurred along sutural lines, but some did not. One of the eosinophilic granulomas was located over the sagittal suture. Seventeen per cent of the “lumps” had significant intracranial extension. An additional 20% of the lumps extended intracranially, but only to the dura mater. Work-up of these lesions should include initial plain skull roentgenograms to assess multiplicity and appropriate computed tomographic scans to assess possible intracranial extension.

scholarly journals Complete Remission of Advanced Adrenocortical Cancer Following Mitotane Monotherapy: A Case Report and Literature Review of Predictive Markers

2021 ◽  
Vol 11 ◽  
Author(s):  
Judit Tőke ◽  
Zsuzsanna Jakab ◽  
Júlia Stark ◽  
Gergely Huszty ◽  
Péter Reismann ◽  
...  
Keyword(s):  
Case Report ◽  
Lymph Node ◽  
Complete Remission ◽  
Vascular Invasion ◽  
Ct Scans ◽  
Adrenocortical Cancer ◽  
High Power Field ◽  
Predictors Of Response ◽  
Number Of Patients ◽  
Work Up

Mitotane has been used for the treatment of adrenocortical cancer (ACC) for over 50 years. Despite its widespread use both in monotherapy and in combination with chemotherapeutics, our knowledge of its mechanism of action and therapeutic efficacy is scarce. The number of patients with advanced ACC who have achieved complete remission documented by detailed clinical data is below ten. We report a case of a 64-year-old woman with a non-functional ACC. Histological examination showed vascular invasion, Ki67 of 10% and a mitotic count of 3/10 high-power field. Immunohistochemistry revealed p53 positivity. Pathological TNM grade was reported as T2N0M0, ENSAT stage 2. Nine months after the initial diagnosis, re-staging CT revealed multiple peritoneal nodules, lymph node and kidney metastases confirmed by histologic examination. Mitotane monotherapy was started with a maintenance dose between 2.0 and 2.5 grams/day. Partial remission was established at six months. Subsequently, for another 12 months, each of the three-monthly CT scans confirmed complete remission. Nineteen months after the initiation of mitotane, an unexpected sudden death occurred. A detailed autopsy work-up, performed in the full awareness of oncological history, confirmed complete remission. The authors review the molecular biomarkers and clinical features reported as predictors of response to mitotane monotherapy.

scholarly journals Additional Value of PET Radiomic Features for the Initial Staging of Prostate Cancer: A Systematic Review from the Literature

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 6026
Author(s):  
Priscilla Guglielmo ◽  
Francesca Marturano ◽  
Andrea Bettinelli ◽  
Michele Gregianin ◽  
Marta Paiusco ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Imaging Modality ◽  
Small Sample ◽  
High Order ◽  
Lesion Detection ◽  
Qualitative Assessment ◽  
Number Of Patients ◽  
Additional Value ◽  
Initial Staging

We performed a systematic review of the literature to provide an overview of the application of PET radiomics for the prediction of the initial staging of prostate cancer (PCa), and to discuss the additional value of radiomic features over clinical data. The most relevant databases and web sources were interrogated by using the query “prostate AND radiomic* AND PET”. English-language original articles published before July 2021 were considered. A total of 28 studies were screened for eligibility and 6 of them met the inclusion criteria and were, therefore, included for further analysis. All studies were based on human patients. The average number of patients included in the studies was 72 (range 52–101), and the average number of high-order features calculated per study was 167 (range 50–480). The radiotracers used were [68Ga]Ga-PSMA-11 (in four out of six studies), [18F]DCFPyL (one out of six studies), and [11C]Choline (one out of six studies). Considering the imaging modality, three out of six studies used a PET/CT scanner and the other half a PET/MRI tomograph. Heterogeneous results were reported regarding radiomic methods (e.g., segmentation modality) and considered features. The studies reported several predictive markers including first-, second-, and high-order features, such as “kurtosis”, “grey-level uniformity”, and “HLL wavelet mean”, respectively, as well as PET-based metabolic parameters. The strengths and weaknesses of PET radiomics in this setting of disease will be largely discussed and a critical analysis of the available data will be reported. In our review, radiomic analysis proved to add useful information for lesion detection and the prediction of tumor grading of prostatic lesions, even when they were missed at visual qualitative assessment due to their small size; furthermore, PET radiomics could play a synergistic role with the mpMRI radiomic features in lesion evaluation. The most common limitations of the studies were the small sample size, retrospective design, lack of validation on external datasets, and unavailability of univocal cut-off values for the selected radiomic features.

Skull growth in achondroplasic (cn) mice; a craniometric study

Development ◽  
1975 ◽  
Vol 33 (4) ◽  
pp. 1013-1022
Author(s):  
Rosemary J. Jolly ◽  
W. J. Moore
Keyword(s):  
Cranial Base ◽  
Septal Cartilage ◽  
Skull Morphology ◽  
Condylar Cartilage ◽  
Central Section ◽  
Condylar Process ◽  
Skull Growth ◽  
Anterior Extension ◽  
Posterior Extension ◽  
Nasal Septal Cartilage

Skull morphology in achondroplasic (cn/cn) mice was compared with that of normal siblings in order to determine the effects of this chondrodystrophy on skull growth, particular attention being given to dimensions reflecting growth at the synchondroses of the cranial base, the nasal septal cartilage and the condylar cartilage of the mandible. The central section of the cranial base (basicranial axis) was reduced by 25 %, the length of the viscerocranium by 18 % and the length of the condylar process by 11 %. The evidence indicates that these reductions are due to diminished growth at respectively the spheno-occipital and midsphenoidal synchondroses, the nasal septal cartilage and the condylar cartilage. The relative sizes of the reductions in cranial base, viscerocranium and condylar process suggest that the growth of synchondrotic and septal cartilages is diminished to a greater extent than that of condylar cartilage. This finding is in agreement with the observations that condylar cartilage, unlike synchondrotic and septal cartilage, grows by surface apposition and that the principal defect in cn/cn mice is a disturbance of interstitial cartilaginous growth. The posterior extension of the basicranial axis of the cn/cn mice was reduced by 14 % and the anterior extension by 2 %. The width of the cranial base was decreased by 9 % and the angle between the basicranial axis and its anterior extension was decreased by 3 %. The length of theneurocranium was reduced by 19 % in the cn/cn animals while the volume of the endocranial cavity was diminished by only 18 %. The latter reduction is less than would be expected from the cube relationship between volume and linear dimensions but is readily accounted for by the lack of reduction in the height or width of the neurocranium, the slight flattening of the cranial base and the doming of the neurocranial vault.

scholarly journals SAT-176 Epidemiology of Adrenal Tumors: A Population Based Study of 1287 Patients

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Andreas Ebbehoj ◽  
Ravinder J Kaur ◽  
Dingfeng Li ◽  
Sumitabh Singh ◽  
Catherine Zhang ◽  
...  
Keyword(s):  
Medical Records ◽  
Adrenal Mass ◽  
Local Community ◽  
Adrenal Adenoma ◽  
Population Based ◽  
Adrenal Cortical Carcinoma ◽  
Adrenal Tumors ◽  
Number Of Patients ◽  
Incidental Discovery ◽  
Work Up

Abstract Background: Adrenal tumors are reported in 5% of adults, with malignancy rates in 1–12%, and rates of overt hormonal excess in 1–15 %. However, most estimates originate from convenience samples. Our objective was to determine the incidence, prevalence and clinical presentation of adrenal tumors in a population-based setting. Methods: We used a centralized epidemiologic database to identify patients diagnosed with adrenal tumors in a local community 1995 to 2017. The database is a unique medical records linkage system that allows access to hospital and community medical records for local residents (population 137,000). We calculated incidence rates (IR) as the number of new patients diagnosed while living in the study area, and prevalence as the number of patients living in the study area on Dec 31 2017. IR and prevalence were sex- and age-adjusted to the 2010 US Census population. Results: Of 1,287 patients diagnosed with adrenal tumor, the median age of diagnosis was 62 years (IQR 52–72), 713 (55%) were women, and 13 (1%) were younger than 18 years at diagnosis. IR was highest in patients >65 YO, followed by patients 40–64 YO, 18–39 YO and <18 YO (142 vs 66 vs 9 vs 2 per 100,000 persons years). IR per 100,000 increased from 4.4 (CI95% 0.3–8.6) in 1995 to 47.8 (CI95% 36.9–58.7) in 2017. Overall prevalence in the population was 0.53% in 2017, ranging from 0.01% among 0–17 YO to 1.9% among +65 YO. Malignant adrenal mass was diagnosed in 8.7% patients (4 patients with adrenal cortical carcinoma (0.3%) and 108 (8.4%) patients with other malignant mass). Pheochromocytoma was diagnosed in 11 (1.1%) patients and benign adrenal mass was diagnosed in 1,175 (90.2%) patients (1,076 (83.6%) with adrenal adenoma and 85 (6.6%) with other benign mass). Median tumor size was 15 mm (range 5–255), and 184 (14%) of patients had bilateral tumors. Only 255 (20%) patients had dexamethasone suppression test, 93 (36%) with cortisol>1.8 mcg/dl. Of 1,076 adrenal adenomas, 53 (4.9%) had overt hormone excess, 140 (13%) had nonfunctioning adrenal adenomas, and 88 (8.2%) had mild autonomous cortisol secretion. Hormonal work up for was incomplete in 795 (73.9%) adenomas. Patients discovered incidentally (1,050, 81.6%) had a lower rate of malignancy and hormone excess (5.3% vs 52% of patients with non-incidental discovery, p <0.001). Rate of malignancy was highest in children (67% vs 8% >18YO, p<0.001), bilateral tumors (16% vs 8% unilateral, p<0.001), tumors ≥4 cm (33% vs 7% in < 4 cm, p<0.001). Conclusion: IR of adrenal tumors increased 10-fold since 1995, and was highest in patients >65 YO. 8.7% of tumors were malignant, with a majority represented by malignant adrenal tumors other than adrenal cortical carcinoma. The risk of malignancy was highest in non-incidental discovery, children, and tumors > 4 cm. Overt hormone excess was diagnosed in 4.5% of patients. The majority of patients with adrenal adenomas had a suboptimal work up for hormone excess.

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