The Value of SPECT-CT in Diagnosing Complex Non-Arthritic and Non-Neoplastic Conditions of the Foot and Ankle

Introduction: There is little information on the value of using single photon emission computerized tomography–computed tomography (SPECT-CT) in non-arthritic and non-neoplastic conditions of the foot and ankle (F&A). The vast majority of studies have investigated the role of SPECT-CT in degenerative conditions, bony pathology, and neoplastic conditions. The diagnostic value of SPECT-CT in purely non-arthritic and non-neoplastic conditions, in the absence of other conclusive radiological findings, is yet to be clarified. The aim of this study was to evaluate the value of SPECT-CT in a cohort of patients with complex F&A pathology, in whom diagnostic uncertainty existed after conventional imaging techniques, and to assess its added value in routine clinical practice. Methodology: A retrospective analysis of 297 SPECT-CTs from 2010 to 2017 found 18 SPECT-CTs (age = 16-56 years) performed for non-arthritic F&A pathology. Changes in diagnosis, management, and clinical outcome scores were recorded before and after SPECT-CT imaging. Results: The results demonstrated that the provisional diagnosis was different from the SPECT-CT diagnosis in 10 (56%) out of the 18 patients and led to a modified treatment plan, which was successful in 8 (80%) out of the 10 patients. The post-intervention Manchester Oxford Foot Questionnaire (MOX-FQ) and Visual Analogue Scale (VAS) score improved from 76 ± 18 to 58 ± 24 ( P = .02), and from 72 ± 17 to 49 ± 32 ( P = .01), respectively. The SPECT-CT scan was useful in confirming the provisional diagnosis in the remaining 8 patients where a diagnostic uncertainty existed after conventional imaging techniques. Overall, a total of 15 out of 18 patients (83%) showed an improvement in their symptoms after management led by SPECT-CT diagnosis. Conclusion: Our study highlights the added value of SPECT-CT in patients presenting with non-arthritic and non-neoplastic F&A conditions in which there is diagnostic uncertainty after conventional imaging. In 80% of cases, a change in management driven by the SPECT-CT findings led to a successful outcome. We have found SPECT-CT to be a useful investigative modality in assessing these complex F&A cases. Levels of Evidence: Level IV

P125 MANAGEMENT OF PERICAECAL HERNIA CAUSING SMALL BOWEL OBSTRUCTION IN THE EVOLVING ERA OF LAPAROSCOPY. A CASE REPORT AND LITERATURE REVIEW

Introduction “Internal hernias are an unusual cause of intestinal obstruction. Pericaecal hernias are an exceptionally rare type of internal hernia. Laparoscopy for small bowel obstruction was previously considered inappropriate. We present a case of Pericaecal hernia causing small bowel obstruction treated successfully with a laparoscopic approach.” Case-Report “64 year old man presented with abdominal pain, vomiting and constipation for 3 days, no previous surgery. Small bowel obstruction confirmed on PFA and CT. He was treated conservatively for 10 days without settling. A an exploratory laparoscopy revealed a Pericaecal hernia. This was reduced with gentle manoeuvre and the peritoneal folds were divided to prevent recurrence. Recovery was uneventful.” Discussion “Perioperative diagnosis of internal hernia is extremely difficult. Pericaecal hernia is an uncommon type of internal hernia. CT diagnosis of internal hernia remains difficult. Laparoscopy is a valuable tool for diagnosis and treatment with the advantage of minimal invasiveness. However, the laparoscopic manipulation of distended bowel loops remain controversial because of high risk of perforation, reduced space to work in the peritoneal cavity and requirement of advanced laparoscopic skills. Laparoscopic treatment of Pericaecal hernia was reported about 17 years ago but has since been reported more frequently and in recent years there is a move towards laparoscopic diagnosis and management of Pericaecal hernias.” Conclusions “CT diagnosis of internal hernia remains difficult. With the advent of minimal access surgery, diagnostic laparoscopy may be a safe and feasible modality to diagnose and deliver definitive treatment of small bowel obstruction secondary to Pericaecal hernia.”

CT Diagnosis of Complications Arising from the Natural History and Treatment of COVID-19

Computed tomography for coronavirus infection (COVID-19) is effective not only in making a diagnosis, but also in timely and accurately detecting some complications of this disease in different organs and systems. The paper shows various complications of coronavirus infection that a radiologist may face in practice, which develop both in the natural course and due to therapy for COVID-19, including hemorrhagic and thrombotic events in coagulopathy, pneumothorax, and pneumomediastinum as a result of the direct cytotoxic effect of SARS-CoV-2 on pneumocytes, and barotrauma during mechanical ventilation, as well as pathological fractures due to osteoporosis, including steroid osteoporosis that has developed during therapy with glucocorticosteroids. It considers the main causes and pathogenesis of various complications of coronavirus infection.

Percutaneous Kyphoplasty Guided by CT Images Based on SEPB Algorithm in the Treatment of Elderly Osteoporotic Thoracolumbar Vertebral Compression Fractures

The paper uses the SEPB algorithm to explore the value of X-ray and CT diagnosis in elderly patients with osteoporotic lumbar compressive fractures, while observing percutaneous kyphoplasty (PKP) in the treatment of elderly osteoporotic compression fractures with clinical efficacy. 38 elderly patients with fractured osteoporotic compression fractures who came to our hospital for treatment were included. All patients were diagnosed by X-ray and CT, the clinical data of all patients were analyzed, the imaging findings related to X-ray and CT diagnosis were clarified, and the diagnostic coincidence rate was analyzed. At the same time, PKP treatment was applied for clinical efficacy and Imaging analysis. And, follow-up was conducted for 2 months after operation. The results showed that compared with the X-ray diagnosis, the accuracy of CT diagnosis was 88.89% (32/38), and the difference between the groups was significant ( P < 0.05 ). 35 cases of low back pain disappeared after operation, and 3 cases of pain were significantly reduced without bone cement leakage. Postoperative imaging examination showed no space occupied in the spinal canal, and kyphosis deformity was significantly improved. The average height of the anterior vertebral column after injury was significantly increased ( P < 0.05 ). The Cobb angle returned to normal level, which was statistically significant compared with that before the operation ( P < 0.05 ). In conclusion, in the diagnosis of elderly patients with osteoporotic lumbar compression fractures, the coincidence rate of CT diagnosis is better than that of X-ray diagnosis. Therefore, the application rate of CT diagnostic methods in diagnosis is higher, which provides an effective basis for clinical diagnosis and treatment. PKP surgery is less invasive, safe, and has good clinical efficacy. It can quickly relieve pain and effectively restore the height of injured vertebrae. It is an ideal treatment method for elderly osteoporotic thoracolumbar vertebral compression fractures.

Low-Rank Matrix Denoising Algorithm-Based Magnetic Resonance Imaging Combined with Computed Tomography Images in the Diagnosis of Cerebral Aneurysm

This study was to analyze the diagnostic effects of computed tomography (CT) and magnetic resonance imaging (MRI) in patients with cerebrovascular diseases (CVDs) based on low-rank matrix denoising (LRMD) algorithm. The LRMD algorithm was adopted for MRI diagnosis and CT diagnosis for comparative analysis. 129 CVD patients were selected as the research objects, 43 cases were diagnosed by CT, 43 cases were diagnosed by MRI under LRMD, and the other 43 cases were diagnosed by CT + MRI. The results showed that the diagnostic compliance rates (DCRs) of CT group in the cerebral hemorrhage (CH), cerebral infarction (CI), and cerebral aneurysm (CA) were 95.1%, 94.7%, and 70%, respectively, while those in the MRI group were 99.01%, 97.71%, and 100%, respectively. Thus, it was obtained that MRI diagnosis was much better than CT diagnosis, and CT + MRI showed the best diagnosis efficacy, showing statistical differences ( P < 0.05 ). The accuracy, sensitivity, and specificity of MRI diagnosis under the LRMD algorithm were 96.28%, 88.76%, and 90.62%, respectively, which were superior to those of CT diagnosis (92.71%, 84.94%, and 80.71%, respectively). The diagnosis cost per case (DC/C) (799.73 ± 100.02 yuan) and the total diagnosis cost (TDC) (58,521.67 ± 301.62 yuan) in the MRI group were higher than those in the CT group (601.42 ± 83.61 yuan and 39,819.2 ± 198.72, respectively) ( P < 0.05 ). In conclusion, CT + MRI under the LRMD algorithm showed good potential in diagnosis of CVD; MRI based on the LRMD algorithm showed a higher positive rate in the diagnosis of CA and was better than CT diagnosis, and CT + MRI showed the best diagnosis effect and could improve the clinical diagnosis rate.

Computed Tomography Analysis Based on Imaging Manifestations of Pulmonary Lymphoma

Objective: The imaging manifestations of lung lymphoma are complex and diverse. This paper discusses the pathological features of lung lymphoma and improves the clinical and radiologist’s understanding of the disease. Methods: Retrospective analysis of chest computed tomography (CT) image data of 58 patients with pulmonary lymphoma confirmed by clinical and histopathology. Results: CT diagnosis of 35 cases of pulmonary lymphoma, including 13 cases of mass nodular type, 15 cases of pneumonia consolidation type, 7 cases of mixed type, and the diagnostic accuracy rate was 60.34%. Airborne bronchial signs, normal vascular crossing signs, coexisting signs of multiple types of lesions, cross-lobe distribution signs, and ground glass signs are typical CT signs of pulmonary lymphoma. The average value of CT vital signs changes of the five types of lung lymphomas is 18%. The scan completion rate is 81%. The number of patients with five types of lung lymphoma were 17 cases of age <35 years old, and 18 cases for age >35 years old, with a balanced age distribution. Conclusions: CT examination is helpful for the diagnosis and differential diagnosis of pulmonary lymphoma.

Underutilization of prophylactic rectal indomethacin and pancreatic duct stent for prevention of post-ERCP Pancreatitis

Background and study aims Incidence of Post-ERCP pancreatitis (PEP) ranges from 1 % to 10 % in unselected patients and as high as 25 % to 30 % in high-risk patients. Rectal indomethacin administered before or immediately after an ERCP and prophylactic pancreatic duct stent placement (PPS) are associated with a reduction in the incidence of PEP. We sought to investigate the utilization rate for prophylactic rectal indomethacin and PPS in average and high-risk patients undergoing ERCP between 2014 and 2019. Patients and methods We performed a retrospective analysis in the IBM Explorys database, a pooled, national de-identified clinical database of over 72 million unique patients from 26 health care networks and 300 hospitals across the United States from 2014 to 2019. Average and high-risk patients undergoing ERCP were identified using Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) diagnosis codes. PEP was defined by the presence of SNOMED CT diagnosis of acute pancreatitis and an inpatient admission within 5 days of an ERCP procedure. Results Out of 31,050 adults who had undergone ERCP from 2014 to 2019, only 10,500 individuals (33.8 %) had a PEP prophylaxis. Rectal indomethacin and PPS accounted for 82.4 % and 12.9 % respectively. Individuals with three risk factors had the highest PEP rates followed by individuals with two risk factors. Conclusions Only one-third of all patients undergoing ERCP received prophylaxis in the form of rectal indothemacin and/or PPS in this large population-based data. Increased implementation of prophylactic use is needed in patients undergoing ERCP as supported by current guidelines.