Acute Presentation of Large Size Clear Cell Ovarian Carcinoma as Double Torsed Ovarian Tumor

We report a 46-year-old patient who presented to the emergency department with complaints of acute abdominal pain, nausea, and vomiting. An abdominal CT scan revealed a large (207 × 155 × 182 mm) thin-walled inhomogeneous tumor connected to the uterus and right ovary. Emergency surgery laparotomy was performed. Inside the abdominal cavity, a 30 × 30 cm heterogenous, dark blue tumor in the right adnexa area, torsed two times, weighing 3700 g was found. Histological examination revealed right ovary clear cell carcinoma. We emphasize the rare nature of the histology and presentation of this case report. Ovarian clear cell carcinomas are relatively rare malignancies, presenting in 5 to 10% of ovarian malignant tumors in the west.

Radiomics and stacking regression model for measuring bone mineral density using abdominal computed tomography

Background Measurement of bone mineral density (BMD) is the most important method to diagnose osteoporosis. However, current BMD measurement is always performed after a fracture has occurred. Purpose To explore whether a radiomic model based on abdominal computed tomography (CT) can predict the BMD of lumbar vertebrae. Material and Methods A total of 245 patients who underwent both dual-energy X-ray absorptiometry (DXA) and abdominal CT examination (training cohort, n = 196; validation cohort, n = 49) were included in our retrospective study. In total, 1218 image features were extracted from abdominal CT images for each patient. Combined with clinical information, three steps including least absolute shrinkage and selection operator (LASSO) regression were used to select key features. A two-tier stacking regression model with multi-algorithm fusion was used for BMD prediction, which can integrate the advantages of linear model and non-linear model. The prediction results of this model were compared with those using a single regressor. The degree-of-freedom adjusted coefficient of determination (Adjusted-R2), root mean square error (RMSE), and mean absolute error (MAE) were used to evaluate the regression performance. Results Compared with other regression methods, the two-tier stacking regression model has a higher regression performance, with Adjusted-R2, RMSE, and MAE of 0.830, 0.077, and 0.06, respectively. Pearson correlation analysis and Bland–Altman analysis showed that the BMD predicted by the model had a high correlation with the DXA results (r = 0.932, difference = −0.01 ± 0.1412 mg/cm2). Conclusion Using radiomics, the BMD of lumbar vertebrae could be predicted from abdominal CT images.

Assessment of the Awareness of Radiology Residents About Ionizing Radiations and Their Risks of Educational Hospitals, Kermanshah, Iran

Background: Although many radiological examinations are requested daily to aid clinical diagnosis by the referring physician, it should be kept in mind that ionizing radiation has adverse biological effects on the life of living organisms, which may vary in individuals depending on the dose and duration of exposure. Therefore, radiologists and their assistants should have comprehensive information about ionizing radiation. Methods: In this descriptive cross-sectional study, all the radiology residents (41) were included in the study. The questionnaire consisted of two parts, the first part including of demographic information and part 2 includes 21 questions about the effective dose created by a chest X-ray, the approximate effective dose from various imaging examines, as well as the awareness of the risks of brain, abdominal CT scans. Results: The results showed that out of 41 residents, 56.1% were male. Based on these results, 19.5% were aware of the approximate effective dose received by a patient on PA chest X-ray. Also, knowledge of some X-ray absorptiometry parameters based on chest X-ray in PA position are: 12.2% abdominal CT scan, 17.1% and 2.4% brain and chest CT scan respectively. In this study the radiology resident’s awareness about dangers of ionizing radiation and the likelihood of cancer were evaluated in 31% and 48.8% of brain and abdominal CT scan, respectively. Conclusions: According to the findings, awareness of radiology residents in Kermanshah university of medical sciences is at an inappropriate level. Therefore, training is needed to raise the awareness of radiology residents by conducting several workshops.

A case of Vaccine-Induced Thrombotic Thrombocytopenia (VITT) with thrombosis of the superior mesenteric artery after ChAdOx1 nCov-19 COVID-19 Vaccine

We describe the case of a 64 years-old woman admitted to the Emergency Department of the ASST-Spedali Civili of Brescia with fever and gastrointestinal symptoms 10 days after the first dose of ChAdOx1 nCov-19 vaccine. Laboratory investigations showed severe thrombocytopenia and high D-dimer, while an abdominal CT scan reported a partially occluding thrombosis of the superior mesenteric artery. Following treatment with fondaparinux, immunoglobulins and high dosage steroid therapy, we observed a rapid improvement of patient’s conditions. An ELISA assay showed the presence of antibodies against heparin PF4-complex. Subsequent abdominal CT-scan showed the superior mesenteric artery thrombosis resolution, and the patient was finally discharged after 12 days of hospitalization. Several reports pointed to the venous system as the main district affected by Vaccine-Induced Thrombotic Thrombocytopenia (VITT), while a peculiar feature of this report is the involvement of the mesenteric arterial system. Further investigation of VITT’s pathophysiological mechanisms is mandatory to develop preventive strategies and effective treatments.

The effect of deep learning reconstruction on abdominal CT densitometry and image quality: a systematic review and meta-analysis

Objective To determine the difference in CT values and image quality of abdominal CT images reconstructed by filtered back-projection (FBP), hybrid iterative reconstruction (IR), and deep learning reconstruction (DLR). Methods PubMed and Embase were systematically searched for articles regarding CT densitometry in the abdomen and the image reconstruction techniques FBP, hybrid IR, and DLR. Mean differences in CT values between reconstruction techniques were analyzed. A comparison between signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of FBP, hybrid IR, and DLR was made. A comparison of diagnostic confidence between hybrid IR and DLR was made. Results Sixteen articles were included, six being suitable for meta-analysis. In the liver, the mean difference between hybrid IR and DLR was − 0.633 HU (p = 0.483, SD ± 0.902 HU). In the spleen, the mean difference between hybrid IR and DLR was − 0.099 HU (p = 0.925, SD ± 1.061 HU). In the pancreas, the mean difference between hybrid IR and DLR was − 1.372 HU (p = 0.353, SD ± 1.476 HU). In 14 articles, CNR was described. In all cases, DLR showed a significantly higher CNR. In 9 articles, SNR was described. In all cases but one, DLR showed a significantly higher SNR. In all cases, DLR showed a significantly higher diagnostic confidence. Conclusions There were no significant differences in CT values reconstructed by FBP, hybrid IR, and DLR in abdominal organs. This shows that these reconstruction techniques are consistent in reconstructing CT values. DLR images showed a significantly higher SNR and CNR, compared to FBP and hybrid IR. Key Points CT values of abdominal CT images are similar between deep learning reconstruction (DLR), filtered back-projection (FBP), and hybrid iterative reconstruction (IR). DLR results in improved image quality in terms of SNR and CNR compared to FBP and hybrid IR images. DLR can thus be safely implemented in the clinical setting resulting in improved image quality without affecting CT values.

Screening Patterns in Abusive Abdominal Trauma

Background: Diagnosis of abusive abdominal trauma (AAT) is often clinically occult. Abdominal CT is the preferred method to diagnose abdominal injuries. However, due to risk of ionizing radiation, and cost, it is performed only in selected children. Recently, elevated liver enzymes were used to screen for occult AAT, but its accuracy is unknown due to inconsistent methodology and results. Objective: To determine the accuracy of elevated liver enzymes (transaminases) in the diagnosis of AAT and if pancreatic enzymes and clinical findings help in patients’ selection for abdominal CT. Methods: A retrospective (2011-2020) study on children younger than 3 years suspected of child abuse. The study group included children that had abdominal CT for suspected AAT, while the control group included similar number of children randomized from 5208 children evaluated for child abuse without an abdominal CT. Patients who had an incomplete medical record, were evaluated for cardiac arrest, or had a CT without contrast were excluded. Results: AAT is rare 0.6% (30/5434) in children suspected of child abuse. Transaminases were obtained in 99.1% of the AAT patients and 55.3% of the control cases. 93.1% (27/29) patients with abdominal injuries had elevated transaminases. The specificity and sensitivity for the transaminases in detecting positive abdominal CT was 93.3% and 90.0%, respectively. Only one additional case was identified with elevated pancreatic enzymes and negative transaminases. There was no clinical or imaging findings that could differentiate between patients with negative and positive abdominal CT scans. Based only on elevated transaminases, 11 CT scans need to be performed for a single positive study. Conclusion/Potential Impact: Transaminases have high sensitivity in predicting AAT. Universal use of transaminases in all children suspected of child abuse may result in 11 CT scans for one positive study. Therefore, more clinical judgement is necessary in selecting patients for CT.

Improving the Diagnosis of Abusive Abdominal Trauma

Background/Objective: Abusive abdominal trauma (AAT) in children when missed can be fatal. In addition, differentiating from accidental trauma is essential in evaluating for other injuries and protecting from continued inflicted injuries. Abdominal CT remains the gold standard study to evaluate for abdominal injuries. Our purpose is to identify findings in presentation, clinical evaluation, the abdominal CT, and other imaging that can improve the diagnosis of abusive abdominal trauma. Methods: A retrospective (2011-2020) study compared children younger than 3 years that had abdominal CT scans for abusive trauma to those with accidental blunt abdominal trauma. Demographic information, clinical presentation, physical exam findings, final diagnoses, lab values, and imaging studies were collected. Descriptive analysis and Fisher’s exact test were used to determine significance of findings. Results: 226 (125 male, average age 11 months) patients had AAT and 90 (48 male, average age 18 months) patients had accidental trauma. 30 patients in the abusive group and 19 patients in the accidental group had positive CT. Most (70%) children with AAT and positive CT had no explanation for the trauma. Fall injury was reported in 27% of abusive (88.9% younger than 1 years) and 32% (83.3% older than 1 year) of accidental trauma. Retinal hemorrhage, abdominal bruising, subdural hematoma, and rib fractures were significantly (p<0.05) more common in the abusive group. In addition, 13 (43%) of patients with AAT and positive CT had rib fractures while none were detected on CT in the accidental group. Conclusions: In children younger than 3 years with abdominal trauma that present with a history of a fall or unknown injury, abusive abdominal trauma should be suspected. These children should subsequently be evaluated for other injuries. Children should be evaluated for nonaccidental trauma if rib fractures are visualized on abdominal CT, as these were only seen in AAT.