Dark crescent sign: high-risk calcified coronary plaque detected by electrocardiogram-gated non-contrast computed tomography

Electrocardiogram-gated non-contrast computed tomography can discriminate a dark crescent-shaped calcified plaque characterised as a low-intensity area surrounded by high-intensity signals. Careful attention should be paid to performing a percutaneous coronary intervention for a plaque with the dark crescent sign because of its potential high risk of no-flow phenomenon.

The crescent sign—a predictor of hip instability in magnetic resonance arthrography

ABSTRACT Currently, much is debated on the optimal treatment of borderline hips, being in the continuum between stable and unstable hips. The diagnosis of stability is often difficult but is a prerequisite for further treatment. Analysis includes a variety of radiographic parameters. We observed that unstable hips often had a crescent-like gadolinium collection in the postero-inferior joint space. We therefore questioned if the ‘crescent sign’ could be an indicator for hip instability? A retrospective comparative study was conducted including 56 hips in the instability group (treated with PAO) and 70 hips with femoroacetabular impingement (FAI) as control group. Based on standard radiographic parameters and magnetic resonance imaging (MRI), the association between hip instability and the ‘crescent sign’ was analyzed. For univariate group comparisons, the non-parametric Wilcoxon two sample test was used. Association between discrete variables was examined by means of chi-square tests. To examine predictive variables, logistic regression models were carried out. Most hips with a crescent sign belong to the instability group. A crescent sign has a sensitivity of 73.3% and specificity of 93% for instability. Based on our results, the crescent sign is a factor that is more prevalent in unstable hips. However, its absence does not exclude instability of the hip. If present, the specificity speaks strongly in favor for instability of the hip.

Comparison of ovarian crescent sign and risk of malignancy index for prediction of ovarian malignancy in adnexal masses

Background: Objective of the study was to evaluate ovarian crescent sign (OCS) as a sonographic parameter for prediction of ovarian cancer in adnexal masses suspicious of ovarian malignancy and to compare it with risk of malignancy index (RMI).Methods: Presence of OCS and calculation of RMI was done for 50 cases of adnexal masses scheduled to undergo surgery taking histopathology as gold standard.Results: 18% (9/50) of adnexal masses were malignant. OCS was absent in all malignant lesions, giving a sensitivity and negative predictive value of 100%. OCS was present in 33/41 of benign masses (specificity 80.4%). Relation of OCS to mass size<10 cm and menopausal status was significant (p<0.001). RMI≥200 could not diagnose malignancy in 4/9 cases (sensitivity 55.5%). RMI had specificity and negative predictive value of 95.1% and 90.7% respectively. Combining OCS and RMI had a lower specificity. Sequential application using OCS as first node and RMI as second node failed to diagnose 44.4% (4/9) cases as malignant.Conclusions: OCS is cheaper, easy to perform and appears to be a better test than RMI to differentiate between benign and early-stage malignant ovarian tumors. It can be used for triaging patient for referral.

1149. Baseline Chest CT Findings in Patients with Pulmonary Mold Infections: A Post-Hoc Analysis from the Phase 3 SECURE Study that Compared Isavuconazole to Voriconazole for the Primary Treatment of Invasive Mold Disease

Background SECURE was a global, double-blind, Phase 3 study that randomized 527 patients 1:1 to isavuconazole (ISAV) or voriconazole (VORI) for the primary treatment of invasive mold disease (IMD) caused by Aspergillus or other filamentous fungi. Patients were classified as having proven/probable IMD (PP-IMD) or possible IMD (PS-IMD) according to EORTC/MSG 2008 criteria, and the majority (n=412) had pulmonary disease only. This post-hoc analysis describes baseline CT findings in these patients and explores the association between these findings and treatment outcomes. Methods A blinded, independent review committee assessed the certainty of diagnosis (PP-IMD vs PS-IMD), location of disease (pulmonary only, pulmonary plus other organ, non-pulmonary only), and both overall and clinical responses at end-of-treatment. Radiology assessments were done by central blinded radiologists who characterized pulmonary lesions as follows: well-defined nodule(s) with or without halo sign, wedge-shaped infiltrate, cavity, air crescent sign, or non-specific focal infiltrate. Results Of the 412 patients with pulmonary disease only, 223 (54%) had PP-IMD and 189 (46%) had PS-IMD. Well-defined nodule(s) was the predominant radiological finding at baseline in patients with PP-IMD or PS-IMD (PP-IMD 55%, PS-IMD 63%), followed by non-specific focal infiltrate (PP-IMD 43%, PS-IMD 41%), wedge-shaped infiltrate (PP-IMD 24%, PS-IMD 30%), and halo (PP-IMD 25%, PS-IMD 28%). A small proportion of patients had a cavity (PP-IMD 12%, PS-IMD 9%) or air crescent sign (PP-IMD 2%, PS-IMD 4%). Patients with air crescent sign had low all-cause mortality through Days 42 and 84, and high overall and clinical response rates at end-of treatment (PP-IMD: 0, 0, 75%, 100% and PS-IMD: 0, 13%, 75%, 88%, respectively). There was no other clear association between baseline CT findings and either outcomes of all-cause mortality or overall and clinical responses. Figure. Chest CT findings at baseline in patients with PP-IMD or PS-IMD (pulmonary only) Conclusion In patients with pulmonary IMD, the predominant radiological finding at baseline was well-defined nodule(s) in both PP-IMD and PS-IMD. Air crescent sign was infrequent, but was associated with lower all-cause mortality and higher overall and clinical responses. Otherwise, baseline CT findings did not appear to predict treatment outcomes in this Phase 3 study. Disclosures Kamal Hamed, n/a, Basilea Pharmaceutica International Ltd. (Employee) Marc Engelhardt, n/a, Basilea Pharmaceutica International Ltd. (Board Member, Consultant, Employee, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Shareholder, Speaker’s Bureau, Independent Contractor, Other Financial or Material Support)Basilea Pharmaceutica International Ltd. (Employee) Mikael Saulay, n/a, Basilea Pharmaceutica International Ltd. (Employee) Laura Kovanda, n/a, Astellas Pharma Inc (Employee)