Refractory Orbital Myositis in Systemic Lupus Erythematosus - A Role for Rituximab

Orbital myositis in systemic lupus erythematosus (SLE) is a rare entity with risk of serious complications. Timely treatment with effective immunosuppressors is desirable. We report a case of a 32-year-old female patient with SLE who presented with an acute ocular pain and extraorbital muscle thickening, consistent with orbital myositis. Association with SLE was made after exclusion of other aetiologies. Due to refractoriness to steroids, off-label rituximab was initiated with clinical and imaging parameter improvement.

MRI-Based Normative Measurement of the Ocular Globe Position in Relation to Inter-Zygomatic Line among Nepalese Subjects

Introduction: Proptosis and enophthalmos are cardinal signs of many orbito-ocular and systemic diseases. The need for an imaging parameter that will aid its early detection is necessary, as visual compromise is a major consequence if they are not diagnosed and managed early. Methodology: This prospective study was performed in a tertiary center. Data were collected over the period of January to April 2021 with total of 300 normal ocular globes. The measurement was done at the level of lens (midglobe section) on T2-weighted axial image. Results: The distance between the anterior margin and inter zygomatic line of the right ocular globe was 16.95 ± 1.48 mm (ranged 14.2 - 20.5 mm) and that of left was 16.86 ± 1.38 mm (ranged 14.2 - 20.3 mm). The position of the globes showed no statistically significant differences among gender groups in our study and the position of the right globe within the orbit was significantly different from that of the left orbit. Conclusion: The position of the globes showed higher values in males than in female. However, a statistically significant difference in globe position was observed between right and left orbits. The distance between the posterior margin of the globe and the inter zygomatic line was found to be lower among the Nepalese population compared with other population.

Construction of Vertebral Body Tracking Algorithm Based on Dynamic Imaging Parameter Measurement and Its Application in the Treatment of Lumbar Instability

Static imaging measurements could not truly reflect the dynamic panorama of the lumbar movement process, and the abnormal activities between the lumbar vertebrae and their dynamic balance could not be observed, resulting in difficulties in the mechanism analysis of lumbar instability and the efficacy evaluation of manipulation therapy. Therefore, this paper constructed a vertebral tracking algorithm based on dynamic imaging parameter measurement through imaging parameter measurement and calculation. According to the imaging data obtained by vertebral body tracking algorithm, the corresponding statistical methods were used to compare the functional scores before and after manipulation and the changes of imaging data, so as to evaluate the therapeutic effect of manipulation on lumbar instability. Through the clinical observation and imaging analysis of 15 patients with lumbar instability before and after manipulation treatment, it is verified that the vertebra tracking algorithm is effective in the vertebra tracking and plays a positive role in the treatment of lumbar instability.

Simple and Reliable Magnetic Resonance Imaging Parameter to Predict Postoperative Ambulatory Function in Patients With Metastatic Epidural Spinal Cord Compression

Study Design: Retrospective case-control study. Objectives: The aim of this study was to develop a simple and reliable imaging parameter to predict postoperative ambulatory status in patients with metastatic epidural spinal cord compression (MESCC). Methods: Sixty-three patients with MESCC underwent spine surgery because of neurologic deficits were included. On preoperative axial MRI, the cord compression ratio was analyzed for postoperative ambulatory status. The relationship between other imaging features, such as fracture of the affected vertebra and increased T2 signal intensity of the spinal cord at the compression level, and the postoperative ambulatory status were also analyzed. Results: Cord compression ratio and increased T2 signal change of the spinal cord were significantly different between the postoperative ambulatory group and the non-ambulatory group. Receiver operating characteristic analysis showed that the optimal cut-off value was 0.84. In the multivariate regression analysis, only a cord compression ratio of more than 0.84 was significantly associated with postoperative ambulatory status (odds ratio = 10.80; 95% confidence interval = 2.79-41.86; P = .001). Interobserver/intraobserver agreements were strong for the cord compression ratio, however those agreements were weak for increased T2 signal intensity. Conclusions: On preoperative MRI, the cord compression ratio may predict postoperative ambulatory status in patients with MESCC. The measurement of this imaging parameter was simple and reliable. This imaging predictor may be helpful for both clinicians and patients.

IC Decomposition and Imaging Metrics to Optimize Design File Recovery for Verification and Validation

This paper presents an in-depth review of the critical front end stages of the fabricated integrated circuit (IC) assurance workflow used for recovering the design stack-up of a fabricated IC. In this work, a Serial Peripheral Interface (SPI) embedded on a 130 nm static random access memory (SRAM) chip is targeted for recovering the full design stack-up. This process leverages state-of-the-art techniques for high precision material processing and image acquisition to optimize and ensure the highest accuracy in the feature extraction stage. To this end, we present metrics that can be leveraged for optimizing the front end stages of the assurance workflow. Novel imaging figures of merit (FOM) for optimizing image acquisition parameters have been developed and are presented. The Image Quality Factor (IQF) FOM was established to quantify overall image quality as it pertains to feature extraction and the Quality and Efficiency Rating (QER) FOM was demonstrated to optimize imaging parameter selection, balancing image quality and image acquisition time.

Introduction of CTA-index as Simplified Measuring Method for Thrombus Perviousness

Purpose Thrombus features on admission CT are useful imaging markers for clot characterization, stroke pathogenesis and outcome prediction. In this context, thrombus perviousness is a promising parameter, but reliable assessment in daily clinical practice is demanding. The aim of the present study was to evaluate an easy to assess measuring method for thrombus permeability at the time of admission. Methods The CTA-index, which measures relative thrombus attenuation on admission CTA, was compared to the known perviousness parameter in a cohort of 101 patients with large-vessel occlusions of the middle cerebral artery and correlated to clinical outcome parameters (mRS after 90 days, ≤2 rated as favorable). For validation, this correlation was tested in a second independent cohort (n = 87), and possible associations between the CTA-index and outcome measurements (NIHSS/mRS/mTICI) were assessed. Results In the first cohort a coherence between conventional perviousness measurements and the CTA-index was shown. The CTA-index differed significantly between favorable (−0.55 ± 0.16) and non-favorable outcomes (−0.64 ± 0.14, p = 0.01). In the validation cohort this result could be independently reproduced (−0.52 ± 0.13/−0.70 ± 0.09, p < 0.01). The CTA-index showed an association with low NIHSS at discharge (p < 0.01), favorable outcome after 90 days (p < 0.001) and with better reperfusion (measured by mTICI score, p = 0.04). Conclusion The CTA-index is an easy to assess imaging parameter on admission CTA in the acute stroke phase and is associated with angiographic and clinical outcome. It can be considered as a simplified measuring method for thrombus perviousness, which is known to provide useful information for further stroke progress and clinical course as well as therapeutic and rehabilitative decisions.

Correlation and Differences in Lumbopelvic Sagittal Alignment Parameters Between Lumbar Radiographs and Magnetic Resonance Images

Study Design: Imaging parameter study. Objective: Though lumbar alignment is better evaluated using standing radiograph than supine magnetic resonance imaging (MRI), few studies have researched this. Our study aimed to observe the correlation and difference in alignment between standing radiograph and supine MRI, and assess whether the change of position affects the lumbopelvic parameters. Methods: We analyzed 105 patients, measuring lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). Inter- and intraparameter analyses were performed to identify any difference between standing radiograph and supine MRI. Statistical differences between the lumbopelvic parameters were compared. Results: There was excellent interobserver agreement for each parameter (interclass correlation coefficient > 0.75), and significant differences were observed in each parameter between radiograph and MRI ( P < .05). Strong correlations were noted between the equivalent parameters in radiograph and MRI, both SS and PI were strongly correlated with LL in radiograph and MRI image, both PT and SS were strongly correlated with PI in radiograph and MRI image ( r = −1.0 to −0.5 or 0.5 to 1.0). Conclusion: Supine MRI obviously underestimated the measurements of lumbopelvic sagittal alignment parameters in standing radiograph. Therefore, standing lumbar radiographs should be obtained preoperatively in all surgical patients, not only supine MRI. In addition, we observed that PI was not a constant morphological parameter.