Unusual Presentation of Treated Colon Cancer with Extramural Venous Invasion: a Case Report

Introduction: Colon cancer is one of the leading malignancies globally and continues to be one of the most typical causes of cancer-related mortality. The clinical outcome of the disease depends on the primary tumor stage, regional nodal involvement, and distant disease dissemination. It often presents with hematogenous spread to the liver at the time of diagnosis. Another factor for increased mortality is the presence of extramural venous invasion (EMVI). This is exceedingly important as it has significant prognostic significance and helps predict survival. Case Description: A middle-aged female with a recent history of cesarean delivery presented with abdominal pain and occasional constipation, which led to a series of investigations. Initial Computed Tomography (CT) scan showed proximal to mid transverse colonic tumoral thickening with locoregional lymphadenopathy and solitary distant metastasis in the left hepatic lobe. This was followed by extended right hemicolectomy and hepatic metastasectomy. The patient remained on follow-up and later presented with thrombus formation in the splenoportal circulation. Initially, this was considered a bland thrombus, and the patient was advised a close follow-up. However, the patient was lost to follow and later presented with extensive thrombosis of the portal and splenic veins. Practical Implications: Confident differentiation of the bland versus malignant thrombosis is crucial to ascertain disease stage and appropriate management. Invasive tissue sampling gives a confident diagnosis of benign versus malignant thrombus. However, using a noninvasive imaging modality, we can still distinguish between the two with reasonable certainty.

Segmentation boosting with compensation methods in optical coherence tomography angiography images

Optical coherence tomography angiography is a noninvasive imaging modality to establish the diagnosis of retinal vascular diseases. However, angiography images are significantly interfered if patients jitter or blink. In this study, a novel retinal image analysis method to accurately detect blood vessels and compensate the effect of interference was proposed. We call this the patch U-Net compensation (PUC) system, which is based on the famous U-Net. Several techniques, including a better training mechanism, direction criteria, area criteria, gap criteria, and probability map criteria, have been proposed to improve its accuracy. Simulations show that the proposed PUC achieves much better performance than state-of-art methods.

Utility of CT venography in monitoring stent patency in idiopathic intracranial hypertension: retrospective single-center study

BackgroundCerebral venous sinus stenting is an established treatment for patients with idiopathic intracranial hypertension (IIH), refractory to medical management and with stenotic venous sinus on conventional cerebral venography. Currently, there are no clear guidelines on optimal noninvasive imaging modality for routine post-stenting follow-up. We investigated diagnostic yield of CT venography (CTV) for evaluation of stent patency.MethodsWe reviewed our clinical database of patients with a diagnosis of IIH, who underwent stenting of stenotic transverse or transverse/sigmoid sinus junction. Patients who had follow-up CTVs after more than 30 days were included in the final study group. All CTVs were reviewed by two readers for in-stent thrombosis, extrinsic stent compression, juxta-stent stenosis, and new contralateral venous sinus stenosis. Inter-observer agreement and association of stent patency with clinical outcomes (headache and papilledema) were assessed.ResultsIn all 36 included patients with 38 cerebral venograms for stenting, follow-up CTVs demonstrated adequate opacifications of the venous sinuses and stents for confident evaluation for in-stent thrombosis, extrinsic stent compression, juxta-stent stenosis, and new contralateral venous sinus stenosis, with inter-observer agreement coefficient of 0.7, 1.0, 0.8, and 1.0 respectively. Association between abnormal CTV and higher rates of persistent headache and lower rates of headache improvement/resolution was statistically significant (P-value of 0.01).ConclusionCTV is a reliable noninvasive imaging modality for evaluation of cerebral venous sinuses and stent patency following treatment of idiopathic intracranial hypertension with venous sinus stenting and could be used as a routine follow-up study.

A new method for accurate in vivo mapping of human brain connections using microstructural and anatomical information

Diffusion magnetic resonance imaging is a noninvasive imaging modality that has been extensively used in the literature to study the neuronal architecture of the brain in a wide range of neurological conditions using tractography. However, recent studies highlighted that the anatomical accuracy of the reconstructions is inherently limited and challenged its appropriateness. Several solutions have been proposed to tackle this issue, but none of them proved effective to overcome this fundamental limitation. In this work, we present a novel processing framework to inject into the reconstruction problem basic prior knowledge about brain anatomy and its organization and evaluate its effectiveness using both simulated and real human brain data. Our results indicate that our proposed method dramatically increases the accuracy of the estimated brain networks and, thus, represents a major step forward for the study of connectivity.

Medical infrared thermal imaging of canine appendicular bone neoplasia

Background Medical infrared thermal imaging (MITI) is a noninvasive imaging modality used in veterinary medicine as a screening tool for musculoskeletal and neurological disease processes. An infrared camera measures the surface body heat and produces a color map that represents the heat distribution. Local trauma or disease can impair the autonomic nervous system, which leads to changes in the local dermal microcirculation and subsequent alteration of surface body heat. Disruption of autonomic flow to the cutaneous vasculature at deeper levels can also result in asymmetric thermographic results. The purpose of this study was to evaluate surface temperature differences between limbs affected by bone neoplasia and their normal contralateral limbs. Results A statistically significant difference in average temperature was noted between regions of interest of the two groups (paired difference: 0.53 C° ± 0.14; P = 0.0005). In addition, pattern recognition analysis yielded a 75–100% success rate in lesion identification. Conclusions Significant alterations noted with average temperature and thermographic patterns indicate that MITI can document discernible changes associated with the presence of canine appendicular bone tumors. While MITI cannot be used as the sole diagnostic tool for bone cancer, it can be used as a screening modality and may be applicable in early detection of cancer.

A Novel Finite Element Model to Assess the Effect of Solid Stress Inside Tumors on Elastographic Normal Strains and Fluid Pressure

Ultrasound elastography is a noninvasive imaging modality used to assess the mechanical behavior of tissues, including cancers. Analytical and finite element (FE) models are useful and effective tools to understand the mechanical behavior of cancers and predict elastographic parameters under different testing conditions. A number of analytical and FE models to describe the mechanical behavior of cancers in elastography have been reported in the literature. However, none of these models consider the presence of solid stress (SS) inside the cancer, a clinically significant mechanical parameter with an influential role in cancer initiation, progression, and metastasis. In this paper, we develop an FE model applicable to cancers, which include both SS and elevated interstitial fluid pressure (IFP). This model is then used to assess the effects of these mechanical parameters on the normal strains and the fluid pressure, estimated using ultrasound poroelastography. Our results indicate that SS creates space-dependent changes in the strains and fluid pressure inside the tumor. This is in contrast to the effects produced by IFP on the strains and fluid pressure, which are uniformly distributed across the cancer. The developed model can help elucidating the role of SS on elastographic parameters and images. It may also provide a means to indirectly obtain information about the SS from the observed changes in the experimental elastographic images.

Evaluation of Diagnostic Accuracy of Anal Fistula by 360° Endoanal Ultrasound

Introduction: 360° endoanal ultrasound (EAUS) has become an effective imaging tool to diagnose anal fistulas for last three decades. Objectives: To assess the diagnostic accuracy of 360° endoanal ultrasound imaging comparing pre and peroperative diagnosis in anal fistulas. Methods: Between Jauary 2015 and June 2018, 240 patients with clinical anal fistula underwent endoanal sonographic assessment using a 360° endoanal transducer (7–15 MHz The sonographic findings, including the fistulas and other inflammatory lesions, were correlated with surgical results. The types of fistulas on endoanal sonography based on classification of Park and the internal opening of the fistula, both pre and peroperative, were compared to those of other studies. Results: The 240 patients studied included 165 male and 75 female patients. Endoanal sonography was able to show and track hypoechoic lesions, their locations, and internal openings of the fistulas. Compared with surgical results, endoanal sonography had sensitivity of 94.6%, specificity of 100%, and accuracy of 94.1% for the diagnosis of perianal fistulas. Also, endoanal sonography had accuracy of 86.1% for determining fistula types based on the Parks classification and 92.8% for identifying internal openings of the fistulas. Conclusions: Endoanal ultrasound is an accurate and noninvasive imaging modality for evaluation of fistulas. It is a very useful tool for preoperative management and surgical planning by providing precise and detailed information on fistulas. J Shaheed Suhrawardy Med Coll, December 2018, Vol.10(2); 66-69

Thyroid nodules: ultrasonographic stratification of malignant risk by TIRADS

<p class="abstract"><strong>Background:</strong> Thyroid neoplasia is easily diagnosed with, noninvasive imaging modality like ultrasonography that is widely available. TIRADS scoring is a useful modality in establishing better stratification of cancer risk in thyroid nodules, particularly, papillary thyroid cancers (PTC) as well as papillary thyroid microcancers (PTMC).</p><p class="abstract"><strong>Methods:</strong> All patients who presented with thyroid swelling and underwent surgery in the department of ENT were included in this study. All patients were evaluated with ultrasonographic examination of the neck. The decision of surgery was based on TIRADS scoring, size of swelling, or patient preference. Ultrasound features of the nodules, number of malignant features and TIRADS scoring were compared with final histopathology of the tumors. </p><p class="abstract"><strong>Results:</strong> A total of 58 thyroid surgeries were performed from January 2014 to December 2017. On statistical analysis, we found that more the number of radiological features favouring malignancy more were the likelihood of finding malignant histopathology.</p><p class="abstract"><strong>Conclusions:</strong> Ultrasonographic features of malignancy along with TIRADS scoring are an extremely useful tool in diagnosing thyroid cancers and will help in standardising all sonographic reports.</p>

WCC 2017-A-112: CT Angiographic Assessment of Coronary Artery Bypass Graft

Introduction: CT Angiography (CTA) is a noninvasive imaging modality to evaluate the vascular system. In coronary artery bypass graft patients, this study is helpful to evaluate the status of graft.