MDCT Imaging of Non-Traumatic Thoracic Aortic Emergencies and Its Impact on Diagnosis and Management—A Reappraisal

Non-traumatic thoracic aorta emergencies are associated with significant morbidity and mortality. Diseases of the intimomedial layers (aortic dissection and variants) have been grouped under the common term of acute aortic syndrome because they are life-threatening conditions clinically indistinguishable on presentation. Patients with aortic dissection may present with a wide variety of symptoms secondary to the pattern of dissection and end organ malperfusion. Other conditions may be seen in patients with acute symptoms, including ruptured and unstable thoracic aortic aneurysm, iatrogenic or infective pseudoaneurysms, aortic fistula, acute aortic thrombus/occlusive disease, and vasculitis. Imaging plays a pivotal role in the patient’s management and care. In the emergency room, chest X-ray is the initial imaging test offering a screening evaluation for alternative common differential diagnoses and a preliminary assessment of the mediastinal dimensions. State-of-the-art multidetector computed tomography angiography (CTA) provides a widely available, rapid, replicable, noninvasive diagnostic imaging with sensitivity approaching 100%. It is an impressive tool in decision-making process with a deep impact on treatment including endovascular or open surgical or conservative treatment. Radiologists must be familiar with the spectrum of these entities to help triage patients appropriately and efficiently. Understanding the imaging findings and proper measurement techniques allow the radiologist to suggest the most appropriate next management step.

PERITONEAL CARCINOMATOSIS SECONDARY TO OVARIAN CANCER: IMAGING FINDINGS

Summary: Peritoneal lesions are a relatively common site of metastases, particularly from tumors of the abdomen and pelvis, which generally carry a poor prognosis, often with a signicant impact on treatment. One of the tumors implicated in peritoneal metastasis is ovarian cancer. Ovarian cancer is the fth most commonly diagnosed cancer among women worldwide and the second most common gynecologic malignancy. Despite clinical screening, ovarian cancer in more than 60% of those affected is diagnosed at an advanced stage with a reported 5-year survival rate of 37% (stage III disease) or 25% (stage III disease). IV). Therefore, ovarian cancer is one of the deadliest cancers affecting women. Ovarian tumors are classied according to the origin of the tumor into epithelial tumors (serous and mucinous tumors, endometrioid and clear cell carcinomas, Brenner's tumor), germ cell tumors (mature and immature teratomas, dysgerminoma, endodermal sinus tumor, carcinoma embryonic), sex cord - stromal tumors (brothecoma; granulosa cell, sclerosing stroma and Sertoli-Leydig cell tumors) and metastatic tumors. Metastases to the ovary are relatively common with a documented incidence of 5% to 30% of all malignant ovarian masses. Ovarian cancer metastases differ from other tumors: they are primarily peritoneal rather than parenchymal in location. These implants are usually isodense in tomography, in relation to the viscera, which makes their detection difcult. For this, a multidisciplinary approach is used, such as physical examination, tumor marker levels and diagnostic images. Such as CT, magnetic resonance imaging (MRI) and positron emission tomography (PET). Objective: Describes ovarian metastasis in a patient with no signicant history, emphasizing peritoneal lesions, through a clinical case. Design: Prospective, observational in a single center. Methodology: This is a systematic review of ovarian metastasis, detailing its clinical characteristics and short-term complications. The information and images obtained belong to the medical personnel in charge of the case, whose reinforcements are provided by the Excel, Word and JPG statistical package.

Comparison of Clinical Outcomes of Different Connection Modes of Extracorporeal Membrane Oxygenation Combine with Continuous Renal Replacement Therapy

Objective: To evaluate the effect of different connection modes of ECMO and CRRT on patients with acute kidney injury (AKI). Methods: Twenty-one patients received ECMO with AKI. These patients were admitted to our center from December 2018 to February 2021, selected, and treated with both ECMO and CRRT. They were divided into A connection mode (pre-membrane–pre-pump connection) and B connection mode (post-membrane–post-pump connection). We compared clinical indicators and outcomes between two connection modes. Results: There were eight cases (38.91%) in A connection mode and 13 cases (61.09%) in B connection mode, with median durations of ECMO assistance of 5 days and 7 days, respectively. Median flow rates of ECMO of 3.0 L/min and 2.5 L/min, respectively; CRRT flow rates of 200 mL/min and 180 mL/min, respectively. CRRT filter lifetime was over 48h in both connection modes. Except for NT-pro BNP, no significant differences in clinical indicators were observed between the two groups before or after the treatment (P > .05). Conclusion: Both connection modes could achieve the therapeutic purpose and need no higher level of anticoagulation for patients simultaneously treated with ECMO and CRRT. Two modes had no impact on treatment effect and clinical indicators in patients. It had no effect on length of ICU stay and prognostic.

Juvenile Idiopathic Arthritis and COVID-19 Pandemic: Good Compliance With Treatment, Reluctance to Return to School

Objective: The SARS-CoV-2 pandemic has induced an exceptional sanitary crisis, potentially having an impact on treatment continuation, for juvenile idiopathic arthritis (JIA) patients receiving immunosuppressive therapies. After national lockdowns, many patients were also concerned about their safety at school. We evaluated the impact of the pandemic on the optimal continuation of treatment and on the return to school in JIA patients.Methods: JIA patients under 18 years of age, usually treated with disease-modifying anti-rheumatic drugs (DMARDs) were prospectively included during their outpatient visit and completed a standardized questionnaire. The primary outcome was DMARD treatment modification in relation to the context of the pandemic but we also evaluated the pandemic's impact on the schooling.Results: One hundred and seventy three patients from 8 different expert centers were included between May and August 2020. Their mean age was 11.6 years (± 4.1 years), and most of them 31.2% (54/173) had a rheumatoid factor-negative polyarticular JIA. Fifty percent (86/172) were treated with methotrexate, and 72.5% (124/171) were treated with bDMARDs. DMARD treatment modification in relation to the pandemic was observed in 4.0% (7/173) of participants. 49.1% (81/165) of the patients did not return to school due to a personal/parental decision in 69.9% (55/81) of cases. Two patients were diagnosed positive for SARS-CoV-2 infection.Conclusion: This study suggests that JIA patients treated with DMARDs continued their treatment during the pandemic and were rarely affected by symptomatic COVID-19. In contrast, parents' reluctance was a major obstacle for returning to school. Therefore, more solidified school reopening strategies should be developed.

NIMG-10. OPTIMIZING IMAGE QUALITY FOR MAGNETIC RESONANCE SIMULATION IN SPINE STEREOTACTIC BODY RADIATION THERAPY

BACKGROUND Currently, the standard MRI sequence for SC imaging in SBRT has been axial 2D T2-weighted Turbo Spin Echo (TSE). Even though 3D T2-weighted sequences such as SPACE (Sampling Perfection with Application optimized Contrasts using different flip angle Evolution) image a whole volume simultaneously and thus offer better reconstruction, they have not been clinically implemented due to their long acquisition times. However, the application of Compressed Sensing (CS) methods on SPACE sequences, achieving clinically acceptable time. METHODS A 3D T2 CS SPACE was obtained and evaluated against the standard 2D TSE for spine SBRT based on a MagPhan RT quality assurance phantom and patients data, analysis was done using the phantom manufacturer software ImageOwl that calculates image distortions by comparing the known position of phantom features to their detected position in the image. RESULTS Results of phantom comparison between 3D T2 and 2D T2 indicate that although the 3D sequence had lower signal-to-noise ratio (SNR) than the 2D sequence, it presented less geometric distortions caused by gradient non-linearities, particularly in the anterior-posterior (A/P) and head-feet (H/F) directions. Distortions caused by chemical shift are in theory smaller for the 3D T2 CS SPACE, amounting to 0.85mm compared to 1.62mm with 2D T2. Between 2D versus 3D MRI defined SC data among 4 patients, average deviation of the centroid point cord contours was 0.08cm. The volume of the cord showed 1cc larger 3D volumes compared to 2D T2. Finally, the mean voxel count overlap coefficient and DICE coefficient was 0.92 and 0.87 respectively. CONCLUSIONS Since 3D MRI is under consideration to replace 2D MRI, it is important to compare SC contours from 3D to 2D MRI and assess their impact on treatment plans. Positive results would pave the path for larger subject cohort evaluation.