The Effectiveness of Laser Treatment for Diabetic Retinopathy in Patients with Chronic Kidney Disease

Background: Panretinal photocoagulation (PRP) remains one of the effective methods of treatment in pre- and proliferative forms of retinopathy with high efficiency. The aim of this study was to investigate the efficacy of PRP depending on the somatic status, laboratory parameters, and the severity of chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) and a history of diabetic retinopathy (DR). Methods and Results: The study included 76 patients (50 women and 26 men) with T2D who underwent PRP for DR (152 eyes) using a VISULAS® 532s solid-state laser (ZEISS). The patients were divided into two groups depending on the severity of CKD. Group 1 (n=32, 64 eyes) included patients with CKD Stage 1, Group 2 (n=44, 88 eyes) included patients with CKD Stage 2. All patients underwent standard ophthalmological examination: visometry, tonometry, perimetry, biomicroscopy of the anterior segment of the eye and vitreous body, and fundus ophthalmoscopy. Thickness map of the retina was obtained using the RTVue-100 OCT (Optovue, Fremont, CA) EMM5 scan protocol and the Stratus OCT (Carl Zeiss Meditec, USA) radial scan protocol. Laboratory methods included a general blood test, PPG, FG, HbA1c, general urine analysis, and the assessment of blood levels of creatinine, ALT, and AST. PRP was carried out according to the standard method, gradually, in three stages; the interval between the stages of laser treatment was 1 month. After laser treatment, all patients, regardless of the treatment stage, were prescribed topical Broxinac® (Bromfenac ophthalmic solution 0.09%). The dynamics of corrected visual acuity (CVA) parameters and the retinal thickness of the macular region were assessed before PRP and 3 months after the complex treatment. Multivariate analysis revealed a linear and nonlinear effect of lipid spectrum indicators (TC and LDL) on the formation of CL (crystalline lens) pathology. After treatment, a significant increase in CVA was noted in both study groups. The effectiveness of PRP coagulation depended on the severity of the CKD stage in T2D patients with DR. Normalization of morphometric parameters of the macular region of the retina was noted in 93.8% of cases in Group 1 and in 86.4% of cases in Group 2. The decrease in the effectiveness of treatment was associated with the presence of macroangiopathy (CAD), concomitant diseases (CHF, AH and dyslipidemia), and CKD stage. Conclusion: Prolonged administration of the non-steroidal, anti-inflammatory drug Bromfenacum® for a month after each stage of PRP is effective.

Establishing scanning protocols for a CT lung cancer screening trial in the UK

Objectives: To develop a CT scanning protocol for lung cancer screening which achieved low radiation dose and a high level of objectively assessed image quality. Methods: An anthropomorphic chest phantom and a commercially available lung screening image quality phantom were scanned on a series of scan protocols from a previous UK lung screening pilot and on an alternative protocol. The chest phantom scans were used to assess the CT dose metrics on community-based mobile CT scanners and comparisons were made with published recommended doses. Scans of the image quality phantom were objectively assessed against the RSNA Quantitative Imaging Biomarkers Alliance (QIBA) recommendations. Protocol adjustments were made to ensure that the recommended dose and image quality levels were both achieved. Results: The alternative scan protocol yielded doses up to 72% lower than on the previously used protocols with a CTDIvol of 0.6mGy for the 55 kg equivalent phantom and 1.3mGy with an additional 6 cm of tissue equivalent material in place. Scans on the existing protocols failed on two of the QIBA image quality metrics (edge enhancement and 3D resolution aspect ratio). Following adjustments to the reconstruction parameters of the resulting image quality met all six QIBA recommendations. Radiologist review of phantom images with this scan protocol deemed them suitable for a lung screening trial. Conclusions: Scan protocols yielding low radiation doses and high levels of objectively assessed image quality which meet published criteria can be established through the use of specific anthropomorphic and image quality phantoms, and are deliverable in community-based lung cancer screening. Advances in knowledge: Development of a standard methodology for establishing CT lung screening scanning protocols Use of QIBA recommendations as objective image quality metrics Standardised lung phantoms are essential tools for setting up lung screening protocols

The Effectiveness of Local Conservative Therapy after Panretinal Laser Coagulation against the Background of Diabetic Neuropathy

Background: Panretinal photocoagulation (PRP) (also called scatter laser treatment) remains one of the effective methods of treatment, and it can help to prevent blindness and low vision in diabetic retinopathy (DR). The aim of this study was to investigate the efficacy of local prolonged conservative therapy after PRP and the effect of somatic polymorbidity on visual functions in patients with diabetic neuropathy (DN) at the stage of clinical manifestations based on monitoring the clinical, functional and morphometric parameters of the macular region of the retina. Methods and Results: The study included 78 patients with type 2 diabetes (T2D) who underwent PRP for DR using a VISULAS® 532s solid-state laser (ZEISS). The patients were divided into two groups depending on the presence or absence of DN. Group 1 (n=60, 120 eyes) included patients with DN (stage of clinical manifestations), Group 2 (n=18, 36 eyes) included patients without DN. All patients underwent standard ophthalmological examination: visometry, tonometry, perimetry, biomicroscopy of the anterior segment of the eye and vitreous body, and fundus ophthalmoscopy. Thickness map of the retina was obtained using the RTVue-100 OCT (Optovue, Fremont, CA) EMM5 scan protocol and the Stratus OCT (Carl Zeiss Meditec, USA) radial scan protocol. After laser treatment, all patients, regardless of the treatment stage, were prescribed topically Broxinac® ( Bromfenac ophthalmic solution 0.09%), 1 drop twice a day for a month. In the presence of macular edema, a carbonic anhydrase inhibitor (Dorzolamide 2% solution) was added to the Broxinac® solution (1 drop twice a day) for up to 1 month after each PRP stage. The dynamics of CVA parameters and the retinal thickness of the macular region were assessed before PRP and 3 months after the complex treatment. Based on the monitoring of the clinical, functional and morphometric parameters of the macular region of the retina after PRP in T2D patients, we found a local, prolonged, 3-month conservative therapy to be effective, using the instillation of Broxinac® supplemented with Dorzolamide 2% solution in the presence of macular edema. Conversely, there is a negative effect of somatic polymorbidity (stage 3 chronic kidney disease), aspartate aminotransferase >40U/L) on corrected visual acuity (CVA) and morphometric parameters of the macular region of the retina during PRP in T2D patients with DN at the stage of clinical manifestations.

Undetected Pancreatic Adenocarcinoma on CT: Frequency According to CT Scan Protocol

Purpose: CT is a main diagnostic modality for detecting pancreatic adenocarcinoma. This study aims to assess the frequency of missed pancreatic adenocarcinoma on CT scans according to different CT protocols.Methods: Consecutive pancreatic adenocarcinoma patients were retrospectively collected (12/2011-12/2015). Patients with abdominal CT scans performed up-to a year prior to cancer diagnosis were included. Two radiologists registered in consensus the presence and radiological signs of missed cancers. The frequency of missed cancers was compared between portal and pancreatic/triphasic CT protocols. Results: Overall, 180 CT scans of pancreatic adenocarcinoma patients were retrieved. 126/180 (70.0%) were pancreatic/triphasic protocols and 54/180 (30.0%) were portal protocols. The overall frequency of missed cancers was 6/180 (3.3%). The frequency of missed cancers was higher in portal CT protocols compared to pancreatic/triphasic protocols: 5/54 (9.3%) vs. 1/126 (0.8%), p=0.01. CT signs of missed cancers included: 3 cases of small hypodense lesions, 2 cases with peri-pancreatic fat stranding, 1 case of dilated pancreatic duct with a cut-off sign.Conclusion: The frequency of missed pancreatic adenocarcinoma is higher on portal CT protocols. Physicians should consider the cancer miss rate on different CT protocols.

The Detection, Outcome, and Presentation of Twin-Twin Transfusion Syndrome in Monochorionic Diamniotic Twin Pregnancies Followed with a Protocol of Fortnightly Ultrasound Examination

<b><i>Background:</i></b> Evidence to support a fortnightly scan protocol for monochorionic diamniotic (MCDA) pregnancies to detect twin-twin transfusion syndrome (TTTS) is scarce. Also, TTTS-related mortality in an unselected cohort is not well documented. Finally, common knowledge suggests that a more frequent follow-up may pick up the disease at a milder stage, but little is known on the ultrasound findings before the diagnosis. <b><i>Objectives:</i></b> We examine if a fortnightly ultrasound scan from 16 weeks onward detects TTTS in time. Also, we document the outcomes in a large unselected cohort of MCDA twins and examine the ultrasound findings within 14 days before diagnosis. <b><i>Methods:</i></b> Retrospective cohort of 675 MCDA twin pregnancies followed with a fortnightly scan protocol from 16 weeks onward. Timely detection of TTTS was defined as before fetal demise (stage V), ruptured membranes, or a dilated cervix. We compared the ultrasound findings before the diagnosis between stage I–II and stage III–IV. <b><i>Results:</i></b> A total of 82/675 (12%) pregnancies developed TTTS, of which 74/82 (90%) were detected in time. In 8/82 (10%), TTTS was diagnosed in stage V: 5 before 16 weeks and 2 after 26 weeks. Fetoscopic laser photocoagulation (FLP) of the placental anastomoses was performed in 48/82 (59%). The survival of TTTS in the entire cohort was 105/164 (64%). In contrast, survival after FLP was 77/96 (80%). In 16/19 (84%) of stage III–IV TTTS, abnormal Doppler findings preceded the diagnosis of TTTS. <b><i>Conclusions:</i></b> A scheme of fortnightly ultrasound scans from 16 weeks onward detects 9 out of ten TTTS pregnancies in time. Most stage V cases presented outside the typical time window of 16 and 26 weeks. Survival rates after FLP underestimate the mortality of TTTS. Most stage III–IV cases have abnormal Doppler findings before the diagnosis of TTTS.

Optimization of scan protocol for high temporal resolution magnetic resonance imaging of the liver under single breath-holding using compressed sensing and parallel imaging techniques in a 1.5-T magnetic resonance system

Objective: To optimize the scan protocol for high temporal resolution magnetic resonance (MR) imaging of the liver under single breath-holding, using compressed sensing (CS) and parallel imaging (PI) techniques in a 1.5 T MR system. Methods: 31 healthy volunteers who underwent fat-suppressed gradient-echo T1 weighted imaging using a 1.5 T MR system were included. Image quality was evaluated on altering various imaging parameters in CS and PI so that the scan time was adjusted to 10 and 6 s within a single breath-holding. Normalized standard deviation (nSD = SD/mean value) and signal-to-noise ratio (SNR = mean value/SD) of liver signal intensity were measured. Visual scores for the outline of the liver and inferior right hepatic vein (IRHV) were evaluated using a 4-point scale and compared with that of the reference standard (20 s scan without CS). Results: The nSD and SNR were not significantly different when the 10 s scan with CS factor 2.0 and the 6 s scan with CS factor 2.0 and 2.5 were compared to the 20 s scan. Overall visual score (mean score of the outline of the liver and IRHV) was significantly better (p < 0.05) with the 10 s scan with CS factor 2.0 compared to the other scan protocols. Conclusion: The 10 s scan with CS factor 2.0 should be recommended for high temporal resolution MR imaging of the liver using CS and PI in a 1.5 T MR system. Advances in knowledge: This study conducts a novel MR imaging of the liver using CS and PI in a 1.5 T MR system.

Low-motion fMRI data can be obtained in pediatric participants undergoing a 60-minute scan protocol

Performing functional magnetic resonance imaging (fMRI) scans of children can be a difficult task, as participants tend to move while being scanned. Head motion represents a significant confound in fMRI connectivity analyses. One approach to limit motion has been to use shorter MRI protocols, though this reduces the reliability of results. Hence, there is a need to implement methods to achieve high-quality, low-motion data while not sacrificing data quantity. Here we show that by using a mock scan protocol prior to a scan, in conjunction with other in-scan steps (weighted blanket and incentive system), it is possible to achieve low-motion fMRI data in pediatric participants (age range: 7–17 years old) undergoing a 60 min MRI session. We also observe that motion is low during the MRI protocol in a separate replication group of participants, including some with autism spectrum disorder. Collectively, the results indicate it is possible to conduct long scan protocols in difficult-to-scan populations and still achieve high-quality data, thus potentially allowing more reliable fMRI findings.

INTEGRATION OF TAGUCHI ANALYSIS WITH PHANTOM AND INNOVATIVE GAUGES: OPTIMIZATION OF THE CT SCAN PROTOCOL FOR PERIPHERAL ARTERIAL OCCLUSIVE DISEASE (PAOD) SYNDROME

The CT scan protocol optimization for peripheral arterial occlusive disease (PAOD) syndrome was performed by organizing seven CT factors [kVp, mAs, pitch, field of view (FOV) (mm), time of rotation (s), slice thickness (mm), and matrix size] into Taguchi unique [Formula: see text] orthogonal array. The minimum detectable difference (MDD) in the optimizing process was quantified by adopting a customized line group gauge. Besides, three qualified experts in radiology examined by the double-blind criterion the gauge scanned images and ranked them, yielding the optimal setting of CT scan protocols. The latter setting for PAOD included the kVp of 100, mAs of 240, pitch of 0.513, FOV of 320[Formula: see text]mm, rotation time of 0.75[Formula: see text]s, slice thickness of 4.0, and matrix size of [Formula: see text]. The ANOVA and revised Student’s [Formula: see text]-test verified the smallest MDD as 1.43[Formula: see text]mm at a 0.45-mm gauge depth. The ranking process, which makes it possible to magnify and emphasize the imaging correlation among groups, was found to be preferable to grading in the optimization process. The comparative analysis of various MDDs obtained from different medical facilities and literary sources was performed, which revealed that the cardiac X-ray provided the finest spatial resolution according to the quantified MDD. Meanwhile, the CT scan protocol for PAOD adopted in this study had finer MDD than that for the abdomen due to comparatively low kVp or/and mAs.