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Abstract Background To analyze preoperatively the composition of renal calculi using dual-energy computed tomography (DECT) and compare it with reference standard biochemical stone analysis. Methods Eighty-one participants who were diagnosed with renal calculi underwent DECT at 80 kVp and 140 kVp. Spectral analysis was performed, and the energy map generated was used to classify the calculus based on available preset data. Average Hounsfield units (HU) were calculated for the two energy levels, and ratio of HU was derived (DE ratio) and calculus was categorized into different stone compositions. Hounsfield units of each calculus was measured at 120 kVp standard dose CT, and Hounsfield density (HU/largest transverse diameter) was derived. Comparison of results of spectral analysis and DE ratio was done and correlated with the biochemical laboratory analysis as reference standard wherever available. Results Spectral analysis and CT prediction of stone were performed for all 81 patients. CT prediction of stone based on DE ratio into “uric acid,” “struvite,” “calcium oxalate” and “calcium carbonate apatite” was performed. Assessment of stone composition by biochemical analysis was done for 65 patients who eventually underwent PCNL for stone extraction. Both DE ratio and spectral analysis were able to differentiate calculus into various types based on composition with statistically significant p values. However, spectral analysis proved to be marginally better in renal stone characterization particularly for mixed stones. The DE ratio for uric acid stones was derived as 0.9–1.1, 0.9–2.3 for mixed stones and 1.0–2.4 for calcium stones. Conclusions Spectral analysis promises a practical approach to predicting calculus composition preoperatively, thereby avoiding unnecessary surgical intervention.

Introduction: Diffusion-weighted image or DWI is commonly used to provide valuable and diverse information on acute stroke in tertiary care hospitals. DWI is a sensitive and accurate method for identifying the infarct core and can expose the area of cerebral infarction within a few hours of onset. This systematic review is planned to evaluate the measurement of stroke volume on DWI and correlate it with functional outcomes (modified ranking scale). Method: We have adhered to the PRISMA-P checklist to report this systematic review protocol. PubMed, Web of Science, Scopus, and TRIP (Turning Research into Practice) databases will be searched. Two independent reviewers will screen the records, extract data, and critically appraise the studies. A checklist for critical appraisal will be applied for data abstraction, and data extraction will be done using predictive modeling for systematic reviews. The risk of bias will be measured by the Prediction Model Risk of Bias Assessment Tool (PROBAST). The meta-analysis will be considered only if included studies have adequate data, and STATA statistical package version 13.1 will be used for performing a meta-analysis. A narrative synthesis will be performed if meta-analysis is not possible. Ethics and Dissemination: As this review will focus on secondary information, there is no ethical consideration required. We will disseminate our findings by publishing our analysis in a peer-reviewed journal. Protocol Registration: In Prospective Register of Systematic Reviews (CRD42019141840).

Background: The liver is primarily or secondarily involved by numerous vascular, metabolic, infectious, and neoplastic processes resulting in formation of focal liver masses, and the detection of such focal liver lesions is frequently accomplished with sonography. However, the categorization a liver mass as benign or malignant on ultrasound has always been a diagnostic dilemma. Objective: This study aimed to assess if the addition of compression sonoelastography to conventional B-mode ultrasound aided in diagnostic accuracy of the focal hepatic lesions. Materials and Methods: We evaluated B-mode characteristics of 52 liver lesions followed by calculation of their strain values on compression sonoelastography. The lesions were categorized as benign or malignant by ascertaining a cutoff strain value and the comparison was made with the histopathological diagnosis/contrast-enhanced computed tomography characteristics of the lesions. Results: The mean strain index value of malignant hepatic lesions (2.12 ± 1.06) was statistically higher than the benign lesions (0.92 ± 1.06) with 2-tailed P = 0.002. The sensitivity, specificity, and positive and negative predictive values of compression sonoelastography in diagnosing a malignant pathology were 74.4%, 88.9%, 94.6%, and 46.7%, respectively, and the additional evaluation of B-mode features yielded higher sensitivity (95.4% vs. 83.7%) and negative predictive value (75% vs. 46.7%). Conclusion: Compression sonoelastography is an efficient and beneficial complementary tool to B-mode imaging in evaluating solid liver lesions.

The human nasal cavity develops from birth with size anatomical changes. This study aims to evaluate the flow parameters and particle deposition parameters. Neonatal and infant nasal cavities are developed using MIMICS 21.0, and the flow is evaluated by ANSYS 2021 R2 using CFD to evaluate velocity, pressure, micro- and nanoparticle depositions under sedentary breathing conditions. Neonatal nasal valve velocity was recorded 3.5 times higher compared to the infant for 1.8 LPM and 2.7 times for 3 LPM. Neonatal vestibular depositions up to 10 µm were 6.6%, which increased to 76% for 60 µm for 1.8 LPM and increased to 21.3% for 10 µm and 79% for 60 µm for 1.8 LPM. The neonatal nasal valve showed maximum depositions of around 35% for 20 µm for both flow rates. Maximum depositions of nanoparticles are in the mid-nasal region. Infant nasal cavities deposit around 1% to 2% for nanoparticles below 20 nm for both flow rates. Neonatal overall microparticle depositions doubled with an increase in flow rate up to 10 µm. The overall deposition efficiency of nanoparticles increases 1.5 times with increasing flow rate. This study will help with the medical administration of aerosol-based medications in the patient and age-specific nasal cavity. [ABSTRACT FROM AUTHOR]

Objective: The nasal cavity effectively captures the particles present in inhaled air, thereby preventing harmful and toxic pollutants from reaching the lungs. This filtering ability of the nasal cavity can be effectively utilized for targeted nasal drug delivery applications. This study aims to understand the particle deposition patterns in three age groups: neonate, infant, and adult. Materials and methods: The CT scans are built using MIMICS 21.0, followed by CATIA V6 to generate a patient-specific airway model. Fluid flow is simulated using ANSYS FLUENT 2021 R2. Spherical monodisperse microparticles ranging from 2 to 60 µm and a density of 1100 kg/m3 are simulated at steady-state and sedentary inspiration conditions. Results: The highest nasal valve depositions for the neonate are 25% for 20 µm, for infants, 10% for 50 µm, 15% for adults, and 15% for 15 µm. At mid nasal region, deposition of 15% for 20 µm is observed for infant and 8% for neonate and adult nasal cavities at a particle size of 10 and 20 µm, respectively. The highest particle deposition at the olfactory region is about 2.7% for the adult nasal cavity for 20 µm, and it is <1% for neonate and infant nasal cavities. Discussion and conclusions: The study of preferred nasal depositions during natural sedentary breathing conditions is utilized to determine the size that allows medication particles to be targeted to specific nose regions. [ABSTRACT FROM AUTHOR]

Introduction: Fractional Anisotropy (FA) values are considered as a solid concrete index for determining white matter integrity in ageing and neurodegenerative diseases. FA is more comparable and reliable parameter than individual diffusivity parameters. A b-value and Time of Echo (TE) significantly affect the reproducibility and accuracy of Diffusion Tensor Imaging (DTI) derived indices at 1.5 Tesla (T) MRI machines in grey and white matter. Hence, no fixed b-value and TE protocol combination is recommended in literature to obtain consistent FA values, as it is a relatively new imaging technique. Aim: To check the consistency of FA values using different combinations of b-value and TE in DTI of normal brain white matter and to establish a standardised protocol for calculating FA values in different regions of normal brain white matter of the corpus callosum, centrum semiovale and pons. Materials and Methods: A cross-sectional study of 23 healthy participants without neurological abnormalities using 1.5 T MRI, DTI of brain white matter was performed. FA values were measured at the corpus callosum, centrum semiovale and pons using fiber track analysis in six different combinations of b-value and TE. Results: The FA values with least coefficient of variation was found with a b-value of 1000 s/mm2 and TE 100 ms. Conclusion: The current study established a standardised protocol for calculating FA values in different regions of normal brain white matter of the corpus callosum, centrum semiovale and pons.

Background: A high dose of statin is used to obtain an intensive lipid-lowering in stroke patients, even in patients with normal lipid levels. There are limited data on effect of dosage of statins and functional outcome in stroke patients. Objectives: 1. To compare serum cholesterol levels with severity of stroke measured by infarct volume. 2. To compare functional outcome measured by mRS at day 90 with the dose of statin. Materials and Methods: This retrospective observational study was conducted in KMC Hospital Manipal, India between 2016 and 2018. Result: A total of 100 consecutive patients were included in the study, out of which 60 (60.0%) were males. Hyperlipidemia was present in 65 (65.0%) patients. On comparing the serum cholesterol levels with infarct volume using MRI, patients with low volume of =70 ml had higher mean serum total cholesterol concentration (223.83 mg/dl), whereas patients with high volume of >70 ml had low mean cholesterol level (218.70 mg/dl). The patients were divided into those who received low dose (=20 mg) versus high dose (=40 mg equivalent) of Atorvastatin. On comparing the mRS values at baseline and on day 90 with the dose of statins, patients who received a higher dosage had a statistically significant fall in mRS (p-0.045) at day 90. Conclusion: It was found that serum cholesterol levels were inversely related to the stroke severity. However, a higher the dose of statins resulted in better functional outcome and survival in post-stroke patients, possibly due to its neuroprotective effect. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To determine the overall performance of an existing CAD algorithm with thin-section computed tomography (CT) in the detection of pulmonary nodules and to evaluate detection sensitivity at a varying range of nodule density, size, and location. Materials and Methods: A cross-sectional prospective study was conducted on 20 patients with 322 suspected nodules who underwent diagnostic chest imaging using 64-row multi-detector CT. The examinations were evaluated on reconstructed images of 1.4 mm thickness and 0.7 mm interval. Detection of pulmonary nodules, initially by a radiologist of 2 years experience (RAD) and later by CAD lung nodule software was assessed. Then, CAD nodule candidates were accepted or rejected accordingly. Detected nodules were classified based on their size, density, and location. The performance of the RAD and CAD system was compared with the gold standard that is true nodules confirmed by consensus of senior RAD and CAD together. The overall sensitivity and false-positive (FP) rate of CAD software was calculated. Observations and Results: Of the 322 suspected nodules, 221 were classified as true nodules on the consensus of senior RAD and CAD together. Of the true nodules, the RAD detected 206 (93.2%) and 202 (91.4%) by the CAD. CAD and RAD together picked up more number of nodules than either CAD or RAD alone. Overall sensitivity for nodule detection with the CAD program was 91.4%, and FP detection per patient was 5.5%. The CAD showed comparatively higher sensitivity for nodules of size 4-10 mm (93.4%) and nodules in hilar (100%) and central (96.5%) location when compared to RAD′s performance. Conclusion: CAD performance was high in detecting pulmonary nodules including the small size and low-density nodules. CAD even with relatively high FP rate, assists and improves RAD′s performance as a second reader, especially for nodules located in the central and hilar region and for small nodules by saving RADs time.

Objective: To assess the performance of mannitol as a luminal contrast as compared to water and positive contrast in evaluation of bowel on multidetector computed tomography (MDCT). Materials and Methods: Three hundred patients were randomly selected for this study and were divided equally into three groups. Each subject received 1500 ml of oral contrast. Group 1 received 3% mannitol in water, group 2 received diluted iodinated positive contrast, and group 3 received plain water without additives. Qualitative and quantitative analysis for distension, fold visibility, and overall image quality were analyzed by actual diameter measurement and point scale system at different bowel levels. One-way analysis of variance (ANOVA) followed by Tukey′s HSD Post-hoc test and Pearson′s Chi-square (exact test) test were applied. Results: Group 1 showed better results for small bowel distension, intraluminal homogeneity, and visibility of mucosal folds on quantitative and qualitative analysis with statistically significant P value (P

The airflow behaviour and particle deposition before and after the maxillary expansion are evaluated using the computational fluid dynamics method. A pediatric patient was subjected to maxillary expansion and the CT scans of pre and post were recorded. The procured CT scans were developed into 3D models using Materialise MIMICS 21.0 (Materialise, Ann Arbor, MI). The analysis was performed using ANSYS FLUENT 2020 R2 with three different flow rates defined at the nostril inlet as 5, 10, and 15 LPM. The surface area and nasal volume increased by 5.1% and 16.5%, respectively, for the post-maxillary expansion case. The velocity profiles show a maximum value at the nasal valve regions followed by a decreased velocity in the mid-nasal region with an 85% lower velocity observed at the nasal valve for the post-maxillary expansion case. The nasal resistance and pressure drop decrease by 46% to 66% in post-maxillary expansion cases. The maximum WSS at the nasal valve region is observed which is reduced by around 47% for postmaxillary expansion cases. Particle deposition studies show a reduction in particle depositions in post cases indicating a greater number of inhaled particles reaching the lungs. The pressure drop and the nasal resistance values were reduced by more than 50% for post-maxillary expansion. The particle deposition studies show increased depositions at higher flow rates for both cases. [ABSTRACT FROM AUTHOR]

Hypomelanosis of Ito (HI) is a neurocutaneous syndrome characterized by hypopigmented cutaneous lesions and extracutaneous manifestations frequently affecting the nervous system and the musculoskeletal system. Dysmorphic features, dental, ophthalmic, gastrointestinal, cardiac, and renal abnormalities are described in a minority of patients. The authors describe a 4-month-old infant having HI with unusual pulmonary hypoplasia that has not been reported so far.