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Purpose To describe the clinical and multimodal imaging (MMI) features of bacillary layer detachment (BD), and its response to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy, in eyes with macular neovascularization (MNV). Design Retrospective, observational case series. Methods Fourteen eyes (14 patients, 7 male) were imaged with spectral-domain optical coherence tomography (OCT), and either fluorescein angiography or OCT angiography. Therapeutic response was monitored with serial imaging and best-corrected visual acuity (BCVA) assessments. Results Mean age was 75±13 (range: 45-96) years, with mean follow-up duration of 27±21 (range: 1-56) months. Neovascular age-related macular degeneration (nAMD) was found in 71% (10/14) eyes. Type 2 MNV lesions were associated with BD in all 14 eyes. Subretinal hemorrhage was noted in 79% (11/14) eyes. BD promptly resolved following intravitreal anti-VEGF therapy in all eyes. Baseline BCVA improved from LogMar 0.84±0.32 (Snellen equivalent 20/138) to LogMar 0.48±0.31 (Snellen equivalent 20/60) at last follow-up, with treatment of the MNV. Conclusions Type 2 MNV and subretinal hemorrhage are associated with BDs, which may be due to a rapid influx of exudative fluid into the potential space between the external limiting membrane and ellipsoid zone. Intravitreal anti-VEGF therapy results in rapid resolution of BDs and visual improvement in most eyes.

Pancreatitis is as common in children as it is in adults, though causes and accepted imaging strategies differ in children. In this narrative review we discuss the epidemiology of childhood pancreatitis and key imaging features for pediatric acute, acute recurrent, and chronic pancreatitis. We rely heavily on our collective experience in discussing advantages and disadvantages of different imaging modalities; practical tips for optimization of ultrasound, CT, and MRI with MRCP in children; and image interpretation pearls. Challenges and considerations unique to imaging pediatric pancreatitis are discussed, including timing of imaging, role of secretin-enhanced MRCP, utility of urgent MRI, severity prediction, autoimmune pancreatitis, and best methods for serial imaging. We suggest a methodical approach to pancreatic MRI interpretation in children and have included a sample structured report, and we provide consensus statements according to our experience imaging children with pancreatitis.

Background Coronary computed tomographic angiography (CCTA) provides a non-invasive assessment of the coronary artery tree. Computed Tomography - adapted Leaman Score (CT-LeSc) has been shown to be an independent predictor of cardiac events in coronary artery disease (CAD) patients with a score greater than 5 (high). Purpose To investigate the relationship between CT-LeSc and the progression of CAD and to provide vessel- and segment-level CAD qualification and quantification at baseline and 7-year follow-up. Methods Patients with multivessel CAD and CCTA assessments at baseline and follow-up were included. The CT-LeSc analysis was performed in a paired fashion. The patient-level scores and the differences between each phase were assessed by 2 analysts in an independent core laboratory. Results This study analyzed 248 coronary segments from 17 patients with a mean follow-up interval of 7.5 ± 0.6 years. The mean CT-LeSc at baseline and follow-up were 14.6 ± 4.2 and 16.9 ± 1.5, respectively, with an absolute increase of 2.3 ± 1.8. The mean cumulative increase of new lesions was 0.2 ± 0.2 per year. Over time, 14.6% of the non-obstructive lesions became obstructive, and 15.0% of the non-calcified plaques became calcified. There were 29 new lesions found at follow-up, and out of these, 16 were obstructive and 19 were non-calcified. Conclusion In patients at high risk for cardiac events, as determined by CT-LeSc, there was an increase in CT-LeSc, obstructive lesions, and calcified plaques over the 7-year follow-up period. Most of the new lesions were obstructive and non-calcified. This is the first report showing long-term serial imaging CCTA changes in a high-risk population.

With improved survival rates of patients with metastatic disease due to continuously evolving multimodality treatment options, radiologists are increasingly interpreting imaging studies from patients with protracted metastatic disease. It is thus crucial for radiologists to have an in-depth understanding of the temporal evolution of metastatic spread and the accompanying findings on imaging studies, to provide accurate interpretation that supports optimal management. A general overview of the evolution of cancer spread on serial imaging studies and common pathways of tumor spread across multiple tumor types and tumor locations is not readily available in radiology literature. The key common pathways of tumor spread across diverse spectrum of tumors relevant to radiologists are summarized in a logical schematic approach which focusses on aiding radiologists to understand the pathways of spread resulting in current sites of metastatic disease involvement and then to potentially predict future sites of metastatic involvement. This article also summarizes the practical applications of this knowledge to the routine oncologic imaging interpretation.

BACKGROUND Sarcomatoid carcinoma of the pancreas is extremely rare and has an extremely poor prognosis. Although a few cases of sarcomatoid carcinoma of pancreas have been reported, most are focused on a histopathological review. To the best of our knowledge, there are no reports documenting multimodality imaging characteristics and chronological changes with emphasis on radiologic features. CASE SUMMARY A 64-year-old woman was admitted to Chungnam National University Hospital with acute appendicitis. Contrast-enhanced computed tomography of the abdomen revealed a 2.6 cm × 2.8 cm multilobular cystic mass in the pancreatic tail. The pancreatic lesion showed suspected mural nodules and thin septa. Hence, mucinous cystic neoplasm of pancreas was considered. After 7 mo, the patient was readmitted for repeated epigastric abdominal pain and nausea. Follow-up contrast-enhanced computed tomography of the abdomen and magnetic resonance imaging revealed a marked enlargement (5.4 cm × 4 cm), with a predominant internal solid component. The mass showed low signal intensity on a T1-weighted image and heterogeneously intermediate high signal intensity on a T2-weighted image. It showed diffusion restriction and peripheral rim enhancement on an arterial phase image, and progressive enhancement on portal venous and delayed phase images. Distal pancreatectomy was performed. Based on the morphology and immunohistochemical staining of the specimen, pancreatic sarcomatoid carcinoma was diagnosed. CONCLUSION We present the computed tomography, magnetic resonance imaging, and positron emission tomography computed tomography findings, pathologic features, and chronological changes for preoperative diagnosis.

The increasing use of low-dose CT for screening for lung cancer will inevitably identify many small, asymptomatic lung nodules and ground-glass opacities (GGOs). Current guidelines for the management of screening-detected lesions tend to advise a conservative approach based on serial imaging and intervention only if ‘suspicious’ features emerge. However, more recent developments in thoracic surgery and in the understanding of the screening-detected lesions themselves prompt some pertinent questions over this conservatism. Is CT surveillance sufficiently reliable to exclude malignancy? Is it really necessary to hold back on operative biopsy and resection given modern surgical safety and efficacy? Is the option for early surgical therapy a viable one—especially with the availability of sublobar resection today? Modern data suggests that the risk of inaction for some screening-detected lesions may be higher than expected, whereas the potential harm of surgical intervention may be substantially reduced by sublobar resection and the latest minimally invasive surgical techniques. A more pro-active approach towards offering surgery for screening-detected lesions should now be considered.

To investigate the relationship between pachydrusen and features of choroidal vascular hyperpermeability (CVH) and punctate hyperfluorescent spots (PHS) on serial imaging in patients with polypoidal choroidal vasculopathy (PCV) or pachychoroid neovasculopathy (PNV). Patients diagnosed between January 2007 and June 2016 at 2 high-volume, tertiary hospitals were retrospectively reviewed with serial multimodal imaging assessment. The primary outcome was the association between drusen subtypes (hard/soft drusen, subretinal drusenoid droplets, or pachydrusen) with CVH and PHS, previously described in central serous chorioretinopathy. Among the 105 eyes (105 patients; mean age, 67.0 years), 87 (82.9%) were diagnosed with PCV and 18 (17.1%) with PNV. Pachydrusen was the most frequently identified subtype (54 eyes, 51.4%). CVH (72.2% vs 41.4%, P = 0.021) and PHS (72.2% vs 44.8%, P = 0.041) were observed with greater frequency in PNV eyes. Significant correlations were found between CVH and PHS (phi coefficient φ 0.30, P = 0.003), and PHS with pachydrusen (φ 0.20, P = 0.040). Over a mean follow-up of 74.8 months, new drusen co-localizing to PHS were noted in 22 (21.0%) eyes (φ 0.54, P

espanolLa evaluacion enfocada con ecografia en trauma (FAST) se ha utilizado y estudiado ampliamente en trauma contundente y penetrante durante las ultimas 3 decadas. Antes de FAST, los procedimientos invasivos como el lavado peritoneal de diagnostico y la laparotomia exploratoria se utilizaban comunmente para diagnosticar lesiones intraabdominales. En la actualidad, el examen FAST se ha convertido en un estudio mas completo del abdomen, el corazon, el torax, la vena cava inferior, entre otras, existiendo muchas variaciones en la tecnica, los protocolos y la interpretacion. Las estrategias de manejo de traumatismos como laparotomia, endoscopia, angiografia por tomografia computarizada, intervencion angiografica, imagenes seriadas y observacion clinica tambien han cambiado a lo largo de los anos. Esta tecnica, en ocasiones, ha logrado reemplazar la tomografia computarizada y el diagnostico de lavado peritoneal, sin producir retrasos en el procedimiento quirurgico. En tal sentido, la relacion entre la informacion clinica del paciente y los resultados del examen deben estar guiados a la orientacion de los enfoques terapeuticos en escenarios de dificil acceso como unidades de cuidados intensivos en zonas de guerra, lugares rurales o distantes, donde otros metodos de imagenologia no estan disponibles. Esta revision discutira la evolucion del examen FAST a su estado actual y evaluara su papel en evolucion en el manejo agudo del paciente traumatizado EnglishFocused trauma ultrasound assessment (FAST) has been used and studied extensively in blunt and penetrating trauma over the past 3 decades. Before FAST, invasive procedures such as diagnostic peritoneal lavage and exploratory laparot-omy were commonly used to diagnose intra-abdominal injuries. Today, the FAST examination has become a more compre-hensive study of the abdomen, heart, thorax, inferior vena cava, among others, with many variations in technique, protocols, and interpretation. Trauma management strategies such as laparotomy, endoscopy, computed tomography angiography, angiographic intervention, serial imaging, and clinical observation have also changed over the years. This technique, on occasion, has succeeded in replacing computed tomography and peritoneal lavage diagnosis, without causing delays in the surgical procedure. In this sense, the relationship between the clinical information of the patient and the results of the examination should be guided to the orientation of therapeutic approaches in settings of difficult access such as intensive care units in war zones, rural or distant places, where other methods imaging are not available. This review will discuss the evolution of the FAST exam to its current state and assess its evolving role in the acute management of the trauma patient

Purpose Magnetic resonance image (MRI) guided radiation therapy has the potential to improve outcomes for glioblastoma by adapting to tumor changes during radiation therapy. This study quantifies interfraction dynamics (tumor size, position, and geometry) based on sequential magnetic resonance imaging scans obtained during standard 6-week chemoradiation. Methods and Materials Sixty-one patients were prospectively imaged with gadolinium-enhanced T1 (T1c) and T2/FLAIR axial sequences at planning (Fx0), fraction 10 (Fx10), fraction 20 (Fx20), and 1 month after the final fraction of chemoradiation therapy (P1M). Gross tumor volumes (GTVs) and clinical target volumes (CTVs) were contoured at all time points. Target dynamics were quantified by absolute volume (V), volume relative to Fx0 (Vrel), and the migration distance (dmigrate; the linear displacement of the GTV or CTV relative to Fx0). Temporal changes were assessed using a linear mixed-effects model. Results Median volumes at Fx0, Fx10, Fx20, and P1M for the GTV were 18.4 cm3 (range, 1.1–110.5 cm3), 14.7 cm3 (range, 0.9–115.1 cm3), 13.7 cm3 (range, 0.6–174.2 cm3), and 13.0 cm3 (range, 0.9–76.3 cm3), respectively, with corresponding median Vrel of 0.88 at Fx10, 0.77 at Fx20, and 0.71 at P1M relative to Fx0 (P 5 mm during chemoradiation therapy. Conclusions Clinically meaningful tumor dynamics were observed during chemoradiation therapy for glioblastoma, supporting evaluation of daily MRI guided radiation therapy and treatment plan adaptation.

OBJECTIVES/HYPOTHESIS Cerebellopontine angle (CPA) and internal auditory canal (IAC) lipomas are rare, benign tumors comprising 0.08% of all intracranial tumors and can be mistaken for other, more common lesions of the CPA/IAC such as vestibular schwannoma. The purpose of this study was to review the literature and assess the evolution of CPA/IAC lipoma diagnosis and management. In addition, we present 17 new lipomas, matching the largest known case series of this rare tumor. STUDY DESIGN Retrospective case series and systematic review. METHODS Systematic review of the literature was performed using PubMed and Google Scholar. References from identified articles were also reviewed to identify potential additional manuscripts. Manuscripts and abstracts were reviewed to identify unique cases. For the case series, the charts of all CPA/IAC lipoma patients seen at a single institution from 2006-2019 were manually reviewed. Logistic regression and chi-squared analysis were performed where appropriate. RESULTS A total of 219 unique lipomas have been reported in the literature, including 17 presented in this study. Surgical management has been performed in 46% of cases and has been conducted less often in recent decades, likely due to improved radiographic diagnostic capabilities and understanding of surgical outcomes. Surgical management is associated with worse neurologic outcomes (P = .002) and has become less common in recent decades. Although growth is unlikely, it has been demonstrated in patients into their 30s. CONCLUSIONS Accurate radiographic diagnosis is imperative for appropriate patient management, as CPA/IAC lipomas should typically be managed through observation and serial imaging whereas vestibular schwannomas and other CPA/IAC lesions may require microsurgical or radiosurgical intervention depending on growth and symptomatology. Laryngoscope, 131:2081-2087, 2021.

Background Management of intracranial Langerhans cell histiocytosis generally includes surgical resection. Case Description A female patient with a diagnosis of Langerhans cell histiocytosis developed multiple brain lesions. As part of her multimodality treatment, she underwent Gamma Knife stereotactic radiosurgery on 4 occasions over a 20-year period. All tumors showed significant shrinkage on serial imaging after initially demonstrating a transient expansion. No permanent postradiosurgery complications occurred. Conclusions As part of multimodality management of this recurrent and refractory disease, Gamma Knife stereotactic radiosurgery should be considered an important salvage option that can control local disease and obviate the need for invasive surgery.

Objectives The National Lung Screening Trial (NLST) demonstrated a 20% reduction in mortality with low-dose computed tomography (CT) for lung cancer screening (LCS). The NLST found the greatest benefit to LCS for patients who underwent annual screening for a full 3-year follow-up period. The adherence to serial imaging in the NLST was 95%. Methods We conducted a prospective study of 268 patients who presented for LCS and who were not enrolled in a research study to determine the adherence to recommended follow-up imaging and biopsy at a single center. We evaluated the correlations among sociodemographic characteristics, Lung Imaging and Reporting Data System, and adherence. Results Only 48% of the patient population received recommended follow-up (either imaging or biopsy) after their referent LCS. Patients with abnormal LCS (Lung Imaging and Reporting Data System 3 or 4) were more likely to adhere to the recommended follow-up (additional imaging or biopsy) compared with those with negative screens. Sex, ethnicity, smoking status, and household income were not correlated with adherence to screening and biopsy. Conclusions The benefits from LCS observed in the NLST may be undermined by low adherence to follow-up screening. Studies targeting LCS patients to bolster adherence to follow-up are needed.

In a patient with infective endocarditis (IE), susceptibility-weighted angiography (SWAN) sequence revealed 2 intracranial infectious aneurysms (IIAs) as bright signal lesion, related to the high-velocity arterial flow within the IIAs. In addition, SWAN revealed a convexal subarachnoid hemorrhage-related to distal IIA rupture-as a dark signal. The risk of IIA rupture emphasizes the need for serial imaging follow-up in patients with IE receiving antibiotic therapy after endovascular treatment and after valve surgery. Considering its specific risks, particularly in patients with IE who may be on anticoagulation, digital subtraction angiography is not used routinely in this context. Therefore, SWAN might be an alternative method for selecting patients with IE who need conventional angiography and might be useful for serial follow-up and monitoring after treatment. Future studies should investigate the role of SWAN for the detection of IIAs.

Objective: To review evidence-based data on spontaneous retrogression of low-grade gliomas with respect to interval till regression, type of glioma and patient outcome. Method: The systematic review comprised medical literature in English language published from January 1997 to January 2017 on Scopus, PubMed and Google Scholar databases to establish consensus about the possible mechanism of spontaneous regression, the role of therapeutic intervention and failure of management strategies in low-grade gliomas. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed during the review. Results: Of the 176 articles identified, 73(41.5%) were shortlisted for detailed assessment. Of them, 10(13.7%) were included; 5(50%) case reports and 5(50%) case series. There were 23 cases of spontaneous regression; 15(65.2%) males and 8(34.7%) females. The interval of regression varied from 3 months to 15.5 years, and the most commonly presenting low-grade glioma type was optic pathway glioma 11(47.4%). Conclusion: The phenomenon of regression was most evident in optic pathway glioma. Literature suggested that low-grade gliomas should undergo serial imaging before implying any therapeutic intervention. However, the evidence-based proof, large-scale experimental studies and ethical considerations are still required to standardise this strategy. Key Words: Pilocytic astrocytomas, Desmoplastic infantile ganglioglioma, DIG, Desmoplastic infantile astrocytomas, DIA, Diffuse astrocytoma, Spontaneous regression. Continuous...

Background Ecchordosis physaliphora (EP) is a congenital, uniformly asymptomatic, hamartomatous lesion of the primitive notochord. Herein we report, to our knowledge, the first credible case report of unprovoked intrasphenoidal rupture resulting in recurrent pneumocephalus and cerebrospinal fluid leak, definitively captured over serial imaging during clinical and radiologic surveillance. Case Description A 68-year old woman with Marfan syndrome presented to the emergency department with the worst headache of her life. Imaging demonstrated extensive pneumocephalus and revealed a small, dorsal midline clival lesion consistent with EP and a transsphenoidal defect. Remote imaging encounters confirmed typical EP without pneumocephalus or cortical defect, and an uneventful clinical course years preceding presentation. Over the ensuing months during neurosurgical follow-up, the patient reported recurrent headaches, imbalance, and unprovoked clear rhinorrhea. Further imaging demonstrated an apparently enlarging transsphenoidal defect which was managed by endoscopic transnasal resection and nasoseptal flap. Pathologic evaluation confirmed the diagnosis of EP and chronic dural defect. Conclusions This represents, to our knowledge, the first unambiguous example of spontaneous EP rupture and recurrent pneumocephalus captured over serial imaging. The case further underscores rare but potentially significant complications of EP and highlights management options.

Background Left bundle branch block (LBBB) and left ventricular (LV) dyssynchrony likely contribute to progressive systolic dysfunction. The evaluation of newly recognized LBBB includes screening for structural heart abnormalities and coronary artery disease (CAD). In patients whose LV ejection fraction (EF) is preserved during initial testing, the incidence of subsequent cardiomyopathy is not firmly established. Hypothesis The risk of developing LV systolic dysfunction among LBBB patients with preserved LVEF is high enough to warrant serial imaging. Methods We screened records of 1000 consecutive patients with LBBB from our ECG database and identified subjects with an initially preserved LVEF (≥45%) without clinically relevant CAD or other cause for cardiomyopathy. Baseline imaging, clinical data, and follow‐up imaging were recorded to determine the risk of subsequent LV systolic dysfunction (LVEF ≤40%). Results (Data are mean + SD) 784 subjects were excluded, the majority for CAD or depressed LVEF upon initial imaging. Of the remaining 216, 37 (17%) developed a decline in LVEF(≤40%) over a mean follow‐up of 55 ± 31 months; 94% of these patients had a baseline LVEF≤60% and LV end systolic diameter (ESD) ≥ 2.9 cm indicating that these measures may be useful to define which patients warrant longitudinal follow‐up. The negative predictive value of a LVEF>60% and LVESD

Patellar tuberculosis (TB) is an uncommon occurrence and has been sparsely reported in the literature. Imaging plays a key role in its diagnosis, as clinical symptoms vary and are often unspecific. We present two cases of isolated patellar tuberculosis, its classical imaging features, and follow-up serial imaging.

Background Basilar perforator aneurysms are rare causes of subarachnoid hemorrhage and their natural history is poorly characterized. Although various treatment strategies have been reported, conservative management is an option that has been associated with a high likelihood of spontaneous resolution. Case Description Here we present 2 cases of subarachnoid hemorrhage, 1 diffuse and the other perimesencephalic, due to small ruptured basilar perforator artery aneurysms. These aneurysms were only identified after repeat angiography. Conservative management with serial imaging was pursued. Both patients did well clinically and repeat imaging demonstrated spontaneous resolution of the ruptured aneurysms. We also provide a literature review of ruptured basilar perforator aneurysms, showing a ~10% re-rupture rate within the early post-rupture period but otherwise a high rate of spontaneous resolution. Conclusions Although basilar perforator aneurysms can re-rupture, there is also a high likelihood of spontaneous resolution. Given the challenges of treatment, conservative management is an option that can be considered.

Background Epidural hematomas (EDHs) involving the venous sinuses are uncommon and carry the risk of hemorrhage or venous infarction. We report the largest case series for superior sagittal sinus− and transverse sinus−related EDHs including surgical and nonsurgical management. We compare our findings to the relevant literature. Methods A retrospective review of the EDH cases at our center was performed from 2013–2018. Patients were analyzed by surgical versus conservative management, outcomes, and complications. Results Of the 268 EDH patients identified, 32 involved the venous sinuses (23 supratentorial and 9 infratentorial). Ten of the patients had surgery, and 22 were managed conservatively. No surgical complications occurred, and all had a Glasgow Outcome Scale score of 5 at follow-up. All of the nonsurgical patients had a Glasgow Outcome Scale score of 4 or 5 at follow-up except for 1 patient with prior disability. The literature search resulted in 39 infratentorial and 47 supratentorial EDHs involving venous sinuses. Conclusions Surgical and nonsurgical management of EDHs involving the venous sinuses are both viable options with good outcomes. Surgical intervention is based on location, size, neurologic examination, expansion on serial imaging, and vascular imaging findings. Surgery has the potential for significant complications, but all surgical patients in our series had good outcomes at follow-up. Similarly, nonsurgically managed patients had good outcomes and our overall series demonstrates better outcomes with fewer complications than other similar series in the literature.

Background Transcatheter left atrial appendage occlusion (LAAO) using Watchman device has been demonstrated to be efficacious in decreasing stroke risk in patients with atrial fibrillation who are not suitable for long-term anticoagulation. Residual leaks are frequently encountered following LAAO procedures and their clinical implications and optimal management remain controversial. Case summary In this report, we describe a case of peri-Watchman device leak treated successfully with percutaneous device closure using an Amplatzer Vascular Plug II device. Discussion The clinical implications of peri-device leaks remain controversial with general consensus to continue anticoagulation along with serial imaging for larger leaks (>5 mm). As an alternative strategy, percutaneous closure of these leaks has been attempted in hope of avoiding anticoagulation and minimizing the risk of stroke and should be studied further.

An 86-year-old right-handed man with medically refractory essential tremor was treated using left-sided MRI-guided focused ultrasound (MRgFUS) thalamotomy targeting the dentatorubrothalamic tract (DRTT) at its intersection with the ventral intermediate nucleus of the thalamus, with immediate symptomatic improvement and immediate postprocedure imaging demonstrating disruption of the DRTT. The patient experienced a partial return of symptoms 9 weeks following the procedure, and MRI demonstrated retraction of the left thalamic ablation site. The patient underwent repeat left-sided MRgFUS thalamotomy 4 months after initial treatment, resulting in reduced tremor. MR thermometry temperature measurements during the second MRgFUS procedure were unreliable with large fluctuations and false readings, likely due to susceptibility effects from the initial MRgFUS procedure. Final sonications were therefore monitored using the amount of energy delivered. The patient fared well after the second procedure and had sustained improvement in tremor control at the 12-month follow-up. This is the first report to describe the technical challenges of repeat MRgFUS with serial imaging.

As knee osteoarthritis is a disease of the entire joint, our pathophysiological understanding could be improved by the characterization of the relationships among the knee components. Diverse quantitative parameters can be characterized using magnetic resonance imaging (MRI) and computed tomography (CT). However, a lack of methods for the coordinated measurement of multiple parameters hinders global analyses. This study aimed to design an expert-supervised registration method to facilitate multiparameter description using complementary image sets obtained by serial imaging. The method is based on three-dimensional tissue models positioned in the image sets of interest using manually placed attraction points. Two datasets, with 10 knees CT-scanned twice and 10 knees imaged by CT and MRI were used to assess the method when registering the distal femur and proximal tibia. The median interoperator registration errors, quantified using the mean absolute distance and Dice index, were ≤0.45 mm and ≥0.96 unit, respectively. These values differed by less than 0.1 mm and 0.005 units compared to the errors obtained with gold standard methods. In conclusion, an expert-supervised registration method was introduced. Its capacity to register the distal femur and proximal tibia supports further developments for multiparameter description of healthy and osteoarthritic knee joints, among other applications.

As knee osteoarthritis is a disease of the entire joint, our pathophysiological understanding could be improved by the characterization of the relationships among the knee components. Diverse quantitative parameters can be characterized using magnetic resonance imaging (MRI) and computed tomography (CT). However, a lack of methods for the coordinated measurement of multiple parameters hinders global analyses. This study aimed to design an expert-supervised registration method to facilitate multiparameter description using complementary image sets obtained by serial imaging. The method is based on three-dimensional tissue models positioned in the image sets of interest using manually placed attraction points. Two datasets, with 10 knees CT-scanned twice and 10 knees imaged by CT and MRI were used to assess the method when registering the distal femur and proximal tibia. The median interoperator registration errors, quantified using the mean absolute distance and Dice index, were = 0.96 unit, respectively. These values differed by less than 0.1 mm and 0.005 units compared to the errors obtained with gold standard methods. In conclusion, an expert-supervised registration method was introduced. Its capacity to register the distal femur and proximal tibia supports further developments for multiparameter description of healthy and osteoarthritic knee joints, among other applications.

The purpose of this case report is to describe the occurrence and management of an ulnar artery pseudoaneurysm post phlebotomy. A 36-year-old worker with progressively painful nondominant forearm swelling was referred at 4 weeks postphlebotomy. Serial imaging showed an expanding proximal ulnar pseudoaneurysm. This was managed with a covered stent in the ulnar artery and coiling of the interosseous artery. The hematoma was evacuated, and the neurovascular bundle was protected with muscle coverage. At follow-up, the stent was patent, and there was no distal ischemia. Pseudoaneurysms post phlebotomy are rare. We demonstrate successful treatment of an ulnar artery pseudoaneurysm with stent graft and coiling of the interosseous branch.

A carotid web is a shelf-like intraluminal filling defect typically arising from the posterolateral wall of the proximal internal carotid artery. It is recognized as a possible cause of ischemic stroke in young adults. However, its etiopathogenesis is controversial and remains to be fully elucidated. The authors report de novo formation of a carotid web from an intimal dissection documented on serial imaging studies. The findings in this case suggest that a focal intimal dissection could be the underlying cause of a carotid web. Lower shear stress at the posterolateral wall of the proximal internal carotid artery is hypothesized to be a predisposing factor and explains the predilection of a carotid web for this specific location.

Active surveillance of renal masses, which includes serial imaging with the possibility of delayed treatment, has emerged as a viable alternative to immediate therapeutic intervention in selected patients. Active surveillance is supported by evidence that many benign masses are resected unnecessarily, and treatment of small cancers has not substantially reduced cancer-specific mortality. These data are a call to radiologists to improve the diagnosis of benign renal masses and differentiate cancers that are biologically aggressive (prompting treatment) from those that are indolent (allowing treatment deferral). Current evidence suggests that active surveillance results in comparable cancer-specific survival with a low risk of developing metastasis. Radiology is central in this. Imaging is used at the outset to estimate the probability of malignancy and degree of aggressiveness in malignant masses and to follow up masses for growth and morphologic change. Percutaneous biopsy is used to provide a more definitive histologic diagnosis and to guide treatment decisions, including whether active surveillance is appropriate. Emerging applications that may improve imaging assessment of renal masses include standardized assessment of cystic and solid masses and radiomic analysis. This article reviews the current and future role of radiology in the care of patients with renal masses undergoing active surveillance.

Sagittal parameters of the spine are closely related to the evaluation and treatment of spine disease. However, there has been little research on variations in preoperative sagittal spinal alignment. This study was conducted to assess the variation in sagittal spinal alignment on serial antero-posterior and latero-lateral projections (EOS imaging) in adult patients before spine surgery. The sagittal parameters of 66 patients were collected from two serial images. Comparison between the first and second sagittal parameters was evaluated using the Wilcoxon signed-rank test. Subgroup analysis was performed based on the time interval between radiographs, patient’s age, and type of surgery. The sagittal vertical axis (SVA) exhibited statistically significant changes (p = 0.023), with the mean SVA increasing statistically (61.7 mm vs. 73.6 mm) and standard deviation increasing (51.5 mm vs. 61.6 mm) in the second image. Subgroup analysis showed significant differences in SVA (p = 0.034) in patients with an interval of &gt, 3 months, statistical differences in borderline levels in the SVA (p = 0.049) were observed in patients aged &gt, 65 years. Other parameters did not show statistically significant differences, except for SVA. Furthermore, SVA differences were statistically significant with increases in the EOS interval (&gt, 3 months) and patient age (&gt, 65 years).

A 9-year-old male with history of mixed hearing loss presented with petrous apex lesion following episode of meningitis. Serial imaging revealed persistence of the lesion necessitating biopsy to rule out malignancy. Biopsy revealed inflammatory changes. The management of petrous apex lesions following meningitis can be conservative but repeat imaging is necessary to rule out progression and to rule out neoplastic process.

Spinal oncology has had many advancements often necessitating serial imaging for post-surgical treatment planning and close follow up. Traditional spinal instrumentation introduces artifact into MRI and CT imaging, which can reduce the efficacy of follow up imaging and treatment. Newly created carbon-fiber instrumentation can offer many advantages compared to traditional instrumentation while typically maintaining biomechanical stability. The utility of this new instrumentation continues to evolve as more surgeons utilize these materials, which can improve patient outcomes. We illustrate the utility of this new hardware technology through various patient examples., Carbon fiber, Oncology, Radiation, Reconstruction.

Background: Epidural hematomas are common intracranial pathologies secondary to traumatic brain injuries and are associated with overlying skull fractures up to 85% of the time. Although many require immediate surgical evacuation, some are observed for stability and followed up conservatively with serial imaging or enlarge slowly overtime, similar to chronic subdural hematomas. Those in the latter category may present with vague symptoms such as diplopia or headache and are often found on routine outpatient evaluation. When concerning findings such as significant mass effect are present, surgical evacuation is necessary. Case Description: Here, we present the case of a 32-year-old man who presented with diplopia 6 weeks after experiencing head trauma and was found to have a chronic epidural hematoma. On resection, thick, inflammatory tissue was observed and carefully resected, revealing normal dura underneath. Six weeks after evacuation of the hematoma, the patient had near-complete resolution of his diplopia and complete resolution of his epidural hematoma. Conclusion: Given the consistency and nature of the fibrous material observed intraoperatively in this case, near-complete resection of the tissue was likely necessary to help facilitate adequate reexpansion of brain parenchyma and improve clinical outcomes.

Patients with aortic enlargement are recommended to undergo serial imaging and clinical follow-up until they reach surgical thresholds. This study aimed to identify aortic diameter and care of patients with aortic imaging before aortic dissection (AD). In a retrospective cohort of AD patients, we evaluated previous imaging results in addition to ordering providers and indications. Imaging was stratified as1 or1 year: 62 patients (53% men) had aortic imaging before AD (most recent test: 82% echo, 11% computed tomography, 6% magnetic resonance imaging). Imaging was ordered most frequently by primary care physicians (35%) and cardiologists (39%). The most frequent imaging indications were arrhythmia (11%), dyspnea (10%), before or after aortic valve surgery (8%), chest pain (6%), and aneurysm surveillance in 13%. Of all patients, 94% had aortic diameters below the surgical threshold before the AD. Imaging was performed1 year before AD in 47% and aortic size was 4.4 ± 0.8 cm in ascending aorta and 4.0 ± 0.8 cm in sinus. In patients whose most recent imaging was1 year before AD (1,317 ± 1,017 days), the mean ascending aortic diameter was 4.2 ± 0.4 cm. In conclusion, in a series of patients with aortic imaging before AD, the aortic size was far short of surgical thresholds in 94% of the group. In50%, imaging was last performed1 year before dissection.

Simple Summary As the optimal strategy for early surveillance after first complete response is unclear in Hodgkin lymphoma (HL), with the aim to identify the best one, we analyzed surveillance strategies after first-line treatment in a group of 640 Hodgkin lymphoma patients from 15 different GELTAMO centers in Spain. In this study, we have demonstrated that surveillance approaches with imaging in HL do not provide benefits for patient survival, nor do they anticipate relapse. Our results are of great importance, because they could contribute to improve the follow up after first complete response of this group of patients. Abstract The optimal strategy for early surveillance after first complete response is unclear in Hodgkin lymphoma. Thus, we compared the various follow-up strategies in a multicenter study. All the included patients had a negative positron emission tomography/computed tomography at the end of induction therapy. From January 2007 to January 2018, we recruited 640 patients from 15 centers in Spain. Comparing the groups in which serial imaging were performed, the clinical/analytical follow-up group was exposed to significantly fewer imaging tests and less radiation. With a median follow-up of 127 months, progression-free survival at 60 months of the entire series was 88% and the overall survival was 97%. No significant differences in survival or progression-free survival were found among the various surveillance strategies. This study suggests that follow-up approaches with imaging in Hodgkin lymphoma provide no benefits for patient survival, and we believe that clinical/analytical surveillance for this group of patients could be the best course of action.

In patients at risk of ascending aortic dissection, timing of surgery typically is based on serial imaging measurements of aortic diameter. Clearly, the risk of dissection in an individual patient is higher at larger aortic diameters. Even so, from a population point-of-view, most acute dissections occur in patients with a diameter below the recommended threshold for prophylactic root replacement. In this issue of Heart , Heuts and colleagues1 evaluated the hypothesis that measures of aortic length and volume would be better predictors of the risk of dissection than diameter alone. (figure 1) In an observation cohort study of 477 consecutive patients with a Type A aortic dissection, 96% did not meet the surgical diameter threshold of 55 mm before dissection onset. Compared with a cohort 75 patients with an aortic aneurysm who did not suffer a dissection, the positive predictive values of aortic measurements for prediction of dissection were 20% for maximal aortic diameter, 55% for aortic volume and 70% for aortic length. Figure 1 Methodology of the three different aortic measurements in a patient with TAA and a patient with pre-ATAAD.(A–C) demonstrate aortic measurements in a patient with TAA. panel a depicts a stretched view of the curved planar CT reconstruction with diameter measurement perpendicular to the centreline. the two right …