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Autism spectrum disorder (ASD) is a wide range of diseases characterized by difficulties with social skills, repetitive activities, speech, and nonverbal communication. The Centers for Disease Control (CDC) estimates that 1 in 44 American children currently suffer from ASD. The current gold standard for ASD diagnosis is based on behavior observational tests by clinicians, which suffer from being subjective and time-consuming and afford only late detection (a child must have a mental age of at least two to apply for an observation report). Alternatively, brain imaging—more specifically, magnetic resonance imaging (MRI)—has proven its ability to assist in fast, objective, and early ASD diagnosis and detection. With the recent advances in artificial intelligence (AI) and machine learning (ML) techniques, sufficient tools have been developed for both automated ASD diagnosis and early detection. More recently, the development of deep learning (DL), a young subfield of AI based on artificial neural networks (ANNs), has successfully enabled the processing of brain MRI data with improved ASD diagnostic abilities. This survey focuses on the role of AI in autism diagnostics and detection based on two basic MRI modalities: diffusion tensor imaging (DTI) and functional MRI (fMRI). In addition, the survey outlines the basic findings of DTI and fMRI in autism. Furthermore, recent techniques for ASD detection using DTI and fMRI are summarized and discussed. Finally, emerging tendencies are described. The results of this study show how useful AI is for early, subjective ASD detection and diagnosis. More AI solutions that have the potential to be used in healthcare settings will be introduced in the future.

Hepatocellular carcinoma (HCC) is the most common primary hepatic neoplasm. Thanks to recent advances in computed tomography (CT) and magnetic resonance imaging (MRI), there is potential to improve detection, segmentation, discrimination from HCC mimics, and monitoring of therapeutic response. Radiomics, artificial intelligence (AI), and derived tools have already been applied in other areas of diagnostic imaging with promising results. In this review, we briefly discuss the current clinical applications of radiomics and AI in the detection, segmentation, and management of HCC. Moreover, we investigate their potential to reach a more accurate diagnosis of HCC and to guide proper treatment planning.

Globally, renal cancer (RC) is the 10th most common cancer among men and women. The new era of artificial intelligence (AI) and radiomics have allowed the development of AI-based computer-aided diagnostic/prediction (AI-based CAD/CAP) systems, which have shown promise for the diagnosis of RC (i.e., subtyping, grading, and staging) and prediction of clinical outcomes at an early stage. This will absolutely help reduce diagnosis time, enhance diagnostic abilities, reduce invasiveness, and provide guidance for appropriate management procedures to avoid the burden of unresponsive treatment plans. This survey mainly has three primary aims. The first aim is to highlight the most recent technical diagnostic studies developed in the last decade, with their findings and limitations, that have taken the advantages of AI and radiomic markers derived from either computed tomography (CT) or magnetic resonance (MR) images to develop AI-based CAD systems for accurate diagnosis of renal tumors at an early stage. The second aim is to highlight the few studies that have utilized AI and radiomic markers, with their findings and limitations, to predict patients’ clinical outcome/treatment response, including possible recurrence after treatment, overall survival, and progression-free survival in patients with renal tumors. The promising findings of the aforementioned studies motivated us to highlight the optimal AI-based radiomic makers that are correlated with the diagnosis of renal tumors and prediction/assessment of patients’ clinical outcomes. Finally, we conclude with a discussion and possible future avenues for improving diagnostic and treatment prediction performance.

Bladder cancer (BC) is the 10th most common cancer globally and has a high mortality rate if not detected early and treated promptly. Non-muscle-invasive BC (NMIBC) is a subclassification of BC associated with high rates of recurrence and progression. Current tools for predicting recurrence and progression on NMIBC use scoring systems based on clinical and histopathological markers. These exclude other potentially useful biomarkers which could provide a more accurate personalized risk assessment. Future trends are likely to use artificial intelligence (AI) to enhance the prediction of recurrence in patients with NMIBC and decrease the use of standard clinical protocols such as cystoscopy and cytology. Here, we provide a comprehensive survey of the most recent studies from the last decade (N = 70 studies), focused on the prediction of patient outcomes in NMIBC, particularly recurrence, using biomarkers such as radiomics, histopathology, clinical, and genomics. The value of individual and combined biomarkers is discussed in detail with the goal of identifying future trends that will lead to the personalized management of NMIBC.

In this systematic review, we report the safety and efficacy of embolization for treating hemarthrosis in patients with bleeding diatheses with or without a history of prior arthroplasty. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, MEDLINE, and SCOPUS databases of patients undergoing embolization for hemarthrosis. Demographic data, clinical history, angiographic findings, interventions, and outcomes were extracted and tabulated. The search identified 97 unique titles of which 15 were deemed relevant comprising 78 patients with coagulopathies undergoing 93 embolization procedures. Mean follow-up time was 29 months (range 3–116.5). In the 29 patients who underwent arthroplasty prior to embolization for hemarthrosis, there were 11 bleeding recurrences (37.9%). Of these patients who experienced recurrences, 10 underwent repeat embolization as coagulation factor replacement was not sufficient to address the re-bleeding. In the 49 patients with bleeding diatheses who underwent embolization for hemarthrosis with no history of prior arthroplasty, there were 11 recurrences (22.4%) and 4 of these patients underwent repeat embolization with favorable results. There were four major procedure-related complications. Transarterial embolization is safe and effective in addressing recurrent hemarthrosis in patients with bleeding diatheses with or without a history of arthroplasty of the affected joint.

To evaluate the predictive power of arterial injury detected on contrast-enhanced CT (trauma CT (tCT)) imaging obtained prior to selective angiography for treatment of patients with traumatic abdominal and pelvic injuries. A retrospective chart review was performed of all patients who underwent angiography after undergoing contrast-enhanced CT imaging for the evaluation/treatment of traumatic injuries to the abdomen and pelvis between March 2014 and September 2018. Data collection included demographics, pertinent history and physical findings, CT and angiography findings, treatment information, and outcomes. Eighty-nine (63 males, mean age = 45.8 ± 20.5 years) patients that were found to have 102 traumatic injuries on tCT and subsequently underwent angiography met inclusion criteria for this study. Sixty-four injuries demonstrated evidence of traumatic vascular injury on initial tCT. A negative tCT was able to predict subsequent negative angiography in 83% of cases (negative predictive power = 83%). The ability of tCT to rule out a positive finding on subsequent angiography was also 83% (sensitivity = 83%). The average systolic blood pressure and hemoglobin concentration at the time of tCT were higher in patients who had positive tCT than in patients with negative tCT (p

Purpose: For transradial interventions, most published studies report an initial Terumo Radial (TR) band placement time of 60 minutes, with gradual deflation over 30 to 90 minutes. We aimed to determine, retrospectively, whether TR band removal time could be expedited to 45 to 60 minutes, without adverse effects via an expedited single-step deflation protocol. Methods: A total of 115 consecutive noncoronary visceral interventions that utilized TR band from September 2017 till February 2019 were retrospectively reviewed. Alternative single-step deflation protocol was utilized where the nursing staff was instructed to deflate the TR band in 1 step between 45 and 60 minutes; 79 patients (43 men, 36 women, mean age of 55.3 ± 13.6 years) underwent 115 transradial interventions. Mean procedure time was 49.8 ± 22.1 minutes, and mean fluoroscopy time was 18.5 ± 10.6 minutes. Data collected included patient demographics, procedure details, and nursing notes on complications including bleeding and reinflation of the TR band. Univariate and Multivariate analyses of independent variables were performed using a binary logistic regression model. All patients were followed up postoperatively before discharge and in clinic upon follow-up. Results: The TR band was deflated at 51.3 ± 14.5 minutes, with successful removal achieved on the first attempt in 103 cases (90.3% primary technical success rate). In 12 cases, bleeding was noted upon initial deflation, secondary technical success was achieved when the band was reinflated for an additional mean time of 37.0 ± 19.1 minutes. There was 1 incidence of radial artery occlusion (0.8%) and 1 incidence of a grade 1 hematoma (0.8%). The only variable predictive of technical outcome upon initial band deflation on univariate binomial logistic regression was initial TR band removal time ( P = .019). Conclusions: A single-step deflation protocol for TR band placement may be safe for nonocclusive patent hemostasis and may translate to even further shorten postprocedural hospital times for patients and cost savings for hospitals.

Transjugular intrahepatic portosystemic shunt (TIPS) is an alternative interventional procedure used to manage refractory Budd-Chiari syndrome (BCS) when conservative medical therapy has failed. However, TIPS is not always technically successful because of hepatic vein thrombosis and inability to catheterize the hepatic veins. In these situations, direct intrahepatic portosystemic shunt (DIPS) with access to the portal vein from the IVC has been shown to be a viable alternative that may ameliorate portal hypertension in these patients. Typically, DIPS involves the use of transabdominal ultrasound to target the portal vein. Herein a case in which a 39-year-old female underwent DIPS without the use of ultrasound guidance is presented. Instead, a hepatic venogram generated using collateral circulation was used to opacify and guide access to the portal vein.

Artificial intelligence is a rapidly evolving computerized technology affecting multiple aspects of our lives. It is predicted that artificial intelligence will lead to a fundamental change in practice of many professional fields, including medicine. One of the most significant advances in artificial intelligence involves digital imaging and image recognition. Consequently, radiologists, who work in the most digitalized field of medicine, need to be familiar with this rapidly progressing technology. “Artificial intelligence,” “machine learning,” and “deep learning” are terms that tend to be used interchangeably in terms of advanced computer algorithms, but each has a different meaning. Objectives for this article are to demystify these terms for radiologists and to establish a basic understanding of this topic for the reader. We also discuss the impact that artificial intelligence might have on the field of radiology in the foreseeable future. Although artificial intelligence is unlikely to replace radiologists any time soon (if ever), we explore how this technology could be beneficial to radiologists.

Purpose To evaluate the safety and efficacy of sacroplasty for the treatment of osteoporotic and malignant sacral fractures by performing a systematic review and meta-analysis of existing literature. Materials and Methods PubMed, Web of Science, and SCOPUS databases were searched from their inception until February 2018 for articles describing sacroplasty. Inclusion criteria were as follows: studies reporting > 5 patients, and pain assessment before and after the procedure recorded with visual analog scale (VAS). Demographic data, procedural details, technical success rates, VAS scores before and after the procedure, and procedural complications were recorded. A random-effects meta-analyses of the VAS pain score before the procedure, at 24–48 hours, at 6 months, and at 12 months were calculated. Results Nineteen studies (18 case series and 1 cohort study) were identified consisting of 861 total patients (682 women and 167 men; mean age 73.89 ± 9.73 years). Patients underwent sacroplasty for the following indications: sacral insufficiency fractures secondary to osteoporosis (n = 664), malignancy (n = 167), and nonspecified sacral insufficiency fractures (n = 30). Technical and clinical successes were achieved in 98.9% (852/861) and 95.7% (623/651) of patients undergoing sacroplasty, respectively. The pooled major complication rate was 0.3%, with 3 patients requiring surgical decompression for cement leakage. Random-effects meta-analyses demonstrated statistically significant differences in the VAS pain level at preprocedure, 24–48 hours, 6 months, and 12 months, with cumulative pain scores of 8.32 ± 0.01, 3.55 ± 0.01, 1.48 ± 0.01, and 0.923 ± 0.01, respectively. Conclusions Sacroplasty appears safe and effective for pain relief in patients with osteoporotic or malignant sacral fractures, with statistically significant sustained improvement in VAS pain scores up to 12 months.

Objectives: The integrated interventional radiology (IR) residency has only been established relatively recently as compared to other specialties. Although some preliminary information is available based on survey data five, no comprehensive bibliometric analysis documenting the importance of the quantity and quality of research in applying to an integrated-IR program currently exists. As the first bibliometric analysis of matched IR residents, the data obtained from this study fills a gap in the literature. Materials and Methods: A list of matched residents from the 2018 integrated-IR match were identified by contacting program directors. The Scopus database was used to search for resident research information, including total publications, first-author publications, radiology-related publications, and h-indices. Each matriculating program was categorized into one of five tiers based on the average faculty Hirsch index (h-index). Results: Sixty-three programs and 117 matched residents were identified and reviewed on the Scopus database. For the 2018 cycle, 274 total publications were produced by matched applicants, with a mean of 2.34 ± 0.41 publication per matched applicant. The average h-index for matched applicants was 0.96 ± 0.13. On univariate analysis, the number of radiology-related publications, highest journal impact factor, and h-index were all associated with an increased likelihood of matching into a higher tier program (P < 0.05). Other research variables displayed no statistical significance. All applicants with PhDs matched into tier one programs. Conclusions: Research serves as an important element in successfully matching into an integrated-IR residency. h-index, number of radiology-related manuscripts, and highest journal impact factors are all positively associated with matching into a higher tier program.

Objective: Symposiums are great avenues to expose students to interventional radiology (IR) and gauge their interest in the field. This study compares student interest and knowledge of the specialty before and after a state- wide IR symposium. Materials and Methods: A state-wide IR symposium consisted of lecture didactics and interactive hands-on IR simulations. Pre-symposium and post-symposium survey assessments were provided to each attendee to complete. The surveys remained anonymous and were performed for quality assurance purposes. The survey included questions on knowledge of IR, interest in IR, application strategies for the IR match, and career options in IR. Results: A total of 101 medical students registered for the symposium. Thirty-nine completed the pre-symposium survey and 40 completed the post-symposium survey. About 71.1% of the respondents reported “Little Knowledge” of IR before the symposium, which decreased to 40.5% after the symposium. Furthermore, 21% of the respondents believed that they had a “Good Foundation” in IR before the symposium and 59.5% after the symposium (P < 0.0001). The percentage of students planning to pursue IR increased from 35.9% to 45.9% (P = 0.160) after the symposium. About 77.8% reported that having an IR clinic is important in their career in the post-symposium survey compared to 64.1% in the pre-symposium survey (P = 0.077). Conclusions: Symposiums are an effective method in exposing medical students to IR. Students have expressed both strong interest in the field and increased knowledge post-symposium. Prospective applicants have reported dual applying to the integrated IR and diagnostic radiology (DR) residencies due to their concern about the competitive nature of integrated IR due to small number of positions available.

To evaluate the safety and effectiveness of n-butyl cyanoacrylate (NBCA) for portal vein embolization (PVE) when used to induce contralateral future liver remnant (FLR) hypertrophy in patients undergoing planned hepatic resection for hepatic malignancy.The PubMed database (including articles indexed by MEDLINE) was searched for articles published from 1970 to 2018 describing patients treated with PVE utilizing NBCA to induce hypertrophy of the FLR prior to contralateral hepatic lobe resection. Demographic data, embolization technique, complications of embolization, resultant FLR hypertrophy, and surgical outcomes were obtained when available. A meta-analysis was performed to determine the cumulative relative hypertrophy rate of the FLR following PVE with NBCA.The literature search yielded 18 relevant articles. Six hundred and seven patients (383 men, 220 women; mean age 60.7 years) with procedures describing PVE utilizing NBCA were reviewed. The most common underlying hepatic malignancies were colorectal metastases (n = 348), followed by cholangiocarcinomas (n = 92), and hepatocellular carcinomas (n = 89). Technical success was reportedly achieved in 603/607 patients, for a success rate of 99.3%. Fixed effects meta-analysis of the relative hypertrophy rate of the FLR among studies resulted in an aggregate rate of 49.4 ± 1.3%. Of the patients who underwent attempted PVE, 461/607 (75.9%) eventually underwent surgical resection. Major complications following PVE occurred in 19 patients (3.13%), while minor complications following PVE occurred in 38 patients (6.26%).PVE utilizing NBCA to induce hypertrophy of the FLR prior to contralateral lobe resection in the setting of hepatic malignancy is safe and effective.Level IIa-Systematic review of cohort studies.

A 38-year-old female was brought to the trauma emergency room after sustaining multiple gunshot wounds to the right chest and abdomen. She had pulmonary contusions involving the right lung and a haemopneumothorax initially managed with chest tube placement. A few weeks into her hospitalisation, she was found to have a giant right pulmonary artery pseudoaneurysm, which corresponded to a bullet tract. The pseudoaneurysm was causing a steal phenomenon and impaired perfusion of the right middle lobe and right lower lobe. Endovascular coil embolisation of the pseudoaneurysm was performed with restoration of perfusion to the right lung.

Spontaneous intrahepatic portal venous shunts are rare with only few case reports published. Treatments using various endovascular techniques have been described, although no single technique has been shown to be preferred. We present a patient who was referred for treatment of a spontaneous portal venous shunt and describe our treatment approach and present a review on previously reported cases.

We present two cases of umbilical hernia incarceration following large volume paracentesis (LVP) in patients with cirrhotic ascites. Both patients became symptomatic within 48 hours after the LVP. Although being rare, given the significantly higher mortality rate of cirrhotic patients undergoing emergent herniorrhaphy, this complication of LVP is potentially serious. Therefore, it is recommended that patients be examined closely for the presence of umbilical hernias before removal of ascitic fluid and an attempt should be made for external reduction of easily reducible hernias, if a hernia is present.

Purpose To evaluate the feasibility and safety of performing image-guided bland embolization and chemoembolization as an outpatient-based procedure in selected patients with hepatocellular carcinoma (HCC). Materials and Methods This is a retrospective review of the authors' experience with outpatient embolization and chemoembolization from January 2005 to June 2006. Patients with nonresectable HCC not eligible for liver transplantation were enrolled. Patients with Child-Pugh class A and early class B liver disease were treated by using the outpatient protocol, patients with Child-Pugh class C and late class B liver disease and those with elevated bilirubin or creatinine levels were excluded and treated as inpatients or denied embolization therapy. One hundred thirty-three bland embolizations or chemoembolizations were performed in 77 patients on an outpatient basis during the study period. Results Patients were discharged home on the same day after 131 of the 133 procedures (99%; 95% confidence interval [CI]: ±2%), in two cases (2%, 95% CI: ±2%), patients were admitted the day of the procedure. In two of the 131 cases (2%, 95% CI: ±2%), patients discharged home returned to the emergency department 1–6 days after the procedure. One hundred twenty-nine of the 133 cases (97%, 95% CI: ±3%) were successfully treated by using the outpatient embolization or chemoembolization protocol, with subsequent hospitalization needed in only four of 133 cases (3%, 95% CI: ±3%). Conclusions Image-guided hepatic bland embolization and chemoembolization performed with an outpatient protocol in carefully selected patients with HCC with aggressive follow-up is safe, with relatively few complications and few requirements for admission or revisitation to the emergency department.

Intravascular synovial sarcoma (IVSS) is an extremely rare tumor with only four well-documented cases in the English literature. All tumors were located in large veins of the lower extremities or trunk in young women except for one case occurring in a 54-yr-old woman. We report here an additional case of IVSS arising from the superior vena cava in a 32-yr-old woman who presented with a cervical mass and superior vena cava syndrome. A fine-needle aspiration biopsy (FNAB) was performed and showed a malignant biphasic tumor with spindle cell and epithelioid components. The tumor cells were negative for CD31, CD34, factor VIII, desmin, smooth muscle actin, and S-100 protein, and had positive staining for vimentin and cytokeratin (AE1/AE3) predominantly in the spindle and epithelial components, respectively. A diagnosis of synovial sarcoma was made and confirmed in a subsequent transvascular biopsy demonstrating chromosomal translocation t(X, 18) by fluorescence in situ hybridization using a dual color, breakapart-style probe for SYT. Although clinically similar to previously reported IVSS, this is the first case arising in large veins of the upper portion of the trunk and diagnosed by FNAB. Diagn. Cytopathol. 2006; 34:834–838. © 2006 Wiley-Liss, Inc.

This article outlines the use of liquid acrylic adhesives in the management of congenital vascular malformations. Specifically, the chemical features of cyanoacrylates, including the physical and chemical properties, exovascular use of cyanoacrylates, and the techniques for use of these agents, are discussed.

Arterio-ureteral fistulae are abnormal connections between an artery and the ureter and carry a high mortality. We present two cases of arterio-ureteral fistulae that presented with life-threatening hematuria. Both patients were treated with endovascular covered stent placement.

Uterine arteriovenous vascular malformations (UAVM) are uncommon and usually present in women of reproductive age. When these occur in a pregnant patient or in the immediate postpartum period, clinical presentation may overlap with several other entities such as retained products of conception (RPOC), postpartum endometritis, as well as gestational trophoblastic disease (GTD) [1]. We present a case of a UAVM that presented with life-threatening vaginal bleeding several months after dilatation and curettage (D&C) of a molar pregnancy. The UAVM was diagnosed with ultrasound (US) and magnetic resonance imaging (MRI), and subsequently treated with transarterial embolization (TAE).

Osteoid osteomas are benign bone lesions that present with bone pain in children and young adults. Over the last 2 decades, radiofrequency ablation has become the mainstay of treatment and is now preferred over surgical resection. Major complications of the procedure are very rare, consisting mostly of local skin burns. We present a case of a child presenting with a gluteal pseudoaneursym following CT-guided radiofrequency ablation of an acetabular osteoid osteoma, which was then treated successfully with percutaneous thrombin injection.

A lumbar intervertebral disc with a herniated nucleus pulposus (HNP) often exhibits a decrease in the height of the intervertebral space. Our purpose was to ascertain whether the loss of volume of an HNP is sufficient to cause a perceptible decrease in the height of the intervertebral space. MRI of 44 patients with 51 HNPs were reviewed. The volumes of the herniated material and of the intervertebral discs were calculated for every level from L 1–2 to L 5–S 1. The average volume of the HNP was 503 ± 301 mm3. The average volumes of all 220 intervertebral discs and of the 127 normal-appearing discs were 14 442 ± 4200 mm3 and 17 476 ± 2885 mm3 respectively. The average volume of the HNP represented 3.5 % of the parent disc. An average HNP caused a decrease in intervertebral space height of 0.35 mm (0.56 pixels). Therefore, the loss of the volume of the HNP does not cause a significant decrease in the intervertebral space height. The average calculated decrease in the disc height is less than that reported in normal diurnal variation.