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Background: Preoperative identification of the bowel on imaging is essential in planning renal access during percutaneous nephrolithotomy (PCNL) and avoiding colonic injury. We aimed this study to assess which noncontrast computed tomography (NCCT) window setting provides the optimal colonic identification for PCNL preoperative planning. Methods: Ten urologic surgeons (four seniors, six residents) reviewed 22 images of NCCT scans in both abdomen and lung window settings in a randomized blinded order. Colonic area delineation in each image was performed using a dedicated, commercially available area calculator software. A comparison of the marked colonic area between the abdomen and lung window settings was performed. Results: Overall, the mean marked colonic area was greater in the lung window compared with the abdomen window (8.82 cm2 vs 7.4 cm2, respectively, p < 0.001). Switching the CT window from abdomen to lung increased the identified colonic area in 50 cases (50%). Intraclass correlation showed good agreement between the senior readers and among all readers (0.92 and 0.87, respectively). Similar measurements of the colonic area in both abdomen and lung windows were observed in 26/44 (60%) of the seniors cases and in 7/66 (10%) of the resident cases (p = 0.002). Conclusion: Lung window solely or in combination with abdomen window appears to provide the most accurate colonic identification for preoperative planning of PCNL access and potentially reduce the risk of colonic injury. This pattern is more evident among young urologists, and we propose to introduce it as a standard sequence in PCNL preplanning. [ABSTRACT FROM AUTHOR]

Accurate volumetric assessment of spontaneous aneurysmal subarachnoid hemorrhage (aSAH) is a labor-intensive task performed with current manual and semiautomatic methods that might be relevant for its clinical and prognostic implications. In the present research, we sought to develop and validate an artificial intelligence-driven, fully automated blood segmentation tool for subarachnoid hemorrhage (SAH) patients via noncontrast computed tomography (NCCT) scans employing a transformer-based Swin-UNETR architecture. We retrospectively analyzed NCCT scans from patients with confirmed aSAH utilizing the Swin-UNETR for segmentation. The performance of the proposed method was evaluated against manually segmented ground truth data using metrics such as Dice score, intersection over union, volumetric similarity index , symmetric average surface distance , sensitivity, and specificity. A validation cohort from an external institution was included to test the generalizability of the model. The model demonstrated high accuracy with robust performance metrics across the internal and external validation cohorts. Notably, it achieved high Dice coefficient (0.873 ± 0.097), intersection over union (0.810 ± 0.092), volumetric similarity index (0.840 ± 0.131), sensitivity (0.821 ± 0.217), and specificity (0.996 ± 0.004) values and a low symmetric average surface distance (1.866 ± 2.910), suggesting proficiency in segmenting blood in SAH patients. The model's efficiency was reflected in its processing speed, indicating potential for real-time applications. Our Swin UNETR-based model offers significant advances in the automated segmentation of blood in SAH patients on NCCT images. Despite the computational demands, the model operates effectively on standard hardware with a user-friendly interface, facilitating broader clinical adoption. Further validation across diverse datasets is warranted to confirm its clinical reliability. [ABSTRACT FROM AUTHOR]

Intracranial hemorrhage (ICH) is a severe condition that requires rapid diagnosis and treatment. Automated methods for calculating ICH volumes can reduce human error and improve clinical decisioPlease provide professional degrees (e.g., PhD, MD) for the corresponding author.n-making. A novel automated method has been developed that is comparable to the ABC/2 method in terms of speed and accuracy while providing more accurate volumetric data. We developed a novel automated algorithm for calculating intracranial blood volume from computed tomography (CT) scans. The algorithm consists of a Python script that processes Digital Imaging and Communications in Medicine images and determines the blood volume and ratio. The algorithm was validated against manual calculations performed by neurosurgeons. Our novel automated algorithm for calculating intracranial blood volume from CT scans demonstrated excellent agreement with the ABC/2 method, with a median overall difference of just 1.46 mL. The algorithm was also validated in patient groups with ICH, epidural hematoma (EDH), and SDH, with agreement coefficients of 0.992, 0.983, and 0.997, respectively. The study introduces a novel automated algorithm for calculating the volumes of various ICHs (EDH, and SDH) within CT scans. The algorithm showed excellent agreement with manual calculations and outperformed the commonly used ABC/2 method, which tends to overestimate ICH volume. The automated algorithm offers a more accurate, efficient, and time-saving approach to quantifying ICH, EDH, and SDH volumes, making it a valuable tool for clinical evaluation and decision-making. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Hematoma expansion (HE) is common and predicts poor outcome in patients with supratentorial intracerebral hemorrhage (ICH). We investigated the predictors and prognostic impact of HE in infratentorial ICH. Methods: We conducted a retrospective analysis of patients with brainstem and cerebellar ICH admitted at seven sites. Noncontrast computed tomography images were analyzed for the presence of hypodensities according to validated criteria, defined as any hypodense region strictly encapsulated within the hemorrhage with any shape, size, and density. Occurrence of HE (defined as > 33% and/or > 6-mL growth) and mortality at 90 days were the outcomes of interest. Their predictors were investigated using logistic regression with backward elimination at p < 0.1. Logistic regression models for HE were adjusted for baseline ICH volume, antiplatelet and anticoagulant treatment, onset to computed tomography time, and presence of hypodensities. The logistic regression model for mortality accounted for the ICH score and HE. Results: A total of 175 patients were included (median age 75 years, 40.0% male), of whom 38 (21.7%) had HE and 43 (24.6%) died within 90 days. Study participants with HE had a higher frequency of hypodensities (44.7 vs. 24.1%, p = 0.013), presentation within 3 h from onset (39.5 vs. 24.8%, p = 0.029), and 90-day mortality (44.7 vs. 19.0%, p = 0.001). Hypodensities remained independently associated with HE after adjustment for confounders (odds ratio 2.44, 95% confidence interval 1.13–5.25, p = 0.023). The association between HE and mortality remained significant in logistic regression (odds ratio 3.68, 95% confidence interval 1.65–8.23, p = 0.001). Conclusion: Early presentation and presence of noncontrast computed tomography hypodensities were independent predictors of HE in infratentorial ICH, and the occurrence of HE had an independent prognostic impact in this population. [ABSTRACT FROM AUTHOR]

Abstract Background Haemorrhage transformation (HT) is a serious complication of intravenous thrombolysis (IVT) in acute ischaemic stroke (AIS). Accurate and timely prediction of the risk of HT before IVT may change the treatment decision and improve clinical prognosis. We aimed to develop a deep learning method for predicting HT after IVT for AIS using noncontrast computed tomography (NCCT) images. Methods We retrospectively collected data from 828 AIS patients undergoing recombinant tissue plasminogen activator (rt-PA) treatment within a 4.5-h time window (n = 665) or of undergoing urokinase treatment within a 6-h time window (n = 163) and divided them into the HT group (n = 69) and non-HT group (n = 759). HT was defined based on the criteria of the European Cooperative Acute Stroke Study-II trial. To address the problems of indiscernible features and imbalanced data, a weakly supervised deep learning (WSDL) model for HT prediction was constructed based on multiple instance learning and active learning using admission NCCT images and clinical information in addition to conventional deep learning models. Threefold cross-validation and transfer learning were performed to confirm the robustness of the network. Of note, the predictive value of the commonly used scales in clinics associated with NCCT images (i.e., the HAT and SEDAN score) was also analysed and compared to measure the feasibility of our proposed DL algorithms. Results Compared to the conventional DL and ML models, the WSDL model had the highest AUC of 0.799 (95% CI 0.712–0.883). Significant differences were observed between the WSDL model and five ML models (P

Background: Haemorrhage transformation (HT) is a serious complication of intravenous thrombolysis (IVT) in acute ischaemic stroke (AIS). Accurate and timely prediction of the risk of HT before IVT may change the treatment decision and improve clinical prognosis. We aimed to develop a deep learning method for predicting HT after IVT for AIS using noncontrast computed tomography (NCCT) images. Methods: We retrospectively collected data from 828 AIS patients undergoing recombinant tissue plasminogen activator (rt-PA) treatment within a 4.5-h time window (n = 665) or of undergoing urokinase treatment within a 6-h time window (n = 163) and divided them into the HT group (n = 69) and non-HT group (n = 759). HT was defined based on the criteria of the European Cooperative Acute Stroke Study-II trial. To address the problems of indiscernible features and imbalanced data, a weakly supervised deep learning (WSDL) model for HT prediction was constructed based on multiple instance learning and active learning using admission NCCT images and clinical information in addition to conventional deep learning models. Threefold cross-validation and transfer learning were performed to confirm the robustness of the network. Of note, the predictive value of the commonly used scales in clinics associated with NCCT images (i.e., the HAT and SEDAN score) was also analysed and compared to measure the feasibility of our proposed DL algorithms. Results: Compared to the conventional DL and ML models, the WSDL model had the highest AUC of 0.799 (95% CI 0.712–0.883). Significant differences were observed between the WSDL model and five ML models (P < 0.05). The prediction performance of the WSDL model outperforms the HAT and SEDAN scores at the optimal operating point (threshold = 1.5). Further subgroup analysis showed that the WSDL model performed better for symptomatic intracranial haemorrhage (AUC = 0.833, F1 score = 0.909). Conclusions: Our WSDL model based on NCCT images had relatively good performance for predicting HT in AIS and may be suitable for assisting in clinical treatment decision-making. [ABSTRACT FROM AUTHOR]

Background and Purpose: The effect of noncontrast CT (NCCT) on the eligibility for endovascular therapy (EVT) in an extended time window remains to be elucidated. We sought to assess the efficacy and safety of NCCT in comparison with CT perfusion (CTP) in selecting patients with acute ischemic stroke (AIS) for EVT 6‐24 hours after onset. Methods: PubMed, Embase, and Cochrane libraries were searched from inception to August 31, 2022, to identify all studies reporting 90‐day outcomes of EVT in patients with AIS in an extended time window. A meta‐analysis was performed for the pooled risk ratio (RR) with 95% confidence interval (CI) using a random‐effects model. The primary outcome used to assess efficacy was good functional independence, defined as a modified Rankin Scale score of 0‐2 at 90 days. Secondary outcomes included successful reperfusion, symptomatic intracranial hemorrhage (sICH), and mortality at 90 days. Results: We included four nonrandomized studies with a total of 2685 patients. The outcomes of good functional independence at 90 days (RR = 0.98; 95% CI: 0.88‐1.07; I2 = 0%; p =.62), successful reperfusion (RR = 0.98; 95% CI: 0.93‐1.03; I2 = 50.5%; p =.11), sICH (RR = 1.11; 95% CI: 0.55‐2.21; I2 = 49.4%; p =.12), or mortality at 90 days (RR = 1.18; 95% CI: 0.99‐1.40; I2 = 0%; p =.42) did not differ significantly between the two groups. Conclusions: These findings suggest that NCCT is as effective as CTP in selecting patients for EVT in an extended time window. [ABSTRACT FROM AUTHOR]

Key points Noncontrast computed tomography (NCCT) is valuable for predicting hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) treatment. Machine learning is vital for predicting HT. NCCT radiomics integrated with clinical factors could facilitate predicting HT.

Objective: To build a clinical–radiomics model based on noncontrast computed tomography images to identify the risk of hemorrhagic transformation (HT) in patients with acute ischemic stroke (AIS) following intravenous thrombolysis (IVT). Materials and methods: A total of 517 consecutive patients with AIS were screened for inclusion. Datasets from six hospitals were randomly divided into a training cohort and an internal cohort with an 8:2 ratio. The dataset of the seventh hospital was used for an independent external verification. The best dimensionality reduction method to choose features and the best machine learning (ML) algorithm to develop a model were selected. Then, the clinical, radiomics and clinical–radiomics models were developed. Finally, the performance of the models was measured using the area under the receiver operating characteristic curve (AUC). Results: Of 517 from seven hospitals, 249 (48%) had HT. The best method for choosing features was recursive feature elimination, and the best ML algorithm to build models was extreme gradient boosting. In distinguishing patients with HT, the AUC of the clinical model was 0.898 (95% CI 0.873–0.921) in the internal validation cohort, and 0.911 (95% CI 0.891–0.928) in the external validation cohort; the AUC of radiomics model was 0.922 (95% CI 0.896–0.941) and 0.883 (95% CI 0.851–0.902), while the AUC of clinical–radiomics model was 0.950 (95% CI 0.925–0.967) and 0.942 (95% CI 0.927–0.958) respectively. Conclusion: The proposed clinical–radiomics model is a dependable approach that could provide risk assessment of HT for patients who receive IVT after stroke. Key points: Noncontrast computed tomography (NCCT) is valuable for predicting hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) treatment. Machine learning is vital for predicting HT. NCCT radiomics integrated with clinical factors could facilitate predicting HT. [ABSTRACT FROM AUTHOR]

Aim and Objectives: The aim of this study is to demonstrate the outcomes of retrograde intrarenal surgery (RIRS) and Mini percutaneous nephrolithotomy (M-PCNL) in the management of 1–2 cm renal stones, with factors considered being operative time, duration of hospital stay, complication rate, and auxiliary procedure rate. Materials and Methods: This is a single-center, prospective study on patients diagnosed with 1–2 cm renal calculi between April 2018 and March 2020. Informed written consent was obtained from all the patients. A total of 60 patients were included in the study. Patients were divided into two groups – Group I and Group II; Group I: 30 patients who underwent RIRS and Group II: 30 patients who underwent Mini-PCNL-Mini percutaneous nephrolithotomy. Data were collected to compare the operative data, postoperative complications, duration of hospital stay, stone-free rate, and auxiliary procedure rate associated with RIRS and Mini pcnl for the treatment of 1–2 cm renal calculi. Inclusion criteria: All patients who presented with 1–2 cm renal calculi between April 2018 and March 2020 Age >15 years. Exclusion criteria: Stones larger than 2 cm and smaller than 1 cm. More than 3 stones in the pelvicalyceal system Pregnant women. Results: The mean age in the Mini Perc and RIRS groups was 30.40 ± 14.36 years and 39.20 ± 12.45 years, respectively, with no statistical significance. Of the 60 renal units, 66.7% were male and 33.3% were female in the Mini Perc group. In the RIRS group, 73.3% were male and 26.7% were female. There was no statistical significance. In the Mini Perc group, 53.3% were operated on the right side and 46.7% were operated on the left side, and in the RIRS group, 33.3% were operated on the right side and 66.7% were operated on the left side, with no statistical significance. The mean stone size in the Mini Perc group was 1.4 ± 0.37 cm and the mean stone size in the RIRS group was 1.3 ± 0.27 cm, with no statistical significance. Of the 60 renal units, 3.3% and 6.7% in Mini Perc and RIRS groups had diabetes alone, and 3.3% and 16.7% in Mini Perc and RIRS groups had hypertension alone. 3.3% in RIRS group had tuberculosis, 6.7% and 13.3% in Mini Perc and RIRS groups had both hypertension and diabetes, and 6.7% in Mini Perc group had diabetes with hypertension with coronary artery disease. The mean operating time in the Mini Perc group was 44.07 ± 9.05 min. The mean operating time in the RIRS group was 72.23 ± 11.01 min. There is statistical significance noted in terms of operating time. There were complications noted in both the groups, of which 6.7% and 16.7% in Mini Perc and RIRS groups had postoperative fever, and 3.3% and 6.7% in Mini Perc and RIRS groups had postoperative hematuria with no statistical significance noted. The mean postoperative pain in the first 24 h was 3.63 ± 1.35 in Mini Perc group, whereas it was 1.43 ± 0.72 in RIRS group; the mean postoperative pain at 48 h was 1.80 ± 0.96 in Mini Perc group, whereas it was 1.03 ± 0.18 in RIRS group, with significance between both the groups. The mean hemoglobin drop in Mini Perc group was 0.88 ± 0.44 g in Mini Perc group, whereas it was 0.99 ± 0.65 in RIRS group, with no statistical significance between both the groups. The mean stone clearance rate for Mini Perc group is 99% ± 5.47%, whereas it was 96.33% ± 10.98% in RIRS group, with no statistical significance. In comparison with both the groups, the retreatment rate was 3.3% in Mini Perc group and 13.3% in RIRS group, with no statistical significance. Conclusion: The result of this study revealed that between both the techniques, patients undergoing RIRS procedure had significantly less pain than Mini Perc, though RIRS procedure took longer operating times. We found that both the techniques were safe, in regard to complications (both intraoperative and postoperative), and there was no significant difference in hospital stay between the groups.

Based on mean Hounsfield Unit (HuMean), we aimed to evaluate the additional use of standard deviation of Hounsfield Unit (HuStd), minimum Hounsfield Unit (HuMin), and maximum Hounsfield Unit (HuMax) in noncontrast computed tomography (NCCT) to evaluate uric acid (UA) stones more accurately. The data of patients who underwent the NCCT examination and infrared spectroscopy in our hospital from August 2017 to December 2021 were analyzed retrospectively. Based on CT scans, the HuMean, HuStd, HuMin, and HuMax of all patients were measured. The patients were divided into groups according to the stone composition. The attenuation value of mixed stones was in the middle of their pure stones. Except for Str, statistically significant differences between UA stones and other pure stones were observed for HuMean, HuStd, HuMin, and HuMax. A moderate correlation was found between HuMean, HuStd, HuMin, and HuMax and UA stones (rs showed −0.585, −0.409, −0.492, and −0.577, respectively). Receiver operator characteristic (ROC) curve showed that the area under the curve (AUC) of HuMean and HuMax were higher than those of HuStd and HuMin (AUC = 0.896, AUC = 0.891 vs. AUC = 0.777, AUC = 0.833). Higher AUC (0.904), specificity (0.899) and positive predictive value (PPV) (0.712) can be obtained by combining HuMean and HuMax in the diagnosis of UA stones. In conclusion, HuMean and HuMax can better predict UA stones than HuStd and HuMin. The combined use of HuMean and HuMax can lead to higher accuracy. [ABSTRACT FROM AUTHOR]

Coronary artery calcium (CAC) is a specific marker of coronary atherosclerosis that can be used to measure calcified subclinical atherosclerotic burden. The Agatston method is the most widely used scoring algorithm for quantifying CAC and is expressed as the product of total calcium area and a quantized peak calcium density weighting factor defined by the calcification attenuation in HU on noncontrast computed tomography. Calcium density has emerged as an important area of inquiry because the Agatston score is upweighted based on the assumption that peak calcium density and atherosclerotic cardiovascular disease (ASCVD) risk are positively correlated. However, recent evidence demonstrates that calcium density is inversely associated with lesion vulnerability and ASCVD risk in population-based cohorts when accounting for age and plaque area. Here, we review calcium density by focusing on 3 main areas: 1) CAC scan acquisition parameters; 2) pathophysiology of calcified plaques; and 3) epidemiologic evidence relating calcium density to ASCVD outcomes. Through this process, we hope to provide further insight into the evolution of CAC scoring on noncontrast computed tomography. [Display omitted] • Coronary artery calcium is expressed as the product of calcium area and a quantized peak calcium density weighting factor. • Calcium density strongly and positively associates with age, which may correspond with the biological framework and natural progression of atherosclerosis. • Calcium density is inversely associated with lesion vulnerability and atherosclerotic cardiovascular disease risk in population-based cohorts when accounting for age and plaque area. • The presence of a calcium density >1,000 HU (1K plaque) is associated with a lower risk of acute coronary syndrome independent of traditional risk factors. • Mean calcium density performs better than peak calcium density factor when combined with plaque area for atherosclerotic cardiovascular disease mortality prediction among persons with limited coronary artery calcium burden. [ABSTRACT FROM AUTHOR]

Background/Aim In noncontrast computed tomography (NCCT), an apparently hyper-attenuated cerebral venous sinus (CVS) may lead to suspicion of CVS thrombosis. Understanding the factors affecting attenuation of CVS can guide us toward true diagnosis. Hence, the aim of the study was to determine the effect of different factors such as hematocrit, hemoglobin, age, blood urea nitrogen (BUN), creatinine, leukocyte and platelet count, and sex on the attenuation of CVS on brain NCCT.

Aim and Objectives: The aim of this study is to demonstrate the outcomes of retrograde intrarenal surgery (RIRS) and Mini percutaneous nephrolithotomy (M-PCNL) in the management of 1–2 cm renal stones, with factors considered being operative time, duration of hospital stay, complication rate, and auxiliary procedure rate. Materials and Methods: This is a single-center, prospective study on patients diagnosed with 1–2 cm renal calculi between April 2018 and March 2020. Informed written consent was obtained from all the patients. A total of 60 patients were included in the study. Patients were divided into two groups – Group I and Group II; Group I: 30 patients who underwent RIRS and Group II: 30 patients who underwent Mini-PCNL-Mini percutaneous nephrolithotomy. Data were collected to compare the operative data, postoperative complications, duration of hospital stay, stone-free rate, and auxiliary procedure rate associated with RIRS and Mini pcnl for the treatment of 1–2 cm renal calculi. Inclusion criteria: All patients who presented with 1–2 cm renal calculi between April 2018 and March 2020 Age >15 years. Exclusion criteria: Stones larger than 2 cm and smaller than 1 cm. More than 3 stones in the pelvicalyceal system Pregnant women. Results: The mean age in the Mini Perc and RIRS groups was 30.40 ± 14.36 years and 39.20 ± 12.45 years, respectively, with no statistical significance. Of the 60 renal units, 66.7% were male and 33.3% were female in the Mini Perc group. In the RIRS group, 73.3% were male and 26.7% were female. There was no statistical significance. In the Mini Perc group, 53.3% were operated on the right side and 46.7% were operated on the left side, and in the RIRS group, 33.3% were operated on the right side and 66.7% were operated on the left side, with no statistical significance. The mean stone size in the Mini Perc group was 1.4 ± 0.37 cm and the mean stone size in the RIRS group was 1.3 ± 0.27 cm, with no statistical significance. Of the 60 renal units, 3.3% and 6.7% in Mini Perc and RIRS groups had diabetes alone, and 3.3% and 16.7% in Mini Perc and RIRS groups had hypertension alone. 3.3% in RIRS group had tuberculosis, 6.7% and 13.3% in Mini Perc and RIRS groups had both hypertension and diabetes, and 6.7% in Mini Perc group had diabetes with hypertension with coronary artery disease. The mean operating time in the Mini Perc group was 44.07 ± 9.05 min. The mean operating time in the RIRS group was 72.23 ± 11.01 min. There is statistical significance noted in terms of operating time. There were complications noted in both the groups, of which 6.7% and 16.7% in Mini Perc and RIRS groups had postoperative fever, and 3.3% and 6.7% in Mini Perc and RIRS groups had postoperative hematuria with no statistical significance noted. The mean postoperative pain in the first 24 h was 3.63 ± 1.35 in Mini Perc group, whereas it was 1.43 ± 0.72 in RIRS group; the mean postoperative pain at 48 h was 1.80 ± 0.96 in Mini Perc group, whereas it was 1.03 ± 0.18 in RIRS group, with significance between both the groups. The mean hemoglobin drop in Mini Perc group was 0.88 ± 0.44 g in Mini Perc group, whereas it was 0.99 ± 0.65 in RIRS group, with no statistical significance between both the groups. The mean stone clearance rate for Mini Perc group is 99% ± 5.47%, whereas it was 96.33% ± 10.98% in RIRS group, with no statistical significance. In comparison with both the groups, the retreatment rate was 3.3% in Mini Perc group and 13.3% in RIRS group, with no statistical significance. Conclusion: The result of this study revealed that between both the techniques, patients undergoing RIRS procedure had significantly less pain than Mini Perc, though RIRS procedure took longer operating times. We found that both the techniques were safe, in regard to complications (both intraoperative and postoperative), and there was no significant difference in hospital stay between the groups. [ABSTRACT FROM AUTHOR]

Background The infarct growth rate (IGR) measures ischemic stroke progression and varies among patients. Clinicoradiological phenotypes of IGR are poorly understood. We evaluated the association of presentation stroke severity and early ischemic changes with infarct progression in patients who underwent successful thrombectomy. Methods This is a retrospective cohort observational study of consecutive endovascular therapy patients with anterior circulation large‐vessel occlusion strokes and successful reperfusion (modified Thrombolysis in Cerebral Ischemia≥2b) from 2 comprehensive stroke centers. National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT [Computed Tomography] Score (ASPECTS) were scored at admission. IGR was defined as the final infarct volume after endovascular therapy divided by the time from stroke onset to successful reperfusion. We used the Youden J index to identify the optimal IGR cutoff to stratify fast and slow progressors. A multivariate logistic regression was used to identify variables associated with a fast IGR and clinical outcomes. Results A total of 212 patients were included in the study. The optimal IGR threshold was 3.2 mL/h, and 135 patients (63.6%) were classified as fast progressors. Presentation National Institutes of Health Stroke Scale score (odds ratio [OR], 1.12; 95% CI, 1.06–1.19) and ASPECTS (OR, 0.56; 95% CI, 0.41–0.73) were accurate predictors of a fast IGR after adjusting for significant confounders. For each 1‐point increase in National Institutes of Health Stroke Scale score at admission, the likelihood of being a fast progressor increased by 12%; for each 1‐point increase in ASPECTS, the likelihood of being a fast progressor decreased by 44%. In the early window (≤6 hours), all patients with ASPECTS

To explore the diagnostic value of noncontrast computed tomography (NCCT) in differentiating pyonephrosis from nonpyogenic hydronephrosis on the basis of CT values (in Horsfield unit [HU]). Data from patients diagnosed with obstructive uropathy at the First affiliated hospital of University of South China from November 2017 to January 2021 were subjected to retrospective analysis. In accordance with the gold standard—the presence of pus during the operation—all patients were divided into the nonpyogenic hydronephrosis group and the pyonephrosis group. The relationship between CT values and the presence or absence of pyonephrosis was performed using binary logistic regression. A receiver operating characteristic (ROC) curve was constructed to determine threshold values for classification on the basis of mean HU. A total of 207 patients, including 100 males and 107 females, were enrolled. Out of the 207 cases, 124 cases of obstructive uropathy were nonpyogenic hydronephrosis and 83 cases were of pyonephrosis. The CT values of the pyonephrosis group were significantly higher than that of the nonpyogenic hydronephrosis group (t = 9.15, P < 0.05). The CT values were dependent on the presence or absence of pyonephrosis (P < 0.05). A HU threshold value of 9.75 could be applied to diagnose the presence of pyonephrosis. The CT values of hydronephrosis might predict the presence of pyonephrosis in the kidney, and the CT value of 9.75 HU might be the appropriate threshold for its prediction. • Noncontrast computer tomography: A non-invasive method to judge pyonephrosis. • Noncontrast computer tomography may speed up the treatment of pyonephrosis. • Sometimes urine tests are not reliable for pyonephrosis. [ABSTRACT FROM AUTHOR]

Objectives: Early hematoma expansion in intracerebral hemorrhage (ICH) patients is strongly associated with poor outcome and potentially preventable if high-risk patients are timely identified. We aimed to investigate whether a novel sign detected by noncontrast computed tomography (NCCT) named absolute hypodensity sign (AHS) was an appropriate candidate for hematoma expansion prediction. Materials and Methods: Spontaneous ICH patients all underwent baseline NCCT scan within 6 h after ICH onset and the follow-up NCCT scan within 24 h after initial CT scan. AHS was defined as a hypoattenuating area with a distinct margin within the hematoma, the minimal density of which should be ≤30 Hounsfeld units. We used univariate and multivariate logistic regression analyses for determining the association between hematoma expansion and the presence of AHS. We also compared the diagnostic efficacy with blend sign and black hole sign. Results: A total of 348 ICH patients were included, 87 of which were found hematoma expansion. AHS was positive in 76 patients (21.8%) (κ = 0.88 for interrater reliability) and 63.2% of the patients with hematoma expansion were observed AHS. The multivariate logistic regression analysis demonstrated AHS was an independent predictor for hematoma expansion (odds ratio: 33.454, 95% confidence interval: 13.628–82.126, P

Background/Aim In noncontrast computed tomography (NCCT), an apparently hyper-attenuated cerebral venous sinus (CVS) may lead to suspicion of CVS thrombosis. Understanding the factors affecting attenuation of CVS can guide us toward true diagnosis. Hence, the aim of the study was to determine the effect of different factors such as hematocrit, hemoglobin, age, blood urea nitrogen (BUN), creatinine, leukocyte and platelet count, and sex on the attenuation of CVS on brain NCCT. Material and Methods Total 1,680 patients were included in this study, and their demographic and laboratory data and brain NCCT were reviewed. In their brain NCCT, the average attenuation of superior sagittal sinus and both right and left sigmoid sinuses was measured. Data analysis was conducted using the Statistical Package for the Social Sciences version 21.0 software by Kolmogorov-Smirnov, Spearman's correlation coefficient, and multiple linear regression tests. The significance level was considered less than 0.05. Results Hematocrit (B = 0.251, p < 0.001), hemoglobin (B = 0.533, p < 0.001), and creatinine (B = − 0.270, p = 0.048) were determined as predictors of attenuation of superior sagittal sinus. For both sigmoid sinuses, hematocrit (p < 0.001) and hemoglobin (p < 0.001) were determined as positive predictors, and creatinine (p < 0.001) and BUN (p < 0.002) were determined as negative and positive predictors, respectively. Conclusion Hemoglobin, hematocrit, creatinine, and BUN are the main factors that should be considered in the assessment of CVS density on brain NCCT. As with increasing hematocrit and hemoglobin of the subject, the CVS density in NCCT increases, and with increasing creatinine and in some instance decreasing BUN of the subject, the CVS density in NCCT decreases. [ABSTRACT FROM AUTHOR]

Introduction: Non-contrast Computerised Tomography (NCCT) Brain is a common referral made from the Accident and Emergency (A&E) department both for traumatic and non traumatic causes. Aim: To evaluate the veracity of the referrals made by the Accident and Emergency Department clinicians for non-contrast computed tomography Head. Materials and Methods: This was the Retrospective evaluation of diagnostic yield of head Computed Tomography (CT) referrals made from A&E Department of a tertiary care hospital located in northern-central India over three year period between January 2015 to December 2017. CT reports were first grouped into two major group’s trauma and non trauma referrals with further subdivision into positive and negative scan on the basis of presence of abnormality. Subsequently, the positive trauma reports were classified into Major findings (three subgroups extra-axial haemorrhage, brain contusions and other miscellaneous findings) and minor findings like undisplaced fractures of the skull or facial bones with or without subgaleal haematoma. Distribution of trauma cases as per National Institute for Health and Care Excellence (NICE) criteria was then tabulated. Non-trauma reports were also further classified in to the two major clinically important findings of haemorrhage and infarct as well as non-specific minor findings. Results: Of the total data of 2185 head CT (980 trauma cases and 1205 in non trauma cases) referrals done by A&E Department during the study period. The 144 (58.5%) out of trauma cases and 328 (27.2%) out of non trauma cases were with major findings. 788 (80.4%) of trauma cases and 965 (80.1%) out of non trauma cases were referred by Medical Officer (MO)/ Resident as revealed from the audit. Positivity percentages for traumatic and non traumatic causes were 25.1% and 27.2%, respectively. Conclusion: Due to non adherence to existing guidelines or due to poor clinical knowledge, there is poor diagnostic yield of CT referrals made from A&E department. Thus clinical Audit is essential at Department of Radiodiagnosis to streamline the referring protocols and improves the overall efficiency of the healthcare system.

Aims And Objectives: We evaluated the role of Dyna CT in localizing HCC lesions and their selective vascular supply to help guide chemoembolization. We also evaluated the role of Dyna CT in assessing drug deposition within the lesion and predict the need of further drug delivery. Methods: 24 patients with documented HCC were taken up for TACE after a pre-procedural contrast CT and MRI. An intra-procedural Dyna CT was done in all patients to obtain a three dimensional overview of the vascular network. Selective cannulation of the tumor arteries was achieved using a combined digital subtraction angiography and Dyna CT image guidance. Additional lesions and vessels identified on Dyna CT were also treated. Drug deposition within the lesion marking technical success was assessed on completion Dyna CT and the need for additional drug delivery was assessed. Results: Contrast CT identified 36 lesions, DSA 33 lesions and Dyna CT 39 lesions in 24 patients. Dyna CT was the most sensitive for lesions <10 mm (p=0.006). Dyna CT identified 4 additional supplying lesion supplying arteries (2 hepatic, 2 extra hepatic) compared to DSA. In 6(25%) patients DYNA CT helped in improvement in catheter position in the form of more selective catheterization. 35 (90%) lesions showed homogenous Type 1 deposition, two lesions (5%) showed Type 2 and the other two (5%) showed type 3 deposition of lipoidol on completion Dyna CT. The latter two were further treated to achieve type 1 deposition and 100% technical success. Conclusion: Dyna CT can effectively guide TACE procedure by not only identifying the lesions and their vascular supply but also helping in guiding the catheter for selective cannulation and drug deposition. Completion Dyna CT can effectively assess drug deposition and the need for additional treatment in the same setting if needed. [ABSTRACT FROM AUTHOR]

Introduction: Non-contrast Computerised Tomography (NCCT) Brain is a common referral made from the Accident and Emergency (A&E) department both for traumatic and non traumatic causes. Aim: To evaluate the veracity of the referrals made by the Accident and Emergency Department clinicians for non-contrast computed tomography Head. Materials and Methods: This was the Retrospective evaluation of diagnostic yield of head Computed Tomography (CT) referrals made from A&E Department of a tertiary care hospital located in northern-central India over three year period between January 2015 to December 2017. CT reports were first grouped into two major group's trauma and non trauma referrals with further subdivision into positive and negative scan on the basis of presence of abnormality. Subsequently, the positive trauma reports were classified into Major findings (three subgroups extra-axial haemorrhage, brain contusions and other miscellaneous findings) and minor findings like undisplaced fractures of the skull or facial bones with or without subgaleal haematoma. Distribution of trauma cases as per National Institute for Health and Care Excellence (NICE) criteria was then tabulated. Non-trauma reports were also further classified in to the two major clinically important findings of haemorrhage and infarct as well as non-specific minor findings. Results: Of the total data of 2185 head CT (980 trauma cases and 1205 in non trauma cases) referrals done by A&E Department during the study period. The 144 (58.5%) out of trauma cases and 328 (27.2%) out of non trauma cases were with major findings. 788 (80.4%) of trauma cases and 965 (80.1%) out of non trauma cases were referred by Medical Officer (MO)/ Resident as revealed from the audit. Positivity percentages for traumatic and non traumatic causes were 25.1% and 27.2%, respectively. Conclusion: Due to non adherence to existing guidelines or due to poor clinical knowledge, there is poor diagnostic yield of CT referrals made from A&E department. Thus clinical Audit is essential at Department of Radiodiagnosis to streamline the referring protocols and improves the overall efficiency of the healthcare system. [ABSTRACT FROM AUTHOR]

Background Epicardial adipose tissue may be associated with the pathogenesis of coronary artery disease (CAD), but its effect on obstructive CAD risk is uncertain. Therefore, we aimed to examine the relationship between epicardial adipose tissue and obstructive CAD in Chinese patients with suspected CAD. Methods and Results The present study enrolled 194 consecutive inpatients with suspected CAD who underwent both noncontrast computed tomography and coronary angiography. We measured epicardial fat volume (EFV) and evaluated its association with obstructive CAD, which was defined as coronary stenosis severity ≥70%. Overall, 44.3% patients had obstructive CAD and tend to have higher EFV. Age, body mass index, triglycerides, incidence of hypertension, and hyperlipidemia were higher across tertiles of EFV (P for trend

Purpose: Early identification of ischemic stroke lesion regions plays a vital role in its treatments like thrombolytic therapy and patients' recovery. Noncontrast computed tomography (ncCT) is the most widespread imaging modality in emergency departments. Unfortunately, it is extremely hard to distinguish the lesion from healthy tissue during the hyper‐acute phase of stroke. In this paper, a two‐stage convolutional neural network‐based method was proposed to identify the invisible ischemic stroke from ncCT. Methods: In order to combine the global and local information of images effectively, a cascaded structure with two coordinated networks was used to detect the suspicious stroke regions on the whole and optimize the detailed localization. In the first stage, an end‐to‐end U‐net with adaptive threshold was proposed to integrate global position, symmetry and gray texture information to detect the suspicious regions. After reducing the interference from most normal regions, a ResNet‐based patch classification network was used to eliminate some false positive samples on suspicious regions by mining deeper image features, contributing to a more precise localization of stroke. Finally, a MAP model was used to optimize the result by combining the classification results of each patch with their spatial constraint information. Results: Three independent experiments, that is, training and testing on dataset from one hospital, on the combination of two, and on the two respectively, were performed on a total of 277 cases from two hospitals to validate the proposed model, The proposed method achieved identification accuracy of 91.89%, 87.21%, and 85.71% in the three experiments, and the final localization accuracy in terms of precise localization of stroke were 82.35%, 83.02%, and 81.40%, respectively, which indicated the robustness and clinical values of the method. Conclusions: There are some deep image feature differences between stroke region and normal region on ncCT images. The proposed two‐stage convolutional neural network model can well seize these features and use them to effectively identify and locate stroke. [ABSTRACT FROM AUTHOR]

Noncontrast computed tomography hypodensities (HD) and ultraearly hematoma growth (uHG) are reliable markers for outcome prediction in patients with spontaneous intracerebral hemorrhage (sICH). The present study aimed to assess whether the combination of these 2 markers could improve the prognostic value for sICH. We recruited 242 patients with sICH who had been admitted within 6 hours from the onset of symptoms. HD was assessed by 2 independent blinded readers, and uHG was calculated as baseline ICH volume/onset-to-imaging time. We divided the study population into 4 groups: uHG(L) HD(-) (uHG <6.16 mL/hour and HD negative), uHG(L) HD(+) (uHG<6.16 mL/hour and HD positive), uHG(H) HD(-) (uHG ≥6.16 mL/hour and HD negative), and uHG(H) HD(+) (uHG ≥6.16 mL/h and HD positive). The outcome at 90 days was evaluated by the modified Rankin Scale (mRS) score and was dichotomized as good (mRS score 0–3) and poor (mRS score 4–6). The association between the combined indicators and unfavorable outcome was investigated using multivariable logistic regression models. Patients with poor outcomes were more likely to have HD and higher uHG in univariate analysis. In multivariate logistic regression analysis, uHG(H) HD(+) had a higher risk of unfavorable outcomes compared with uHG(L) HD(-) (odds ratio [OR], 5.710; P < 0.001). In addition, the risk of unfavorable outcomes was increased in uHG(H) HD(-) (OR, 2.957, P = 0.044) and uHG(L) HD(+) (OR, 1.924; P = 0.232). The proportions of unfavorable prognoses were 32.6% in uHG(L) HD(-), 48.3% in uHG(L) HD(+), 72.2% in uHG(H) HD(-), and 87.5% in uHG(H) HD(+) (P < 0.001). The combination of uHG and HD improves the stratification of unfavorable prognoses in patients with sICH. [ABSTRACT FROM AUTHOR]

Background: We developed an image patch classification-based method to detect early ischemic stroke. The accuracy of this method was >75%. We aimed to analyze patients' image data to identify interference factors that would affect its accuracy. Methods: We conducted a retrospective analysis of 162 patients who were hospitalized with acute ischemic stroke. Factors related to the noncontrast computed tomography (ncCT) determination results were analyzed according to the patient's sex, age, clinical symptoms, cerebral infarction volume, cerebral infarction location, and whether or not the white matter high (WMH) signal was combined. Results: The volume of cerebral infarction was positively correlated with the predicted results. The correct percentages of patients with volumes >1 and <1 mL were 59.18 and 83.19%, respectively, and the difference was statistically significant (p = 0.001). The correct percentage of the internal capsule region (47.1%) was significantly lower than that of the other groups (p = 0.011). The correct percentage of lateral ventricular paraventricular infarction was significantly lower than that of non-lateral ventricle patients (70.8 vs. 85.7%). In patients with lateral ventricular paraventricular infarction, if the WMH was combined, the correct percentage will decreased further as the Fazekas level increased. The correct percentage of lateral ventricle infarction combined with Fazekas 3 was 40.0%, which was statistically significant compared with the patient having Fazekas 0 with lateral ventricular infarction (p = 0.01). Conclusions: WMH had a similar computed tomography appearance to cerebral infarction and could interfere with the prediction of the cerebral infarction region by ncCT. This result provides a reference for clinicians to choose imaging methods for identifying acute cerebral infarction areas. [ABSTRACT FROM AUTHOR]

Background: Early hematoma expansion in intracerebral hemorrhage (ICH) patients is associated with poor outcome. We aimed to investigate whether the minimal computed tomography (CT) attenuation value predicted hematoma expansion and poor outcome.Methods: This study involved spontaneous ICH patients of two cohorts who underwent baseline CT scan within 6 h after ICH onset and follow-up CT scan within 24 h after initial CT scan. We determined the critical value of the minimal CT attenuation value via retrospective analysis of the data from a derivation cohort. Then, a prospective study on the validation cohort of three clinical centers was performed for determining the association between the minimal CT attenuation value and hematoma expansion as well as poor outcome (modified Rankin Scale scores > 3) at 90 days by using univariate and multivariate logistic regression analyses.Results: One hundred and forty eight ICH patients were included in the derivation cohort. Minimal CT attenuation value ≤ 31 Hounsfield units (HU) was demonstrated as the critical value to predict hematoma expansion by using receiver operating characteristic analysis. A total of 311 ICH patients were enrolled in the validation cohort, 86 (27.7%) and 133 (42.8%) of which were found hematoma expansion and poor outcome. Minimal CT attenuation value ≤ 31 HU was positive in 73 patients (23.5%). The multivariate logistic regression analysis demonstrated minimal CT attenuation value and minimal CT attenuation value ≤ 31 HU independently predicted hematoma expansion (p < 0.001) and poor outcome (p < 0.001). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of minimal CT attenuation value ≤ 31 HU for hematoma expansion and poor outcome prediction were 64.0, 92.0, 75.3, 87.0, 84.2 and 45.1%, 92.7%, 82.2%, 69.3%, 72.3%, respectively.Conclusions: The minimal CT attenuation value independently predicts early hematoma expansion and poor outcome in patients with ICH. [ABSTRACT FROM AUTHOR]

Objectives: The characterization of markers capable of predicting clinically significant hematoma growth (HG) in patients with intracerebral hemorrhage (ICH) may be useful for the selection of patients for clinical trials. The use of several noncontrast computed tomography (NCCT) markers has been suggested to stratify the risk of HG. The aim of this study was to analyze HG prediction using different NCCT markers in patients with spontaneous ICH. Methods: Single-hospital retrospective study of patients with spontaneous ICH, who underwent initial NCCT <24 hours after symptom onset. Clinical characteristics were collected and two independent observers analyzed hemorrhage characteristics, volumes and 8 NCCT markers. HG was defined as a growth of ≥33% or ≥6mL in follow-up CT and 30-day survival was collected. Results: 328 patients were included. The most frequent NCCT marker was 'any hypodensity' (68.0%) and the less frequent was the blend sign (11.6%). HG occurred in 22.1% of patients and the only independent predictors for HG were 'any hypodensity' (OR=3.32, 95%CI=1.18–9.34, p=0.023) and the swirl sign (OR=3.98, 95%CI=1.41–11.21, p=0.009). Although all NCCT markers were more frequent in patients who died within 30 days, the only independent predictors were 'irregular margins' (OR=4.54, 95%CI=1.63–12.66, p=0.004) and the satellite sign (OR=2.49, 95%CI=1.07–5.75, p=0.034). NCCT markers with greater sensitivity for HG were 'any hypodensity' and the swirl sign, although with poor positive predictive values and poor areas under the curve. Conclusion: Even though some NCCT markers are independent predictors of HG and 30-day survival, they have suboptimal diagnostic test performances for such outcomes. Abbreviation: OR: odds ratio; 95%CI: 95% confidence interval [ABSTRACT FROM AUTHOR]

Upper gastrointestinal (GI) endoscopy is a safe procedure in the present gastroenterology practice. There are few complications related to the procedure and medications, which need to be observed carefully. We report a case of acute swelling of the right parotid gland which developed immediately after upper GI endoscopy.

• An effective radiomic system is proposed to identify the early ischemic stroke that is invisible to the radiologist in ncCT images. • A novel multi-scale symmetry image patch classification model is designed to detect the stroke regions. • A MAP model integrating the multi-scale and spatial constraint information is built to improve the identification performance. Early identification of stroke is critical for the treatment and subsequent recovery. Non-contrast computed tomography (ncCT) is a routinely employed imaging modality for stroke evaluation. However, the early identification of stroke in ncCT images is very difficult, since there are subtle differences between lesion and healthy tissue during the hyperacute phase. In this paper, an image patch classification-based method was developed to detect the early ischemic stroke that is invisible to the radiologist in ncCT. First, we proposed radiomics-based patch classification model to identify whether each patch in ncCT is stroke region or not. To improve the identification accuracy, a symmetry image patch classification was developed, in which an image patch in one brain hemisphere was combined with its contralateral image patch for classification. Second, based on the spatial dependencies between neighboring patches, we built a maximum a posteriori identification model which integrated the spatial constraint information to improve the identification performance. Finally, after performing morphological post-processing, we defined the detected results containing more than 300 voxels as the stroke region. 108 stroke cases that were all invisible to radiologists in ncCT were enrolled in the study and divided into one training cohort and two independent testing cohorts to validate the proposed method. The proposed method has achieved identification accuracies of 76.67% and 75.00% on the two independent testing cohorts, respectively. The results proved the potential of the proposed radiomics model in the task which possessed great clinical values. [ABSTRACT FROM AUTHOR]

Abstract Background Secondary neurological deterioration in patients with spontaneous intracerebral hemorrhage (sICH) develops within the first 24 or 48 h after ICH onset and appears to portend a poor prognosis. We aimed to verify whether hypodensities within an acute ICH detected by noncontrast computed tomography (NCCT) were able to predict secondary neurological deterioration and investigate which monitoring window was of the highest predictive value. Materials/methods This study involved sICH patients from three clinical centers of Fudan University between October 1, 2016 and March 31, 2018. Logistic regression analysis was used to assess the association between hypodensities and secondary neurological deterioration. The receiver operating characteristic curve of the subjects was performed to evaluate the critical value of the detection time window of hypodensities that best predicted the secondary neurological injury. Then, we divided the detection time window of hypodensities into 0–1.5 h, 1.5–3 h, 3–4.5 h and 4.5–6 h, and calculated the sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV) and accuracy respectively. Results A total of 240 ICH patients met the inclusion criteria, 97 (40.42%) of whom were observed secondary neurological deterioration. Hypodensities were positive in 113 patients (47.08%), and more common in patients with secondary neurological deterioration (76.25%). The multivariate logistic regression analysis demonstrated that infratentorial hemorrhage (P <.001), the baseline hematoma volume (P =.015), and the presence of hypodensities on admission CT scan (P <.001) were independent predictors of secondary neurological deterioration. The sensitivity, specificity, PPV, and NPV of hypodensities in predicting secondary neurological deterioration were 76.3%, 72.7%, 65.5%, and 81.9%, respectively. When the time to the baseline NCCT was 114.5 min, the hypodensities were of the highest predictive value. Besides, the risk of secondary neurological deterioration predicted by hypodensities detected during 1.5–3.0 h was higher than other time periods. Conclusions Hypodensities within hematoma detected by an NCCT scan may predict secondary neurological deterioration, independent of other clinical and imaging predictors. Hypodensities detected at 1.5–3.0 h after ICH onset have better predictive efficacy. Highlights • There has been no study working on the optimal detecting time of a certain NCCT imaging feature. • Hypodensities within hematoma detected by an NCCT scan may predict secondary neurological deterioration. • Hypodensities detected at 1.5–3.0 h after ICH onset have better predictive efficacy. [ABSTRACT FROM AUTHOR]

• The thresholding 3D segmentation method increased performance in predicting pure uric acid stones. • The variant coefficient of stone density measured using the thresholding 3D segmentation-based method showed higher prediction performance for discriminating pure uric acid stones than the mean stone density and stone heterogeneity index. • The incorporated pure uric acid stone predictive model using clinical predictive parameters and the variant coefficient of stone density demonstrated high predictive efficacy. Urinary stones are common urological diseases with increasing prevalence and incidence worldwide. Among the various types of stones, uric acid stones can be dissolved by oral chemolysis without any surgical procedure. Therefore, our study demonstrates that variant coefficient of stone density measured by thresholding a three-dimensional segmentation-based method from noncontrast computed tomography images can be used to identify pure uric acid stones from non-pure uric acid stones. This study provides a preoperative pure uric acid stone prediction model that could reduce invasive procedural treatments. The pure uric acid stone prediction model may offer optimized clinical decision-making for patients with urinary stones. While most urinary stones are managed with interventional therapy, uric acid (UA) stones can be dissolved by oral chemolysis without invasive procedures. This study aimed to develop and validate a pure UA (pUA) stone prediction model using a variant coefficient of stone density (VCSD) measured by thresholding a three-dimensional (3D) segmentation-based method. Patients with urolithiasis treated at Keimyung University Dongsan Hospital between January 2017 and December 2020 were divided into training and internal validation sets, and patients from Kyungpook National University Hospital between January 2017 and December 2018 were used as an external validation set. Each stone was segmented by a thresholding 3D segmentation-based method using an attenuation threshold of 130 Hounsfield units. VCSD was calculated as the stone heterogeneity index divided by the mean stone density. A total of 1175 urinary stone cases in 1023 patients were enrolled in this study. Of these, 224 (19.1%) were pUA stone cases. Among the potential predictors, thresholding 3D segmentation-based VCSD, age, sex, radio-opacity, hypertension, diabetes, and urine pH were identified as independent pUA stone predictors, and VCSD was the most powerful indicator. The pUA stone prediction model showed good discrimination, yielding area under the receiver operating characteristic curve of 0.960 (95% confidence interval (CI): 0.940–0.979, P < 0.001), 0.931 (95% CI: 0.875–0.987, P < 0.001), and 0.938 (95% CI: 0.912–0.965, P < 0.001) in the training, internal validation, and external validation sets, respectively. VCSD measured using 3D segmentation was a decisive independent predictive factor for pUA stones. Furthermore, the established prediction model with VCSD can serve as a noninvasive preoperative tool to identify pUA stones. [ABSTRACT FROM AUTHOR]

Ruptured vertebral artery (VA) dissecting aneurysm carries high risk of rerupture and mortality if not treated immediately. Dissecting aneurysm of the VA involving the posteroinferior cerebellar artery (PICA) origin is difficult to treat by surgical and endovascular route. With the availability of flow diversion device for reconstructive procedure, endovascular treatment has now become easy to treat difficult aneurysm while maintaining the patency of the PICA. However, instead of using flow diverter (FD) in our case, we successfully treated dissecting VA aneurysm involving the PICA origin with retrograde stent placement from distal right VA to the left PICA to maintain the patency of PICA and occlusion of dissecting aneurysm of VA with detachable coils instead of performing surgical bypass and FD placement. [ABSTRACT FROM AUTHOR]

Hematoma expansion (HE) is an independent predictor of poor outcome and secondary neurological deterioration in intracerebral hemorrhage (ICH) and is associated with high morbidity and mortality. Noncontrast computed tomography (NCCT) may identify the sites of active extravasation. Therefore, we have attempted to (1) devise a reliable and easyto- use prediction score to predict the risk of HE in ICH and (2) validate the accuracy of this grading system and perform an independent analysis of HE predictors. We included patients in whom an intracerebral hemorrhage (ICH) occurred in the basal ganglia between Jan. 2015 and Jan. 2018. These patients had undergone a baseline CT scan at Qinghai Provincial People's Hospital within 24 hours after the onset of ICH symptoms. Two observers independently assessed the presence of the island sign, blend sign, or swirl sign on an NCCT scan during patient selection. Patients underwent a baseline NCCT scan and 24-hour NCCT follow-up for analysis of HE. The accuracy of this grading system was assessed. Independent predictors of HE were identified using multivariable regression. Of 266 patients with ICH, 61 (22.93%) presented with the island sign, 63 (23.68%) presented with the blend sign, and 50 (18.80%) presented with the swirl sign. The overall incidence of HE was 37.22% (99/266). Of 125 patients (46.99%) who underwent a baseline CT scan within 6 hours of onset, 141 (53.01%) underwent a scan in 6-24 hours. Multivariable logistic regression analysis identified the hematoma volume (OR, 0.974; P = 0.042), intraventricular hemorrhage (IVH) extension (OR, 3.225; P = 0.003), time from onset to the baseline CT scan (OR, 0.986; P < 0.001), and anticoagulant use or an international normalized ratio (INR) > 1.5 (OR, 3.362; P = 0.006) as closely associated with HE. In conclusion, the grading system demonstrated reliable accuracy at predicting HE. The grading system demonstrated acceptable accuracy in an independent single-institution study. The role of the grading system in predicting HE and poor outcome in patients with ICH is significant. NCCT imaging markers may serve as key markers for HE prediction. [ABSTRACT FROM AUTHOR]

Objective This systematic review and meta-analysis was aimed to evaluate the predictive values of shape irregularity and density heterogeneity of hematoma on noncontrast computed tomography (NCCT) for hematoma expansion (HE). Methods A literature search was performed in PubMed, Embase, Scopus, Web of Science, and Cochrane Library. Studies about predictive values of shape regularity or density heterogeneity of hematoma on NCCT for HE in spontaneous intracerebral hemorrhage were included. Meta-analysis was performed to pool the data. Publication bias assessment, subgroup analysis, and univariate meta-regression were conducted. Results A total of 7 studies with 2294 patients were included. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of shape irregularity were 67%, 47%, 1.30, and 0.71, respectively. In contrast, the pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of density irregularity were 52%, 69%, 1.70, and 0.69, respectively. Conclusions Considering the relatively low sensitivity and specificity, the predictive values of shape irregularity and density heterogeneity of hematoma for HE are limited. Further studies are still needed to find optimal NCCT predictors for HE in spontaneous intracerebral hemorrhage patients. [ABSTRACT FROM AUTHOR]

Background: Non-contrast computed tomography (NCCT) is the diagnostic choice for renal stone disease. Knowing the composition of a stone before passage can help to choose a better management. We sought to determine whether the Hounsfield unit (HU) measured by NCCT can predict the composition. Materials and Methods: 180 urinary stones from patients seen at Shariati, Kashani and Alzahra CT centers, were submitted to stone analysis, 2012. All scans had been interpreted for HU. Primitive statistical findings showed an effect of size on the HU. To avoid confounding bias, Hounsfield Density (HD: HU/largest transverse diameter) was calculated. Statistical comparisons were performed between composition with HU and HD. Results: Calcium stones had specific ranges for HD and HU. No non-calcium stone had HU more than 448 and HD greater than 50 HU/mm. Conclusion: NCCT can differentiate just Calcium from non-calcium stones.

Purpose: The presence of severely calcified plaque remains problematic in endovascular therapy, and no specific endovascular treatment strategy has been established. Estimating plaque solidity before the procedure may help operators penetrate calcified plaque with a guide wire. The aim of this study was to establish a method of measuring plaque solidity with noncontrast computed tomography (CT)., Methods: This retrospective, single-center study included consecutive patients who, between October 2020 and July 2022, underwent noncontrast 5 mm and 1 mm CTs before endovascular therapy to penetrate calcified plaque with a wire in the common femoral, superficial femoral, and popliteal arteries. Three cross-sectional CT slices were selected. To target a calcified plaque lesion, the operator identified a region of interest, which corresponded to 24×24 pixels, and Hounsfield unit (HU) values of each pixel were displayed on the CT image. The average HU values and the ratio of number of pixels of lower values (130-599 HU) represented plaque solidity. We used the Mann-Whitney-Wilcoxon rank-sum test and the chi-square test to compare the solidity of plaques penetrated and not penetrated by the wire., Results: We evaluated 108 images of 36 calcified plaque lesions (in 19 patients). The wire penetrated 28 lesions (77.8%) successfully. The average HU value was significantly lower in the lesions that the wire penetrated than in the others, in both the 5 mm CT slices (434.7±86.8 HU vs 554.3±112.7 HU, p=0.0174) and 1 mm slices (497.8±103.1 HU vs 593.5±114.5 HU, p=0.0381). The receiver operating curve revealed that 529.9 and 533.9 HU in the 5 and 1 mm slices, respectively, were the highest values at which wires could penetrate. Moreover, at the lesions that were penetrates successfully, the ratio of number of lower HU value pixels was significantly higher both in 5 mm slice CTs (74.7±13.4 vs 61.7±13.1%, p=0.0347) and 1 mm (68.7±11.8 vs 57.1±11.4%, p=0.0174)., Conclusion: The use of noncontrast CT to evaluate plaque solidity was associated with successful wire penetration of calcified lesions in peripheral arteries., Clinical Impact: This study revealed an association between the wire penetration inside calcified plaque and plaque solidity estimated using non-contrasted computed tomography. The mean Hounsfield unit values of three cross-sections in calcified plaques were associated with the successful wire penetration. This wire penetration difficulty is associated with extended procedure time, excessive radiation exposure, usage of extra contrast agents, and increased medical costs. Therefore, estimating calcified plaque solidity before procedure enables us to choose effective and lean procedures. In addition, to predict the success of dilating calcified plaque from the inside is also beneficial when the operator wants to avoid extra scaffold implantation for target lesions.

Background: Computed tomography (CT) clarity has significantly improved since it became widely available in the early 1980s, making the utility and benefit of contrast material for image quality of the abdomen and pelvis uncertain, and so far, minimally studied.Objectives: This study sought to assess the efficacy of a noncontrast CT scan of the abdomen and pelvis by evaluating patients presenting to the emergency department (ED) with acute nontraumatic abdominal pain by following them for 7 days and observing for signs and symptoms of clinically significant acute emergent pathology.Methods: We enrolled, and for 7 days followed, a prospective observational convenience sample of patients who received a noncontrast CT scan of the abdomen and pelvis in the ED for acute nontraumatic abdominal pain. The primary outcome, and defined as a failure, was abdominal surgery or death as the result of an intraabdominal process not found on the original noncontrast CT scan, or a subsequent contrasted CT scan with a finding that could explain the original complaint of abdominal pain that was also not seen on the initial noncontrast CT, during the 7-day observation.Results: Seventy-two patients were enrolled in the study. The incidence of failure was 0% (0/72), 46% of patients (33/72) had a negative CT scan, 54% (39/72) had a positive CT scan, 57% (41/72) were admitted, 43% (31/72) discharged, 11% (8/72) had abdominal surgery, and a repeat contrasted CT scan was done on 4% (3/72).Conclusions: With certain inclusion and exclusion criteria, noncontrast CT of the abdomen and pelvis is likely a reliable diagnostic modality for the evaluation of acute nontraumatic abdominal pain in the ED. [ABSTRACT FROM AUTHOR]

Non contrast helical computed tomography (CT) study of the abdomen is frequently performed in evaluation of suspected ureteric colic. We present CT images of a young adult male patient who had torsion of an undescended, non-neoplastic testis and describe the “Inguinoscrotal whirlpool sign on CT”.

Background: Non-contrast computed tomography (NCCT) is the diagnostic choice for renal stone disease. Knowing the composition of a stone before passage can help to choose a better management. We sought to determine whether the Hounsfield unit (HU) measured by NCCT can predict the composition. Materials and Methods: 180 urinary stones from patients seen at Shariati, Kashani and Alzahra CT centers, were submitted to stone analysis, 2012. All scans had been interpreted for HU. Primitive statistical findings showed an effect of size on the HU. To avoid confounding bias, Hounsfield Density (HD: HU/largest transverse diameter) was calculated. Statistical comparisons were performed between composition with HU and HD. Results: Calcium stones had specific ranges for HD and HU. No non-calcium stone had HU more than 448 and HD greater than 50 HU/mm. Conclusion: NCCT can differentiate just Calcium from non-calcium stones. [ABSTRACT FROM AUTHOR]

Studies have shown that aortic calcification is associated with cardiovascular disease. In this study, a method for localization, centerline extraction, and segmentation of the thoracic aorta in noncontrast cardiac-computed tomography (CT) images, toward the detection of aortic calcification, is presented. The localization of the right coronary artery ostium slice is formulated as a regression problem whose input variables are obtained from simple intensity features computed from a pyramid representation of the slice. The localization, centerline extraction, and segmentation of the aorta are formulated as optimal path detection problems. Dynamic programming is applied in the Hough space for localizing key center points in the aorta which guide the centerline tracing using a fast marching-based minimal path extraction framework. The input volume is then resampled into a stack of 2-D cross-sectional planes orthogonal to the obtained centerline. Dynamic programming is again applied for the segmentation of the aorta in each slice of the resampled volume. The obtained segmentation is finally mapped back to its original volume space. The performance of the proposed method was assessed on cardiac noncontrast CT scans and promising results were obtained. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: To assess the value of noncontrast computed tomography (NCCT) as a possible predictor of renal stone disintegration by shock wave lithotripsy (SWL). Patients and methods: The study included 120 consecutive patients (71 males, 49 females; mean age: 42.6 yr) with a solitary renal stone of 0.5–2.5cm in length. NCCT was performed using a multidetector row CT scanner at 120KV and 240mA, with 1.25-mm collimation. A bone window was used to measure stone attenuation values. SWL was performed with an electromagnetic lithotripter. Failure of disintegration was defined as no fragmentation of the stone after three sessions. The impact of patients’ sex, age, and body mass index (BMI) and the stones’ laterality, location, volume, mean attenuation value, and the skin-to-stone distance on disintegration were evaluated by univariate and multivariate analyses. Results: Failure of disintegration was observed in 15 patients (12.5%). BMI and stone density >1000HU were the significant independent predictors of failure (p =0.04 and 0.02, respectively). The success rate of extracorporeal SWL at 3 mo was 87.5% (105 of 120 patients); 90 patients were stone free and 15 had residual fragments <4mm. The only significant predictor of residual fragments was stone density (p <0.001). Conclusions: Obesity and increased stone density as detected by NCCT are significant predictors of failure to fragment renal stones by SWL. An alternative treatment should be devised for obese patients with stone density >1000HU. [Copyright &y& Elsevier]

Background/Aim  In noncontrast computed tomography (NCCT), an apparently hyper-attenuated cerebral venous sinus (CVS) may lead to suspicion of CVS thrombosis. Understanding the factors affecting attenuation of CVS can guide us toward true diagnosis. Hence, the aim of the study was to determine the effect of different factors such as hematocrit, hemoglobin, age, blood urea nitrogen (BUN), creatinine, leukocyte and platelet count, and sex on the attenuation of CVS on brain NCCT. Material and Methods  Total 1,680 patients were included in this study, and their demographic and laboratory data and brain NCCT were reviewed. In their brain NCCT, the average attenuation of superior sagittal sinus and both right and left sigmoid sinuses was measured. Data analysis was conducted using the Statistical Package for the Social Sciences version 21.0 software by Kolmogorov-Smirnov, Spearman's correlation coefficient, and multiple linear regression tests. The significance level was considered less than 0.05. Results  Hematocrit (B = 0.251, p  < 0.001), hemoglobin (B = 0.533, p  < 0.001), and creatinine (B =  - 0.270, p  = 0.048) were determined as predictors of attenuation of superior sagittal sinus. For both sigmoid sinuses, hematocrit ( p  < 0.001) and hemoglobin ( p  < 0.001) were determined as positive predictors, and creatinine ( p  < 0.001) and BUN ( p  < 0.002) were determined as negative and positive predictors, respectively. Conclusion  Hemoglobin, hematocrit, creatinine, and BUN are the main factors that should be considered in the assessment of CVS density on brain NCCT. As with increasing hematocrit and hemoglobin of the subject, the CVS density in NCCT increases, and with increasing creatinine and in some instance decreasing BUN of the subject, the CVS density in NCCT decreases., Competing Interests: Conflicts of Interest There are no conflicts of interest., (Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

We report the case of a 15-year-old male patient with polyarteritis nodosa who presented with ruptured lenticulostriate artery (LSA) aneurysm and was successfully treated with endovascular N-butyl-2-cyanoacrylate (Histoacryl, B. Braun, Melsungen, Germany) acrylic glue embolization. Selective catheterization of LSA is sometimes difficult even with a low-profile microcatheter (Magic 1.2 FM, Balt Extrusion, Montmorency, France) due to acute angulation at the origin of the artery. In this 2-dimensional video illustration of the roadmap in digital subtraction angiography, reproduced after informed consent of the patient, we illustrate the balloon blocking technique to safely and effectively navigate the microcatheter through the small perforator with difficult angulation at the origin. A Magic microcatheter was passed via a distal access catheter 070 (Concentric Medical, Mountain View, California, USA) 105 cm in the internal carotid artery. The Magic microcatheter advancement was supported with a 0.008-inch guidewire (Hybrid 008, Balt Extrusion, Montmorency, France). Initial catheterization of LSA even with a low-profile Magic microcatheter was difficult as the origin of LSA was acute angled. While trying the navigate the microcatheter into the perforator, it was continuously flopping into the distal M1 segment of the middle cerebral artery. The balloon microcatheter (Scepter XC 4 × 11mm, Microvention, Tustin, California, USA) was passed separately via 5 French Envoy guiding catheter (Codman, Raynham, Massachusetts, USA) 100 cm in the proximal ICA using a contralateral left femoral artery puncture. The Balloon microcatheter advancement into the middle cerebral artery was supported with a Traxcess 0.014-inch microguidewire (Microvention). It was then inflated just beyond the origin of LSA which provided support to the magic microcatheter and thus allowing its easy navigation into the LSA. Super-selective microcatheter injection confirmed filling of the LSA aneurysm. A dilute 33% concentration of the liquid embolic agent N-butyl-2-cyanoacrylate mixed with Lipiodol (Guerbet, Aulnay-sous-Bois, France) was injected slowly under direct vision. The final-check angiogram revealed complete occlusion of the aneurysm (Video 1). Patient underwent craniotomy and hematoma evacuation 1 day after the procedure in view of his rapidly deteriorating neurological status. He was later discharged with Modified Rankin Scale of 3. Follow up angiography after 3 months showed completely occluded aneurysm (Video 2). [ABSTRACT FROM AUTHOR]

Background Epicardial adipose tissue may be associated with the pathogenesis of coronary artery disease (CAD), but its effect on obstructive CAD risk is uncertain. Therefore, we aimed to examine the relationship between epicardial adipose tissue and obstructive CAD in Chinese patients with suspected CAD. Methods and Results The present study enrolled 194 consecutive inpatients with suspected CAD who underwent both noncontrast computed tomography and coronary angiography. We measured epicardial fat volume (EFV) and evaluated its association with obstructive CAD, which was defined as coronary stenosis severity ≥70%. Overall, 44.3% patients had obstructive CAD and tend to have higher EFV. Age, body mass index, triglycerides, incidence of hypertension, and hyperlipidemia were higher across tertiles of EFV ( P for trend <0.05). In univariate regression analysis, a per-SD increase in EFV was independently associated with obstructive CAD (odds ratio [OR], 2.31; 95% CI, 1.61-3.32; P <0.001). Consistent with these findings, EFV was still significantly related to obstructive CAD as continuous variable after adjustment for all traditional risk factors and coronary artery calcium (OR per SD, 2.82; 95% CI, 1.68-4.74; P <0.001). Generalized additive model indicated that EFV was linearly associated with risk of obstructive CAD. E -value analysis suggested robustness to unmeasured confounding. Conclusions Our results suggested that in Chinese patients with suspected CAD, EFV was significantly and positively associated with the risk of obstructive CAD, independent of traditional risk factors and coronary artery calcium.

Background and Purpose: This study aimed to analyze the impact of baseline posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS) on the efficacy and safety of endovascular therapy (EVT) for patients with acute basilar artery occlusion., Methods: The BASILAR was a nationwide prospective registry of consecutive patients with a symptomatic and radiologically confirmed acute basilar artery occlusion within 24 hours of symptom onset. We estimated the effect of standard medical therapy alone (SMT group) versus SMT plus EVT (EVT group) for patients with documented pc-ASPECTS on noncontrast CT, both as a categorical (0-4 versus 5-7 versus 8-10) and as a continuous variable. The primary outcomes included favorable functional outcomes (modified Rankin Scale ≤3) at 90 days and mortality within 90 days., Results: In total, 823 cases were included: 468 with pc-ASPECTS 8 to 10 (SMT: 71; EVT: 397), 317 with pc-ASPECTS 5 to 7 (SMT: 85; EVT: 232), and 38 with pc-ASPECTS 0 to 4 (SMT: 13; EVT: 25). EVT was associated with higher rate of favorable outcomes (adjusted relative risk with 95% CI, 4.35 [1.30-14.48] and 3.20 [1.68-6.09]; respectively) and lower mortality (60.8% versus 77.6%, P =0.005 and 35.0% versus 66.2%, P< 0.001; respectively) than SMT in the pc-ASPECTS 5 to 7 and 8 to 10 subgroups. Continuous benefit curves also showed the superior efficacy and safety of EVT over SMT in patients with pc-ASPECTS ≥5. Furthermore, the prognostic effect of onset to puncture time on favorable outcome with EVT was not significant after adjustment for pc-ASPECTS (adjusted odds ratio, 0.98 [95% CI, 0.94-1.02])., Conclusions: Patients of basilar artery occlusion with pc-ASPECTS ≥5 could benefit from EVT. The baseline pc-ASPECTS appears more important for decision making and predicting prognosis than time to EVT. Registration: URL: http://www.chictr.org.cn. Unique identifier: ChiCTR1800014759.