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Background/aims: Nausea is a major complaint of gastroparesis (GP), and the pathophysiology of this condition is poorly understood. Therefore, this study utilized fMRI to investigate the possible central nervous system (CNS) mechanisms of nausea in 10 GP patients versus 8 healthy controls (HCs)., Methods: Nausea severity was assessed on a 0-10 scale and presented as mean ± SD. Nausea was increased from baseline utilizing up to 30 min of visual stimulation (VS). Functional network connectivity was measured with fMRI at baseline and after 30 min of VS. fMRI data were preprocessed using statistical parametric mapping software. Thirty-four independent components were identified as meaningful resting-state networks (RSNs) by group independent component analysis. The Functional Network Connectivity (FNC) among 5 RSNs considered important in CNS nausea mechanisms was calculated as the Pearson's pairwise correlation., Results: Baseline nausea score in GP patients was 2.7 ± 2.0 and increased to 7.0 ± 1.5 after stimulation (P < 0.01). In HCs nausea scores did not increase from baseline after stimulus (0.3 ± 0.5). When comparing GP patients to HCs after VS, a significant reduction (P < 0.001) in bilateral insula network connectivity compared to the right insula network was detected. No significant differences in connectivity were noted among the other RSNs. Additionally, the average gray matter volume was non-significantly reduced in the insula in GP patients compared to HC., Conclusions: The insula connectivity network is impaired in nauseated GP patients. This phenomenon could explain the susceptibility of GP patients to nausea or may have resulted from a state of chronic nausea.

Healthcare for poor children, also known as Medicaid, is disproportionately relied upon by citizens of poor states such as New Mexico, where (a) there are more unintended pregnancies, (b) domestic violence during and after pregnancies occurs with regularity, (c) youth substance use is much more common, (d) crime rates are some of the worst in the country, (e) many never graduate from high school, and (f) incarceration is often inevitable. Yet, there is a dearth of research into the neuropsychological health of these children. Meanwhile, nonneuropsychologists working for managed care organizations routinely deny authorization for neuropsychological testing based on a lack of medical necessity. The present article addresses the question of neuropsychological medical necessity using community-based neuropsychological data from New Mexico collected on Medicaid and non-Medicaid youth via retroactive chart review. Downstream fiscal implications that are related to the eventual cost of mental illness and crime among those with poor neuropsychological health are discussed.

Double right coronary artery is a very rare anomaly that is usually discovered incidentally during conventional coronary angiography. Double right coronary artery may have clinical implications in symptomatic patients requiring percutaneous coronary intervention and may be associated with other congenital abnormalities, myocardial ischemia and ventricular fibrillation in the absence of atherosclerosis. Here the reported cases in the literature are reviewed and a case of double right coronary artery with ischemia in inferior left ventricular wall is presented., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Fungal infections of the central nervous system (CNS) pose a threat to especially immunocompromised patients and their development is primarily determined by the immune status of the host. With an increasing number of organ transplants, chemotherapy, and human immunodeficiency virus infections, the number of immunocompromised patients as susceptible hosts is growing and fungal infections of the CNS are more frequently encountered. They may result in meningitis, cerebritis, abscess formation, cryptococcoma, and meningeal vasculitis with rapid disease progression and often overlapping symptoms. Although radiological characteristics are often nonspecific, unique imaging patterns can be identified through computer tomography as a first imaging modality and further refined by magnetic resonance imaging. A rapid diagnosis and the institution of the appropriate therapy are crucial in helping prevent an often fatal outcome.

Fungal infections of the nose and paranasal sinuses can be categorized into invasive and non-invasive forms. The clinical presentation and course of the disease is primarily determined by the immune status of the host and can range from harmless or subtle presentations to life threatening complications. Invasive fungal infections are categorized into acute, chronic or chronic granulomatous entities. Immunocompromised patients with poorly controlled diabetes mellitus, HIV and patients receiving chemotherapy or chronic oral corticosteroids are mostly affected. Mycetoma and Allergic Fungal Rhinosinusitis are considered non-invasive forms. Computer tomography is the gold-standard in sinonasal imaging and is complimented by Magnetic resonance imaging (MRI) as it is superior in the evaluation of intraorbital and intracranial extensions. The knowledge and identification of the characteristic imaging patterns in invasive - and non- invasive fungal rhinosinusitis is crucial and the radiologist plays an important role in refining the diagnosis to prevent a possible fatal outcome.

Introduction: Magnetic resonance imaging (MRI) sequence acquisition techniques for iron assessment have revolutionized the study of iron overload in different organs. We hypothesized that MRI can accurately and reliably assess possible iron deposition in the myocardium and liver by measurement of T2* value., Materials and Methods: Seventeen patients with end-stage renal disease on hemodialysis were enrolled. An electrocardiography-gated single breath hold fast multiecho T2* sequence was acquired in the short axis at basal and mid-ventricular levels. The same technique was utilized to estimate liver parenchyma iron content., Results: Iron deposition in the liver was present in 50% of the hemodialysis patients. No iron deposition was found in the myocardium. A strong univariable inverse linear association was detected between serum albumin and T2* in the liver (r = -0.84, P < .001). Patients who had been on dialysis for 10 years and longer had a 91% reduction in their odds of developing iron overload in the liver compared to the referent group (exact odds ratio, 0.09; P = .048)., Conclusions: Even though using intravenous iron infusion is a common practice in chronic dialysis patients, it seems the myocardium as opposed to the liver is resistant to or protected against iron deposition. There were no meaningful differences in the relationship between iron overload in the liver and the dialysis time vintage. A more aggressive trend of iron therapy and different formulations of iron infusion could be an explanation of iron deposition in the liver.

Objective: To evaluate the performance of a computer-aided algorithm for automated stenosis detection at coronary CT angiography (cCTA).Methods: We investigated 59 patients (38 men, mean age 58 +/- 12 years) who underwent cCTA and quantitative coronary angiography (QCA). All cCTA data sets were analyzed using a software algorithm for automated, without human interaction, detection of coronary artery stenosis. The performance of the algorithm for detection of stenosis of 50% or more was compared with QCA.Results: QCA revealed a total of 38 stenoses of 50% or more of which the algorithm correctly identified 28 (74%). Overall, the automated detection algorithm had 74%/100% sensitivity, 83%/65% specificity, 46%/58% positive predictive value, and 94%/100% negative predictive value for diagnosing stenosis of 50% or more on per-vessel/per-patient analysis, respectively. There were 33 false positive detection marks (average 0.56/patient), of which 19 were associated with stenotic lesions of less than 50% on QCA and 14 were not associated with an atherosclerotic surrogate.Conclusion: Compared with QCA, the automated detection algorithm evaluated has relatively high accuracy for diagnosing significant coronary artery stenosis at cCTA. If used as a second reader, the high negative predictive value may further enhance the confidence of excluding significant stenosis based on a normal or near-normal cCTA study. [ABSTRACT FROM AUTHOR]

Paragangliomas are rare tumors of the endocrine system. They are highly vascular and in some cases hormonally active, making their management challenging. Although there is strong evidence of the safety and effectiveness of preoperative embolization in the management of spinal tumors, only five cases have been reported in the setting of thoracic paragangliomas. We present the case of a 19-year-old man with a large, primary, functional, malignant paraganglioma of the thoracic spine causing a vertebral fracture and spinal cord compression. To our knowledge this is the first report of preoperative trans-arterial balloon augmented Onyx embolization of a thoracic paraganglioma.

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Motion sickness is a common issue in electric vehicles, significantly impacting passenger comfort. This study aims to develop a functional brain network analysis model by integrating electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) signals to evaluate motion sickness symptoms. During real-world testing with the Feifan F7 series of new energy-electric vehicles from SAIC Motor Corp, data were collected from 32 participants. The EEG signals were divided into four frequency bands: delta-range, theta-range, alpha-range, and beta-range, and brain oxygenation variation was calculated from the fNIRS signals. Functional connectivity between brain regions was measured to construct functional brain network models for motion sickness analysis. A motion sickness detection model was developed using a graph convolutional network (GCN) to integrate EEG and fNIRS data. Our results show significant differences in brain functional connectivity between participants in motion and non-motion sickness states. The model that combined fNIRS data with high-frequency EEG signals achieved the best performance, improving the F1 score by 11.4% compared to using EEG data alone and by 8.2% compared to using fNIRS data alone. These results highlight the effectiveness of integrating EEG and fNIRS signals using GCN for motion sickness detection. They demonstrate the model's superiority over single-modality approaches, showcasing its potential for real-world applications in electric vehicles. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this article is to review the normal anatomy of the aortic arch and the most common variations of congenital aortic arch anomalies using low-radiation-dose, defined as a dose-length product of 7-15 mGy × cm, MDCT angiography., Conclusion: Radiologists should be prepared to fully describe congenital aortic arch anomalies; recognize them on CT angiography, especially the presence or absence of vascular rings or aberrant arteries; and explain their association with the trachea and esophagus.

Objective: The purpose of our study was to determine the interobserver reproducibility of CT findings of right ventricular (RV) dysfunction in pulmonary embolism (PE)., Materials and Methods: Two experienced observers independently and retrospectively evaluated pulmonary CT angiography (CTA) studies of 50 patients with acute PE for the following signs: bowing of the interventricular septum, inferior vena cava (IVC) contrast medium reflux, RV diameter (RVD)/left ventricular diameter (LVD) ratio on axial sections and four-chamber (4-CH) views, and RV volume (RVV)/left ventricular volume (LVV) ratio. Analysis used kappa statistics, Spearman's rank correlation, and Bland-Altman statistics., Results: The two observers had fair to moderate agreement (kappa = 0.32-0.44) for septal bowing and moderate to good agreement (kappa = 0.57-0.68) for diagnosing IVC reflux. The Spearman's rank correlation coefficients for RVD(axial)/LVD(axial) ratio and RVD(4-CH)/LVD(4-CH) ratio between the two observers were 0.88 (p < 0.001) and 0.85 (p < 0.001), respectively. On Bland-Altman analysis, the mean differences for RVD(axial)/LVD(axial) ratio and RVD(4-CH)/LVD(4-CH) ratio were 0.014 (+/- 0.195) and 0.001 (+/- 0.242), respectively. The correlation coefficient for RVV/LVV ratio was 0.93 (p < 0.001), and the mean difference was 0.033 (+/- 0.229)., Conclusion: Considerable differences exist in the interobserver reproducibility of CT findings of RV dysfunction on pulmonary CTA in patients with acute PE. Cardiac chamber measurements are more reproducible than septal bowing and IVC reflux. Volumetric determination of the RVV/LVV ratio is the least user dependent and most reproducible.

Objective: To evaluate the feasibility of adenosine-stress dynamic myocardial volume perfusion imaging with second generation dual source computed tomography (CT) for the qualitative and quantitative assessment of myocardial blood flow (MBF) compared with stress perfusion and viability magnetic resonance imaging (MRI)., Material and Methods: Ten patients (8 male, 2 female, mean age 62.7 +/- 7.1 years) underwent stress/rest perfusion and delayed-enhancement MRI, and a cardiac CT protocol comprising prospectively electrocardiogram -triggered coronary CT angiography, dynamic adenosine-stress myocardial perfusion imaging using a "shuttle" mode, and delayed enhancement acquisitions. Two independent observers visually assessed myocardial perfusion defects. For semi-quantitative evaluation, CT- and MRI-derived myocardial-to-left ventricular upslope indices were compared. Additionally, absolute MBF was quantified based on dynamic perfusion CT and correlated with semi quantitative CT measurements. Myocardial perfusion analysis was performed on a segmental basis. Analysis used paired t tests, Wilcoxon signed-rank test, linear correlation, and Bland-Altman statistics., Results: A total of 149 segments (93.1%) were suitable for analysis. Sensitivity, specificity, positive and negative predictive values for detection of myocardial perfusion defects at CT compared with MRI were 86.1%, 98.2%, 93.9%, and 95.7%, respectively. Semiquantitative analysis of CT data showed significant differences between ischemic and nonischemic myocardium with a signal intensity upslope that was comparable with MRI-derived values (CT: 5.2 +/- 2 SI/s, MRI: 4.8 +/- 2.3 SI/s, P > 0.05). Moderate correlation was observed between absolute CT quantification of MBF and semi-quantitative CT measurements. Mean total dose length product for the entire cardiac CT protocol was 1290.4 +/- 233.3 mGy cm., Conclusion: Adenosine-stress volumetric first pass CT perfusion imaging is feasible and may enable the evaluation of qualitative and semi quantitative parameters of myocardial perfusion in a comparable fashion as MRI.

Recent research suggests that multidetector-row CT may have potential as a standalone modality for integrative imaging of coronary heart disease, including the assessment of the myocardial blood supply. However, the technical prerequisites for volumetric, time-resolved imaging of the passage of a contrast medium bolus through the myocardium have only been met with latest generation wide-detector CT scanners. Second-generation dual-source CT enables performing electrocardiographic (ECG)-synchronized dynamic myocardial perfusion imaging by a dedicated "shuttle" mode. With this acquisition mode, image data can be acquired during contrast medium infusion at 2 alternating table positions with the table shuttling back and forth between the 2 positions covering a 73-mm anatomic volume. We applied this acquisition technique for detecting differences in perfusion patterns between healthy and diseased myocardium and for quantifying myocardial blood flow under adenosine stress in 3 patients with coronary heart disease. According to our initial experience, the addition of adenosine stress volumetric dynamic CT perfusion to a cardiac CT protocol comprising coronary artery calcium quantification, prospectively ECG-triggered coronary CT angiography, and delayed acquisition appears promising for the comprehensive assessment of coronary artery luminal integrity, cardiac function, perfusion, and viability with a single modality., (Copyright 2010 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Introduction: It has been demonstrated that an increase in the diameter of the right ventricle or pulmonary artery in COVID-19 patients could be associated with the severity of lung involvement and may lead to unfavorable outcomes, particularly in the presence of pulmonary vascular diseases. This study investigated the relationship between these right heart strain features, the extent of lung involvement, and their prognostic values in patients without vascular comorbidities. Methods: This study selected 154 consecutive patients with positive chest computed tomography (CT) findings and no evidence of concurrent pulmonary disease. Clinical characteristics and adverse outcomes in in-hospital settings were collected retrospectively. Diameters of cardiac ventricles and arteries, along with lung opacification scores, were obtained using CT pulmonary angiography (CTPA) findings, and the association of these variables was evaluated. Results: An increase in pulmonary artery (PA) to ascending aorta (AO) diameter ratio and lung parenchymal damage were significantly and positively correlated (P =0.017), but increased right ventricle (RV) to left ventricle (LV) diameter ratio showed no association with the extent of chest opacification (P =0.098). Evaluating the prognostic ability of both ratios using logistic regression and receiver operating characteristic (ROC) analysis proved no significant class separation in regards to predicting adverse outcomes (PA/AO: OR:1.081, P Value:0.638, RV/LV: OR:1.098, P Value:0.344). Conclusion: In COVID-19 patients without vascular comorbidities, a higher PA/AO diameter ratio was significantly associated with increased lung involvement severity on CT imaging but not with adverse in-hospital outcomes. Conversely, an increased RV/LV ratio on CTPA did not correlate significantly with adverse outcomes or the severity of parenchymal lung damage. [ABSTRACT FROM AUTHOR]

Introduction: Intracranial fungal infections' (IcFIs) varying clinical manifestations lead to difficulties in diagnosis and treatment. African populations are disproportionately affected by the high burden of the disease. There is a lack of clarity as to the diagnostic and treatment modalities employed across the continent. In this review, we aim to detail the management, and outcome of IcFIs across Africa. Methods: This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, Cochrane Library, African Index Medicus, and African Journals Online were searched for relevant articles from database inception to August 10th, 2021. The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews guidelines were used to report the findings of the review. Results: Of the 5,779 records identified, 131 articles were included. The mean age was 35.6 years, and the majority (56.4%) were males. The majority (n = 8,433/8,693, 97.0%) of IcFIs presented as a meningitis, the most common communicable predisposing factor of IcFIs was HIV/AIDS (n = 7,815/8,693, 89.9%), and the most common non-communicable risk factor was diabetes mellitus (n = 32/8,693, 0.4%). Cryptococcus species was the most common (n = 8,428/8,693, 97.0%) causative organism. The most commonly used diagnostic modality was cerebrospinal (CSF) cultures (n = 4,390/6,830, 64.3%) for diffuse IcFIs, and MRI imaging (n = 12/30, 40%) for focal IcFIs. The most common treatment modality was medical management with antifungals only (n = 4,481/8,693, 51.6%). The most commonly used antifungal agent in paediatric, and adult patients was amphotericin B and fluconazole dual therapy (51.5% vs 44.9%). The overall mortality rate was high (n = 3,475/7,493, 46.3%), and similar for both adult and paediatric patients (47.8% vs 42.1%). Conclusion: Most IcFIs occurred in immunosuppressed individuals, and despite the new diagnostic techniques, CSF culture was mostly used in Africa. Antifungals regimens used was similar between children and adults. The outcome of IcFIs in Africa was poor for both paediatric and adult patients. [ABSTRACT FROM AUTHOR]

Key Clinical Message: A report of Balo's concentric sclerosis developed alongside with fingolimod use in a patient with previously diagnosed multiple sclerosis. [ABSTRACT FROM AUTHOR]

Background/Objectives: The right-sided aortic arch (RAA) is an uncommon variation of the aortic arch (AA), characterized by the aorta crossing over the right main bronchus. In the RAA, the descending aorta can be found on either the right or left side of the spine. The current study comprises a comprehensive retrospective computed tomography angiography (CTA) investigation into the prevalence of the RAA within the Greek population. Additionally, we will conduct a systematic review and meta-analysis to elucidate both common and rare morphological variants of the RAA. This research is significant as it sheds light on the prevalence and characteristics of the RAA in a specific population, providing valuable insights for clinical practice. Methods: Two hundred CTAs were meticulously investigated for the presence of a RAA. In addition, the PubMed, Google Scholar, and Scopus online databases were thoroughly searched for studies referring to the AA morphology. The R programming language and RStudio were used for the pooled prevalence meta-analysis, while several subgroup analyses were conducted. Results: Original study: A unique case of 200 CTAs (0.5%) was identified with an uncommon morphology. The following branches emanated from the RAA under the sequence: the right subclavian artery (RSA), the right common carotid artery (RCCA), the left common carotid artery (LCCA), and the left vertebral artery (LVA) in common origin with the aberrant left subclavian artery (ALSA). The ALSA originated from a diverticulum (of Kommerell) and followed a retroesophageal course. Systematic Review and Meta-Analysis: Sixty-two studies (72,187 total cases) met the inclusion criteria. The pooled prevalence of the RAA with a mirror-image morphology was estimated at 0.07%, and the RAA with an ALSA was estimated at <0.01%. Conclusions: AA anomalies, specifically the RAA, raise clinical interest due to their coexistence with developmental heart anomalies and possible interventional complications. Congenital heart anomalies, such as the Tetralogy of Fallot and patent foramen ovale, coexisted with RAA mirror-image morphology. [ABSTRACT FROM AUTHOR]

Background & Objective: Capparis spinosa is a plant belonging to the genus Capari which is important for medicinal purposes. It is also known as a multipurpose plant in Persian medicine. In this study, we searched for natural active ingredients in mouthwash for immunocompromised patients and examined the antifungal plus antibacterial properties of the hydroalcoholic extract of the root of the Capparis plant against Streptococcus mutans (S. mutans) PTCC 1683 and Candida albicans (C. albicans) ATCC-10231 was investigated. Materials & Methods: Ethanol extracts of plant roots were extracted by the percolation method. The diameter of the growth inhibition zone of C. albicans and S. mutans extracts was measured using the well plate method. Minimum inhibitory concentrations (MICs) were calculated for bacterial and fungal strains. In addition, the minimum sterilization concentration (MBC) and minimum sterilization concentration (MFC) of the extract were investigated using the broth microdilution method. The results were compared with an antibacterial and antifungal drug of 0.2% chlorhexidine nystatin. Results: The results for both pathogens revealed that the diameter of the growth inhibition zone increased with elevation of the extract concentration. The MIC and MBC of S. mutans extract were 62.5 and 62.5 mg/ml, compared to 0.39 and 0.39 mg/ml for chlorhexidine. The MIC and MFC of the plant against the fungus C. albicans were 7.812 and 31.25 mg/ml, compared to 0.25 and 1.25 μg/ml for nystatin. Conclusion: The ethanol extract of the Caparis plant had an antifungal effect on C. albicans and an antibacterial effect on S. mutans. However, the inhibitory and lethal effects against bacterial and fungal strains were lower than those of nystatin and chlorhexidine. [ABSTRACT FROM AUTHOR]

Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The study aims to evaluate the magnetic resonance (MR) features of central nervous system (CNS) fungal infections and determine the associations between these findings and the type of fungus. Our main objective was to assess whether imaging can serve as a predictor for identifying the specific group of fungi responsible for the infection using microbiology and histopathology as a benchmark., Materials and Methods: A retrospective analysis was done on 50 patients with proven CNS fungal infections. Fungal type was determined and grouped according to microbial classifications into four subtypes: hyalohyphomycetes, mucorales, yeasts and dematiaceous molds. MR findings were compared with histopathology/microbiology and associations between fungal groups were sought., Results: A total of 37 males and 13 females with a mean age of 39.3 years were included in the study. Aspergillus spp. infection (48%) was the most common. Most patients (54%) had an underlying risk factor for the infection. Pseudo-tumoral mass-like behavior was observed with Aspergillus, and the presence of meningitis was associated with yeast infections (p < 0.001). Of the 19 abscesses, 9 (47.3%) showed a dual rim sign on susceptibility-weighted imaging (SWI), and 10 (52.6%) showed intracavitary dot-like foci of dropouts on SWI. Both findings were statistically significant with dematiaceous molds (p = 0.04 and p = 0.009, respectively)., Conclusion: Although radiological characteristics are non-specific and can overlap with each type of fungi, our study shows that certain MR features can help radiologists point towards the causative type. More specifically, dot-like foci of susceptibility point towards abscesses caused by dematiaceous molds possibly owing to melanin pigment and metal chelation properties., Competing Interests: Declarations. Ethics approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent: The requirement for obtaining written informed consent was waived by our Institutional Review Board. (IRB number 2022-7838-22486) Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Presentation: The preliminary findings of this study have been presented as an award-winning oral research presentation at Malaysian Congress of Radiology, July 2023 and as a poster presentation in European Congress of Radiology, March 2024., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Talaromyces marneffei is prevalent in South Asia. Latent Talaromyces marneffei infection of travellers make the diagnosis difficult. There are similarities in clinical manifestations between Talaromyces marneffei infection and lymphoma. Brain abscess is a rare form of Talaromyces marneffei infection. Case Presentation: We reported a very rare case of a 19-year-old man with HIV infection who suffered from a brain mass and lymphadenopathy. His blood culture, bone marrow culture and sputum culture all grew Talaromyces marneffei. One month after treatment with voriconazole, the symptoms improved except brain mass. Surgical incision of the brain mass showed a compact mass, and pathological analysis showed the coexisting Talaromyces marneffei abscess and lymphoma. The patient is currently in a stable condition after receiving antifungal therapy and chemotherapy. Conclusion: Based on a case report of a traveller who suffered from a brain mass of Talaromyces marneffei abscess and lymphoma after a visit to an endemic area, this review summarized the cases where there was confusion between lymphoma and the brain abscess of Talaromyces marneffei. Talaromyces marneffei infection can be found globally due to the increasing number of international travels. Talaromyces marneffei infection and lymphoma had similar characteristics which is easy to misdiagnose in clinic. Infection may also be accompanied by tumors, especially in patients infected with HIV. The manifestations and imaging of brain abscess of Talaromyces marneffei were not characteristic in different patients. [ABSTRACT FROM AUTHOR]

Coronary computed tomography angiography (CTA) is a widely accepted, non-invasive diagnostic modality for the evaluation of patients with suspected coronary artery disease (CAD). However, a limitation of CTA is its inability to provide information on the hemodynamic significance of the coronary lesion. The recently developed stress dynamic CT perfusion technique has emerged as a potential solution to this diagnostic challenge. Dynamic CT myocardial perfusion provides information on the hemodynamic consequences of coronary stenosis and is used to detect myocardial ischemia. The combination of stress dynamic CT myocardial perfusion with CTA provides a comprehensive assessment that integrates anatomical and functional information. CT myocardial perfusion has been validated in several clinical studies and has shown comparable accuracy to Positron Emission Tomography (PET) and stress magnetic resonance imaging (MRI) in the diagnosis of hemodynamically significant coronary stenosis and superior performance to Single Photon Emission Computed Tomography (SPECT). More importantly, CTP-derived myocardial perfusion has been shown to have a strong correlation with FFR, and the use of CTP results in a reduction of negative catheterizations. In the context of suspected stable coronary artery disease, the CT protocol with dynamic perfusion imaging combined with CTA eliminates the need for additional testing, making it a convenient "one-stop-shop" method and an effective gatekeeper to an invasive approach. [ABSTRACT FROM AUTHOR]

Right ventricular (RV) failure is a critical cause of morbidity and mortality in patients presenting with pulmonary embolism (PE). The presentation of RV failure is based on the combination of clinical findings, laboratory abnormalities, and imaging evidence. An improved understanding of the pathophysiology of RV dysfunction following PE has given rise to more accurate risk stratification and broader therapeutic approaches. A subset of patients with PE develop chronic RV dysfunction with or without pulmonary hypertension. In this review, we focus on the impact of PE on the RV and its implications for risk stratification, prognosis, acute management, and long-term therapy. [ABSTRACT FROM AUTHOR]

Background: Myocardial bridges are congenital anatomical abnormalities in which myocardium covers a segment of coronary arteries, leading to stenocardia, myocardial ischemia, and sudden cardiac death in severe cases. However, automatic diagnosis of myocardial bridge presents significant challenges. Method: A novel framework of myocardial bridge detection with x-ray angiography sequence is proposed, which can realize automatic detection of vessel stenosis and myocardial bridge. Firstly, we employ a novel neural network model for coronary vessel segmentation, which consists of both CNNs and transformer structures to effectively extract both local and global information of the vessels. Secondly, we describe the vessel segment information, establish the vessel tree in the image, and fuse the vessel tree information between sequences. Finally, based on vessel stenosis detection, we realize automatic detection of the myocardial bridge by querying the blood vessels between the image sequence information. Results: In experiment, we evaluate the segmentation results using two metrics, Dice and ASD, and achieve scores of 0.917 and 1.39, respectively. In the stenosis detection, we achieve an average accuracy rate of 92.7% in stenosis detection among 262 stenoses. In multi-frame image processing, vessels in different frames can be well-matched, and the accuracy of myocardial bridge detection achieves 75%. Conclusions: Our experimental results demonstrate that the algorithm can automatically detect stenosis and myocardial bridge, providing a new idea for subsequent automatic diagnosis of coronary vessels. [ABSTRACT FROM AUTHOR]

Cerebral abscesses are uncommon space occupying lesions; they are associated with high morbidity and mortality, though are potentially treatable. Patients often present with nonspecific symptoms and may have few clinical signs. Routine clinical imaging may not give a definite diagnosis, as the findings can be indistinguishable from those of other intracranial mass lesions. We review the role of advanced MR techniques to characterise brain abscesses and discuss the role of imaging in monitoring their response to the treatment. [ABSTRACT FROM AUTHOR]

Objectives: Computed tomography (CT) myocardial perfusion imaging (CT-MPI) with hyperemia induced by regadenoson was evaluated for the detection of myocardial ischemia, safety, relative radiation exposure, and patient experience compared with single-photon emission computed tomography (SPECT) imaging., Materials and Methods: Twenty-four patients (66.5 y, 29% male) who had undergone clinically indicated SPECT imaging and provided written informed consent were included in this phase II, IRB-approved, and FDA-approved clinical trial. All patients underwent coronary CT angiography and CT-MPI with hyperemia induced by the intravenous administration of regadenoson (0.4 mg/5 mL). Patient experience and findings on CT-MPI images were compared to SPECT imaging., Results: Patient experience and safety were similar between CT-MPI and SPECT procedures and no serious adverse events due to the administration of regadenoson occurred. SPECT resulted in a higher number of mild adverse events than CT-MPI. Patient radiation exposure was similar during the combined coronary computed tomography angiography and CT-MPI (4.4 [2.7] mSv) and SPECT imaging (5.6 [1.7]  mSv) (P-value 0.401) procedures. Using SPECT as the reference standard, CT-MPI analysis showed a sensitivity of 58.3% (95% confidence interval [CI]: 27.7-84.8), a specificity of 100% (95% CI: 73.5-100), and an accuracy of 79.1% (95% CI: 57.9-92.87). Low apparent sensitivity occurred when the SPECT defects were small and highly suspicious for artifacts., Conclusions: This study demonstrated that CT-MPI is safe, well tolerated, and can be performed with comparable radiation exposure to SPECT. CT-MPI has the benefit of providing both complete anatomic coronary evaluation and assessment of myocardial perfusion., Competing Interests: U.J.S. receives institutional research support from Astellas, Bayer, General Electric, and Siemens Healthineers. U.J.S. has received honoraria for speaking and consulting from Bayer, Elucid, Guerbet, HeartFlow Inc., and Siemens Healthineers. C.N.D.C. is a consultant for/receives institutional research support from Bayer and Siemens. A.V.-S. receives institutional research support from Siemens Healthineers. The remaining authors declare no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background Except for cryptococcosis, fungal infection of the central nervous system (FI-CNS) is a rare but severe complication. Clinical and radiological signs are non-specific, and the value of conventional mycological diagnosis is very low. This study aimed to assess the value of β1,3-D-glucan (BDG) detection in the cerebrospinal fluid (CSF) of non-neonatal non-cryptococcosis patients. Methods Cases associated with BDG assay in the CSF performed in 3 French University Hospitals over 5 years were included. Clinical, radiological, and mycological results were used to classify the episodes as proven/highly probable, probable, excluded, and unclassified FI-CNS. Sensitivity and specificity were compared to that calculated from an exhaustive review of the literature. Results In total, 228 episodes consisting of 4, 7, 177, and 40 proven/highly probable, probable, excluded, and unclassified FI-CNS, respectively, were analysed. The sensitivity of BDG assay in CSF to diagnose proven/highly probable/probable FI-CNS ranged from 72.7% [95% confidence interval {CI}: 43.4%‒90.2%] to 100% [95% CI: 51%‒100%] in our study and was 82% in the literature. For the first time, specificity could be calculated over a large panel of pertinent controls and was found at 81.8% [95% CI: 75.3%‒86.8%]. Bacterial neurologic infections were associated with several false positive results Conclusions Despite its sub-optimal performance, BDG assay in the CSF should be added to the diagnostic armamentarium for FI-CNS. [ABSTRACT FROM AUTHOR]

Objective: To investigate the accuracy of aortic dimensions measured by RevolutionTM computed tomography (CT) in infants with complex coarctation of the aorta (CoA) and to further analyze the utility of the degree of CoA in predicting the risk of prolonged postoperative cardiac intensive care unit stay. Methods: A total of 30 infants with complex CoA who underwent surgical correction from January 2020 to July 2022 were retrospectively enrolled. General demographic data, preoperative imaging, and perioperative outcomes were collected. Univariate and multivariate analyses were performed to investigate predictors of prolonged postoperative cardiac intensive care unit stay, and the reliability of the CT measurements was assessed by the intraclass correlation coefficient. Results: All infants were divided into a mild or severe CoA group. The duration of mechanical ventilation and cardiac intensive care unit stay in the mild CoA group were significantly lower than those in the severe CoA group. After multivariate analysis, we found that the degree of CoA and age at surgery were significant predictors of prolonged postoperative cardiac intensive care unit stay. The intraclass correlation coefficient between CT measurements and intraoperative measurements was between 0.937 and 0.975, and the measurement results had good reliability. Conclusion: CT angiography can provide a comprehensive and accurate preoperative evaluation of aortic dimensions measured in infants with complex CoA. The degree of CoA is an independent risk factor for prolonged postoperative cardiac intensive care unit stay in infants with complex CoA. [ABSTRACT FROM AUTHOR]

Gastroparesis (GP) is a chronic disease characterized by upper gastrointestinal symptoms, primarily nausea and vomiting, and delayed gastric emptying (GE), in the absence of mechanical GI obstruction. The underlying pathophysiology of GP remains unclear, but factors contributing to the condition include vagal nerve dysfunction, impaired gastric fundic accommodation, antral hypomotility, gastric dysrhythmias, and pyloric dysfunction. Currently, gastric emptying scintigraphy (GES) is considered the gold standard for GP diagnosis. However, the overall delay in GE weakly correlates with GP symptoms and their severity. Recent research efforts have focused on developing treatments that address the presumed underlying pathophysiological mechanisms of GP, such as pyloric hypertonicity, with Gastric Peroral Endoscopic Myotomy (G-POEM) one of these procedures. New promising diagnostic tools for gastroparesis include wireless motility capsule (WMC), the 13 carbon-GE breath test, high-resolution electrogastrography, and the Endoluminal Functional Lumen Imaging Probe (EndoFLIP). Some of these tools assess alterations beyond GE, such as muscular electrical activity and pyloric tone. These modalities have the potential to characterize the pathophysiology of gastroparesis, identifying patients who may benefit from targeted therapies. The aim of this review is to provide an overview of the current knowledge on diagnostic pathways in GP, with a focus on the association between diagnosis, symptoms, and treatment. [ABSTRACT FROM AUTHOR]

This paper presents a literature review and a case of an 83-year-old otherwise healthy female patient with a history of recent syncope, a sudden-onset right-sided temporal headache, diplopia, and vision loss. An exam revealed right-sided upper eyelid ptosis, myosis, vision loss, ophthalmoplegia, and a positive relative afferent pupillary defect on the right eye. CT showed sphenoid sinus opacification, eroded lateral sinus wall, Vidian canal, disease extension to the posterior ethmoid air cells, orbital apex, medial orbital wall, and pterygopalatine fossa. An orbital apex syndrome (Jacod's syndrome), Horner syndrome, and pterygopalatine fossa infection were diagnosed due to the acute invasive fungal sinusitis developed from a sphenoid sinus fungal ball. The patient was treated with antimicrobial therapy and transnasal endoscopic surgery twice to decompress the orbital apex, drain the abscess and obtain specimens for analysis. The right-sided ptosis, visual loss, ophthalmoplegia, and headache resolved entirely. No immune or comorbid diseases were identified, microbiological and histopathological analyses were negative, and MRI could not be performed on the presented patient. For that reason, the diagnostic procedure was non-standard. Nevertheless, the treatment outcome of this vision and life-threatening disease was satisfactory. Treating the fungal ball in an older or immunocompromised patient is essential to prevent invasive fungal rhinosinusitis and fatal complications. [ABSTRACT FROM AUTHOR]

Introduction: Hemosiderosis of chronic dialysis has always been a frequent phenomenon in dialysis; formerly related to blood transfusions before the advent of Erythropoiesis Stimulating Agents (ESA), it is currently in connection with the use of massive doses of injectable iron, to ensure the full therapeutic efficacy of ESA. Few studies have looked at the therapeutic aspect of iron chelators in the dialysis population. Methods: We followed 31 dialysis patients treated for secondary hemosiderosis with deferasirox (DFX) at the dose 10 mg/kg/day, by hepatic MRI from September 2017 to September 2021, in order to evaluate the efficacy of iron chelators on the reduction of liver iron concentration (LIC). The diagnosis of hemosiderosis was carried for a value of the LIC > 50 μmol/g of dry liver. Results: Chelation resulted in a significant reduction in liver iron burden as measured by liver MRI: (201.4 ± 179.9 vs. 122.6 ± 154.3 μmol/g liver) (p = 0.000) and in mean ferritin level: (2058.8 ± 2004.9 vs. 644.2 ± 456.6 ng/mL) (p = 0.002). A gain of 1.1 g/dL in mean hemoglobin level: (10.5 ± 1.6 vs. 11.6 ± 2.0 g/dL) (p = 0.006). A significant increase in mean albumin level: (43 ± 5.5 to 46.2 ± 6.1 g/L) (p = 0.04). The therapeutic response was clearly influenced by the cause of overload, longer in polytransfused patients (p = 0.023) and the degree of overload assessed by MRI (p = 0.003) and ferritin level (p = 0.04). Conclusion: DFX, prescribed at a dose of 10 mg/kg/day, resulted in a significant reduction in hepatic iron burden as measured by liver MRI and ferritin. The therapeutic response was clearly influenced by blood transfusions and the degree of iron overload. [ABSTRACT FROM AUTHOR]

Double aortic arch (DAA) is a rare, congenital anomaly in small animals, resulting in a complete vascular ring encircling the esophagus and trachea, and subsequent compression of these organs. Few studies have reported utilizing CT angiography (CTA) for diagnosing DAA in dogs; thus, the imaging features are currently lacking in the literature. The objectives of this retrospective, multicenter, descriptive case series were to report the clinical and CTA characteristics of DAA in surgically treated cases. Medical records and CTA images were reviewed. Six juvenile dogs met the inclusion criteria (median age: 4.2 months; range: 2–5 months). The most common clinical signs included chronic regurgitation (100%), decreased body condition (67%), and coughing (50%). Common CTA features of DAA included a dominant left aortic arch (median diameter: 8.1 mm) and minor right aortic arch (median diameter: 4.3 mm; 83%), an aberrant right subclavian artery arising directly from the right aortic arch (83%), segmental esophageal constriction (100%), and variable degrees of dilation cranial to the heart base, and marked tracheal luminal compression (median percent change: –55%; 100%) and leftward curvature of the trachea at the level of the bifurcation of the aortic arches (100%). All dogs underwent successful surgical correction with only minor postoperative complications. Due to the similarity of clinical and imaging characteristics described to that of other forms of vascular ring anomalies (VRA), CTA is vital for the specific diagnosis of DAA in dogs. [ABSTRACT FROM AUTHOR]

Invasive fungal infection is a major cause of morbidity and mortality after intensive chemotherapy in patients with leukemia who present with febrile neutropenia. The most common sites of involvement are the lungs, sinonasal region, and disseminated blood stream infection. Visceral organ involvement is usually seen in the form of fungal abscesses, with parenchymal infarcts being less common. We report an unusual case of invasive fungal infection presenting with extensive liver infarction, global renal infarction, and multiple brain lesions in a 4-year-old boy with acute lymphoblastic leukemia on induction chemotherapy. [ABSTRACT FROM AUTHOR]

Introduction: Abnormal Cranial Nerve (CN) enhancement can point towards an underlying disorder or disease severity. Therefore, the depiction of this feature is of utmost importance in the evaluation of various pathologies. Various Magnetic Resonance Imaging (MRI) sequences have a role in the early identification of such findings. Aim: To study the spectrum of cases of abnormal CN enhancement on MRI and the role of contrast-enhanced 3 Dimensional (3D) T1-weighted CUBE Fat saturated sequence in evaluating pathological CN enhancement. Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis at Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India. The duration of the study was 2 years, from June 2020 to June 2022. Study included 50 patients who presented with signs and symptoms of CN involvement or were referred for other pathologies with incidental detection of pathological nerve enhancement on 1.5 Tesla (T) MRI Scanner. The data was transferred to a Microsoft Excel 2010 sheet and results were expressed in terms of frequency and percentages. Results: The mean age of the study participants was 33.3±20.9 years. Male to female ratio was 28:22=1.27:1. Infections were the most common cause of abnormal CN enhancement 26 (52%) cases followed by demyelination 3 (6%) cases, haematological malignancy 4 (8%) cases, metastatic neural infiltration 5 (20%), primary neural tumours 4 (18%), Bell's palsy 1 (2%) case, Tolosa Hunt Syndrome (THS) 1 (2%) case and idiopathic polyneuritis cranialis 1 (2%) case. Conclusion: Contrast-enhanced 3D T1 CUBE Fat-saturation (FS) sequence is excellent in depicting abnormal CN enhancement, especially the cisternal segments. [ABSTRACT FROM AUTHOR]

Pulmonary embolism (PE) is a potentially life-threatening condition that requires immediate medical intervention. Although PE was previously thought to occur infrequently in the pediatric population, recent studies have found a higher-than-expected prevalence of PE in the pediatric population of up to 15.5%. The imaging modality of choice for detecting PE in the pediatric population is multi-detector CT angiography, although MRI is assuming a growing and more important role as a potential alternative modality. Given the recent advances in both computed tomography pulmonary angiography (CTPA) and MRI techniques, a growing population of pediatric patients with complex comorbidities (such as children with a history of surgeries for congenital heart disease repair), and the recent waves of coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C), which are associated with increased risk of PE, there is new and increased need for an up-to-date review of practical CT and MRI protocols for PE evaluation in children. This article provides guidance for up-to-date CT and MR imaging techniques, reviews key recent studies on the imaging of pediatric PE, and discusses relevant pediatric PE imaging pearls and pitfalls, in hopes of providing readers with up-to-date and accurate practice for imaging evaluation of PE in children. [ABSTRACT FROM AUTHOR]