High prevalence of middle cerebral artery calcification is associated with cardiovascular mortality in hemodialyzed patients: an overlooked part of arterial tree?

PURPOSE

We have analyzed markers of accelerated atherosclerosis like large artery stiffness, ankle-brachial index, carotid and vertebral duplex ultrasonography and their possible associations with the incidence of intracranial calcifications, clinical course of hemodialyzed patients, and cardiovascular mortality.

METHODS

A computed tomographic scan of the head was performed for any neurological indication on 100 hemodialyzed patients. Eleven intracranial arteries were analyzed for calcification score, while internal carotid arteries and vertebral arteries were excluded in cerebral artery calcification score. As a control group for assessing intracranial calcifications, we have analyzed computed tomographic scans from diabetic patients who had an acute stroke.

RESULTS

Deceased patients had significantly higher values of augmentation index and pulse wave velocity, lower ankle-brachial index, and higher internal carotid arteries peak systolic value than survived patients. Deceased patients had significantly higher number of calcified middle cerebral arteries as well as significantly higher intracranial artery calcification score and cerebral artery calcification score. Hemodialyzed patients had significantly higher both intracranial and cerebral artery calcification scores than diabetic control group. Age and calcified middle cerebral arteries had increased HR of 1.08 and 1.36 for cardiovascular mortality.

CONCLUSION

This study showed that large artery stiffness and not the presence of peripheral arterial disease or carotid artery stenosis have the prognostic role of middle cerebral arteries' calcifications and cardiovascular mortality in hemodialyzed patients. The presence of middle cerebral arteries' calcifications diagnosed by a non-invasive method should be considered a marker of middle-sized conduit arteries atherosclerosis, subclinical brain damage, and future fatal cardiovascular events.

Contemporary technologies to modify calcified plaque in coronary artery disease

With aging society, one of the more challenging obstacles in percutaneous coronary interventions are calcified coronary lesions. Calcified lesions may impede stent delivery, limit balloon and stent expansion, cause uneven drug distribution, and hinder wire advancement. Even in the setting of acceptable procedural success, vessel calcification is independently associated with increased target lesion revascularization rates at follow-up and lower survival rates. In order to effectively manage such lesions, dedicated technologies have been developed. Atherectomy aims at excising tissue and debulking plaques, as well as compressing and reshaping the atheroma, generally referred to as lesion preparation that enables further balloon and/or stent expansion in contemporary clinical practice. In the current review, we will discuss the available methods for atherectomy, including rotational, orbital, and excimer laser coronary atherectomy, as well as intravascular lithotripsy. In addition, we will review the role of imaging in calcified lesions.

Local, non-systemic, and minimally invasive therapies for calcinosis cutis: a systematic review

Calcinosis cutis is a deposition of calcium in the skin and subcutaneous tissue, often accompanied by pain, reduced mobility, and chronic infections. Limited evidence is available about the feasibility and efficacy of therapies alternative to systemic treatment and surgical excision, both of which often lead to unsatisfactory results or complications. We conducted a systematic review to evaluate the efficacy and safety of topical and intralesional sodium thiosulfate, extracorporeal shock-wave lithotripsy (ESWL), and laser for calcinosis cutis. PubMed, Embase, and Web of Science were searched. Reports of calciphylaxis and treatment combined with systemic medications were excluded. A total of 40 studies including 136 patients were analysed. Partial or complete remission after monotherapy was observed in 64% to 81% of cases. Self-applied topical sodium thiosulfate required patient’s adherence (mean treatment duration, 4.9 months; range 2–24). Laser therapy enabled complete remission of microcalcifications after a single procedure (57%; 12/21). ESWL and intralesional sodium thiosulfate injections decreased calcinosis-associated pain (median reduction in VAS score, 3; range 0–9 and 1; range 0–5, respectively). The most common adverse event was scarring and hyperkeratosis, observed after CO₂ laser (56%; 10/18). Intralesional sodium thiosulfate injections caused transient pain in over 11% of patients. Recurrences within the follow-up were rare (2%; 3/136). This study provides an overview of minimally invasive and local therapies that in selected cases might transcend conventional treatment. The limitation of this study is the poor level of evidence, which emerges mainly from non-randomized studies at high risk of bias.

Ink on the move: tattoo pigment resembling axillary lymph node calcifications

High-density foci within axillary lymph nodes are associated with a number of potential diagnoses. In this case series, we present four tattooed patients who had mammographic findings that demonstrated high-density material in axillary lymph nodes, indicative of tattoo pigment migration. The aim of presenting these cases is to highlight the importance of recognizing such pigment migration in order to help breast radiologists form an appropriate differential diagnosis that might include this entity.

A Rare Case of Peripheral Ossifying Fibroma in an Infant

Peripheral ossifying fibroma (POF) associated with natal/neonatal teeth is extremely rare. In general, POF occurs as a soft-tissue gingival nodule occurring in young adults. We report an unusual and a rare case in a 5-month-old male child who had two, localized, soft-tissue growth over the mandibular anterior alveolar ridge. History revealed the presence of natal teeth in the same mandibular anterior region, which exfoliated at the age of 2 months. Intraoral periapical radiograph showed soft tissue density with evidence of calcifications that also corroborated with the histopathological finding of masses of mineralized areas. Excision of the lesions followed by histopathological examination proved the final diagnosis of POF. Inspite of being a benign reactive lesion, a high recurrence rate has been reported. Such lesions require long-term follow-up subsequent to excision with histopathological examination due to a high recurrence rate.

A pulmonary hamartoma in Covid-19 pneumonia: an interesting case studied with computed tomography

Since the widespread of acute respiratory syndrome infection caused by Coronavirus-19, chest computed tomography (CT) was considered a useful imaging tool commonly used in early diagnosis and monitoring of patients with complicated Covid-19 pneumonia. Many typical imaging features of this disease were carefully described with chest CT, as well as the collateral CT findings in the lungs and mediastinum. Here we describe the case of a patient with Covid-19 pneumonia, that collaterally had a pulmonary hamartoma in the left lung, documented at CT.

Encephalotrigeminal Angiomatosis with Facial Lobular Capillary Hemangioma: An Unusual Case Report

Encephalotrigeminal angiomatosis, also called Sturge–Weber syndrome (SWS), is a syndrome of etiology which is not yet clear. It is a nonhereditary condition. The clinical features include pigmentation over the facial skin known as port-wine stain, abnormalities of ocular region, and central nervous system involvement as leptomeningeal angioma. In this manuscript, we present a rare case report with an unusual combination of SWS with facial lobular capillary hemangioma.

MRI as a complementary tool for the assessment of suspicious mammographic calcifications: Does it have a role?

INTRODUCTION

Mammography remains the standard imaging modality for the identification and characterization of breast calcifications. However, its low specificity results in high biopsy rates in cases of suspicious calcifications.

OBJECTIVES

To evaluate the diagnostic performance of MRI as an additional tool in the assessment of suspicious mammographic calcifications and to identify the enhancement patterns most related to malignancy.

METHODS

An observational, prospective, cross-sectional, bi-centre study was conducted including consecutive patients with suspicious calcification groups on mammography (BI-RADS® 4 and 5). Anatomopathological results obtained from biopsies were considered the reference standard, and the patients were followed up for at least two years. MRI examinations were interpreted by two radiologists in consensus. The chi-square test was used to evaluate the correlation between MRI features and histological results. The overall diagnostic performance of MRI for malignancy was calculated.

RESULTS

162 female patients were included (mean age, 53 years; range 34-82 years), with 163 mammographic lesions, of which 77 (47.2%) were benign, 64 (39.3%) malignant, and 22 (13.5%) precursor lesions on histopathology. Malignant lesions demonstrated a significantly higher presence of enhancement (56/64; 87.5%) than benign lesions (17/77; 22.1%) (p < 0.001). Non-mass enhancement (NME) was the morphology most related to malignant lesions (38/56; 67.9%). The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of MRI for malignancy were 81.5%, 87.5%, 77.8%, 71.8%, and 90.5%, respectively.

CONCLUSION

MRI performed as an adjunct tool allows to increase imaging specificity for malignancy in suspicious calcifications, which may contribute to reduce the need for biopsy.

Effect of Calcifications on Shear-Wave Elastography in Evaluating Breast Lesions

This study aimed to investigate the effect of calcifications on shear-wave elastography in evaluating breast lesions. We retrospectively reviewed ultrasound images of 673 breast lesions and compared the elasticity between lesions with and without calcifications in three subgroups: benign lesions, in situ carcinomas and invasive carcinomas. Breast lesions were confirmed histologically (n = 401) or by follow-up images for more than 2 y (n = 272). Calcifications were present in 25.3% (170/673) of the lesions. The E_mean values with and without calcifications, respectively, were as follows: 62.8 and 29.8 kPa in benign lesions (p = 0.000), 114.6 and 52.8 kPa in in situ carcinomas (p = 0.037) and 171.9 and 146.4 kPa in invasive carcinomas (p = 0.018). The presence of calcifications significantly increased the E_mean of breast lesions. Shear-wave elastography should be carefully interpreted in benign lesions with calcifications and in situ carcinomas without calcifications.

Lithogenic Potential of Ureaplasma in Chronic Prostatitis

INTRODUCTION

The role of Ureaplasma spp. (UPs) in the pathogenesis of chronic prostatitis is debated. The lithogenic potential of UPs could be a risk factor for the development of chronic prostatitis.

METHODS

A total of 143 patients with identification of UPs were retrospectively selected from a database including patients with prostatitis-like symptoms who were studied according to the same protocol including clinical, microbiological and microscopic evaluation, and transrectal prostate ultrasound. A control group of patients with negative UPs was considered including 393 with chronic bacterial prostatitis (CBP), 42 patients with Chlamydia trachomatis (CT), and 781 patients with chronic pelvic pain syndrome. UPs and Mycoplasma hominis (MH) were identified using a semiquantitative assay.

RESULTS

Calcifications were observed more frequently in patients with UPs (64%) than in patients with CBP without UPs (39%), CT infection (37%), and chronic pelvic pain syndrome (29%) (p < 0.0001). UPs were isolated in VB1 alone in 35 patients (urethral UPs), in expressed prostatic secretion (EPS) or post-massage urine (VB3) or sperm in 77 patients (prostatic UPs) and associated with other pathogens in 31 patients (associated UPs). Calcifications were more frequent in prostatic UPs (71%) and associated UPs (73%) than in urethral UPs (34%). Mean NIH-CPSI scores were not significantly different between groups, although mean WBC counts of sperm of patients with urethral UPs were significantly lower than in patients with prostatic UPs (p = 0.000) and associated UPs (p = 0.002).

CONCLUSIONS

UPs identification in the urogenital fluids is related to higher rates of prostate calcifications. The ability of UPs to promote the formation of calcifications could be related to the chronicization of prostate infection. In particular, the presence of UPs in VB3/EPS/sperm is associated with higher rates of calcifications and high WBC sperm counts, suggesting a partial or full causative role of UPs in the pathogenesis of this disease.

Digital breast tomosynthesis (DBT)-guided biopsy of calcifications: pearls and pitfalls

As digital breast tomosynthesis (DBT) is quickly becoming the standard of care in clinical practice, DBT-guided procedures are being more frequently utilized. DBT-guided biopsies of calcifications are efficient and easy to perform. As radiologists seek proficiency in these biopsies, there are some unique features of DBT-guided biopsies that they must consider. In this review, we provide a step-by-step guide on performing DBT-guided biopsies of calcifications, with a focus on pearls and pitfalls for problem solving in difficult biopsy cases.

Predicting Upstaging of DCIS to Invasive Disease: Radiologists's Predictive Performance

RATIONALE AND OBJECTIVES

The purpose of this study is to quantify breast radiologists' performance at predicting occult invasive disease when ductal carcinoma in situ (DCIS) presents as calcifications on mammography and to identify imaging and histopathological features that are associated with radiologists' performance.

MATERIALS AND METHODS

Mammographically detected calcifications that were initially diagnosed as DCIS on core biopsy and underwent definitive surgical excision between 2010 and 2015 were identified. Thirty cases of suspicious calcifications upstaged to invasive ductal carcinoma and 120 cases of DCIS confirmed at the time of definitive surgery were randomly selected. Nuclear grade, estrogen and progesterone receptor status, patient age, calcification long axis length, and breast density were collected. Ten breast radiologists who were blinded to all clinical and pathology data independently reviewed all cases and estimated the likelihood that the DCIS would be upstaged to invasive disease at surgical excision. Subgroup analysis was performed based on nuclear grade, long axis length, breast density and after exclusion of microinvasive disease.

RESULTS

Reader performance to predict upstaging ranged from an area under the receiver operating characteristic curve (AUC) of 0.541-0.684 with a mean AUC of 0.620 (95%CI: 0.489-0.751). Performances improved for lesions smaller than 2 cm (AUC: 0.676 vs 0.500; p = 0.002). The exclusion of microinvasive cases also improved performance (AUC: 0.651 vs 0.620; p = 0.005). There was no difference in performance based on breast density (p = 0.850) or nuclear grade (p = 0.270) CONCLUSION: Radiologists were able to predict invasive disease better than chance, particularly for smaller DCIS lesions (<2 cm) and after the exclusion of microinvasive disease.

Combined texture analysis and machine learning in suspicious calcifications detected by mammography: Potential to avoid unnecessary stereotactical biopsies

OBJECTIVES

To investigate whether combined texture analysis and machine learning can distinguish malignant from benign suspicious mammographic calcifications, to find an exploratory rule-out criterion to potentially avoid unnecessary benign biopsies.

METHODS

Magnification views of 235 patients which underwent vacuum-assisted biopsy of suspicious calcifications (BI-RADS 4) during a two-year period were retrospectively analyzed using the texture analysis tool MaZda (Version 4.6). Microcalcifications were manually segmented and analyzed by two readers, resulting in 249 image features from gray-value histogram, gray-level co-occurrence and run-length matrices. After feature reduction with principal component analysis (PCA), a multilayer perceptron (MLP) artificial neural network was trained using histological results as the reference standard. For training and testing of this model, the dataset was split into 70 % and 30 %. ROC analysis was used to calculate diagnostic performance indices.

RESULTS

226 patients (150 benign, 76 malignant) were included in the final analysis due to missing data in 9 cases. Feature selection yielded nine image features for MLP training. Area under the ROC-curve in the testing dataset (n = 54) was 0.82 (95 %-CI: 0.70-0.94) and 0.832 (95 %-CI 0.72-0.94) for both readers, respectively. A high sensitivity threshold criterion was identified in the training dataset and successfully applied to the testing dataset, demonstrating the potential to avoid 37.1-45.7 % of unnecessary biopsies at the cost of one false-negative for each reader.

CONCLUSION

Combined texture analysis and machine learning could be used for risk stratification in suspicious mammographic calcifications. At low costs in terms of false-negatives, unnecessary biopsies could be avoided.

Neglected double J stent for 8 Years with giant bladder calculi formation: A case report

Double-j ureteral stents have been widely used as part of urologic practice. The main use is to provide urinary drainage from the kidney to the bladder. With the increase use, several complications are seen related to stents. We present a 17- year-old male with neglected double-j stent for eight years after right pyelolithotomy. He skipped follow up. An open surgery for extracting bladder stones and removing the encrusted double-j stent is done successfully. In conclusion, neglected double-j stent for a long time leads to major complications such as extremely encrustation, stone formation and renal hydronephrosis.

Scoring System to Stratify Malignancy Risks for Mammographic Microcalcifications Based on Breast Imaging Reporting and Data System 5th Edition Descriptors

Objective

To develop a scoring system stratifying the malignancy risk of mammographic microcalcifications using the 5th edition of the Breast Imaging Reporting and Data System (BI-RADS).

Materials and Methods

One hundred ninety-four lesions with microcalcifications for which surgical excision was performed were independently reviewed by two radiologists according to the 5th edition of BI-RADS. Each category's positive predictive value (PPV) was calculated and a scoring system was developed using multivariate logistic regression. The scores for benign and malignant lesions or BI-RADS categories were compared using an independent t test or by ANOVA. The area under the receiver operating characteristic curve (AUROC) was assessed to determine the discriminatory ability of the scoring system. Our scoring system was validated using an external dataset.

Results

After excision, 69 lesions were malignant (36%). The PPV of BI-RADS descriptors and categories for calcification showed significant differences. Using the developed scoring system, mean scores for benign and malignant lesions or BI-RADS categories were significantly different (p < 0.001). The AUROC of our scoring system was 0.874 (95% confidence interval, 0.840–0.909) and the PPV of each BI-RADS category determined by the scoring system was as follows: category 3 (0%), 4A (6.8%), 4B (19.0%), 4C (68.2%), and 5 (100%). The validation set showed an AUROC of 0.905 and PPVs of 0%, 8.3%, 11.9%, 68.3%, and 94.7% for categories 3, 4A, 4B, 4C, and 5, respectively.

Conclusion

A scoring system based on BI-RADS morphology and distribution descriptors could be used to stratify the malignancy risk of mammographic microcalcifications.

Potential Role of Convolutional Neural Network Based Algorithm in Patient Selection for DCIS Observation Trials Using a Mammogram Dataset

RATIONALE AND OBJECTIVES

We investigated the feasibility of utilizing convolutional neural network (CNN) for predicting patients with pure Ductal Carcinoma In Situ (DCIS) versus DCIS with invasion using mammographic images.

MATERIALS AND METHODS

An IRB-approved retrospective study was performed. 246 unique images from 123 patients were used for our CNN algorithm. In total, 164 images in 82 patients diagnosed with DCIS by stereotactic-guided biopsy of calcifications without any upgrade at the time of surgical excision (pure DCIS group). A total of 82 images in 41 patients with mammographic calcifications yielding occult invasive carcinoma as the final upgraded diagnosis on surgery (occult invasive group). Two standard mammographic magnification views (CC and ML/LM) of the calcifications were used for analysis. Calcifications were segmented using an open source software platform 3D Slicer and resized to fit a 128 × 128 pixel bounding box. A 15 hidden layer topology was used to implement the neural network. The network architecture contained five residual layers and dropout of 0.25 after each convolution. Five-fold cross validation was performed using training set (80%) and validation set (20%). Code was implemented in open source software Keras with TensorFlow on a Linux workstation with NVIDIA GTX 1070 Pascal GPU.

RESULTS

Our CNN algorithm for predicting patients with pure DCIS achieved an overall diagnostic accuracy of 74.6% (95% CI, ±5) with area under the ROC curve of 0.71 (95% CI, ±0.04), specificity of 91.6% (95% CI, ±5%) and sensitivity of 49.4% (95% CI, ±6%).

CONCLUSION

It's feasible to apply CNN to distinguish pure DCIS from DCIS with invasion with high specificity using mammographic images.

Phenotypic Variability in Leukoencephalopathy with Brain Calcifications and Cysts: Case Report of Siblings from an Irish Traveller Family with a Homozygous SNORD118 Mutation

Leukoencephalopathy with brain calcifications and cysts (LCC) is a rare cerebral microangiopathy, the cause of which was recently determined to be recessively inherited mutations in the SNORD118 gene. We report the case of a 32-year-old Irish Traveller woman who presented to the emergency department in convulsive status epilepticus with abnormal neuroimaging features characteristic of LCC. Her medical history consisted of epilepsy, intellectual impairment, previous craniotomies for excision of cerebral cysts and resection of a tibial osteogenic sarcoma. Whole exome sequencing identified a previously described homozygous variant, NR_033294.1 n.*5C>G, in the 3' UTR of the SNORD118 gene. Her sister was subsequently found to be homozygous for the same variant but with a significantly milder clinical phenotype consisting of migraine without aura and mild, non-specific, cerebral white matter changes on neuroimaging. Knowledge of the existence of LCC within this population means that targeted genetic testing for this specific mutation should be considered in Irish Traveller patients presenting with the characteristic clinical and radiological features. Given the striking phenotypic variability seen within this family, LCC should also be considered in Irish Traveller patients even in the absence of the complete radiological triad.

Super-Resolution in Digital Breast Tomosynthesis: Limitations of the Conventional System Design and Strategies for Optimization

Our previous work explored the use of super-resolution as a way to improve the visibility of calcifications in digital breast tomosynthesis. This paper demonstrates that there are anisotropies in super-resolution throughout the reconstruction, and investigates new motion paths for the x-ray tube to suppress these anisotropies. We used a theoretical model of a sinusoidal test object to demonstrate the existence of the anisotropies. In addition, high-frequency test objects were simulated with virtual clinical trial (VCT) software developed for breast imaging. The simulated objects include a lead bar pattern phantom as well as punctate calcifications in a breast-like background. In a conventional acquisition geometry in which the source motion is directed laterally, we found that super-resolution is not achievable if the frequency is oriented in the perpendicular direction (posteroanteriorly). Also, there are positions, corresponding to various slices above the breast support, at which super-resolution is inherently not achievable. The existence of these anisotropies was validated with VCT simulations. At locations predicted by theoretical modeling, the bar pattern phantom showed aliasing, and the spacing between individual calcifications was not properly resolved. To show that super-resolution can be optimized by re-designing the acquisition geometry, we applied our theoretical model to the analysis of new motion paths for the x-ray tube; specifically, motions with more degrees of freedom and with more rapid pulsing (submillimeter spacing) between source positions. These two strategies can be used in combination to suppress the anisotropies in super-resolution.

Staining efficacy assessment of a differential routine and special stains for pathological stromal calcifications in maxillofacial lesions

Head and neck connective tissue lesions may have diverse calcifications within the fibrous connective tissue stroma. The perplexity involved in the identification and determination of the nature or degree of calcification through routine hematoxylin and eosin (H&E) stains necessitates the usage of a specific, simple, and cost- and time-effective differential staining techniques. The aim of the present study was to develop criteria to distinguish bone formation from bone resorption using methylene blue-acid fuchsin (MB/AF) stain and the role of collagen fibers in the identification of stromal calcifications using polarizing microscopy with picrosirius red stain. Twenty cases with pathological diagnoses for various stromal calcifications in maxillofacial lesions were retrieved from the departmental archives. Decalcified formalin fixed paraffin embedded tissue sections were stained with hematoxylin and eosin, Masson's trichrome (MT), methylene blue-acid fuchsin (MB/AF), and picrosirius red. The stained sections were assessed to identify the calcifications found in the surrounding connective tissue stroma. It was observed that most cases showed maximum staining intensity with MB/AF stain as compared to the other staining methods. Moreover, the results suggested that contrast between calcification and stromal soft tissue was best distinguished with the MB/AF stain except in the case of dystrophic calcifications. Along with this, polarizing microscopy with picrosirius red enables better characterization of stromal components. Although the H&E stain and a connective tissue stain i.e. Masson's trichrome, are employed routinely in histopathology; the use of special stains such as MB-AF and picrosirius red facilitates the identification of calcifications from the stromal tissues.

[Basal ganglia calcification]

Calcifications of the basal ganglia are frequently seen on the cerebral CT scans and particularly in the globus pallidus. Their frequency increases physiologically with age after 50 years old. However, pathological processes can also be associated with calcium deposits in the gray nuclei, posterior fossa or white matter. Unilateral calcification is often related to an acquired origin whereas bilateral ones are mostly linked to an acquired or genetic origin that will be sought after eliminating a perturbation of phosphocalcic metabolism. In pathological contexts, these calcifications may be accompanied by neurological symptoms related to the underlying disease: Parkinson's syndrome, psychiatric and cognitive disorders, epilepsy or headache. The purpose of this article is to provide a diagnostic aid, in addition to clinical and biology, through the analysis of calcification topography and the study of different MRI sequences.

Intracranial calcifications under vitamin K antagonists or direct oral anticoagulants: Results from the French VIKING study in older adults

OBJECTIVES

The use of vitamin K antagonists (VKA) is associated with the onset of vascular and soft-tissue calcifications. Whether there are more intracranial calcifications under VKA remains unclear. The objective of this study was to determine whether the regular use of VKA in older adults was associated with an increased burden of intracranial calcifications compared with the use of direct oral anticoagulant (DOA).

STUDY DESIGN

Nineteen patients aged 70 years or more using VKA for more than 3 months and 19 controls (matched for age, gender and indication for anticoagulation) using DOA for more than 3 months were consecutively included in this study.

MAIN OUTCOMES MEASURES

The burden of intracranial calcifications was graded by an experienced neuroradiologist from 0 (no burden) to 3 (high burden) according to the quantity, size, intensity and confluence of calcifications on computed tomography scan of the brain. Age, gender, frontal assessment battery (FAB) score, hypertension, dyslipidaemia, carotid artery stenosis, kidney failure and indication for anticoagulation were investigated as potential confounders.

RESULTS

The 19 patients using VKA (median[IQR], 84years[7]; 10females) exhibited a greater burden of falcian calcifications than the 19 controls using DOA (respectively, 2[1] versus 1[2], P = 0.025). Overall, we found that using VKA was directly associated with the global burden of intracranial calcifications (β = 1.54, P = 0.049). No correlation was found with calcifications in sites other than the falx cerebri.

CONCLUSIONS

The use of VKA was associated with a greater burden of intracranial calcifications compared with the use of DOA, specifically in the falx cerebri. This finding may explain part of the neurocognitive morbidity met with VKA.

Impact of the Kaiser score on clinical decision-making in BI-RADS 4 mammographic calcifications examined with breast MRI

Objectives

To investigate whether the application of the Kaiser score for breast magnetic resonance imaging (MRI) might downgrade breast lesions that present as mammographic calcifications and avoid unnecessary breast biopsies

Methods

This IRB-approved, retrospective, cross-sectional, single-center study included 167 consecutive patients with suspicious mammographic calcifications and histopathologically verified results. These patients underwent a pre-interventional breast MRI exam for further diagnostic assessment before vacuum-assisted stereotactic-guided biopsy (95 malignant and 72 benign lesions). Two breast radiologists with different levels of experience independently read all examinations using the Kaiser score, a machine learning–derived clinical decision-making tool that provides probabilities of malignancy by a formalized combination of diagnostic criteria. Diagnostic performance was assessed by receiver operating characteristics (ROC) analysis and inter-reader agreement by the calculation of Cohen’s kappa coefficients.

Results

Application of the Kaiser score revealed a large area under the ROC curve (0.859–0.889). Rule-out criteria, with high sensitivity, were applied to mass and non-mass lesions alike. The rate of potentially avoidable breast biopsies ranged between 58.3 and 65.3%, with the lowest rate observed with the least experienced reader.

Conclusions

Applying the Kaiser score to breast MRI allows stratifying the risk of breast cancer in lesions that present as suspicious calcifications on mammography and may thus avoid unnecessary breast biopsies.

Key Points

• The Kaiser score is a helpful clinical decision tool for distinguishing malignant from benign breast lesions that present as calcifications on mammography.

• Application of the Kaiser score may obviate 58.3–65.3% of unnecessary stereotactic biopsies of suspicious calcifications.

• High Kaiser scores predict breast cancer with high specificity, aiding clinical decision-making with regard to re-biopsy in case of negative results.

[The optimal work-up before TAVI]

The number of TAVI procedures is rapidly increasing owing to the extension of indications. Procedural and long-term success warrant appropriate patient selection and rigorous preparation of the procedure during the pre-TAVI work-up. The aims of this work-up are several: validation of the indication, feasibility and safety of the procedure, selection of the prosthesis and of the route, anticipation of technical challenges. The CT-scan is the cornerstone of this assessment allowing for valve and vascular access appraisal. The geriatric evaluation remains important in the elderly, frail, high-risk patients. The assessment of cardiac and extracardiac comorbidities is systematic and may be incorporated into dedicated risk scores to improve the prediction of post-TAVI outcomes; this should be the basis of the decision-making process by the Heart Team.