Body composition measures as a determinant of Alpelisib related toxicity

BACKGROUND

Body composition has emerged as an important prognostic factor in patients treated with cancer. Severe depletion of skeletal muscle, sarcopenia, has been associated with poor performance status and worse oncological outcomes. We studied patients with metastatic breast cancer receiving alpelisib, to determine if sarcopenia and additional body composition measures accounting for muscle and adiposity are associated with toxicity.

METHODS

A retrospective observational analysis was conducted, including 38 women with metastatic breast cancer and a PIK3CA mutation, treated with alpelisib as advanced line of therapy. Sarcopenia was determined by measuring skeletal muscle cross-sectional area at the third lumbar vertebra using computerized tomography. Various body composition metrics were assessed along with drug toxicity, dose reductions, treatment discontinuation, hospitalizations, time to treatment failure and overall survival.

RESULTS

Sarcopenia was observed in half of the patients (n = 19, 50%), spanning normal weight, overweight, and obese individuals. Among the body composition measures, lower skeletal muscle density (SMD) was associated with an increased risk of treatment-related hyperglycaemia (P = 0.03). Additionally, lower visceral adipose tissue (VAT) was associated with alpelisib-induced rash (P = 0.04) and hospitalizations (P = 0.04). Notably, alpelisib treatment discontinuation was not impacted by alpelisib toxicity.

CONCLUSION

Body composition measures, specifically SMD and VAT may provide an opportunity to identify patients at higher risk for severe alpelisib related hyperglycemia, and cutaneous toxicity. These findings suggest the potential use of body composition assessment to caution toxicity risk, allowing for personalized therapeutic observation and intervention.

The diagnostic performance of ultrafast MRI to differentiate benign from malignant breast lesions: a systematic review and meta-analysis

OBJECTIVES

To assess the diagnostic performance of ultrafast magnetic resonance imaging (UF-DCE MRI) in differentiating benign from malignant breast lesions.

MATERIALS AND METHODS

A comprehensive search was conducted until September 1, 2023, in Medline, Embase, and Cochrane databases. Clinical studies evaluating the diagnostic performance of UF-DCE MRI in breast lesion stratification were screened and included in the meta-analysis. Pooled summary estimates for sensitivity, specificity, diagnostic odds ratio (DOR), and hierarchic summary operating characteristics (SROC) curves were pooled under the random-effects model. Publication bias and heterogeneity between studies were calculated.

RESULTS

A final set of 16 studies analyzing 2090 lesions met the inclusion criteria and were incorporated into the meta-analysis. Using UF-DCE MRI kinetic parameters, the pooled sensitivity, specificity, DOR, and area under the curve (AUC) for differentiating benign from malignant breast lesions were 83% (95% CI 79-88%), 77% (95% CI 72-83%), 18.9 (95% CI 13.7-26.2), and 0.876 (95% CI 0.83-0.887), respectively. We found no significant difference in diagnostic accuracy between the two main UF-DCE MRI kinetic parameters, maximum slope (MS) and time to enhancement (TTE). DOR and SROC exhibited low heterogeneity across the included studies. No evidence of publication bias was identified (p = 0.585).

CONCLUSIONS

UF-DCE MRI as a stand-alone technique has high accuracy in discriminating benign from malignant breast lesions.

CLINICAL RELEVANCE STATEMENT

UF-DCE MRI has the potential to obtain kinetic information and stratify breast lesions accurately while decreasing scan times, which may offer significant benefit to patients.

KEY POINTS

• Ultrafast breast MRI is a novel technique which captures kinetic information with very high temporal resolution. • The kinetic parameters of ultrafast breast MRI demonstrate a high level of accuracy in distinguishing between benign and malignant breast lesions. • There is no significant difference in accuracy between maximum slope and time to enhancement kinetic parameters.

[THE MULTIDISCIPLINARY APPROACH TO ACUTE NECROTIZING PANCREATITIS]

INTRODUCTION

Acute pancreatitis is among the most common gastrointestinal diseases, and a major cause of hospitalization and morbidity. Gallstones and alcohol abuse are the most common causes of acute pancreatitis. Other etiologies include hypertriglyceridemia, medications, post- endoscopic retrograde cholangiopancreatography (ERCP), trauma, hypercalcemia, infections and toxins, anatomic anomalies, etc. In most cases acute pancreatitis is a mild self-limiting disease. However, up to 20% of patients develop severe pancreatitis with pancreatic necrosis, which possess high rates of multi-organ failure and mortality. Conservative management of acute necrotizing pancreatitis includes fluid resuscitation, nutritional support, and broad spectrum antibiotics for infected necrotic peripancreatic fluid collection (PFC). Indications for further invasive interventions include infected necrotic PFC and/or persistent severe symptoms due to mass effect. Current clinical management algorithms favor endoscopic ultrasound (EUS)-guided drainage of PFCs. In case of a large collection or extension to the paracolic gutters, a percutaneous drainage is indicated. Dual modalities (percutaneous together with endoscopic drainage) possess lower rates of pancreatic-cutaneous fistulas, shorter length of hospitalization and less endoscopic interventions. Direct endoscopic necrosectomy should be considered when the patient fails to improve despite endoscopic and percutaneous drainage. A multidisciplinary approach, which involves advanced endoscopists, interventional radiologists, pancreaticobiliary surgeons as well as nutrition and infectious disease specialists, is needed for the optimal management of severe necrotizing pancreatitis.

Ultrasonography in the intensive care unit: a bibliometrics analysis

Background

Ultrasonography is widely used in critical care practice. The status of related studies remains unclear. The purpose of this study is to analyze current literature investigating the use of ultrasound in critical care units by using bibliometric analysis.

Methods

The Science Citation Index Expanded (SCI-E) database was used for data retrieval. The search formula for literature retrieval was "ultrasound" OR "ultrasonography" AND "intensive care unit" OR "critical care unit" OR "intensive care" OR "critical care". The bibliometric software package of R software was used to analyze the results. Information of related literatures were analyzed.

Results

Finally, 3,715 articles were included. The number of published articles and the number of references increased annually. The research fields included medical imaging, critical care medicine, cardiology, etc. The United States has published more documents in this field than other countries and has shown the highest rate of cooperation with other countries. Among the top 10 research institutions with the largest number of publications, 5 are from France and 3 are from the United States. There are many authors from China in the top 10 published studies. Among the top 10 journals with the largest number of published articles, 5 journals are top journals in the field of critical care medicine. Among the top 10 keywords, there are 5 of ultrasound specialty and 2 of critical care medicine.

Conclusions

Researches on the use of ultrasound in critical care units are mainly concentrated in several developed countries in Europe and the United States. Chinese research institutions should perform more studies in this field and increase cooperation with institutions from other countries.

Thyroid nodule characterization using Spectral Detector Computed Tomography (SDCT) in comparison to ultrasound

OBJECTIVE

To characterize thyroid nodules seen on Spectral Detector computed tomography (SDCT) in respect to their Thyroid Imaging Reporting and Data System (TI-RADS) category on Ultrasound (US).

METHODS

We included patients that underwent US examination for the evaluation of thyroid nodules and contrast-enhanced SDCT examination of the neck/thorax, between the years 2018-2020. The SDCT and US were performed within 6 months of each other. Only patients with a visible thyroid nodule on SDCT were included. Attenuation measurements of the nodules in Hounsfield units (HU) were performed on the conventional CT images, virtual non-contrast (VNC) images and virtual monoenergetic images of 40 keV and 100 keV. The Iodine concentration, spectral slope and enhancement estimation results of the nodules were measured. We compared the spectral results between two groups of nodules, according to the US report: TI-RADS 2-3 and TI-RADS 4-5 groups.

RESULTS

Thirty-eight nodules were included in the study, 22 nodules in the TI-RADS 2-3 group and 16 in the TI-RADS 4-5 group. The nodules of the TI-RADS 4-5 group had significantly higher Iodine concentration measurement, 4.6 ± 1.8 mg/ml, compared to 2.3 ± 1.2 mg/ml in the TI-RADS 2-3 group; significantly higher estimated enhancement, 3.9 ± 1.5, compared to 2.2 ± 0.7; and significantly higher calculated spectral slope, 5.6 ± 2.2 compared to 2.9 ± 1.5 (p < 0.001).

CONCLUSION

Spectral results of SDCT may assist in differentiating intermediate-high risk (TI-RADS 4-5) from low risk (TI-RADS 2-3) thyroid nodules.

ADVANCES IN KNOWLEDGE

SDCT offers additional information for the characterization of thyroid nodules.

Virtual versus true non-contrast images of the brain from spectral detector CT: comparison of attenuation values and image quality

BACKGROUND

Prior studies focused on utilization of dual-energy computed tomography (DECT) to better detect intracranial pathology and to reduce artifacts. It is still unclear whether virtual non-contrast (VNC) images of DECT can replace true non-contrast (TNC) images.

PURPOSE

To compare attenuation values and image quality of VNC images to TNC images of the brain, obtained using spectral detector CT (SDCT).

MATERIAL AND METHODS

We retrospectively evaluated patients that underwent head CT with and without contrast material, on a SDCT scanner at our institution (n = 33). The attenuation values of different brain structures were obtained from TNC images, the conventional images of the post-contrast exams (n = 16) or the CT angiography (CTA) (n = 17), and the derived VNC images. In total, 591 regions of interest were obtained, including white and gray matter. Two neuroradiologists independently evaluated the image quality of the VNC and TNC images, using a 5-point Likert scale.

RESULTS

The mean difference between the attenuation values on the VNC versus the TNC images was <4 HU for almost all the structures. The difference reached statistical significance (P < 0.05) for the deep gray structures but not for the white matter. The image quality score of the TNC images was 5 in all the patients (excellent gray-white matter differentiation). The scores of the VNC images differed between post-contrast and CTA examinations, with means of 4.9 ± 0.3 (excellent) and 3.2 ± 0.4 (fair), respectively (P < 0.001).

CONCLUSION

Our results show minor differences between attenuation values of different brain structures on VNC versus TNC images of SDCT.

Abstract P5-13-19: Sarcopenia and skeletal muscle density as predictors of toxicity in patients with metastatic breast cancer receiving alpelisib

Background: Poor body composition metrics (BCM) are associated with inferior cancer outcomes. Alpelisib, a PIK3CA inhibitor, is increasingly used in approximately 40% of hormone receptor positive HER2 negative (luminal) metastatic breast (HR-MBC) patients who carry a somatic mutation in the PIK3CA gene. In the SOLAR-1, the clinical trial that led to FDA approval, serious adverse reactions occurred in 35% patients who were treated with Alpelisib and severe hyperglycemia was reported in 65% of the patients. Alpelisib is given at a fixed dose (300 mg daily) regardless of variables such as high adiposity or low muscle mass also called sarcopenia. In this study we investigated the association of BCM with toxicity and response to Alpelisib. Methods: Eligible HR-MBC patients treated with Alpelisib at Tel Aviv Sourasky Medical Center were identified. Toxicity grading, dose reduction, treatment discontinuation and hospitalizations were recorded. Using computerized tomography (CT) images taken for the evaluation of disease burden, skeletal muscle area (SMA), and skeletal muscle density (SMD) were measured at the third lumbar (L3) vertebrae. Sarcopenia was defined as skeletal muscle index (SMI = SMA/height2) &lt;41 (Martin, JCO 2012). Low skeletal muscle density (SMD) was defined as &lt; 37.8 Hounsfield Units (HU). Fisher exact tests, t tests, the Kaplan-Meier method, and Cox regression modeling were used. Results: All together Seventeen HR-MBC with PIK3CA mutation treated with Alpelisib met the study requirements. Median age was 63 (range 37-82). Of them 71% were sarcopenic. Any grade toxicity appeared in 83% of the sarcopenic patients versus 20% is the non-sarcopenic (P=0.0276). Both toxicity-related hospitalization and grade 3-4 toxicities and were found in 25% of the sarcopenic vs 0% in the non-sarcopenic. Severe adverse events - defined as grade 3-4 toxicities, hospitalization and dose reductions appeared in 66.6% of the sarcopenic vs 40% of the non-sarcopenic (P=NS). Low SMD appeared in 76% of the cohort. In the low SMD group 69% experienced grade 3-4 toxicity vs 25% in high SMD (P=NS). Hyperglycemia in all grades appeared in all the sarcopenic patients and 80% of the non-sarcopenic. Time to treatment failure (time to progression or toxicity) was numerically shorter in the sarcopenic group vs non-sarcopenic group (82 days vs 114 days respectively). Conclusion: AEs percentage was significantly higher in patients with sarcopenia. These AEs were seen more often in the early cycles. TTF on Alpelisib was shorter in the sarcopenic and low SMD groups. We assume that it was not statistically significant probably due to the low number of patients. Hence, we suggest a novel tool including two parameters (sarcopenia and SMD) for prediction of treatment toxicity which may serve for better treatment decision in the course of the disease in HR-MBC. As Aplelisib is reimbursed in Israel since 2021, we expect additional patients in our cohort and at SABCS 2021, we will extend our cohort and analysis.

Data and statisticsSarcopenicNon-SarcopenicP-valueLow SMDHigh SMDP-valueHyperglicemia all grades100%80%0.294192.31%100%0.0475Hyperglicemia grade 3-433.33%40%138.46%25%1AEs all grades83.33%20%0.027669.23%50%0.584AEs grade 3-425%00.514715.38%25%1SAE including G3-4 AEs + hospitalization + dose reductions66.67%40%0.592869.23%25%0.25TTF (days)82114187991

Citation Format: Ari Raphael, Rivka Kessner, Rebeka Raphael, Amir Sonnenblick, Shlomit Strulov Shachar. Sarcopenia and skeletal muscle density as predictors of toxicity in patients with metastatic breast cancer receiving alpelisib [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-13-19.

ROS1-positive Inflammatory Myofibroblastic Tumor of the Small Bowel Causing Obstruction: A Case Report

Inflammatory Myofibroblastic Tumors (IMTs) are rare fibroblastic/myofibroblastic neoplasms that affect predominately pediatric patients and young adults. Almost half of the patients with IMTs have a chromosomal abnormality in the Anaplastic Lymphoma Kinase 1 gene on chromosome 2p23. Although these tumors occur primarily in the lung, lesions have been reported in a variety of intra-abdominal organs like the liver, spleen, and mesentery. Small bowel IMTs are particularly rare. IMTs generally pursue a benign clinical course, however intra-abdominal and retroperitoneal tumors have typically shown higher local recurrence and even distant metastases. The most common presenting symptoms of an intra-abdominal IMT are abdominal pain and change in bowel habits. Laboratory results are nonspecific and can include anemia and minor elevation of inflammatory markers like C-reactive protein. We report an unusual case of IMT in the small bowel causing the obstruction.

Spectral CT of the abdomen: Where are we now?

Spectral CT adds a new dimension to radiological evaluation, beyond assessment of anatomical abnormalities. Spectral data allows for detection of specific materials, improves image quality while at the same time reducing radiation doses and contrast media doses, and decreases the need for follow up evaluation of indeterminate lesions. We review the different acquisition techniques of spectral images, mainly dual-source, rapid kV switching and dual-layer detector, and discuss the main spectral results available. We also discuss the use of spectral imaging in abdominal pathologies, emphasizing the strengths and pitfalls of the technique and its main applications in general and in specific organs.

Kambô-Induced Systemic Inflammatory Response: A Case Report of Acute Disease Progression of Cholangiocarcinoma

Kambô is a cleansing ritual involving the application of a toxin produced by the giant leaf frog (Phyllomedusa bicolor). The Kambô ritual has increasingly been adopted among cancer patients in Europe. Accumulating data indicate various adverse effects. We report another severe adverse reaction to Kambô, a systemic inflammatory response syndrome mimicking disease progression in a patient with cholangiocarcinoma. We describe a systemic reaction to Kambô, manifested as tachycardia, tachypnea, impaired liver cholestatic enzymes, and enlargement of lymphadenopathy mimicking disease progression. The clinical features and onset of symptoms, the rapid reaction, and the lack of other identified causes make the diagnosis of Kambô-induced SIRS highly probable. This case report calls for future studies examining standard oncological care such as chemotherapy, radiotherapy, and immunotherapy in conjunction with alternative therapy. Additionally, greater awareness and physician education should be promoted, encouraging inquiry of oncology patients’ administration of alternative, complementary, and integrative medicine.

Contrast-Enhanced Ultrasound Guidance for Interventional Procedures

Since its introduction, contrast-enhanced ultrasound (CEUS) has gained an important role in the diagnosis and management of abdominal and pelvic diseases. Contrast-enhanced ultrasound can improve lesion detection rates as well as success rates of interventional procedures when compared to conventional ultrasound alone. Additionally, CEUS enables the interventionalist to assess the dynamic enhancement of different tissues and lesions, without the adverse effects of contrast-enhanced computed tomography, such as exposure to ionizing radiation and nephrotoxicity from iodinated contrast material. This review article describes the various applications and advantages of the use of CEUS to enhance performance of ultrasound-guided interventions in the abdomen and pelvis.

Improving Bone Mineral Density Assessment Using Spectral Detector CT

INTRODUCTION

Bone mineral density (BMD) analysis by Dual-Energy x-ray Absorptiometry (DXA) can have some false negatives due to overlapping structures in the projections. Spectral Detector CT (SDCT) can overcome these limitations by providing volumetric information. We investigated its performance for BMD assessment and compared it to DXA and phantomless volumetric bone mineral density (PLvBMD), the latter known to systematically underestimate BMD. DXA is the current standard for BMD assessment, while PLvBMD is an established alternative for opportunistic BMD analysis using CT. Similarly to PLvBMD, spectral data could allow BMD screening opportunistically, without additional phantom calibration.

METHODOLOGY

Ten concentrations of dipotassium phosphate (K2HPO4) ranging from 0 to 600 mg/ml, in an acrylic phantom were scanned using SDCT in four different, clinically-relevant scan conditions. Images were processed to estimate the K2HPO4 concentrations. A model representing a human lumbar spine (European Spine Phantom) was scanned and used for calibration via linear regression analysis. After calibration, our method was retrospectively applied to abdominal SDCT scans of 20 patients for BMD assessment, who also had PLvBMD and DXA. Performance of PLvBMD, DXA and our SDCT method were compared by sensitivity, specificity, negative predictive value and positive predictive value for decreased BMD.

RESULTS

There was excellent correlation (R2 >0.99, p < 0.01) between true and measured K2HPO4 concentrations for all scan conditions. Overall mean measurement error ranged from -11.5 ± 4.7 mg/ml (-2.8 ± 6.0%) to -12.3 ± 6.3 mg/ml (-4.8 ± 3.0%) depending on scan conditions. Using DXA as a reference standard, sensitivity/specificity for detecting decreased BMD in the scanned patients were 100%/73% using SDCT, 100%/40% using PLvBMD provided T-scores, and 90-100%/40-53% using PLvBMD hydroxyapatite density classifications, respectively.

CONCLUSIONS

Our results show excellent sensitivity and high specificity of SDCT for detecting decreased BMD, demonstrating clinical feasibility. Further validation in prospective clinical trials will be required.

Renal cystic lesions characterization using spectral detector CT (SDCT): Added value of spectral results

OBJECTIVES

To evaluate the added value of spectral results derived from Spectral Detector CT (SDCT) to the characterization of renal cystic lesions (RCL).

METHODS

This retrospective study was approved by the local Institutional review board. 70 consecutive patients who underwent abdominopelvic SDCT and had at least one RCL were included. 84 RCL were categorized as simple, complex or neoplastic based on attenuation values on single-phase post-contrast images. Attenuation values were measured in each lesion on standard conventional CT images (stCI) and virtual monoenergetic images of 40keV and 100keV. A spectral curve slope was calculated and intra lesional iodine concentration (IC) was measured using iodine-density maps. Reference standard was established using histopathologic correlation, prior and follow-up imaging. Analysis of variance (ANOVA) was used to compare between the groups.

RESULTS

Mean attenuation values for benign simple and complex RCL differed significantly (42 ± 16 vs 8 ± 3 HU; p < 0.001). IC was almost identical in benign simple and complex RCL (0.23 ± 0.04 mg ml^-1 vs 0.24 ± 0.04 mg ml^-1), while IC in neoplastic RCL was significantly higher (2.10 ± 0.08 mg ml^-1 ; p < 0.001). The mean spectral curve slope did not differ significantly between simple and complex RCL (0.30 ± 0.03 vs 0.33 ± 0.05) but was significantly higher in neoplastic RCL (2.60 ± 0.10; p < 0.001).

CONCLUSIONS

Spectral results of SDCT are highly promising in distinguishing benign complex RCL from enhancing neoplastic RCL based on single-phase post-contrast imaging only.

ADVANCES IN KNOWLEDGE

SDCT can assist in differentiating between benign complex and neoplastic renal cystic lesions.

Differentiation of Hemorrhage from Iodine Using Spectral Detector CT: A Phantom Study

BACKGROUND AND PURPOSE

Conventional CT often cannot distinguish hemorrhage from iodine extravasation following reperfusion therapy for acute ischemic stroke. We investigated the potential of spectral detector CT in differentiating these lesions.

MATERIALS AND METHODS

Centrifuged blood with increasing hematocrit (5%-85%) was used to model hemorrhage. Pure blood, blood-iodine mixtures (75/25, 50/50, and 25/75 ratios), and iodine solutions (0-14 mg I/mL) were scanned in a phantom with attenuation ranging from 12 to 75 HU on conventional imaging. Conventional and virtual noncontrast attenuation was compared and investigated for correlation with calculation of relative virtual noncontrast attenuation. Values for all investigated categories were compared using the Mann-Whitney U test. Sensitivity and specificity of virtual noncontrast, relative virtual noncontrast, conventional CT attenuation, and iodine quantification for hemorrhage detection were determined with receiver operating characteristic analysis.

RESULTS

Conventional image attenuation was not significantly different among all samples containing blood (P > .05), while virtual noncontrast attenuation showed a significant decrease with a decreasing blood component (P < .01) in all blood-iodine mixtures. Relative virtual noncontrast values were significantly different among all investigated categories (P < .01), with correct hemorrhagic component size estimation for all categories within a 95% confidence interval. Areas under the curve for hemorrhage detection were 0.97, 0.87, 0.29, and 0.16 for virtual noncontrast, relative virtual noncontrast, conventional CT attenuation, and iodine quantification, respectively. A ≥10-HU virtual noncontrast, ≥20-HU virtual noncontrast, ≥40% relative virtual noncontrast, and combined ≥10-HU virtual noncontrast and ≥40% relative virtual noncontrast attenuation threshold had a sensitivity/specificity for detecting hemorrhage of 100%/23%, 89%/95%, 100%/82%, and 100%/100%, respectively.

CONCLUSIONS

Spectral detector CT can accurately differentiate blood from iodinated contrast in a phantom setting.

Contrast enhanced ultrasound guided biopsies of liver lesions not visualized on standard B-mode ultrasound-preliminary experience

Background

To assess the technical success of contrast enhanced ultrasound (CEUS) guided biopsies of liver lesions poorly visualized on B-mode ultrasound.

Methods

Patients were selected during the procedure based on the real-time clinical scenario of unsatisfactory B-mode ultrasound lesion visualization and all patients would have otherwise undergone CT guided liver lesion biopsy. A total of 26 patients underwent CEUS guided biopsy and were included in this retrospective analysis. The review of the patients' files included demographic information, lesion characteristics on imaging, procedural details and pathology outcome. Technical success was defined as concordance between the radiological findings, pathology report and clinical follow-up-demonstrating lack of need for re-biopsy or re-biopsy with identical pathological results. Patients with less than 2 months follow-up were excluded from the study.

Results

CEUS guided liver biopsy was successful in 23 out of 26 patients (88.5%). The average procedure time was 30.7±12.3 minutes and the average lesion size was 2.2±1.7 cm. The majority of lesions (80.8%) were hypoenhancing on the delayed phase of CEUS. The mean number of samples taken from each lesion per procedure was 3.2 (±1.7).

Conclusions

CEUS guidance biopsies of focal liver lesions (FLL) that were difficult to visualize on B-mode ultrasound demonstrated high success rate and may be an evolving image guidance modality in selected patients to avoid CT guided procedures.

CT for Acute Nontraumatic Abdominal Pain-Is Oral Contrast Really Required?

RATIONALE AND OBJECTIVES

This study aims to compare the diagnostic performance of abdominal computed tomography (CT) performed with and without oral contrast in patients presenting to the emergency department (ED) with acute nontraumatic abdominal pain.

MATERIALS AND METHODS

Between December 2013 and December 2014, 348 adult patients presenting to the ED of a large tertiary medical center with nontraumatic abdominal pain were evaluated. Exclusion criteria for the study were history of inflammatory bowel disease, recent abdominal operation and suspected renal colic, abdominal aortic aneurysm rupture, or intestinal obstruction. All patients underwent intravenous contrast-enhanced abdominal CT on a Philips Brilliance 64-slice scanner using a routine abdomen protocol. The study group included 174 patients who underwent abdominal CT scanning without oral contrast, recruited using convenience sampling. A control group of 174 patients was matched to the cohort groups' gender and age and underwent abdominal CT with oral contrast material during the same time period. The patients' medical records were reviewed for various clinical findings and for the final clinical diagnosis. The CT exams were initially reviewed by a senior attending radiologist to determine the exams' technical adequacy and to decide whether an additional scan with oral contrast was required. Two senior radiologists, blinded to the clinical diagnosis, later performed consensus reading to determine the contribution of oral contrast administration to the radiologists' diagnostic confidence and its influence on diagnosing various radiological findings.

RESULTS

Each group consisted of 82 men and 92 women. The average age of the two groups was 48 years. The main clinical diagnoses of the pathological examinations were appendicitis (17.5%), diverticulitis (10.9%), and colitis (5.2%). A normal CT examination was found in 34.8% of the patients. There was no significant difference between the groups regarding most of the clinical parameters that were examined. None of the examinations of all of the 174 study group patients was found to be technically inadequate, and therefore no patient had to undergo additional scanning to establish a diagnosis. The consensus reading of the senior radiologists determined that the lack of oral contrast was insignificant in 96.6% of the cases and that contrast material might have been useful in only 6 of 174 study group patients (3.4%). The radiologists found oral contrast to be helpful only in 8 of 174 control group patients (4.6%). There was no significant difference between the clinical and radiological diagnoses in both groups (study group, P = 0.261; control group, P = 0.075).

CONCLUSIONS

Our study shows that oral contrast is noncontributory to radiological diagnosis in most patients presenting to the ED with acute nontraumatic abdominal pain. These patients can therefore undergo abdominal CT scanning without oral contrast, with no effect on radiological diagnostic performance.

Pseudophakic rhegmatogenous retinal detachment: combined pars plana vitrectomy and scleral buckle versus pars plana vitrectomy alone

PURPOSE

To compare the outcomes of combined vitrectomy + scleral buckle (SB) and vitrectomy alone for pseudophakic rhegmatogenous retinal detachment (RRD).

METHODS

Cases included 65 eyes of 63 patients with primary non-complex pseudophakic RRD. The first group underwent combined vitrectomy + SB between January 2010 and August 2012, and the second group was treated with vitrectomy alone between September 2012 and October 2013. The medical records of the patients were reviewed for preoperative examinations, follow-up examinations (including final visual acuity [VA]), appearance of redetachment and complications. The main outcomes were recurrent retinal detachment, complications, and VA improvement.

RESULTS

The rate of single-surgery anatomic success was non-significantly lower in the combined vitrectomy + SB group compared with the vitrectomy alone group - 75.8 % versus 84.4 % respectively (P = 0.683). Complications were significantly more frequent in the former compared to the latter (P = 0.014). The final VAs were 0.580 (logMAR) and 0.486, respectively (P = 0.258). VA improvement of ≥3 lines was achieved in 48.5 % and in 50 % of the eyes respectively (P = 0.769).

CONCLUSIONS

There were no significant differences in single-surgery anatomic success rates and VA improvement between combined vitrectomy + SB and vitrectomy alone for pseudophakic RRD. Significantly more complications occurred in the combination group.

Macular Thickness Following Strabismus Surgery as Determined by Optical Coherence Tomography

PURPOSE

To investigate macular changes following strabismus surgery by using optical coherence tomography (OCT).

METHODS

The authors prospectively evaluated 60 eyes of 30 patients undergoing unilateral extraocular muscle surgery. OCT measurements employing the fast macular thickness mapping protocol were performed 1 day prior to surgery and 1 day postoperatively. Postoperative macular changes in the study eye that was operated on (n = 30) were compared with the fellow control eye (n = 30, controls).

RESULTS

There was an increase in mean ± standard deviation central foveal thickness (CFT) in the operated eyes, from 201.63 ± 18.36 µm at baseline to 206.03 ± 22.73 µm postoperatively (P = .024). Preoperative and postoperative perifoveal outer temporal quadrant thicknesses were 220.10 ± 16.23 and 225.80 ± 14.78 µm, respectively (P = .009). There were no differences between preoperative and postoperative retinal thickness measurements for all measured areas in the control eyes. Eyes that underwent surgery involving the rectus muscles showed a trend toward a greater CFT increase compared with eyes that had oblique muscle surgery (P = .070).

CONCLUSIONS

The authors found subclinical increases in the foveal and perifoveal macular thicknesses following extraocular muscle surgery. These findings could be attributed to change in the mechanical forces caused by the new position of the extraocular muscles and transmitted via the sclera or, alternatively, to postoperative inflammation and alterations in the blood-retinal barrier. The clinical implications of these findings remain to be clarified.

Retrobulbar blood flow changes in eyes with diabetic retinopathy: a 10-year follow-up study

Purpose

We sought to assess long-term changes in the flow parameters of retrobulbar vessels in diabetic patients.

Methods

The retrobulbar circulation of 138 eyes was evaluated between 1994 and 1995 and 36 eyes were reevaluated between 2004 and 2008 (study group). They were divided into four groups: eyes of diabetic patients without diabetic retinopathy (DR), eyes with nonproliferative DR, eyes with proliferative DR, and eyes of nondiabetic patients (controls). Color Doppler imaging was used to assess the flow velocities in the major retrobulbar vessels. The resistive index (RI) was calculated and compared among the groups and between the two time periods.

Results

RI values of the central retinal artery and posterior ciliary artery had increased in the two non-DR groups and in the nonproliferative DR group, with a surprising decrease measured in eyes with proliferative DR (P= nonsignificant [NS]). Combining the nonproliferative DR and proliferative DR groups resulted in a milder increase of the RI of the posterior ciliary artery (P= NS) and the central retinal artery (P=0.02) in the DR group compared to the other groups.

Conclusion

Our results demonstrate that an increase of the resistance in the retrobulbar vessels, as a part of DR, can lessen over time and may even be reversed.

Intraretinal Exudates in Coats' Disease as Demonstrated by Spectral-Domain OCT

Purpose

To describe the spectral-domain optical coherence tomography (SD-OCT) findings in a case of Coats' disease, with emphasis on the intraretinal exudates.

Methods

Case report of a 4.5-year-old girl who presented with total exudative retinal detachment and organized exudates in a stellate configuration. SD-OCT was performed before and after treatment, which included surgical drainage of subretinal fluid and indirect laser application during the surgery.

Results

At presentation, the SD-OCT showed an elevation of the foveal contour, with thickening of the retina, many exudates and a large quantity of subretinal fluid. Two months after the surgical treatment, SD-OCT revealed a significant reduction in the amount of subretinal fluids, but with persistence of the exudates.

Conclusion

SD-OCT can be used as an important tool in order to describe the changes in each layer of the retina in Coats' disease. Considering the histopathological findings in Coats' disease, it is reasonable to assume that the exudates accumulate in the outer plexiform layer.