1
|
Radano I, Mabritto B, Luceri S, Bongioanni S, Maiellaro F, Zappia L, Lario C, Macera A, Cirillo S, Pizzuti A, Citro R, Galasso G, Musumeci G. Intramyocardial calcification in apical hypertrophic cardiomyopathy assessed using multimodality imaging: a case series. ESC Heart Fail 2024. [PMID: 38634252 DOI: 10.1002/ehf2.14775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
Apical hypertrophic cardiomyopathy (ApHCM) is an HCM variant, affecting frequently males in midlife. It is characterized by apical obliteration and persistent diastolic contraction, often resulting in microvascular ischaemia. We report five cases of ApHCM, with evidence of intramyocardial calcification on echocardiogram. On cardiac magnetic imaging (MRI), a hypointense component at early gadolinium enhancement (EGE) sequences, compatible with calcium, and a deep layer, with hyperintensity at late gadolinium enhancement (LGE) sequences, referable to fibrosis, suggest an endomyocardial fibrosis (EMF) diagnosis. EMF pathologic hallmark is endocardium and myocardium scarring, evolving to dystrophic calcification. It is found only in few ApHCM patients. Our series is the largest one described until now. Analysing patients' history, coexistent inflammatory triggers were evident in all of them, so their co-morbidities could represent a further cause of small vessel disease, in the context of ischaemic microvascular stress due to hypertrophy, leading to fibrosis and dystrophic calcification. This series could demonstrate the relation between apical fibrosis/calcification and microvascular ischaemia due to hypertrophy and inflammatory triggers.
Collapse
Affiliation(s)
- Ilaria Radano
- Department of Cardiology, Mauriziano Hospital, Torino, Italy
| | | | - Stefania Luceri
- Department of Cardiology, Mauriziano Hospital, Torino, Italy
| | | | | | - Luca Zappia
- Department of Cardiology, Mauriziano Hospital, Torino, Italy
| | - Chiara Lario
- Department of Radiology, Mauriziano Hospital, Torino, Italy
| | | | | | - Alfredo Pizzuti
- Department of Cardiology, Mauriziano Hospital, Torino, Italy
| | - Rodolfo Citro
- Department of Cardiology, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Gennaro Galasso
- Department of Cardiology, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | | |
Collapse
|
2
|
Shivatzki S, Yogev D, Goldberg T, Parmet Y, Dagan M, Vazgovsky O, Tessler I, Sagiv D, Tejman-Yarden S, Primov-Fever A. Virtual Reality Helps Describe the Progression of Thyroid Cartilage Calcification. J Voice 2024:S0892-1997(24)00030-4. [PMID: 38523021 DOI: 10.1016/j.jvoice.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES Thyroid cartilage (TC) calcifications may impact surgical planning and clinical management. However, few studies to date have implemented virtual reality (VR) to evaluate these calcifications. This study assessed the feasibility of evaluating TC calcifications in various regions and measuring their volumes through VR models generated from computed tomography scans. We also investigated age and gender-related differences in calcification patterns. METHODS Ninety-two participants were categorized into younger, middle-aged, and older age groups. Calcification patterns (degree in Hounsfield units and volume of calcification in cm3) in different TC regions were identified by VR analysis, which enabled comparisons between age groups and genders. RESULTS Significant differences in calcification patterns were observed between males and females, particularly in the middle right, middle left, bottom left, and vertex regions. Age-related differences in the vertex region showed increased calcification in the older age group. CONCLUSION This study points to the contribution of VR in the evaluation of complex anatomical structures. The findings revealed significant gender and age patterns in TC calcification. These insights can inform surgical planning and highlight the potential of using VR to gain a better understanding of TC calcification clinically.
Collapse
Affiliation(s)
- Shaked Shivatzki
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel; The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel; The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - David Yogev
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel; The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel; The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Goldberg
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel; The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben Gurion University, Beer Sheva, Israel
| | - Mayan Dagan
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Oliana Vazgovsky
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Idit Tessler
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel; The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Doron Sagiv
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California
| | - Shai Tejman-Yarden
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel; The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Adi Primov-Fever
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel; The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
3
|
Kasahara M, Kanematsu S, Tanaka Y, Okazaki S, Watatani M. Clinical benefits of tomosynthesis-guided vacuum assisted breast biopsy: a comparison with stereotactic vacuum assisted biopsy. Breast Cancer 2024; 31:329-334. [PMID: 38324059 DOI: 10.1007/s12282-024-01542-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 12/30/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Tomosynthesis-guided vacuum assisted breast biopsy (3D-VAB) has been used increasingly. The aim of our study is to compare the clinical effectiveness of 3D-VAB and stereotactic vacuum assisted biopsy (2D-VAB) on the number of tissue cores containing targeted calcifications and on the procedure time. METHODS Consecutive 87 women who underwent biopsy at our hospital from April 2020 to March 2022 for calcifications mammographically suspicious of malignancy were included in this study: 57 patients with 3D-VAB and 30 patients with 2D-VAB. RESULTS Grouped or clustered calcified lesions were found in 39 and 21 patients among the 3D-VAB group and the 2D-VAB group, respectively. The mean number of tissue cores per biopsy containing targeted calcifications from the grouped or clustered calcified lesions was 3 and 2.3 specimens for the 3D-VAB group and for the 2D-VAB group, respectively. The mean procedure time for grouped or clustered calcifications was significantly shorter in the 3D-VAB group than in the 2D-VAB group (16.5 min vs. 27.4 min, P < 0.01). Comparing the procedure time between 3D-VAB and 2D-VAB based on calcification category, 3D-VAB had significantly shorter procedure time than 2D-VAB for both category 3 and category 4 calcification. For all patients, the mean procedure time was 18.1 min for the 3D-VAB group and 27.7 min for the 2D-VAB, thus being significantly shorter with 3D-VAB than 2D-VAB (P < 0.01). CONCLUSION Our study demonstrated that the clinical effectiveness of 3D-VAB is superior to that of 2D-VAB and that the significant reduction in examination time with 3D-VAB is expected to benefit patients.
Collapse
Affiliation(s)
- Mikiko Kasahara
- Department of Surgery, Division of Breast Surgery, Kansai Medical University Kori Hospital, 8-45 Kourihondoricho, Neyagawa, Osaka, 572-8551, Japan
| | - Sayaka Kanematsu
- Department of Surgery, Division of Breast Surgery, Kansai Medical University Kori Hospital, 8-45 Kourihondoricho, Neyagawa, Osaka, 572-8551, Japan
| | - Yoshihito Tanaka
- Department of Surgery, Division of Breast Surgery, Kansai Medical University Kori Hospital, 8-45 Kourihondoricho, Neyagawa, Osaka, 572-8551, Japan
| | - Satoshi Okazaki
- Department of Surgery, Division of Breast Surgery, Kansai Medical University Kori Hospital, 8-45 Kourihondoricho, Neyagawa, Osaka, 572-8551, Japan
| | - Masahiro Watatani
- Department of Surgery, Division of Breast Surgery, Kansai Medical University Kori Hospital, 8-45 Kourihondoricho, Neyagawa, Osaka, 572-8551, Japan.
| |
Collapse
|
4
|
Tidke P, Agarwal MC, Kini VV, Singh S, Patel HJ, Kumar S, Vasant J. Peripheral Ossifying Fibroma of Maxillary Gingiva with Calcification: A Case Report. J Pharm Bioallied Sci 2024; 16:S963-S965. [PMID: 38595507 PMCID: PMC11001151 DOI: 10.4103/jpbs.jpbs_690_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 04/11/2024] Open
Abstract
Peripheral ossifying fibroma is presented as an exophytic growth with a smooth surface. It is located mostly on the gingiva, and it is an unusual growth of gingiva that occurs after irritational trauma. It is seen in the later decade of life, with the calcifications in the lesion in advanced stages seen on radiographic images. In the present case, a 50-year-old male reported with a huge gingival growth in the left maxillary posterior gingival region; when radiograph was taken, it showed calcifications. The patient was treated by surgical excision of the growth.
Collapse
Affiliation(s)
- Priyanka Tidke
- Department of Oral Medicine and Radiology, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Manvi C. Agarwal
- Department of Periodontology and Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
| | - Vineet V. Kini
- Department of Periodontology, MGM Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Subhasini Singh
- Department of Oral Pathology and Microbiology, Awadh Dental College and Hospital, Jamshedpur, Jharkhand, India
| | - Hetul J. Patel
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, Dharmsinh Desai University, Nadiad, Gujarat, India
| | - Santosh Kumar
- Department of Periodontology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, Gujarat, India
| | - Jill Vasant
- BDS, MHA, Muhlenberg Dental Associates, Reading, PA, USA
| |
Collapse
|
5
|
Kuzemczak M, Lipiecki J, Jeyalan V, Farhat H, Kleczyński P, Legutko J, Minten L, Bennett J, Poels E, Dens J, Spyridopoulos I, Kunadian V, Pawłowski T, Gil R, Egred M, Zaman A, Alkhalil M. Clinical outcomes of coronary intravascular lithotripsy in patients with stent failure (COIL registry). Int J Cardiol 2023; 391:131274. [PMID: 37598907 DOI: 10.1016/j.ijcard.2023.131274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/25/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Intravascular lithotripsy (IVL) has been demonstrated to be an effective treatment of calcified de novo coronary lesions. Safety data on the use of IVL within stented segments are lacking. We sought to evaluate the safety, feasibility, and long-term outcomes of IVL in patients with stent failure. METHODS This was a retrospective multi-centre registry that included consecutive patients with stent failure who had undergone IVL treatment. The primary efficacy endpoint was procedural success defined as residual stenosis <30% (determined by quantitative coronary angiography analysis) in patients who survived hospital admission without in-hospital adverse events. Major adverse cardiovascular events (MACE) were defined as the composite endpoints of cardiovascular death, spontaneous myocardial infarction, and target vessel revascularisation at one-year follow up. RESULTS 102 patients were included in this study. Mean age was 73 ± 9 years and 81% were male. The duration from previous stent implantation and IVL treatment was 24 (interquartile range 7-76) months, of which 10.8% received IVL for acute under-expanded stent. IVL treatment allowed significant improvement in both minimal lumen diameter (1.14 ± 0.60 to 2.53 ± 0.59, P < 0.001) and degree of stenosis (66.8 ± 19.9 to 20.3 ± 11.3%, P < 0.001). The rate of procedural success was 78.4% (80/102 of patients). The one-year MACE was 15.7%. Ostial disease (HR 5.16; 95% CI 1.19 to 22.33; P = 0.028) and lesion length (HR 1.05; 95% CI 1.01 to 1.10; P = 0.010) were independently associated with one-year MACE. CONCLUSIONS In patients with stent failure, IVL is a safe and feasible treatment for this high-risk group.
Collapse
Affiliation(s)
- Michał Kuzemczak
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland; Poznań University of Medical Sciences, Division of Emergency Medicine, Poznań, Poland
| | - Janusz Lipiecki
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Visvesh Jeyalan
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Hicham Farhat
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Paweł Kleczyński
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland; Clinical Department of Interventional Cardiology, John Paul II Hospital, Cracow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland; Clinical Department of Interventional Cardiology, John Paul II Hospital, Cracow, Poland
| | - Lennert Minten
- Department of Cardiovascular Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Ioakim Spyridopoulos
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Vijay Kunadian
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Tomasz Pawłowski
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Robert Gil
- Department of Cardiology, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Mohaned Egred
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Azfar Zaman
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Mohammad Alkhalil
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom.
| |
Collapse
|
6
|
JiueLan K, Sekine C, Kurozumi S, Matsuoka R, Komuta M, Shiomi T, Horiguchi J. Fibrocystic breast disease with pleomorphic calcifications and segmental distribution: A case report. Radiol Case Rep 2023; 18:3828-3830. [PMID: 37670913 PMCID: PMC10475390 DOI: 10.1016/j.radcr.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 09/07/2023] Open
Abstract
Fibrocystic breast disease is the most common benign condition and is important for differentiating breast cancer. We present the case of a 27-year-old female patient with pleomorphic calcifications and segmental distribution on mammography, which was highly suggestive of breast cancer; however, the pathological findings were fibrocystic disease. Although fibrocystic breast disease does not require treatment, appropriate follow-up is necessary after assessing the risk of breast cancer.
Collapse
Affiliation(s)
- Kuo JiueLan
- Department of Breast Surgery, International University of Health and Welfare, Narita Hospital, 852 Hatakeda Narita, Chiba 286-8520, Japan
| | - Chikako Sekine
- Department of Breast Surgery, International University of Health and Welfare, Narita Hospital, 852 Hatakeda Narita, Chiba 286-8520, Japan
| | - Sasagu Kurozumi
- Department of Breast Surgery, International University of Health and Welfare, Narita Hospital, 852 Hatakeda Narita, Chiba 286-8520, Japan
| | - Ryosuke Matsuoka
- Department of Anatomic Pathology, International University of Health and Welfare, Narita Hospital, Chiba, Japan
| | - Mina Komuta
- Department of Anatomic Pathology, International University of Health and Welfare, Narita Hospital, Chiba, Japan
| | - Takayuki Shiomi
- Department of Anatomic Pathology, International University of Health and Welfare, Narita Hospital, Chiba, Japan
| | - Jun Horiguchi
- Department of Breast Surgery, International University of Health and Welfare, Narita Hospital, 852 Hatakeda Narita, Chiba 286-8520, Japan
| |
Collapse
|
7
|
Røndbjerg AK, Gyldenløve M, Krustrup D, Rix M, Vejborg I, Lonn L, Jørgensen NR, Pasch A, Skov L, Hansen D. Cutaneous vascular calcifications in patients with chronic kidney disease and calcific uremic arteriolopathy: a cross-sectional study. J Nephrol 2023; 36:1991-1999. [PMID: 37466817 PMCID: PMC10543801 DOI: 10.1007/s40620-023-01707-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/09/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Calcific uremic arteriolopathy is a life-threatening cutaneous condition in patients with chronic kidney disease. Often, clinical diagnosis is accompanied by histopathologic evaluations demonstrating vascular calcium deposits. We aimed to investigate the presence of cutaneous calcifications in non-lesional tissue in patients with chronic kidney disease, and the relation to systemic vascular calcification. METHODS We investigated the presence of cutaneous vascular calcifications in non-lesional skin biopsies from patients with current or previous calcific uremic arteriolopathy and patients with different stages of chronic kidney disease without calcific uremic arteriolopathy, and explored their association with vascular calcification in other vascular beds. Systemic vascular calcification was examined by mammography and lumbar X-ray. RESULTS Thirty-nine adults were enrolled (current or previous calcific uremic arteriolopathy, n = 9; end-stage chronic kidney disease, n = 12; chronic kidney disease stage 3b-4, n = 12; healthy controls, n = 6). All calcific uremic arteriolopathy patients had end-stage kidney disease. Cutaneous vascular calcifications were not present in any of the non-lesional skin punch biopsies. Breast arterial calcification was demonstrated in patients with calcific uremic arteriolopathy (75%) and chronic kidney disease (end-stage 67% and stage 3b-4 25%, respectively), but in none of the controls. All chronic kidney disease patients had systemic calcification on lumbar X-ray (median score 21, 22, and 15 in patients with calcific uremic arteriolopathy, end-stage kidney disease and chronic kidney disease stage 3b-4). The serum calcification propensity was significantly different between groups. DISCUSSION Despite a high burden of systemic vascular calcification, cutaneous calcium deposits in non-lesional tissue could not be demonstrated histopathologically in patients with chronic kidney disease (with or without current or previous calcific uremic arteriolopathy). Further studies to determine whether these findings are representative or attributed to other factors are warranted.
Collapse
Affiliation(s)
- Anne Kristine Røndbjerg
- Department of Internal Medicine, University Hospital Zealand, Roskilde, Denmark
- Department of Nephrology, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Nephrology, Copenhagen University Hospital, Herlev, Denmark
| | - Mette Gyldenløve
- Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
| | - Dorrit Krustrup
- Department of Pathology, Copenhagen University Hospital, Herlev, Denmark
| | - Marianne Rix
- Department of Nephrology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ilse Vejborg
- Department of Breast Examinations, Copenhagen University Hospital, Gentofte, Denmark
| | - Lars Lonn
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Herlev, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Herlev, Denmark
| | - Andreas Pasch
- Calciscon, Biel, Switzerland
- Department of Physiology and Pathophysiology, Johannes Kepler University Linz, Linz, Austria
| | - Lone Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Herlev, Denmark
| | - Ditte Hansen
- Department of Nephrology, Copenhagen University Hospital, Herlev, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Herlev, Denmark.
- Department of Nephrology, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| |
Collapse
|
8
|
Benzalim M, Ouassil S, Alj S, Boutakioute B, Hadri K, Idrissi MO, Guennouni NI. Ossifying skeletal muscle metastasis as an initial manifestation of colorectal adenocarcinoma. Radiol Case Rep 2023; 18:2264-2267. [PMID: 37128252 PMCID: PMC10147951 DOI: 10.1016/j.radcr.2023.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/09/2023] [Accepted: 02/18/2023] [Indexed: 05/03/2023] Open
Abstract
Skeletal muscle metastases from colorectal cancer (CRC) are very rare. They have usually been described in patients with known CRC and as a well-defined mass. In this case report, we present a unique case of diffuse and ossifying skeletal muscle metastasis as the first manifestation of CRC. A 36-year-old man presented with progressive left thigh swelling and left hip pain of 6 months duration. He denied any gastrointestinal complaints. CT and MRI of the thigh showed diffuse muscular swelling, signal abnormalities with linear calcifications involving the muscles of the posterior and medial compartments of the left thigh and both gluteal regions. Histology confirmed the metastatic nature of a colorectal adenocarcinoma. The patient was treated with chemotherapy and showed a good evolution after 6 months of follow-up.
Collapse
Affiliation(s)
- Meriam Benzalim
- Radiology Department Ibn Tofail Hospital, Mohammed VIth University Hospital in Marrakech, Morocco
- Faculty of Medicine and Pharmacy, Cadi Ayyad University, Sidi Abbad, B.P. 7010, Marrakech 40000, Morocco
- Corresponding author.
| | - Sara Ouassil
- Radiology Department Ibn Tofail Hospital, Mohammed VIth University Hospital in Marrakech, Morocco
- Faculty of Medicine and Pharmacy, Cadi Ayyad University, Sidi Abbad, B.P. 7010, Marrakech 40000, Morocco
| | - Soumya Alj
- Radiology Department Ibn Tofail Hospital, Mohammed VIth University Hospital in Marrakech, Morocco
- Faculty of Medicine and Pharmacy, Cadi Ayyad University, Sidi Abbad, B.P. 7010, Marrakech 40000, Morocco
| | - Bader Boutakioute
- Radiology Department Arrazi Hospital, Mohammed VIth University Hospital in Marrakech, Morocco
- Faculty of Medicine and Pharmacy, Cadi Ayyad University, Sidi Abbad, B.P. 7010, Marrakech 40000, Morocco
| | - Kenza Hadri
- Radiology Department Arrazi Hospital, Mohammed VIth University Hospital in Marrakech, Morocco
- Faculty of Medicine and Pharmacy, Cadi Ayyad University, Sidi Abbad, B.P. 7010, Marrakech 40000, Morocco
| | - Meriem Ouali Idrissi
- Radiology Department Arrazi Hospital, Mohammed VIth University Hospital in Marrakech, Morocco
- Faculty of Medicine and Pharmacy, Cadi Ayyad University, Sidi Abbad, B.P. 7010, Marrakech 40000, Morocco
| | - Najat Idrissi Guennouni
- Radiology Department Arrazi Hospital, Mohammed VIth University Hospital in Marrakech, Morocco
- Faculty of Medicine and Pharmacy, Cadi Ayyad University, Sidi Abbad, B.P. 7010, Marrakech 40000, Morocco
| |
Collapse
|
9
|
Mergen V, Ghouse S, Sartoretti T, Manka R, Euler A, Kasel AM, Alkadhi H, Eberhard M. Cardiac Virtual Noncontrast Images for Calcium Quantification with Photon-counting Detector CT. Radiol Cardiothorac Imaging 2023; 5:e220307. [PMID: 37404795 PMCID: PMC10316300 DOI: 10.1148/ryct.220307] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/29/2023] [Accepted: 05/08/2023] [Indexed: 07/06/2023]
Abstract
Purpose To assess the accuracy of aortic valve calcium (AVC), mitral annular calcium (MAC), and coronary artery calcium (CAC) quantification and risk stratification using virtual noncontrast (VNC) images from late enhancement photon-counting detector CT as compared with true noncontrast images. Materials and Methods This retrospective, institutional review board-approved study evaluated patients undergoing photon-counting detector CT between January and September 2022. VNC images were reconstructed from late enhancement cardiac scans at 60, 70, 80, and 90 keV using quantum iterative reconstruction (QIR) strengths of 2-4. AVC, MAC, and CAC were quantified on VNC images and compared with quantification of AVC, MAC, and CAC on true noncontrast images using Bland-Altman analyses, regression models, intraclass correlation coefficients (ICC), and Wilcoxon tests. Agreement between severe aortic stenosis likelihood categories and CAC risk categories determined from VNC and true noncontrast images was assessed by weighted κ analysis. Results Ninety patients were included (mean age, 80 years ± 8 [SD]; 49 male patients). Scores were similar on true noncontrast images and VNC images at 80 keV for AVC and MAC, regardless of QIR strengths, and VNC images at 70 keV with QIR 4 for CAC (all P > .05). The best results were achieved using VNC images at 80 keV with QIR 4 for AVC (mean difference, 3; ICC = 0.992; r = 0.98) and MAC (mean difference, 6; ICC = 0.998; r = 0.99), and VNC images at 70 keV with QIR 4 for CAC (mean difference, 28; ICC = 0.996; r = 0.99). Agreement between calcification categories was excellent on VNC images at 80 keV for AVC (κ = 0.974) and on VNC images at 70 keV for CAC (κ = 0.967). Conclusion VNC images from cardiac photon-counting detector CT enables patient risk stratification and accurate quantification of AVC, MAC, and CAC.Keywords: Coronary Arteries, Aortic Valve, Mitral Valve, Aortic Stenosis, Calcifications, Photon-counting Detector CT Supplemental material is available for this article © RSNA, 2023.
Collapse
|
10
|
Chen JL, Cheng LH, Wang J, Hsu TW, Chen CY, Tseng LM, Guo SM. A YOLO-based AI system for classifying calcifications on spot magnification mammograms. Biomed Eng Online 2023; 22:54. [PMID: 37237394 DOI: 10.1186/s12938-023-01115-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES Use of an AI system based on deep learning to investigate whether the system can aid in distinguishing malignant from benign calcifications on spot magnification mammograms, thus potentially reducing unnecessary biopsies. METHODS In this retrospective study, we included public and in-house datasets with annotations for the calcifications on both craniocaudal and mediolateral oblique vies, or both craniocaudal and mediolateral views of each case of mammograms. All the lesions had pathological results for correlation. Our system comprised an algorithm based on You Only Look Once (YOLO) named adaptive multiscale decision fusion module. The algorithm was pre-trained on a public dataset, Curated Breast Imaging Subset of Digital Database for Screening Mammography (CBIS-DDSM), then re-trained and tested on the in-house dataset of spot magnification mammograms. The performance of the system was investigated by receiver operating characteristic (ROC) analysis. RESULTS We included 1872 images from 753 calcification cases (414 benign and 339 malignant) from CBIS-DDSM. From the in-house dataset, 636 cases (432 benign and 204 malignant) with 1269 spot magnification mammograms were included, with all lesions being recommended for biopsy by radiologists. The area under the ROC curve for our system on the in-house testing dataset was 0.888 (95% CI 0.868-0.908), with a sensitivity of 88.4% (95% CI 86.9-8.99%), specificity of 80.8% (95% CI 77.6-84%), and an accuracy of 84.6% (95% CI 81.8-87.4%) at the optimal cutoff value. Using the system with two views of spot magnification mammograms, 80.8% benign biopsies could be avoided. CONCLUSION The AI system showed good accuracy for classification of calcifications on spot magnification mammograms which were all categorized as suspicious by radiologists, thereby potentially reducing unnecessary biopsies.
Collapse
Affiliation(s)
- Jian-Ling Chen
- Department of Radiology, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist., Taipei City, 112, Taiwan
| | - Lan-Hsin Cheng
- Institute of Computer Science and Information Engineering, National Cheng Kung University, No. 1, University Rd., Tainan City, 701, Taiwan
| | - Jane Wang
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist., Taipei City, 112, Taiwan
- Department of Radiology, National Taiwan University College of Medicine, No. 1, Jenai Rd., Taipei City, 100, Taiwan
- Department of Nurse-Midwifery and Women Health, and School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, No. 365, Mingde Rd., Beitou Dist., Taipei City, 112, Taiwan
| | - Tun-Wei Hsu
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist., Taipei City, 112, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei City, 112, Taiwan
| | - Chin-Yu Chen
- Department of Radiology, Chi-Mei Medical Center, No. 901, Zhonghua Rd. Yongkang Dist., Tainan City, 710, Taiwan
| | - Ling-Ming Tseng
- Comprehensive Breast Health Center, Taipei-Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist., Taipei, 112, Taiwan
- Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist., Taipei, 112, Taiwan
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Beitou Dist., Taipei, 112, Taiwan
| | - Shu-Mei Guo
- Institute of Computer Science and Information Engineering, National Cheng Kung University, No. 1, University Rd., Tainan City, 701, Taiwan.
| |
Collapse
|
11
|
Gandini R, Semeraro V, Salimei F. Foot Dorsal and Plantar Flexion to Enhance Crossing of Tortuous Highly-Calcific Ankle Vessels During Lower Limb Revascularization Procedures: A Technical Note. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03436-8. [PMID: 37039865 DOI: 10.1007/s00270-023-03436-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To describe a crossing technique of stenotic/occluded and tortuous highly calcific ankle vessels during complex percutaneous limb salvage intervention in diabetic patients with ischaemic foot ulcers (Rutherford 5 and 6). TECHNIQUE We propose a simple technique to achieve "straightening" of the tortuous vessel and allow safe devices passage into the foot arteries, Patients were asked to hold their foot in plantar or dorsal flexion, accordingly to the treated artery. If unable to do so, an equipe member executed the manoeuvre on their behalf. RESULTS The technique was applied in 148 cases, with a success rate of 81% (120/148). No complications related to the manoeuvre were observed. CONCLUSION Crossing of tortuous distal crural vessels can be challenging in diabetic patients; in our experience, this technique can be a useful tool to obtain a successful recanalization in complex procedures with high risk of failure.
Collapse
Affiliation(s)
- Roberto Gandini
- Department of Interventional Radiology, University Hospital "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy
| | - Vittorio Semeraro
- Department of Interventional Radiology, Santissima Annunziata Hospital, Taranto, Italy
| | - Fabio Salimei
- Department of Interventional Radiology, University Hospital "Tor Vergata", Viale Oxford, 81, 00133, Rome, Italy.
| |
Collapse
|
12
|
Li J, Li C, Zhang Q, Qiu C. Leukoencephalopathy with calcifications and cysts: A case report with literature review. Neurol Sci 2023:10.1007/s10072-023-06776-y. [PMID: 37004603 DOI: 10.1007/s10072-023-06776-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
Leukoencephalopathy with calcifications and cysts (LCC; OMIM #614561) is a rare disease and at present there are less than 100 cases reported worldwide. Mutations in the SNORD118 gene is now known to be the cause of LCC. We present a case who was heterozygous for the n.70G>A and n.6C>T sequence variants of the SNORD118 gene, variants which to date have not been described. Compared with the cases that we reviewed, our patient had the second longest time to diagnosis (age 56) from onset of symptoms 40 years prior. Moreover, his cousin's family has a high prevalence of epilepsy. This paper reviewed all published reports to date that had descriptive cases involving LCC as well as testing for the SNORD118 gene. Since 1996 only 85 patients have been described in 59 case reports. In this review, we summarize their clinical features, especially central nervous system symptoms, treatment, pathology, and gene testing results.
Collapse
Affiliation(s)
- Jingya Li
- Department of Neurology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, Zhejiang Province, P. R. China
| | - Chun Li
- Department of Neurology, Anji Traditional Chinese Medical Hospital, 299 Shengli West Road,, Anji Huzhou, Zhejiang Province, P. R. China
| | - Qing Zhang
- Department of Neurology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, Zhejiang Province, P. R. China
| | - Chao Qiu
- Department of Neurology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, Zhejiang Province, P. R. China.
| |
Collapse
|
13
|
Liu A, Ma Y, Yin L, Zhu Y, Lu H, Li H, Ye Z. Comparison of malignant calcification identification between breast cone-beam computed tomography and digital mammography. Acta Radiol 2023; 64:962-970. [PMID: 35815702 DOI: 10.1177/02841851221112562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Calcifications are important abnormal findings in breast imaging and help in the diagnosis of breast cancer. PURPOSE To compare breast cone-beam computed tomography (CBCT) with digital mammography (DM) in terms of the ability to identify malignant calcifications. MATERIAL AND METHODS In total, 115 paired examinations were performed utilizing breast CBCT and DM; 86 pathology-proven malignant lesions with calcifications detected on DM and 29 randomly selected breasts without calcifications were reviewed by three radiologists. The ability to detect calcifications was assessed on CBCT images. The characterization agreement of two imaging modalities was evaluated by the kappa coefficient. For breast CBCT images, the parameters for the display of calcifications were recorded. The Kruskal-Wallis test was used to compare the preferred slice thickness chosen by each of the three radiologists. The degree of calcification clarity was compared between two modalities using the Mann-Whitney U-test. RESULTS The combined sensitivity and specificity of three radiologists in 85 DM-detected calcifications detection on breast CBCT images were 98.43% (251/255) and 98.85% (86/87), respectively. CBCT images showed substantial agreement with mammograms in terms of the characterization of calcifications morphology (k = 0.703; P < 0.05) and distribution (k = 0.629; P < 0.05). CBCT images with a slice thickness of 0.273 mm and three-dimensional maximum-intensity projection (3D-MIP) were more beneficial for calcifications identification. No statistically significant difference was found between standard DM views and CBCT images for three radiologists on calcification display clarity. CONCLUSION CBCT images were comparable to mammograms in calcification identification and may be sufficient for malignant calcifications detection and characterization.
Collapse
Affiliation(s)
- Aidi Liu
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Yue Ma
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Lu Yin
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Yueqiang Zhu
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Hong Lu
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Haijie Li
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| | - Zhaoxiang Ye
- Department of Radiology, 74675Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Tianjin's Clinical Research Center for Cancer; Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Huan-Hu-Xi Road, Ti-Yuan-Bei, Hexi District, Tianjin, PR China
| |
Collapse
|
14
|
Vos A, Houben IB, Celeng C, Takx RAP, Isgum I, Mali WPTM, Vink A, de Jong PA. Aortic calcification: A postmortem CT validation study in a middle-aged population. Eur J Radiol 2023; 159:110687. [PMID: 36610325 DOI: 10.1016/j.ejrad.2023.110687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/26/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND Computed tomography (CT)-detected aortic calcification is strongly associated with aortic stiffness and is an accurate predictor of cardiovascular and all-cause mortality and cognitive decline. Some previous pathologic studies have shown calcium accumulation in the medial layer of the vessel wall, while others have suggested localisation in the atherosclerotic intimal layer. OBJECTIVES The aim of this study was to histologically validate CT findings of aortic calcification for detectability and location in the aortic wall. METHODS We acquired postmortem CT images and collected 170 aortic tissue samples from five different locations in the thoracic and abdominal aorta of 40 individuals who underwent autopsy. Microscopic slides were stained with haematoxylin and eosin and elastic van Gieson stain. Calcified lesions were characterised and calcifications were manually annotated in the intima and media. The presence and morphology of calcifications were scored on CT images. RESULTS The mean age of the autopsied individuals was 63 years, and 28 % died of cardiovascular disease. Calcifications were present in 74/170 (44 %) samples. Calcification was more common in the abdominal aorta than in the thoracic aorta. In all samples with calcifications, 99 % were located in the intimal layer. Only 16/170 samples had a small amount of medial arterial calcification. The histological results showed an 85 % concordance for the presence or absence of CT calcifications. There was complete inter-method agreement for annularity of calcifications in 68 % of the samples (linear weighted kappa 0.68 (95 %CI 0.60-0.77). CONCLUSIONS Aortic calcifications visible on CT are located in the intimal layer of the abdominal aorta wall, at least in aortas that are not aneurysmatic or dissected. The presence and annularity of these calcifications can be reliably determined by CT.
Collapse
Affiliation(s)
- Annelotte Vos
- University Medical Center Utrecht and Utrecht University, Department of Pathology, The Netherlands
| | - Ignas B Houben
- University Medical Center Utrecht and Utrecht University, Department of Vascular Surgery, The Netherlands; Frankel Cardiovascular Center, University of Michigan, Department of Cardiac Surgery, United States
| | - Csilla Celeng
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands
| | - Richard A P Takx
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands
| | - Ivana Isgum
- Amsterdam University Medical Centers, The Netherlands
| | - Willem P T M Mali
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands
| | - Aryan Vink
- University Medical Center Utrecht and Utrecht University, Department of Pathology, The Netherlands
| | - Pim A de Jong
- University Medical Center Utrecht and Utrecht University, Department of Radiology, The Netherlands.
| |
Collapse
|
15
|
Nicita F, Aiello C, Carboni A, Longo D, Bertini E, Travaglini L. Leukoencephalopathy with spot-like calcifications caused by recessive COL4A2 variants. Clin Neurol Neurosurg 2023; 225:107584. [PMID: 36603335 DOI: 10.1016/j.clineuro.2022.107584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/24/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
Dominant COL4A1 and COL4A2 mutations cause a broad spectrum of cerebrovascular diseases, whose onset varies from fetal to adult life, mostly represented by prenatal-neonatal intracerebral hemorrhage with porencephaly and by periventricular leukomalacia with calcifications, corresponding clinical diagnoses of cerebral palsy mimics. Axenfeld-Rieger syndrome with leukoencephalopathy, HANAC syndrome, young- and late-onset stroke and malformation of cortical development are rarer presentations. Very recently, the existence of recessive COL4A1- and COL4A2-related forms has been documented. We broaden the phenotypic and genotypic spectra of COL4A2-related disease by describing this second family with recessive pathogenic variants and neuroimaging phenotype of leukoencephalopathy with spot-like calcifications.
Collapse
|
16
|
Ronen N, Suster D. Psammomatous calcifications in thyroid oncocytic (Hürthle cell) follicular tumors. Ann Diagn Pathol 2023; 62:152061. [PMID: 36459776 DOI: 10.1016/j.anndiagpath.2022.152061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022]
Abstract
Concentric calcifications, also known as psammoma bodies, are a relatively frequent finding in certain types of tumors, particularly papillary thyroid carcinoma (PTC). In the thyroid, they have been assigned a significant role in the diagnosis of PTC and in distinguishing between these tumors and other types of thyroid neoplasms. Concentric calcifications have also less commonly been noted in other processes in the thyroid, such as in tumors characterized by cells containing abundant oxyphilic cytoplasm (i.e., Hürthle cells). We have studied 12 patients with oncocytic thyroid follicular tumors that contained scattered psammomatous calcifications that led to difficulties in diagnosis. The patients were 9 women and 3 men, aged 34 to 63 years. 10 cases corresponded to benign, non-invasive oncocytic tumors and 2 cases were minimally invasive follicular carcinomas of oncocytic (so called Hürthle cell) type. The psammomatous calcifications were randomly scattered throughout the lesions and were present as a focal, incidental finding in 8 cases and were diffuse in 4 cases. They were composed of concentrically laminated deposits of dense basophilic material closely resembling psammoma bodies, often associated with more homogeneous deposits of lightly eosinophilic material without concentric lamination that were interpreted as precipitated thyroglobulin. Seven patients with clinical follow-up, including one with minimally invasive carcinoma, were alive and well between 5 and 12 years after diagnosis. Concentric laminated calcifications may be encountered in oncocytic (Hürthle cell) follicular tumors and should not be interpreted as indicative of PTC in the context of oncocytic neoplasms of the thyroid.
Collapse
Affiliation(s)
- Natali Ronen
- Department of Pathology, The Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - David Suster
- Department of Pathology, Rutgers University New Jersey Medical School, Newark, NJ, United States of America.
| |
Collapse
|
17
|
Amabile N, Bressollette E, Souteyrand G, Landolff Q, Veugeois A, Honton B. [Invasive and non-invasive imaging analysis for calcified coronary artery lesions]. Ann Cardiol Angeiol (Paris) 2022; 71:372-380. [PMID: 36220707 DOI: 10.1016/j.ancard.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Coronary calcifications are frequently identified within coronary lesions as their incidence increases with age and cardiovascular risk factors. Their location can be superficial or deep, according to different pathological process. In all cases, the presence of calcifications within the vascular wall predicts poor clinical prognosis and unfavorable evolution after percutaneous revascularization. Coronary calcifications can be analyzed by angiography, CT or intracoronary imaging (IVUS or OCT) with variable accuracies. Angiography is the most frequently used method but is not very sensitive (sensitivity close to 50%) and insufficient for their precise quantification. The CT scan is a more effective non-invasive method leading to an accurate analysis of the lesion before coronary angiography. IVUS and OCT have an excellent spatial resolution and are the most sensitive methods for the identification (present in nearly 75-80% of lesions) and quantification of calcifications. These intracoronary imaging techniques offer interesting perspectives for identification of the highest-risk lesions, PCI procedures planning (including the choice of an optimal dedicated plaque preparation devices), the monitoring of their execution and the evaluation of the immediate post-stenting results.
Collapse
Affiliation(s)
- Nicolas Amabile
- Service de Cardiologie, Institut Mutualiste Montsouris, Paris, France.
| | | | - Géraud Souteyrand
- Service de Cardiologie, CHU Gabriel Montpied, Clermont Ferrand, France
| | | | - Aurèlie Veugeois
- Service de Cardiologie, Institut Mutualiste Montsouris, Paris, France
| | | |
Collapse
|
18
|
Darrigade Fleury M, Frouin E, Hainaut E, Boutin D. Eccrine syringofibroadenomatosis with calcifications of the sweat ducts. Ann Dermatol Venereol 2022; 149:202-203. [PMID: 35803764 DOI: 10.1016/j.annder.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/19/2021] [Accepted: 01/04/2022] [Indexed: 11/15/2022]
Affiliation(s)
- M Darrigade Fleury
- Department of dermatology, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - E Frouin
- Department of pathology, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - E Hainaut
- Department of dermatology, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - D Boutin
- Department of dermatology, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| |
Collapse
|
19
|
Anugula D, Cardoso R, Grandhi GR, Blankstein R, Nasir K, Al-Mallah M, Shah DJ, Cainzos-Achirica M. Extra-coronary Calcification and Cardiovascular Events: What Do We Know and Where Are We Heading? Curr Atheroscler Rep 2022. [PMID: 36040566 DOI: 10.1007/s11883-022-01051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The coronary artery calcium score is a guideline-endorsed aid for further risk stratification in the primary prevention of atherosclerotic cardiovascular disease. The non-contrast scan performed for detection of coronary artery calcium also gives an opportunity to visualize calcifications in the thoracic aorta and in the heart valves, at no additional cost or radiation exposure. The purpose of this review was to discuss the potential clinical value of measuring thoracic aortic calcification, aortic valve calcification, and mitral annulus calcification. RECENT FINDINGS After two decades of active research, all three calcifications have been extensively evaluated, across various cohorts. We discuss classic and recent studies, current knowledge gaps, and future directions in this space. The added value of these measurements has traditionally been considered modest at best, and they are not currently discussed in relevant primary prevention guidelines in North America and Europe. However, recent studies evaluating high thoracic calcification thresholds and younger populations have further enriched this space. Specifically, some studies suggest that detection of severe thoracic aortic calcification may be helpful in further risk assessment and that detection of aortic valve calcifications may have important prognostic implications in younger individuals. Although more research is needed, particularly in larger young-to-middle-aged cohorts, future guidelines might consider including these features as risk-enhancing factors.
Collapse
|
20
|
Bode M, Charlotte Huck L, Raaff V, Hitpass L, Braunschweig T, Nebelung S, Katharina Kuhl C. Digital breast tomosynthesis-guided vacuum-assisted biopsy of suspicious calcifications at different sites within one breast: Is biopsy of more than one location needed? Eur J Radiol 2022; 154:110456. [PMID: 35914364 DOI: 10.1016/j.ejrad.2022.110456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/12/2022] [Accepted: 07/25/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate how often biopsy of two sites of morphologically similar or equally suspicious calcifications within the same breast yield differing histopathologic results, and how this may affect clinical management. MATERIALS AND METHODS We identified patients with two or more sites of calcifications categorized as Breast Imaging Reporting and Data System (BI-RADS) ≥ 4b within the same breast who underwent digital breast tomosynthesis-guided vacuum-assisted biopsy (DBT-guided VAB). We analyzed how often biopsy of two distinct sites yielded the same or differing histopathologic findings. The histopathologic findings were dichotomized into "actionable" and "non-actionable", depending on the respective further management. We then analyzed how often the consecutive management would have been the same or different. RESULTS Of 206 women undergoing DBT-guided VAB at our institution within 24 months, 21 consecutive patients (54 ± 10.2 years; range: 35-71) underwent DBT-guided VAB of two distinct sites of calcifications. Management of histologic findings was the same (both sites actionable or both sites non-actionable) in 12/21 (57 %), different in the remaining 9/21 patients (43 %). Of the nine patients whose differing histologic findings would have led to different clinical management, 4/9 had a high-risk lesion (atypical ductal hyperplasia n = 3, papilloma with epithelial atypia n = 1) vs benign changes (adenosis n = 4), 2/9 had high-grade DCIS vs benign changes (adenosis n = 1, fat necrosis n = 1), and 3/9 had invasive cancer (luminal A n = 2, luminal B n = 1) with high-grade DCIS vs pure high-grade DCIS. CONCLUSIONS Multiple sites of calcifications within the same breast, even when morphologically similar or equally suspicious, may represent different histopathologic findings with different clinical management implications. Accordingly, in the presence of suspicious calcifications at multiple distinct sites within the same breast, biopsy of more than one site of calcification should be considered.
Collapse
Affiliation(s)
- Maike Bode
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
| | - Luisa Charlotte Huck
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Vanessa Raaff
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Lea Hitpass
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Till Braunschweig
- Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Christiane Katharina Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| |
Collapse
|
21
|
Huang ML, Hess K, Ma J, Santiago L, Scoggins ME, Arribas E, Adrada BE, Le-Petross HT, Leung JW, Yang W, Geiser W, Candelaria RP. Prospective Comparison of Synthesized Mammography with DBT and Full-Field Digital Mammography with DBT Uncovers Recall Disagreements That may Impact Cancer Detection. Acad Radiol 2022; 29:1039-1045. [PMID: 34538550 DOI: 10.1016/j.acra.2021.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/06/2021] [Accepted: 08/18/2021] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES Synthesized mammography with digital breast tomosynthesis (SM+DBT) and full-field digital mammography with DBT were prospectively evaluated for recall rate (RR), cancer detection rate (CDR), positive predictive value 1 (PPV1), lesion recall differences, and disagreements in recall for additional imaging. MATERIALS AND METHODS From December 15, 2015 to January 15, 2017, after informed consent was obtained for this Health Insurance Portability and Accountability Act compliant study, each enrolled patient's SM+DBT and FFDM+DBT were interpreted sequentially by one of eight radiologists. RR, CDR, PPV1, and imaging findings (asymmetry, focal asymmetry, mass, architectural distortion, and calcifications) recalled were reviewed. RESULTS For SM+DBT and FFDM+DBT in 1022 patients, RR was 7.3% and 7.9% (SM+DBT vs. FFDM+DBT: diff= -0.6%; 90% CI= -1.4%, 0.1%); CDR was 6.8 and 7.8 per 1000 (SM+DBT vs. FFDM+DBT: diff= -1.0, 95% CI= -5.5, 2.8, p = 0.317); PPV1 was 9.3% and 9.9% (relative positive predictive value for SM+DBT vs. FFDM+DBT: 0.95, 95% CI: 0.73-1.22, p = 0.669). FFDM+DBT detected eight cancers; SM+DBT detected seven (missed 1 cancer with calcifications). SM+DBT and FFDM+DBT disagreed on patient recall for additional imaging in 19 patients, with majority (68%, 13/19 patients) in the recall of patients for calcifications. For calcifications, SM+DBT recalled six patients that FFDM+DBT did not recall, and FFDM+DBT recalled seven patients that SM+DBT did not recall, even though the total number of calcifications finding recalled was similar overall for both SM+DBT and FFDM+DBT. CONCLUSION Disagreement in recall of patients for calcifications may impact cancer detection by SM+DBT, warranting further investigation.
Collapse
|
22
|
Vanbuggenhout L, Aertsen M, De Catte L, Naulaers G. Pre- and postnatal brain magnetic resonance imaging in congenital cytomegalovirus infection: a case report and a review of the literature. BMC Pediatr 2022; 22:293. [PMID: 35585581 PMCID: PMC9118604 DOI: 10.1186/s12887-022-03334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Congenital cytomegalovirus infection (cCMV) is the most common known viral cause of neurodevelopmental delay in children. The risk of severe cerebral abnormalities and neurological sequelae is greatest when the infection occurs during the first trimester of pregnancy. Pre- and postnatal imaging can provide additional information and may help in the prediction of early neurological outcome. Case presentation This report presents the case of a newborn with cCMV infection with diffuse parenchymal calcifications, white matter (WM) abnormalities and cerebellar hypoplasia on postnatal brain imaging after magnetic resonance imaging (MRI) and neurosonogram (NSG) at 30 weeks showing lenticulostriate vasculopathy, bilateral temporal cysts and normal gyration pattern according to the gestational age (GA). No calcifications were seen on prenatal imaging. Conclusion cCMV infection can still evolve into severe brain damage after 30 weeks of GA. For this reason, a two-weekly follow-up by fetal NSG with a repeat in utero MRI (iuMRI) in the late third trimester is recommended in cases with signs of active infection.
Collapse
Affiliation(s)
- Laurien Vanbuggenhout
- Department of Pediatrics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Michael Aertsen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Luc De Catte
- Department of Feto-Maternal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Gunnar Naulaers
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
23
|
Trifa A, Stambouli M, Benhaddou L, Parker F. Surgical management of leukoencephalopathy with calcifications and cysts. Acta Neurol Belg 2022. [PMID: 35147867 DOI: 10.1007/s13760-022-01879-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/27/2022] [Indexed: 11/01/2022]
|
24
|
Koons E, VanMeter P, Rajendran K, Yu L, McCollough C, Leng S. Improved quantification of coronary artery luminal stenosis in the presence of heavy calcifications using photon-counting detector CT. Proc SPIE Int Soc Opt Eng 2022; 12031. [PMID: 35677467 DOI: 10.1117/12.2613019] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Coronary CT Angiography (cCTA) is commonly used to detect and quantify luminal stenoses in patients with coronary artery disease (CAD). However, its use is limited in patients with heavy coronary calcifications due to calcium blooming, which is caused by insufficient spatial resolution. This study evaluated the ability of a photon-counting-detector (PCD) CT in quantifying luminal stenosis in the presence of heavy calcifications relative to an energy-integrating-detector (EID) CT. Cylindrical rods of 4.5 mm diameter (with 3 mm lumen), which contained calcium hydroxyapatite (CaHA) to emulate calcifications of varying shapes and sizes and an iodine or blood analog to emulate the coronary lumen, were placed within an anthropomorphic thorax phantom and scanned at matched dose on an EID-CT and a PCD-CT scanner. Stenoses were qualitatively evaluated and quantified using commercial software. Measured percent area stenosis was compared to reference values. PCD-CT provided better visualization of calcium plaques and the patent lumen, and more accurate stenosis quantification for all plaques. In one rod (75% occlusion with ring-shaped plaque), only PCD-CT was able to determine that the vessel was not fully obstructed. The phantom results indicate luminal stenoses that were previously considered non-assessable due to the presence of heavily-calcified plaques can be assessed using PCD-CT. Clinical studies to support these conclusions are underway.
Collapse
Affiliation(s)
- Emily Koons
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
25
|
|
26
|
Premužić V, Gardijan D, Herega T, Perkov D, Jelaković B. High prevalence of middle cerebral artery calcification is associated with cardiovascular mortality in hemodialyzed patients: an overlooked part of arterial tree? Int Urol Nephrol 2022; 54:1995-2004. [PMID: 35031973 DOI: 10.1007/s11255-021-03092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/08/2021] [Indexed: 10/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- Vedran Premužić
- Department of Nephrology, Hypertension, Dialysis and Transplantation, School of Medicine, University Hospital Center Zagreb, 10000, Zagreb, Croatia.
| | - Danilo Gardijan
- Department of Radiology, School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Tomislav Herega
- Department of Radiology, School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Dražen Perkov
- Department of Radiology, School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Bojan Jelaković
- Department of Nephrology, Hypertension, Dialysis and Transplantation, School of Medicine, University Hospital Center Zagreb, 10000, Zagreb, Croatia
| |
Collapse
|
27
|
Pollari F, Fischlein T. Calcium load assessment for aortic valve interventions: a call for consensus. Eur J Cardiothorac Surg 2021; 60:437. [PMID: 33599724 DOI: 10.1093/ejcts/ezab083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/31/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Francesco Pollari
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg - Paracelsus Medical University, Nuremberg, Germany
| | | |
Collapse
|
28
|
Rozenbaum Z, Takahashi T, Kobayashi Y, Bliagos D, Menegus M, Colombo A, Latib A. Contemporary technologies to modify calcified plaque in coronary artery disease. Prog Cardiovasc Dis 2021; 69:18-26. [PMID: 34252411 DOI: 10.1016/j.pcad.2021.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023]
Abstract
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.
Collapse
Affiliation(s)
- Zach Rozenbaum
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Tatsunori Takahashi
- Jacobi Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Yuhei Kobayashi
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Dimitrios Bliagos
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Mark Menegus
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States
| | - Antonio Colombo
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, United States; Albert Einstein College of Medicine, New York, NY, United States.
| |
Collapse
|
29
|
Nowaczyk J, Zawistowski M, Fiedor P. Local, non-systemic, and minimally invasive therapies for calcinosis cutis: a systematic review. Arch Dermatol Res 2021; 314:515-525. [PMID: 34165603 PMCID: PMC9232439 DOI: 10.1007/s00403-021-02264-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/11/2021] [Indexed: 11/24/2022]
Abstract
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.
Collapse
Affiliation(s)
- Joanna Nowaczyk
- Department of General and Transplantation Surgery, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland
| | - Michał Zawistowski
- Department of General and Transplantation Surgery, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland
| | - Piotr Fiedor
- Department of General and Transplantation Surgery, Medical University of Warsaw, Nowogrodzka 59, 02-006, Warsaw, Poland.
| |
Collapse
|
30
|
Lane EG, Eisen CS, Ginter PS, Drotman MB. Ink on the move: tattoo pigment resembling axillary lymph node calcifications. Clin Imaging 2021; 79:154-157. [PMID: 33951571 DOI: 10.1016/j.clinimag.2021.04.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 11/18/2022]
Abstract
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.
Collapse
Affiliation(s)
- Elizabeth G Lane
- Department of Radiology Weill Cornell at NewYork-Presbyterian, United States of America.
| | - Carolyn S Eisen
- Department of Radiology Weill Cornell at NewYork-Presbyterian, United States of America.
| | - Paula S Ginter
- Department of Pathology and Laboratory Medicine Weill Cornell at NewYork-Presbyterian, United States of America.
| | - Michele B Drotman
- Department of Radiology Weill Cornell at NewYork-Presbyterian, United States of America.
| |
Collapse
|
31
|
Singh K, Gupta S, Hussain I, Augustine J, Ghosh S, Gupta S. A Rare Case of Peripheral Ossifying Fibroma in an Infant. Contemp Clin Dent 2021; 12:81-83. [PMID: 33967544 PMCID: PMC8092083 DOI: 10.4103/ccd.ccd_364_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/20/2020] [Accepted: 07/07/2020] [Indexed: 11/12/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Khushboo Singh
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Shikha Gupta
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Itrat Hussain
- Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Jeyaseelan Augustine
- Department of Oral Pathology and Microbiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sujoy Ghosh
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Sunita Gupta
- Department of Oral Medicine and Radiology, Maulana Azad Institute of Dental Sciences, New Delhi, India
| |
Collapse
|
32
|
Messina F, Calabrese G, Turano L, Tebala C, Arcadi N. A pulmonary hamartoma in Covid-19 pneumonia: an interesting case studied with computed tomography. Radiol Case Rep 2021; 16:942-4. [PMID: 33552326 DOI: 10.1016/j.radcr.2021.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/22/2021] [Accepted: 01/28/2021] [Indexed: 12/05/2022] Open
Abstract
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.
Collapse
|
33
|
Karagir A, Adaki S, Magdum D. Encephalotrigeminal Angiomatosis with Facial Lobular Capillary Hemangioma: An Unusual Case Report. Int J Appl Basic Med Res 2021; 11:44-46. [PMID: 33842296 PMCID: PMC8025953 DOI: 10.4103/ijabmr.ijabmr_301_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 06/15/2020] [Accepted: 09/18/2020] [Indexed: 11/08/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Amol Karagir
- Department of Oral Medicine and Radiology, BVDU Dental College, Sangli, Maharashtra, India
| | - Shridevi Adaki
- Department of Oral Medicine and Radiology, BVDU Dental College, Sangli, Maharashtra, India
| | - Dilip Magdum
- Department of Oral and Maxillofacial Pathology, BVDU Dental College, Sangli, Maharashtra, India
| |
Collapse
|
34
|
Di Ninno AAM, Mello GGN, Torres US, Shimizu C, Tucunduva TCM, Reis FRS, Ananias MPF, Lederman HM. MRI as a complementary tool for the assessment of suspicious mammographic calcifications: Does it have a role? Clin Imaging 2021; 74:76-83. [PMID: 33454580 DOI: 10.1016/j.clinimag.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/22/2020] [Accepted: 01/04/2021] [Indexed: 01/17/2023]
Abstract
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.
Collapse
|
35
|
Choi SH, Ko EY, Han BK, Ko ES, Choi JS, Park KW. Effect of Calcifications on Shear-Wave Elastography in Evaluating Breast Lesions. Ultrasound Med Biol 2021; 47:95-103. [PMID: 33097314 DOI: 10.1016/j.ultrasmedbio.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
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 Emean 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 Emean of breast lesions. Shear-wave elastography should be carefully interpreted in benign lesions with calcifications and in situ carcinomas without calcifications.
Collapse
Affiliation(s)
- Seung Hee Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Boo-Kyung Han
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sook Ko
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Soo Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ko Woon Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
36
|
Magri V, Perletti G, Stamatiou K, Montanari E, Trinchieri A. Lithogenic Potential of Ureaplasma in Chronic Prostatitis. Urol Int 2020; 105:328-333. [PMID: 33264795 DOI: 10.1159/000511653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/16/2020] [Indexed: 11/19/2022]
Abstract
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.
Collapse
Affiliation(s)
| | - Gianpaolo Perletti
- Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese, Italy.,Faculty of Medicine and Medical Sciences, Ghent University, Ghent, Belgium
| | | | - Emanuele Montanari
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Milan, Italy
| | - Alberto Trinchieri
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Milan, Italy,
| |
Collapse
|
37
|
Choudhery S, Anderson T, Valencia E. Digital breast tomosynthesis (DBT)-guided biopsy of calcifications: pearls and pitfalls. Clin Imaging 2021; 72:83-90. [PMID: 33217675 DOI: 10.1016/j.clinimag.2020.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 10/06/2020] [Accepted: 11/12/2020] [Indexed: 11/20/2022]
Abstract
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.
Collapse
|
38
|
Selvakumaran V, Hou R, Baker JA, Yoon SC, Ghate SV, Walsh R, Litton TP, Lu LX, Devalapalli A, Kim C, Soo MS, Hwang ES, Lo JY, Grimm LJ. Predicting Upstaging of DCIS to Invasive Disease: Radiologists's Predictive Performance. Acad Radiol 2020; 27:1580-1585. [PMID: 32001164 DOI: 10.1016/j.acra.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 12/24/2022]
Abstract
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.
Collapse
|
39
|
Stelzer PD, Steding O, Raudner MW, Euller G, Clauser P, Baltzer PAT. Combined texture analysis and machine learning in suspicious calcifications detected by mammography: Potential to avoid unnecessary stereotactical biopsies. Eur J Radiol 2020; 132:109309. [PMID: 33010682 DOI: 10.1016/j.ejrad.2020.109309] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/28/2020] [Accepted: 09/18/2020] [Indexed: 10/23/2022]
Abstract
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.
Collapse
Affiliation(s)
- P D Stelzer
- Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - O Steding
- Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - M W Raudner
- Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - G Euller
- Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - P Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - P A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| |
Collapse
|
40
|
Hamroun A, Maanaoui M, Lenain R, Lionet A. Marble brain disease: a rare cause of renal tubular acidosis. J Nephrol 2020; 34:1261-1262. [PMID: 32960441 DOI: 10.1007/s40620-020-00857-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Aghilès Hamroun
- Nephrology, Dialysis and Kidney Transplantation Department, Lille University, Regional and University Hospital Center of Lille, 59000, Lille, France.
- Center for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, National Institute of Health and Medical Research, Villejuif, France.
| | - Mehdi Maanaoui
- Nephrology, Dialysis and Kidney Transplantation Department, Lille University, Regional and University Hospital Center of Lille, 59000, Lille, France
- INSERM U1190, Translational Research for Diabetes, Lille, France
| | - Rémi Lenain
- Nephrology, Dialysis and Kidney Transplantation Department, Lille University, Regional and University Hospital Center of Lille, 59000, Lille, France
| | - Arnaud Lionet
- Nephrology, Dialysis and Kidney Transplantation Department, Lille University, Regional and University Hospital Center of Lille, 59000, Lille, France
| |
Collapse
|
41
|
Al-Hajjaj M, Kazan MN. Neglected double J stent for 8 Years with giant bladder calculi formation: A case report. Urol Case Rep 2020; 32:101195. [PMID: 32322528 PMCID: PMC7171453 DOI: 10.1016/j.eucr.2020.101195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 11/25/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Maher Al-Hajjaj
- Department of Urology, Aleppo University Hospital, Aleppo, Syria
| | | |
Collapse
|
42
|
Youk JH, Gweon HM, Son EJ, Eun NL, Choi EJ, Kim JA. Scoring System to Stratify Malignancy Risks for Mammographic Micro calcifications Based on Breast Imaging Reporting and Data System 5th Edition Descriptors. Korean J Radiol 2020; 20:1646-1652. [PMID: 31854152 PMCID: PMC6923207 DOI: 10.3348/kjr.2019.0262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/26/2019] [Indexed: 01/22/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Ji Hyun Youk
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Hye Mi Gweon
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ju Son
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Na Lae Eun
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jung Choi
- Department of Radiology, Chonbuk National University Medical School and Hospital, Institute of Medical Science, Research Institute of Clinical Medicine, Jeonju, Korea
| | - Jeong Ah Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
43
|
Mutasa S, Chang P, Van Sant EP, Nemer J, Liu M, Karcich J, Patel G, Jambawalikar S, Ha R. Potential Role of Convolutional Neural Network Based Algorithm in Patient Selection for DCIS Observation Trials Using a Mammogram Dataset. Acad Radiol 2020; 27:774-779. [PMID: 31526687 DOI: 10.1016/j.acra.2019.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022]
Abstract
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.
Collapse
Affiliation(s)
| | - Peter Chang
- Division of Neuroradiology, Center for Artificial Intelligence in Diagnostic Medicine (CAIDM), UCI Health, Department of Radiological Sciences, Orange, California
| | | | - John Nemer
- Department of Radiology, New York, New York
| | | | | | - Gita Patel
- Department of Radiology, New York, New York
| | - Sachin Jambawalikar
- Department of Medical Physics and Radiology, Columbia University Medical Center, New York, New York
| | - Richard Ha
- Breast Imaging Section, 622 West 168th Street, PB-1-301, New York, NY 10032.
| |
Collapse
|
44
|
Cullinane PW, Lynch SA, Marnane M. Phenotypic Variability in Leukoencephalopathy with Brain Calcifications and Cysts: Case Report of Siblings from an Irish Traveller Family with a Homozygous SNORD118 Mutation. J Mol Neurosci 2020; 70:1354-1356. [PMID: 32361877 DOI: 10.1007/s12031-020-01550-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
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.
Collapse
Affiliation(s)
- Patrick W Cullinane
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.
| | - Sally Ann Lynch
- Academic Centre on Rare Diseases, University College Dublin School of Medicine and Medical Science, Dublin, Ireland
| | - Michael Marnane
- Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
45
|
Acciavatti RJ, Vent TL, Barufaldi B, Wileyto EP, Noël PB, Maidment ADA. Super-Resolution in Digital Breast Tomosynthesis: Limitations of the Conventional System Design and Strategies for Optimization. Proc SPIE Int Soc Opt Eng 2020; 11513:115130V. [PMID: 37842133 PMCID: PMC10573083 DOI: 10.1117/12.2563839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
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.
Collapse
Affiliation(s)
- Raymond J Acciavatti
- University of Pennsylvania, Department of Radiology, 3400 Spruce Street, Philadelphia PA 19104
| | - Trevor L Vent
- University of Pennsylvania, Department of Radiology, 3400 Spruce Street, Philadelphia PA 19104
| | - Bruno Barufaldi
- University of Pennsylvania, Department of Radiology, 3400 Spruce Street, Philadelphia PA 19104
| | - E Paul Wileyto
- University of Pennsylvania, Department of Epidemiology, Biostatistics, & Informatics, 423 Guardian Drive, Philadelphia, PA 19104
| | - Peter B Noël
- University of Pennsylvania, Department of Radiology, 3400 Spruce Street, Philadelphia PA 19104
| | - Andrew D A Maidment
- University of Pennsylvania, Department of Radiology, 3400 Spruce Street, Philadelphia PA 19104
| |
Collapse
|
46
|
Shefali, Sethi A, Tandon A, Shetty DC, Juneja S. Staining efficacy assessment of a differential routine and special stains for pathological stromal calcifications in maxillofacial lesions. J Histotechnol 2020; 43:118-124. [PMID: 32156221 DOI: 10.1080/01478885.2020.1739192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
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.
Collapse
Affiliation(s)
- Shefali
- Department of Oral Pathology and Microbiology, I.T.S Centre for Dental Studies and Research , Ghaziabad, India
| | - Aashka Sethi
- Department of Oral Pathology and Microbiology, I.T.S Centre for Dental Studies and Research , Ghaziabad, India
| | - Ankita Tandon
- Department of Oral Pathology and Microbiology, I.T.S Centre for Dental Studies and Research , Ghaziabad, India
| | - Devi Charan Shetty
- Department of Oral Pathology and Microbiology, I.T.S Centre for Dental Studies and Research , Ghaziabad, India
| | - Saurabh Juneja
- Department of Oral Pathology and Microbiology, I.T.S Centre for Dental Studies and Research , Ghaziabad, India
| |
Collapse
|
47
|
Auffray-Calvier E, Lintia-Gaultier A, Bourcier R, Aguilar Garcia J. [Basal ganglia calcification]. Rev Med Interne 2020; 41:404-412. [PMID: 32165049 DOI: 10.1016/j.revmed.2020.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/06/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
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.
Collapse
Affiliation(s)
- E Auffray-Calvier
- Service de neuroradiologie, hôpital René-et-Guillaume-Laënnec, boulevard Jacques-Monod, 44093 Saint-Herblain cedex 1, France.
| | - A Lintia-Gaultier
- Service de neuroradiologie, hôpital René-et-Guillaume-Laënnec, boulevard Jacques-Monod, 44093 Saint-Herblain cedex 1, France
| | - R Bourcier
- Service de neuroradiologie, hôpital René-et-Guillaume-Laënnec, boulevard Jacques-Monod, 44093 Saint-Herblain cedex 1, France
| | - J Aguilar Garcia
- Service de neuroradiologie, hôpital René-et-Guillaume-Laënnec, boulevard Jacques-Monod, 44093 Saint-Herblain cedex 1, France
| |
Collapse
|
48
|
Annweiler G, Labriffe M, Ménager P, Ferland G, Brangier A, Annweiler C. Intracranial calcifications under vitamin K antagonists or direct oral anticoagulants: Results from the French VIKING study in older adults. Maturitas 2019; 132:35-39. [PMID: 31883661 DOI: 10.1016/j.maturitas.2019.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/01/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022]
Abstract
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.
Collapse
Affiliation(s)
- Gaëlle Annweiler
- Department of Geriatric Medicine, Angers University Hospital, Angers, France; Angers University Memory Clinic, Angers, France; Research Center on Autonomy and Longevity, Angers, France
| | - Mathieu Labriffe
- Department of Radiology, Angers University Hospital, Angers, France
| | - Pierre Ménager
- Department of Geriatric Medicine, Angers University Hospital, Angers, France; Angers University Memory Clinic, Angers, France; Research Center on Autonomy and Longevity, Angers, France; Department of Geriatrics, Le Mans Hospital, Le Mans, France
| | - Guylaine Ferland
- Montreal Heart Institute Research Centre & Department of Nutrition, Université de Montréal, Montréal, Quebec, Canada
| | - Antoine Brangier
- Department of Geriatric Medicine, Angers University Hospital, Angers, France; Angers University Memory Clinic, Angers, France; Research Center on Autonomy and Longevity, Angers, France
| | - Cédric Annweiler
- Department of Geriatric Medicine, Angers University Hospital, Angers, France; Angers University Memory Clinic, Angers, France; Research Center on Autonomy and Longevity, Angers, France; UPRES EA 4638, University of Angers, Angers, France; Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, ON, Canada.
| |
Collapse
|
49
|
Wengert GJ, Pipan F, Almohanna J, Bickel H, Polanec S, Kapetas P, Clauser P, Pinker K, Helbich TH, Baltzer PAT. Impact of the Kaiser score on clinical decision-making in BI-RADS 4 mammographic calcifications examined with breast MRI. Eur Radiol 2019; 30:1451-1459. [PMID: 31797077 PMCID: PMC7033072 DOI: 10.1007/s00330-019-06444-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/05/2019] [Accepted: 09/09/2019] [Indexed: 01/28/2023]
Abstract
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.
Collapse
Affiliation(s)
- G J Wengert
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - F Pipan
- Institute of Diagnostic Radiology, University of Udine, Udine, Italy
| | - J Almohanna
- Security Forces Hospital, Riyadh, Saudi Arabia
| | - H Bickel
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - S Polanec
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - P Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - P Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - K Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - P A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria.
| |
Collapse
|
50
|
Abstract
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.
Collapse
Affiliation(s)
- P Lantelme
- Service de cardiologie, hôpital Croix-Rousse et hôpital Lyon Sud, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France; Université Lyon 1, CREATIS UMR5220, Inserm U1044, INSA-15, Lyon, France.
| | - B Harbaoui
- Service de cardiologie, hôpital Croix-Rousse et hôpital Lyon Sud, hospices civils de Lyon, 103, grande rue de la Croix-Rousse, 69004 Lyon, France; Université Lyon 1, CREATIS UMR5220, Inserm U1044, INSA-15, Lyon, France
| |
Collapse
|