Background: Orificial tuberculosis is a rare type of tuberculosis, which is easy to be misdiagnosed, and can cause great damage to the perianal skin and mucosa. Early diagnosis can avoid further erosion of the perianal muscle tissue by tuberculosis bacteria.
Case summary: Here, we report a case of disseminated tuberculosis in a 62-year-old male patient with a perianal tuberculous ulcer and active pulmonary tuberculosis, intestinal tuberculosis and orificial tuberculosis. This is an extremely rare case of cutaneous tuberculosis of the anus, which was misdiagnosed for nearly a year. The patient received conventional treatment in other medical institutions, but specific treatment was delayed. Ultimately, proper diagnosis and treatment with standard anti-tuberculosis drugs for one year led to complete cure.
Conclusion: For skin ulcers that do not heal with repeated conventional treatments, consider ulcers caused by rare bacteria, such as Mycobacterium tuberculosis.
{"title":"Perianal tuberculous ulcer with active pulmonary, intestinal and orificial tuberculosis: A case report.","authors":"Bao Yuan, Chao-Qun Ma","doi":"10.4329/wjr.v16.i8.356","DOIUrl":"10.4329/wjr.v16.i8.356","url":null,"abstract":"<p><strong>Background: </strong>Orificial tuberculosis is a rare type of tuberculosis, which is easy to be misdiagnosed, and can cause great damage to the perianal skin and mucosa. Early diagnosis can avoid further erosion of the perianal muscle tissue by tuberculosis bacteria.</p><p><strong>Case summary: </strong>Here, we report a case of disseminated tuberculosis in a 62-year-old male patient with a perianal tuberculous ulcer and active pulmonary tuberculosis, intestinal tuberculosis and orificial tuberculosis. This is an extremely rare case of cutaneous tuberculosis of the anus, which was misdiagnosed for nearly a year. The patient received conventional treatment in other medical institutions, but specific treatment was delayed. Ultimately, proper diagnosis and treatment with standard anti-tuberculosis drugs for one year led to complete cure.</p><p><strong>Conclusion: </strong>For skin ulcers that do not heal with repeated conventional treatments, consider ulcers caused by rare bacteria, such as <i>Mycobacterium tuberculosis</i>.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":"16 8","pages":"356-361"},"PeriodicalIF":1.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Postoperative aortobronchial fistula (ABF) is a rare complication that can occur in 0.3%-5.0% of patients over an extended period of time after thoracic aortic surgery. Direct visualization of the fistula via imaging is rare.
Aim: To investigate the relationship between computed tomography (CT) findings and the clinical signs/symptoms of ABF after thoracic aortic surgery.
Methods: Six patients (mean age 71 years, including 4 men and 2 women) with suspected ABF on CT (air around the graft) at our hospital were included in this retrospective study between January 2004 and September 2022. Chest CT findings included direct confirmation of ABF, peri-graft fluid, ring enhancement, dirty fat sign, atelectasis, pulmonary hemorrhage, and bronchodilation, and the clinical course were retrospectively reviewed. The proportion of each type of CT finding was calculated.
Results: ABF detection after surgery was found to have a mean and median of 14 and 13 years, respectively. Initial signs and symptoms were asymptomatic in 4 patients, bloody sputum was found in 1 patient, and fever was present in 1 patient. The complications of ABF included graft infection in 2 patients and graft infection with hemoptysis in 2 patients. Of the 6 patients, 3 survived, 2 died, and 1 was lost to follow-up. The locations of the ABFs were as follows: 1 in the ascending aorta; 1 in the aortic arch; 2 in the aortic arch leading to the descending aorta; and 2 in the descending aorta. ABFs were directly confirmed by CT in 4/6 (67%) patients. Peri-graft dirty fat (4/6, 67%) and peri-graft ring enhancement (3/6, 50%) were associated with graft infection, endoleaks and pseudoaneurysms were associated with hemoptysis (2/6, 33%).
Conclusion: Asymptomatic ABF after thoracic aortic surgery can be confirmed on chest CT. CT is useful for the diagnosis of ABF and its complications.
{"title":"Direct visualization of postoperative aortobronchial fistula on computed tomography.","authors":"Nanae Tsuchiya, Hitoshi Inafuku, Satoko Yogi, Yuko Iraha, Gyo Iida, Mizuki Ando, Takaaki Nagano, Shotaro Higa, Tatsuya Maeda, Yuya Kise, Kojiro Furukawa, Koji Yonemoto, Akihiro Nishie","doi":"10.4329/wjr.v16.i8.337","DOIUrl":"10.4329/wjr.v16.i8.337","url":null,"abstract":"<p><strong>Background: </strong>Postoperative aortobronchial fistula (ABF) is a rare complication that can occur in 0.3%-5.0% of patients over an extended period of time after thoracic aortic surgery. Direct visualization of the fistula <i>via</i> imaging is rare.</p><p><strong>Aim: </strong>To investigate the relationship between computed tomography (CT) findings and the clinical signs/symptoms of ABF after thoracic aortic surgery.</p><p><strong>Methods: </strong>Six patients (mean age 71 years, including 4 men and 2 women) with suspected ABF on CT (air around the graft) at our hospital were included in this retrospective study between January 2004 and September 2022. Chest CT findings included direct confirmation of ABF, peri-graft fluid, ring enhancement, dirty fat sign, atelectasis, pulmonary hemorrhage, and bronchodilation, and the clinical course were retrospectively reviewed. The proportion of each type of CT finding was calculated.</p><p><strong>Results: </strong>ABF detection after surgery was found to have a mean and median of 14 and 13 years, respectively. Initial signs and symptoms were asymptomatic in 4 patients, bloody sputum was found in 1 patient, and fever was present in 1 patient. The complications of ABF included graft infection in 2 patients and graft infection with hemoptysis in 2 patients. Of the 6 patients, 3 survived, 2 died, and 1 was lost to follow-up. The locations of the ABFs were as follows: 1 in the ascending aorta; 1 in the aortic arch; 2 in the aortic arch leading to the descending aorta; and 2 in the descending aorta. ABFs were directly confirmed by CT in 4/6 (67%) patients. Peri-graft dirty fat (4/6, 67%) and peri-graft ring enhancement (3/6, 50%) were associated with graft infection, endoleaks and pseudoaneurysms were associated with hemoptysis (2/6, 33%).</p><p><strong>Conclusion: </strong>Asymptomatic ABF after thoracic aortic surgery can be confirmed on chest CT. CT is useful for the diagnosis of ABF and its complications.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":"16 8","pages":"337-347"},"PeriodicalIF":1.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zhu-Qin Li, Wu Liu, Wei-Liang Luo, Su-Qin Chen, Yu-Ping Deng
Background: With the increasingly extensive application of artificial intelligence (AI) in medical systems, the accuracy of AI in medical diagnosis in the real world deserves attention and objective evaluation.
Aim: To investigate the accuracy of AI diagnostic software (Shukun) in assessing ischemic penumbra/core infarction in acute ischemic stroke patients due to large vessel occlusion.
Methods: From November 2021 to March 2022, consecutive acute stroke patients with large vessel occlusion who underwent mechanical thrombectomy (MT) post-Shukun AI penumbra assessment were included. Computed tomography angiography (CTA) and perfusion exams were analyzed by AI, reviewed by senior neurointerventional experts. In the case of divergences among the three experts, discussions were held to reach a final conclusion. When the results of AI were inconsistent with the neurointerventional experts' diagnosis, the diagnosis by AI was considered inaccurate.
Results: A total of 22 patients were included in the study. The vascular recanalization rate was 90.9%, and 63.6% of patients had modified Rankin scale scores of 0-2 at the 3-month follow-up. The computed tomography (CT) perfusion diagnosis by Shukun (AI) was confirmed to be invalid in 3 patients (inaccuracy rate: 13.6%).
Conclusion: AI (Shukun) has limits in assessing ischemic penumbra. Integrating clinical and imaging data (CT, CTA, and even magnetic resonance imaging) is crucial for MT decision-making.
{"title":"Artificial intelligence software for assessing brain ischemic penumbra/core infarction on computed tomography perfusion: A real-world accuracy study.","authors":"Zhu-Qin Li, Wu Liu, Wei-Liang Luo, Su-Qin Chen, Yu-Ping Deng","doi":"10.4329/wjr.v16.i8.329","DOIUrl":"10.4329/wjr.v16.i8.329","url":null,"abstract":"<p><strong>Background: </strong>With the increasingly extensive application of artificial intelligence (AI) in medical systems, the accuracy of AI in medical diagnosis in the real world deserves attention and objective evaluation.</p><p><strong>Aim: </strong>To investigate the accuracy of AI diagnostic software (Shukun) in assessing ischemic penumbra/core infarction in acute ischemic stroke patients due to large vessel occlusion.</p><p><strong>Methods: </strong>From November 2021 to March 2022, consecutive acute stroke patients with large vessel occlusion who underwent mechanical thrombectomy (MT) post-Shukun AI penumbra assessment were included. Computed tomography angiography (CTA) and perfusion exams were analyzed by AI, reviewed by senior neurointerventional experts. In the case of divergences among the three experts, discussions were held to reach a final conclusion. When the results of AI were inconsistent with the neurointerventional experts' diagnosis, the diagnosis by AI was considered inaccurate.</p><p><strong>Results: </strong>A total of 22 patients were included in the study. The vascular recanalization rate was 90.9%, and 63.6% of patients had modified Rankin scale scores of 0-2 at the 3-month follow-up. The computed tomography (CT) perfusion diagnosis by Shukun (AI) was confirmed to be invalid in 3 patients (inaccuracy rate: 13.6%).</p><p><strong>Conclusion: </strong>AI (Shukun) has limits in assessing ischemic penumbra. Integrating clinical and imaging data (CT, CTA, and even magnetic resonance imaging) is crucial for MT decision-making.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":"16 8","pages":"329-336"},"PeriodicalIF":1.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ran Ma, Yan-Mei Wang, Hua Guan, Li Zhang, Wei Zhang, Ling-Cai Chen
Background: Lung abscess found on chest X-ray and computed tomography examinations is rare in infants and young children. Several pathogens can cause lung abscesses, with the most common pathogens being anaerobes, Streptococci and Staphylococcus aureus. Streptococcus pseudopneumoniae (S. pseudopneumoniae) is a member of the Streptococcaceae family, and is mainly isolated from respiratory tract specimens. There are currently no cases of lung abscess caused by S. pseudopneumoniae in the literature.
Case summary: A 2-year-old boy was admitted to hospital due to persistent cough and fever. Lung computed tomography examination suggested the formation of a lung abscess. His diagnosis was not confirmed by testing for serum respiratory pathogens (6 items), respiratory pathogen nucleic acid (27 items), and laboratory culture. Finally, metagenomic next-generation sequencing of bronchoalveolar lavage fluid revealed the presence of S. pseudopneumoniae, confirming its role in causing the lung abscess. After receiving antibiotic treatment, reexamination with lung computed tomography showed that the abscess was resorbed and the patient's outcome was good.
Conclusion: This is the first report of a lung abscess in a child caused by S. pseudopneumoniae infection. Metagenomic next-generation sequencing of bronchoalveolar lavage fluid is helpful in achieving rapid and accurate pathogen identification.
背景:胸部 X 光和计算机断层扫描检查发现的肺脓肿在婴幼儿中很少见。多种病原体可导致肺脓肿,最常见的病原体是厌氧菌、链球菌和金黄色葡萄球菌。假肺炎链球菌(S. pseudopneumoniae)属于链球菌科,主要从呼吸道标本中分离出来。病例摘要:一名两岁男孩因持续咳嗽和发烧入院。肺部计算机断层扫描检查显示有肺脓肿形成。通过检测血清呼吸道病原体(6 项)、呼吸道病原体核酸(27 项)和实验室培养,均未确诊。最后,支气管肺泡灌洗液的元基因组下一代测序发现了假肺炎双球菌,证实了它是导致肺脓肿的罪魁祸首。接受抗生素治疗后,肺部计算机断层扫描复查显示脓肿已吸收,患者预后良好:这是首例由假肺炎双球菌感染导致儿童肺脓肿的报告。支气管肺泡灌洗液的元基因组下一代测序有助于快速准确地鉴定病原体。
{"title":"Pulmonary abscess caused by <i>Streptococcus pseudopneumoniae</i> in a child: A case report and review of literature.","authors":"Ran Ma, Yan-Mei Wang, Hua Guan, Li Zhang, Wei Zhang, Ling-Cai Chen","doi":"10.4329/wjr.v16.i8.362","DOIUrl":"10.4329/wjr.v16.i8.362","url":null,"abstract":"<p><strong>Background: </strong>Lung abscess found on chest X-ray and computed tomography examinations is rare in infants and young children. Several pathogens can cause lung abscesses, with the most common pathogens being anaerobes, <i>Streptococci</i> and <i>Staphylococcus aureus. Streptococcus pseudopneumoniae</i> (<i>S. pseudopneumoniae</i>) is a member of the <i>Streptococcaceae</i> family, and is mainly isolated from respiratory tract specimens. There are currently no cases of lung abscess caused by <i>S. pseudopneumoniae</i> in the literature.</p><p><strong>Case summary: </strong>A 2-year-old boy was admitted to hospital due to persistent cough and fever. Lung computed tomography examination suggested the formation of a lung abscess. His diagnosis was not confirmed by testing for serum respiratory pathogens (6 items), respiratory pathogen nucleic acid (27 items), and laboratory culture. Finally, metagenomic next-generation sequencing of bronchoalveolar lavage fluid revealed the presence of <i>S. pseudopneumoniae</i>, confirming its role in causing the lung abscess. After receiving antibiotic treatment, reexamination with lung computed tomography showed that the abscess was resorbed and the patient's outcome was good.</p><p><strong>Conclusion: </strong>This is the first report of a lung abscess in a child caused by <i>S. pseudopneumoniae</i> infection. Metagenomic next-generation sequencing of bronchoalveolar lavage fluid is helpful in achieving rapid and accurate pathogen identification.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":"16 8","pages":"362-370"},"PeriodicalIF":1.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Woongsoon John Choi, Peggy Lee, Penelope C Thomas, Tanya J Rath, Monique A Mogensen, Roberta W Dalley, Pattana Wangaryattawanich
Jaw and maxillofacial bone lesions encompass a wide variety of both neoplastic and non-neoplastic pathologies. These lesions can arise from various tissues, including bone, cartilage, and soft tissue, each presenting distinct challenges in diagnosis and treatment. While some pathologies exhibit characteristic imaging features that aid in diagnosis, many others are nonspecific. This overlap often necessitates a multimodal imaging approach, combining techniques such as radiographs, computed tomography, and magnetic resonance imaging to achieve a diagnosis or narrow the diagnostic considerations. This article provides a comprehensive review of the imaging approach to jaw and maxillofacial bone tumors, including updates on the 2022 World Health Organization classification of these tumors. The relevant anatomy of the jaw and dental structures that is important for accurate imaging interpretation is discussed.
{"title":"Imaging approach for jaw and maxillofacial bone tumors with updates from the 2022 World Health Organization classification.","authors":"Woongsoon John Choi, Peggy Lee, Penelope C Thomas, Tanya J Rath, Monique A Mogensen, Roberta W Dalley, Pattana Wangaryattawanich","doi":"10.4329/wjr.v16.i8.294","DOIUrl":"10.4329/wjr.v16.i8.294","url":null,"abstract":"<p><p>Jaw and maxillofacial bone lesions encompass a wide variety of both neoplastic and non-neoplastic pathologies. These lesions can arise from various tissues, including bone, cartilage, and soft tissue, each presenting distinct challenges in diagnosis and treatment. While some pathologies exhibit characteristic imaging features that aid in diagnosis, many others are nonspecific. This overlap often necessitates a multimodal imaging approach, combining techniques such as radiographs, computed tomography, and magnetic resonance imaging to achieve a diagnosis or narrow the diagnostic considerations. This article provides a comprehensive review of the imaging approach to jaw and maxillofacial bone tumors, including updates on the 2022 World Health Organization classification of these tumors. The relevant anatomy of the jaw and dental structures that is important for accurate imaging interpretation is discussed.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":"16 8","pages":"294-316"},"PeriodicalIF":1.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zhen-Kun Xiao, Yong-Hong Duan, Xin-Yu Mao, Ri-Chu Liang, Min Zhou, Yong-Mei Yang
Background: Minimally invasive surgery (MIS) and craniotomy (CI) are the current treatments for spontaneous supratentorial cerebral haemorrhage (SSTICH).
Aim: To compare the efficacy and safety of MIS and CI for the treatment of SSTICH.
Methods: Clinical and imaging data of 557 consecutive patients with SSTICH who underwent MIS or CI between January 2017 and December 2022 were retrospectively analysed. The patients were divided into two subgroups: The MIS group and CI group. Propensity score matching was performed to minimise case selection bias. The primary outcome was a dichotomous prognostic (favourable or unfavourable) outcome based on the modified Rankin Scale (mRS) score at 3 months; an mRS score of 0-2 was considered favourable.
Results: In both conventional statistical and binary logistic regression analyses, the MIS group had a better outcome. The outcome of propensity score matching was unexpected (odds ratio: 0.582; 95%CI: 0.281-1.204; P = 0.144), which indicated that, after excluding the interference of each confounder, different surgical modalities were more effective, and there was no significant difference in their prognosis.
Conclusion: Deciding between MIS and CI should be made based on the individual patient, considering the hematoma size, degree of midline shift, cerebral swelling, and preoperative Glasgow Coma Scale score.
背景:目的:比较微创手术(MIS)和开颅手术(CI)治疗SSTICH的有效性和安全性:回顾性分析2017年1月至2022年12月期间接受MIS或CI治疗的557例连续SSTICH患者的临床和影像学数据。患者被分为两个亚组:MIS组和CI组。为尽量减少病例选择偏倚,进行了倾向评分匹配。主要结果是根据3个月时的改良Rankin量表(mRS)评分得出的二分法预后结果(有利或不利);mRS评分为0-2分为有利:在传统统计分析和二元逻辑回归分析中,MIS 组的预后更好。倾向得分匹配的结果出乎意料(几率比:0.582;95%CI:0.281-1.204;P = 0.144),这表明在排除了各种混杂因素的干扰后,不同手术方式的疗效更佳,而其预后并无显著差异:结论:应根据患者的个体情况,考虑血肿大小、中线移位程度、脑肿胀和术前格拉斯哥昏迷量表评分,决定采用 MIS 还是 CI。
{"title":"Traditional craniotomy versus current minimally invasive surgery for spontaneous supratentorial intracerebral haemorrhage: A propensity-matched analysis.","authors":"Zhen-Kun Xiao, Yong-Hong Duan, Xin-Yu Mao, Ri-Chu Liang, Min Zhou, Yong-Mei Yang","doi":"10.4329/wjr.v16.i8.317","DOIUrl":"10.4329/wjr.v16.i8.317","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive surgery (MIS) and craniotomy (CI) are the current treatments for spontaneous supratentorial cerebral haemorrhage (SSTICH).</p><p><strong>Aim: </strong>To compare the efficacy and safety of MIS and CI for the treatment of SSTICH.</p><p><strong>Methods: </strong>Clinical and imaging data of 557 consecutive patients with SSTICH who underwent MIS or CI between January 2017 and December 2022 were retrospectively analysed. The patients were divided into two subgroups: The MIS group and CI group. Propensity score matching was performed to minimise case selection bias. The primary outcome was a dichotomous prognostic (favourable or unfavourable) outcome based on the modified Rankin Scale (mRS) score at 3 months; an mRS score of 0-2 was considered favourable.</p><p><strong>Results: </strong>In both conventional statistical and binary logistic regression analyses, the MIS group had a better outcome. The outcome of propensity score matching was unexpected (odds ratio: 0.582; 95%CI: 0.281-1.204; <i>P</i> = 0.144), which indicated that, after excluding the interference of each confounder, different surgical modalities were more effective, and there was no significant difference in their prognosis.</p><p><strong>Conclusion: </strong>Deciding between MIS and CI should be made based on the individual patient, considering the hematoma size, degree of midline shift, cerebral swelling, and preoperative Glasgow Coma Scale score.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":"16 8","pages":"317-328"},"PeriodicalIF":1.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peng Guo, Wei Sun, Ling-Xie Song, Wen-Yu Cao, Jin-Ping Li
Background: The rare co-occurrence of oligodendroglioma and arteriovenous malformation (AVM) in the same intracranial location.
Case summary: In a 61-year-old man presenting with progressive headaches, is described in this case study. Preoperative multimodal imaging techniques (computed tomography, magnetic resonance imaging, magnetic resonance spectroscopy, digital subtraction angiography, and computed tomography angiography) were employed to detect hemorrhage, cystic and solid lesions, and arteriovenous shunting in the right temporal lobe. The patient underwent right temporal craniotomy for lesion removal, and postoperative pathological analysis confirmed the presence of oligodendroglioma (World Health Organization grade II, not otherwise specified) and AVM.
Conclusion: The preoperative utilization of multimodal imaging examination can help clinicians reduce the likelihood of misdiagnosis or oversight of these conditions, and provides important information for subsequent treatment. This case supports the feasibility of craniotomy for the removal of glioma with AVM.
{"title":"Multimodal imaging for the diagnosis of oligodendroglioma associated with arteriovenous malformation: A case report.","authors":"Peng Guo, Wei Sun, Ling-Xie Song, Wen-Yu Cao, Jin-Ping Li","doi":"10.4329/wjr.v16.i8.348","DOIUrl":"10.4329/wjr.v16.i8.348","url":null,"abstract":"<p><strong>Background: </strong>The rare co-occurrence of oligodendroglioma and arteriovenous malformation (AVM) in the same intracranial location.</p><p><strong>Case summary: </strong>In a 61-year-old man presenting with progressive headaches, is described in this case study. Preoperative multimodal imaging techniques (computed tomography, magnetic resonance imaging, magnetic resonance spectroscopy, digital subtraction angiography, and computed tomography angiography) were employed to detect hemorrhage, cystic and solid lesions, and arteriovenous shunting in the right temporal lobe. The patient underwent right temporal craniotomy for lesion removal, and postoperative pathological analysis confirmed the presence of oligodendroglioma (World Health Organization grade II, not otherwise specified) and AVM.</p><p><strong>Conclusion: </strong>The preoperative utilization of multimodal imaging examination can help clinicians reduce the likelihood of misdiagnosis or oversight of these conditions, and provides important information for subsequent treatment. This case supports the feasibility of craniotomy for the removal of glioma with AVM.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":"16 8","pages":"348-355"},"PeriodicalIF":1.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Radiologists play a key role in establishing an early and accurate diagnosis, especially for rare diseases. Mahvash disease (OMIM 619290) is an autosomal recessive hereditary disease caused by inactivating mutations of the glucagon receptor and its main clinical consequences are pancreatic neuroendocrine tumors and in some cases, porto-sinusoidal vascular disease and portal hypertension. Untreated Mahvash disease can be lethal. The diagnosis of Mahvash disease has almost always been delayed in the past due to radiologists' unawareness of or unfamiliarity with the unique imaging features of Mahvash disease which are moderately to enormously enlarge pancreas with preserved pancreas contour and parenchyma without vascular involvement or lymphadenopathy. These features help differentiate Mahvash disease from other etiologies of diffusely enlarged pancreas such as diffuse pancreatic ductal carcinoma, diffuse pancreatic lymphoma, and autoimmune pancreatitis. Invoking Mahvash disease in the differential diagnosis of an enlarged pancreas has recently been shown to facilitate early diagnosis. To prevent missing the diagnosis of this significant disease, I sincerely ask radiologists to consider Mahvash disease in their differential diagnoses of diffusely enlarged pancreas.
{"title":"Plea to radiologists: Please consider Mahvash disease when encountering an enlarged pancreas.","authors":"Run Yu","doi":"10.4329/wjr.v16.i8.371","DOIUrl":"10.4329/wjr.v16.i8.371","url":null,"abstract":"<p><p>Radiologists play a key role in establishing an early and accurate diagnosis, especially for rare diseases. Mahvash disease (OMIM 619290) is an autosomal recessive hereditary disease caused by inactivating mutations of the glucagon receptor and its main clinical consequences are pancreatic neuroendocrine tumors and in some cases, porto-sinusoidal vascular disease and portal hypertension. Untreated Mahvash disease can be lethal. The diagnosis of Mahvash disease has almost always been delayed in the past due to radiologists' unawareness of or unfamiliarity with the unique imaging features of Mahvash disease which are moderately to enormously enlarge pancreas with preserved pancreas contour and parenchyma without vascular involvement or lymphadenopathy. These features help differentiate Mahvash disease from other etiologies of diffusely enlarged pancreas such as diffuse pancreatic ductal carcinoma, diffuse pancreatic lymphoma, and autoimmune pancreatitis. Invoking Mahvash disease in the differential diagnosis of an enlarged pancreas has recently been shown to facilitate early diagnosis. To prevent missing the diagnosis of this significant disease, I sincerely ask radiologists to consider Mahvash disease in their differential diagnoses of diffusely enlarged pancreas.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":"16 8","pages":"371-374"},"PeriodicalIF":1.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11372551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Solid pseudopapillary neoplasms of the pancreas (SPN) share similar imaging findings with pancreatic ductal adenocarcinoma with cystic changes (PDAC with cystic changes), which may result in unnecessary surgery.
Aim: To investigate the value of computed tomography (CT) in differentiation of SPN from PDAC with cystic changes.
Methods: This study retrospectively analyzed the clinical and imaging findings of 32 patients diagnosed with SPN and 14 patients diagnosed with PDAC exhibiting cystic changes, confirmed through pathological diagnosis. Quantitative and qualitative analysis was performed, including assessment of age, sex, tumor size, shape, margin, density, enhancement pattern, CT values of tumors, CT contrast enhancement ratios, "floating cloud sign," calcification, main pancreatic duct dilatation, pancreatic atrophy, and peripancreatic invasion or distal metastasis. Multivariate logistic regression analysis was used to identify relevant features to differentiate between SPN and PDAC with cystic changes, and receiver operating characteristic curves were obtained to evaluate the diagnostic performance of each variable and their combination.
Results: When compared to PDAC with cystic changes, SPN had a lower age (32 years vs 64 years, P < 0.05) and a slightly larger size (5.41 cm vs 3.90 cm, P < 0.05). SPN had a higher frequency of "floating cloud sign" and peripancreatic invasion or distal metastasis than PDAC with cystic changes (both P < 0.05). No significant difference was found with respect to sex, tumor location, shape, margin, density, main pancreatic duct dilatation, calcification, pancreatic atrophy, enhancement pattern, CT values of tumors, or CT contrast enhancement ratios between the two groups (all P > 0.05). The area under the receiver operating characteristic curve of the combination was 0.833 (95% confidence interval: 0.708-0.957) with 78.6% sensitivity, 81.3% specificity, and 80.4% accuracy in differentiation of SPN from PDAC with cystic changes.
Conclusion: A larger tumor size, "floating cloud sign," and peripancreatic invasion or distal metastasis are useful CT imaging features that are more common in SPN and may help discriminate SPN from PDAC with cystic changes.
{"title":"Comparison between solid pseudopapillary neoplasms of the pancreas and pancreatic ductal adenocarcinoma with cystic changes using computed tomography.","authors":"Shuai Ren, Li-Chao Qian, Xiao-Jing Lv, Ying-Ying Cao, Marcus J Daniels, Zhong-Qiu Wang, Li-Na Song, Ying Tian","doi":"10.4329/wjr.v16.i6.211","DOIUrl":"10.4329/wjr.v16.i6.211","url":null,"abstract":"<p><strong>Background: </strong>Solid pseudopapillary neoplasms of the pancreas (SPN) share similar imaging findings with pancreatic ductal adenocarcinoma with cystic changes (PDAC with cystic changes), which may result in unnecessary surgery.</p><p><strong>Aim: </strong>To investigate the value of computed tomography (CT) in differentiation of SPN from PDAC with cystic changes.</p><p><strong>Methods: </strong>This study retrospectively analyzed the clinical and imaging findings of 32 patients diagnosed with SPN and 14 patients diagnosed with PDAC exhibiting cystic changes, confirmed through pathological diagnosis. Quantitative and qualitative analysis was performed, including assessment of age, sex, tumor size, shape, margin, density, enhancement pattern, CT values of tumors, CT contrast enhancement ratios, \"floating cloud sign,\" calcification, main pancreatic duct dilatation, pancreatic atrophy, and peripancreatic invasion or distal metastasis. Multivariate logistic regression analysis was used to identify relevant features to differentiate between SPN and PDAC with cystic changes, and receiver operating characteristic curves were obtained to evaluate the diagnostic performance of each variable and their combination.</p><p><strong>Results: </strong>When compared to PDAC with cystic changes, SPN had a lower age (32 years <i>vs</i> 64 years, <i>P</i> < 0.05) and a slightly larger size (5.41 cm <i>vs</i> 3.90 cm, <i>P</i> < 0.05). SPN had a higher frequency of \"floating cloud sign\" and peripancreatic invasion or distal metastasis than PDAC with cystic changes (both <i>P</i> < 0.05). No significant difference was found with respect to sex, tumor location, shape, margin, density, main pancreatic duct dilatation, calcification, pancreatic atrophy, enhancement pattern, CT values of tumors, or CT contrast enhancement ratios between the two groups (all <i>P ></i> 0.05). The area under the receiver operating characteristic curve of the combination was 0.833 (95% confidence interval: 0.708-0.957) with 78.6% sensitivity, 81.3% specificity, and 80.4% accuracy in differentiation of SPN from PDAC with cystic changes.</p><p><strong>Conclusion: </strong>A larger tumor size, \"floating cloud sign,\" and peripancreatic invasion or distal metastasis are useful CT imaging features that are more common in SPN and may help discriminate SPN from PDAC with cystic changes.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":"16 6","pages":"211-220"},"PeriodicalIF":1.4,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11229942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141564631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The hemodynamic alterations seen in liver cirrhosis lead to renal vasoconstriction, ultimately causing acute kidney injury (AKI). The renal resistive index (RRI) is the most common Doppler ultrasound variable for measuring intrarenal vascular resistance.
Aim: To evaluate the association of the RRI with AKI in patients with liver cirrhosis and to identify risk factors for high RRI.
Methods: This was a prospective observational study, where RRI was measured using Doppler ultrasound in 200 consecutive hospitalized patients with cirrhosis. The association of RRI with AKI was studied. The receiver operating characteristic (ROC) curve analysis was utilized to determine discriminatory cut-offs of RRI for various AKI phenotypes. Multivariate analysis was conducted to determine the predictors of high RRI.
Results: The mean patient age was 49.08 ± 11.68 years, with the majority (79.5%) being male; the predominant etiology of cirrhosis was alcohol (39%). The mean RRI for the study cohort was 0.68 ± 0.09, showing a progressive increase with higher Child-Pugh class of cirrhosis. Overall, AKI was present in 129 (64.5%) patients. The mean RRI was significantly higher in patients with AKI compared to those without it (0.72 ± 0.06 vs 0.60 ± 0.08; P < 0.001). A total of 82 patients (41%) had hepatorenal syndrome (HRS)-AKI, 29 (22.4%) had prerenal AKI (PRA), and 18 (13.9%) had acute tubular necrosis (ATN)-AKI. The mean RRI was significantly higher in the ATN-AKI (0.80 ± 0.02) and HRS-AKI (0.73 ± 0.03) groups than in the PRA (0.63 ± 0.07) and non-AKI (0.60 ± 0.07) groups. RRI demonstrated excellent discriminatory ability in distinguishing ATN-AKI from non-ATN-AKI (area under ROC curve: 93.9%). AKI emerged as an independent predictor of high RRI (adjusted odds ratio [OR]: 11.52), and high RRI independently predicted mortality among AKI patients (adjusted OR: 3.18).
Conclusion: In cirrhosis patients, RRI exhibited a significant association with AKI, effectively differentiated between AKI phenotypes, and predicted AKI mortality.
背景:肝硬化患者的血流动力学改变会导致肾血管收缩,最终引起急性肾损伤(AKI)。肾脏阻力指数(RRI)是测量肾内血管阻力最常用的多普勒超声变量。目的:评估肝硬化患者的肾脏阻力指数与 AKI 的关系,并确定高肾脏阻力指数的风险因素:这是一项前瞻性观察研究,使用多普勒超声测量了连续住院的 200 名肝硬化患者的 RRI。研究了 RRI 与 AKI 的关系。利用接收者操作特征(ROC)曲线分析确定了各种 AKI 表型的 RRI 鉴别临界值。进行了多变量分析以确定高 RRI 的预测因素:患者平均年龄为(49.08 ± 11.68)岁,大多数(79.5%)为男性;肝硬化的主要病因是酒精(39%)。研究队列的平均 RRI 为 0.68 ± 0.09,显示随着肝硬化 Child-Pugh 分级的升高而逐渐升高。总体而言,129 例(64.5%)患者出现了 AKI。与无 AKI 患者相比,有 AKI 患者的平均 RRI 明显更高(0.72 ± 0.06 vs 0.60 ± 0.08;P < 0.001)。共有 82 名患者(41%)患有肝肾综合征(HRS)-AKI,29 名患者(22.4%)患有肾前性 AKI(PRA),18 名患者(13.9%)患有急性肾小管坏死(ATN)-AKI。ATN-AKI 组(0.80 ± 0.02)和 HRS-AKI 组(0.73 ± 0.03)的平均 RRI 明显高于 PRA 组(0.63 ± 0.07)和非 AKI 组(0.60 ± 0.07)。RRI 在区分 ATN-AKI 和非 ATN-AKI 方面表现出卓越的鉴别能力(ROC 曲线下面积:93.9%)。AKI是高RRI的独立预测因素(调整后比值比[OR]:11.52),高RRI可独立预测AKI患者的死亡率(调整后比值比:3.18):肝硬化患者的 RRI 与 AKI 有显著关联,能有效区分 AKI 表型并预测 AKI 死亡率。
{"title":"Renal resistive index measurements by ultrasound in patients with liver cirrhosis: Magnitude and associations with renal dysfunction.","authors":"Himanshu Surya, Ramesh Kumar, Rajeev Nayan Priyadarshi, Sabbu Surya Prakash, Sudhir Kumar","doi":"10.4329/wjr.v16.i6.221","DOIUrl":"10.4329/wjr.v16.i6.221","url":null,"abstract":"<p><strong>Background: </strong>The hemodynamic alterations seen in liver cirrhosis lead to renal vasoconstriction, ultimately causing acute kidney injury (AKI). The renal resistive index (RRI) is the most common Doppler ultrasound variable for measuring intrarenal vascular resistance.</p><p><strong>Aim: </strong>To evaluate the association of the RRI with AKI in patients with liver cirrhosis and to identify risk factors for high RRI.</p><p><strong>Methods: </strong>This was a prospective observational study, where RRI was measured using Doppler ultrasound in 200 consecutive hospitalized patients with cirrhosis. The association of RRI with AKI was studied. The receiver operating characteristic (ROC) curve analysis was utilized to determine discriminatory cut-offs of RRI for various AKI phenotypes. Multivariate analysis was conducted to determine the predictors of high RRI.</p><p><strong>Results: </strong>The mean patient age was 49.08 ± 11.68 years, with the majority (79.5%) being male; the predominant etiology of cirrhosis was alcohol (39%). The mean RRI for the study cohort was 0.68 ± 0.09, showing a progressive increase with higher Child-Pugh class of cirrhosis. Overall, AKI was present in 129 (64.5%) patients. The mean RRI was significantly higher in patients with AKI compared to those without it (0.72 ± 0.06 <i>vs</i> 0.60 ± 0.08; <i>P</i> < 0.001). A total of 82 patients (41%) had hepatorenal syndrome (HRS)-AKI, 29 (22.4%) had prerenal AKI (PRA), and 18 (13.9%) had acute tubular necrosis (ATN)-AKI. The mean RRI was significantly higher in the ATN-AKI (0.80 ± 0.02) and HRS-AKI (0.73 ± 0.03) groups than in the PRA (0.63 ± 0.07) and non-AKI (0.60 ± 0.07) groups. RRI demonstrated excellent discriminatory ability in distinguishing ATN-AKI from non-ATN-AKI (area under ROC curve: 93.9%). AKI emerged as an independent predictor of high RRI (adjusted odds ratio [OR]: 11.52), and high RRI independently predicted mortality among AKI patients (adjusted OR: 3.18).</p><p><strong>Conclusion: </strong>In cirrhosis patients, RRI exhibited a significant association with AKI, effectively differentiated between AKI phenotypes, and predicted AKI mortality.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":"16 6","pages":"221-231"},"PeriodicalIF":1.4,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11229947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141564538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}