World journal of radiology最新文献

Background: Immune checkpoint inhibitors (ICIs) are therapeutic agents for advanced and metastatic non-small cell lung cancer (NSCLC) with high clinical antitumor efficacy. However, immune-related adverse events occur in 20% of these patients and often requiring treatment with immunosuppressive agents, such as corticosteroids. Consequently, this may increase the risk of patients to opportunistic infections. Pneumocystis jirovecii pneumonia (PJP), a rare but serious opportunistic infection typically observed in patients with human immunodeficiency virus, can also occur in cancer patients undergoing long-term glucocorticoid treatment.

Case summary: We report a case of a 56-year-old male with squamous NSCLC treated with triplimab combined with paclitaxel, carboplatin, and radical thoracic radiation therapy. Following this regimen, he developed acute kidney injury (AKI) with elevated creatinine levels. After concurrent radical chemoradiotherapy ended, he developed a grade 3 immune-related AKI. High-dose corticosteroids were administered to treat AKI, and renal function gradually recovered. Corticosteroids were reduced to a dose of 10 mg prednisone equivalent daily eight weeks later; however, he developed severe pneumonia with spontaneous pneumothorax. Next-generation sequencing of the bronchoscopic lavage revealed PJP co-infection with herpes simplex virus 1 and cytomegalovirus. The inflammation was more severe in areas exposed to radiation. Piperacillin-tazobactam, acyclovir, sulfamethoxazole, and trimethoprim were used to control the infection. The patient recovered, and immunotherapy was terminated.

Conclusion: PJP is rare but can occur in patients with ICI adverse events and should be differentiated from tumor progression or immune-related adverse events. Thoracic radiation may increase risk, necessitating careful monitoring and prevention.

Background: The February 6, 2023, twin earthquakes in Türkiye caused significant structural damage and a high number of injuries, particularly affecting the spine, which underscores the importance of understanding the distribution and nature of vertebral injuries in disaster victims.

Aim: To investigate the distribution of radiological findings of vertebral injuries in patients referred to a major tertiary center during the February 6, 2023 twin earthquakes in Türkiye.

Methods: With the approval of the institutional ethics committee, 1216 examinations of 238 patients transferred from the region to a tertiary major hospital after the twin earthquakes of February 6, 2023, were retrospectively analyzed for spine injuries.

Results: Spine computed tomography (CT) scans were performed in 192 of 238 patients with a suspected spinal injury, 42 of whom also had an magnetic resonance imaging (MRI). In 86 of 192 patients (44.79%; M:F = 33:53) a spinal fracture was detected on CT and in 33 of 42 patients (78.57%; M:F = 20:13) a spinal injury was found on MRI. Of the 86 patients in whom vertebral injury was detected, fractures were detected in the Denis-B group in 33, Denis-C in 4, Denis-D in 20 and Denis-E in 11 patients. Among the vertebral bodies: 40 "compression fractures", 17 "burst fractures", 5 "translational dislocation fractures", 5 "flexion-distraction fractures" and 58 "prolonged forced fetal posture fractures" were detected. In addition, isolated transverse or spinous process fractures were found in eighteen vertebrae.

Conclusion: Our study highlights the prevalence and diverse spectrum of spinal injuries following the February 6, 2023 twin earthquakes in Turkey underscoring the urgent need for effective management strategies in similar disaster scenarios, and emphasizing the "prolonged forced fetal posture" damage we encountered in earthquake victims who remained under the collapse for a long time.

Background: Anti-vascular endothelial growth factor (anti-VEGF) therapy is critical for managing neovascular age-related macular degeneration (nAMD), but understanding factors influencing treatment efficacy is essential for optimizing patient outcomes.

Aim: To identify the risk factors affecting anti-VEGF treatment efficacy in nAMD and develop a predictive model for short-term response.

Methods: In this study, 65 eyes of exudative AMD patients after anti-VEGF treatment for ≥ 1 mo were observed using optical coherence tomography angiography. Patients were classified into non-responders (n = 22) and responders (n = 43). Logistic regression was used to determine independent risk factors for treatment response. A predictive model was created using the Akaike Information Criterion, and its performance was assessed with the area under the receiver operating characteristic curve, calibration curves, and decision curve analysis (DCA) with 500 bootstrap re-samples.

Results: Multivariable logistic regression analysis identified the number of junction voxels [odds ratio = 0.997, 95% confidence interval (CI): 0.993-0.999, P = 0.010] as an independent predictor of positive anti-VEGF treatment outcomes. The predictive model incorporating the fractal dimension, number of junction voxels, and longest shortest path, achieved an area under the curve of 0.753 (95%CI: 0.622-0.873). Calibration curves confirmed a high agreement between predicted and actual outcomes, and DCA validated the model's clinical utility.

Conclusion: The predictive model effectively forecasts 1-mo therapeutic outcomes for nAMD patients undergoing anti-VEGF therapy, enhancing personalized treatment planning.

Background: Factor XIII (FXIII) deficiency is a rare yet profound coagulopathy. FXIII plays a pivotal role in hemostasis, and deficiencies in this factor can precipitate unchecked or spontaneous hemorrhaging. Immunological assays for detecting FXIII inhibitors are indispensable for diagnosing acquired FXIII deficiency; however, the availability of suitable testing facilities is limited, resulting in prolonged turnaround times for these assays.

Case summary: In this case study, a 53-year-old male devoid of significant medical history presented with recurrent intracranial hemorrhages and a hematoma in the right hip. Subsequent genetic analysis revealed a homozygous mutation in the ACE gene, confirming the diagnosis of acquired FXIII deficiency.

Conclusion: This case underscores the significance of considering acquired deficiencies in clotting factors when evaluating patients with unexplained bleeding episodes.

Background: Primary hyperparathyroidism is typically caused by a single parathyroid adenoma. Ectopic parathyroid adenomas occur as well, with cases involving various sites, including the mediastinum, presenting in varying frequencies. Secondary hyperparathyroidism develops in the context of chronic kidney disease, primarily due to vitamin D deficiency, hypocalcemia, and hyperphosphatemia. It is frequently diagnosed in patients undergoing dialysis. This article presents a rare case of hyperparathyroidism involving multiple hyperplastic parathyroid glands with pulmonary seeding in a 50-year-old female patient undergoing hemodialysis (HD).

Case summary: The patient had a history of parathyroidectomy 10 years prior but developed recurrent hyperparathyroidism with symptoms of pruritus and cough with sputum during a period of routine dialysis. Radiographic imaging revealed multiple nodules in both lungs, with the largest measuring approximately 1.35 cm. Surgical histopathology confirmed the presence of hyperplastic parathyroid glands within the pulmonary tissue. After tumor resection surgery via video-assisted thoracic surgery with wedge resection, the patient was discharged in stable condition and in follow-up her symptoms showed improvement.

Conclusion: This article describes hyperparathyroidism presenting as pulmonary nodules in a patient undergoing post-parathyroidectomy HD, highlighting diagnostic challenges and a positive outcome from tumor resection surgery.

Background: Cases of myelin oligodendrocyte glycoprotein (MOG) antibody-related disease have a history of coronavirus disease 2019 infection or its vaccination before disease onset. Severe acute respiratory syndrome virus 2 (SARS-CoV-2) infection has been considered to be a trigger of central nervous system autoimmune diseases.

Case summary: Here we report a 20-year male with MOG-associated transverse myelitis after a SARS-CoV-2 infection. The patient received a near-complete recovery after standard immunological treatments.

Conclusion: Attention should be paid to the evaluation of typical or atypical neurological symptoms that may be triggered by SARS-CoV-2 infection.

Background: Secondary rectal linitis plastica (RLP) from prostatic adenocarcinoma is a rare and poorly understood form of metastatic spread, characterized by a desmoplastic response and concentric rectal wall infiltration with mucosal preservation. This complicates endoscopic diagnosis and can mimic gastrointestinal malignancies. This case series underscores the critical role of magnetic resonance imaging (MRI) in identifying the distinct imaging features of RLP and highlights the importance of considering this condition in the differential diagnosis of patients with a history of prostate cancer.

Case summary: Three patients with secondary RLP due to prostatic adenocarcinoma presented with varied clinical features. The first patient, a 76-year-old man with advanced prostate cancer, had rectal pain and incontinence. MRI showed diffuse prostatic invasion and significant rectal wall thickening with a characteristic "target sign" pattern. The second, a 57-year-old asymptomatic man with elevated prostate-specific antigen levels and a history of prostate cancer exhibited rectoprostatic angle involvement and rectal wall thickening on MRI, with positron emission tomography/computed tomography PSMA confirming the prostatic origin of the metastatic spread. The third patient, an 80-year-old post-radical prostatectomy, presented with refractory constipation. MRI revealed a neoplastic mass infiltrating the rectal wall. In all cases, MRI consistently showed stratified thickening, concentric signal changes, restricted diffusion, and contrast enhancement, which were essential for diagnosing secondary RLP. Biopsies confirmed the prostatic origin of the neoplastic involvement in the rectum.

Conclusion: Recognizing MRI findings of secondary RLP is essential for accurate diagnosis and management in prostate cancer patients.

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.

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.

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.