Journal of the Belgian Society of Radiology最新文献

Objective: Stroke is a leading cause of global disability and mortality, a burden projected to grow as populations age worldwide. Early recognition and our ever-advancing interventions can substantially change outcomes and final costs. This has warranted adapting strategies that maximize sensitivity, including a lower threshold for code stroke imaging. This growing demand requires matching resources, an issue that is particularly noticeable in community hospital settings. The National Institutes of Health Stroke Scale (NIHSS) is a well-established quantitative tool for guiding clinical management. This study aimed to assess the availability and applicability of the NIHSS at the time of imaging for code stroke evaluations in a community hospital setting and in comparison to the previous studies conducted in tertiary academic centers. Materials and methods: We performed a retrospective analysis of all code stroke activations at a community Level 1 stroke center from October 2021 to September 2023, when institutional benchmarks were last adapted. All patients underwent non-contrast head CT, CT angiography of the head and neck, and subsequent brain MRI. Data collected included NIHSS documentation status, door-to-CT and door-to-NIHSS times, imaging positivity, final neurological diagnosis, and therapeutic interventions. Statistical analysis included descriptive statistics, t-tests, and receiver operating characteristic (ROC) analysis using NIHSS to predict positive strokes. Results: A total of 291 patients were included (151 women, 140 men). NIHSS documentation prior to imaging was available in 61.2% of cases. Median door-to-CT time was 12 minutes, while median door-to-NIHSS time was 29 minutes. Imaging was positive for acute stroke in 33.6% of cases. Patients with NIHSS documented prior to imaging had a higher stroke positivity rate (36.5% vs 28.0%; odds ratio [OR] 1.45 (95% CI 0.86-2.42). The mean NIHSS among all patients was 6.3, and higher scores correlated with positive imaging (mean 9.1 vs 3.7). ROC analysis for NIHSS predicting imaging positivity yielded an AUC of 0.69. Notably, eight patients (2.7% of all patients) had an NIHSS of 0 but demonstrated acute infarcts on imaging. Conclusion: Our findings demonstrate that NIHSS documentation often lags behind imaging in a community setting, yet its availability can provide useful prognostic information. Higher NIHSS scores correlate with a higher number of positive strokes by imaging, yet, strokes may be seen even with an NIHSS score of 0. These findings emphasize maintaining a low threshold for imaging and the importance of prompt NIHSS documentation, especially in community stroke centers increasingly relying on tele-neurology.

Objectives: to determine (1) a target Hounsfield unit (HU) for portal venous phase iodinated contrast media enhanced abdominal CT scans, (2) an equation for a personalized total contrast agent volume, and (3) the best/most appropriate time between injection and plateau/peak in HU enhancement. Material and methods: from an original dataset of 5,000 cases, a weight representative subset of 370 cases was sampled for detailed HU measurements. An additional 90 cases were used for visual grading to define the minimal HU required for diagnostic quality, which led to the proposed target HU. This study uses the fact that in a first approach, the injected contrast agent volume and HU correlate linearly. Based on the injected contrast agent volumes and HU measurements in the patient scans, it was then calculated which (ideal) volume would have reached the target value. The ideal volumes and patient data (weight, height, heart rate, age, and gender) were correlated by means of a regression analysis, to determine a new patient-specific contrast volume calculation equation. The best scan delay time was derived from the start of the injection to the HU enhancement plateau/peak evaluated from manually triggered venous phase scans. Results: The target HU value was 125. This can be achieved with a personalized contrast agent volume (ml), equal to - 108.5 + ∗ weight(kg) + 0.40 ∗ heart rate(bpm) + 0.61 ∗ height(cm). The time delay between injection and HU plateau/peak was found to be, on average, 102 s. Conclusion: this study proposes a comprehensive protocol for contrast enhanced venous phase scans, including a target HU, a personalized contrast volume, and a scan delay.

We report the case of a 54‑year‑old woman with 3‑year‑history of right facial paralysis. Computed tomography (CT) and magnetic resonance imaging (MRI) findings were highly suggestive of a primary paraganglioma (PGL) of the facial nerve canal (FNC). ⁶⁸Ga‑DOTATATE positron emission tomography (PET)/CT confirmed the neuroendocrine nature of the tumor. Teaching point: The combined imaging findings of permeative bone destruction, rapid wash‑in and wash‑out perfusion, and ⁶⁸Ga‑DOTATATE tracer uptake in a lesion arising from the mastoid segment of the FNC are diagnostic of a primary PGL of the FNC and may obviate the need for histological confirmation.

Teaching point: Description of a new radiological sign named "pulmonary hilar cavernoma" in a case of unilateral total pulmonary vein thrombosis.

Giuseppe Carlo Antonio Vicentini (1860-1944), professor of experimental physics at the University of Padova, Italy, presented on January 26, 1896, the X‑rays he made during a brief pioneering study period. Among those was the first roentgenograph of an opacified gastro‑intestinal tract, obtained of an animal model.

Teaching point: The role of magnetic resonance imaging (MRI) in diagnosing endometriosis is growing, requiring radiologists to become familiar with both typical and atypical presentations of deep infiltrating endometriosis.

Teaching point: Cemento‑ossifying fibroma is a benign tumor of the jaws with a mixed radiolucent-radiopaque appearance and causes root resorption and bone expansion.

Aorto‑esophageal fistulas (AEF) are rare, often fatal connections between the thoracic aorta and esophagus, arising from aortic disease, esophageal conditions, or iatrogenic causes. Case: A 76‑year‑old woman, treated for esophageal nutcracker syndrome with endoscopic injection of botox, developed chest pain and esophageal hemorrhage. Computed tomography (CT) confirmed an AEF from an aortic pseudoaneurysm. She succumbed to circulatory collapse before treatment. Discussion: Endoscopic botox injections are a rare cause of AEF. The diagnosis relies on imaging and endoscopy, with surgery often required. Teaching point: Aorto‑esophageal fistulas are rare, life‑threatening complications, particularly after iatrogenic procedures. Early diagnosis is crucial, but prognosis remains poor.

Teaching point: Denervation pseudohypertrophy of the medial gastrocnemius muscle is an uncommon cause of calf swelling that may be secondary to chronic radiculopathy.