The efficacy of postoperative middle meningeal artery embolization on chronic subdural hematoma - A multicentered randomized controlled trial.

Background: Middle meningeal artery (MMA) embolization has recently emerged as a potential treatment for chronic subdural hematoma (cSDH). Numerous retrospective studies have suggested that it can potentially reduce the risk of hematoma recurrence following surgical evacuation. We have conducted a randomized controlled trial to investigate the effectiveness of postoperative MMA embolization in reducing recurrence rate, residual hematoma thickness as well as improving functional outcome. Methods: Patients aged 18 or above were recruited. Following evacuation through burr hole or craniotomy, patients were randomly allocated to undergo either MMA embolization or standard care (monitoring). The primary outcome was symptomatic recurrence requiring redo evacuation. Secondary outcomes include residual hematoma thickness and modified Rankin Scale (mRS) at 6 weeks and 3 months. Results: Thirty-six patients (41 cSDHs) were recruited between April 2021 and September 2022. Seventeen patients (19 cSDHs) were allocated to the embolization group and 19 patients (22 cSDHs) were in the control group. No symptomatic recurrence was observed in the treatment group while 3 control patients (15.8%) underwent repeat surgery for symptomatic recurrence, however, it was not statistically significant (P = 0.234). Furthermore, there was no significant difference in residual hematoma thickness at 6 weeks or 3 months between the two groups. All patients in the embolization group had a good functional outcome (mRS 0-1) at 3 months, which was significantly higher than the 53% observed in the control group. No complications related to MMA embolization were reported. Conclusion: Further study with larger sample size is required to evaluate the efficacy of MMA embolization.

AI software detection of large vessel occlusion stroke on CT angiography: a real-world prospective diagnostic test accuracy study.

BACKGROUND: Artificial intelligence (AI) software is increasingly applied in stroke diagnostics. However, the actual performance of AI tools for identifying large vessel occlusion (LVO) stroke in real time in a real-world setting has not been fully studied. OBJECTIVE: To determine the accuracy of AI software in a real-world, three-tiered multihospital stroke network. METHODS: All consecutive head and neck CT angiography (CTA) scans performed during stroke codes and run through an AI software engine (Viz LVO) between May 2019 and October 2020 were prospectively collected. CTA readings by radiologists served as the clinical reference standard test and Viz LVO output served as the index test. Accuracy metrics were calculated. RESULTS: Of a total of 1822 CTAs performed, 190 occlusions were identified; 142 of which were internal carotid artery terminus (ICA-T), middle cerebral artery M1, or M2 locations. Accuracy metrics were analyzed for two different groups: ICA-T and M1 ±M2. For the ICA-T/M1 versus the ICA-T/M1/M2 group, sensitivity was 93.8% vs 74.6%, specificity was 91.1% vs 91.1%, negative predictive value was 99.7% vs 97.6%, accuracy was 91.2% vs 89.8%, and area under the curve was 0.95 vs 0.86, respectively. Detection rates for ICA-T, M1, and M2 occlusions were 100%, 93%, and 49%, respectively. As expected, the algorithm offered better detection rates for proximal occlusions than for mid/distal M2 occlusions (58% vs 28%, p=0.03). CONCLUSIONS: These accuracy metrics support Viz LVO as a useful adjunct tool in stroke diagnostics. Fast and accurate diagnosis with high negative predictive value mitigates missing potentially salvageable patients.

Bilateral extraocular muscle enlargement and proptosis associated with squamous cell carcinoma of the lung.

Thyroid-associated orbitopathy is characterised on cross-sectional imaging by symmetric extraocular muscle enlargement sparing the musculotendinous junction. We report a case of this imaging finding in a biochemically euthyroid patient with metastatic squamous cell carcinoma of the lung undiagnosed at time of presentation.

Utility of a repeat PET/CT scan in HPV-associated Oropharyngeal Cancer following incomplete nodal response from (chemo)radiotherapy.

OBJECTIVES: To assess the utility of a repeat positron emission tomography/computed tomography (PET/CT) instead of immediate neck dissection (ND) for incomplete nodal response (IR) in Human Papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPC) following chemoradiotherapy/radiotherapy [(chemo)RT]. MATERIALS AND METHODS: Patients with non-distant metastatic, node positive (N+) disease treated between Jan/2005 to Jan/2016, achieved complete response at the primary with no distant relapse on a 12-week re-staging PET/CT were evaluated. Patients underwent surveillance after complete nodal response (CR). Patients with IR underwent repeat PET/CT at 16 weeks to direct neck management. Primary endpoints were CR conversion rate and subsequent regional failure following a 16-week PET/CT directed ND. Secondary endpoints were predictive values (PV) of the 12- and 16-week PET/CT for residual nodal disease, predictors for requiring the 16-week PET/CT, 5 year regional, locoregional failure free survival (FFS) and overall survival (OS). RESULTS: 235 patients were evaluated. Median follow up was 56 (range 19-60) months. 41 patients underwent 16-week re-staging PET/CT, 29 (71%) converted to CR. No subsequent regional failures occurred following a 16-week PET/CT directed ND. Positive and negative PV of the 12- and 16-week PET/CT for residual nodal disease was 12% & 98%, and 33% & 97%, respectively. N-category (AJCC/UICC 7th edition) predicted for requiring a 16-week PET/CT on univariate analysis (P-value 0.02). 5 year regional, locoregional FFS and OS was 95.8%, 93.4% and 90.8%, respectively. CONCLUSION: For N+ HPV-associated OPC achieving IR on the 12-week re-staging PET/CT following (chemo)RT, a repeat 16-week PET/CT can spare patients from unnecessary surgery.

Stereoscopy in diagnostic radiology and procedure planning: does stereoscopic assessment of volume-rendered CT angiograms lead to more accurate characterisation of cerebral aneurysms compared with traditional monoscopic viewing?

INTRODUCTION: Stereoscopic vision is a critical part of the human visual system, conveying more information than two-dimensional, monoscopic observation alone. This study aimed to quantify the contribution of stereoscopy in assessment of radiographic data, using widely available three-dimensional (3D)-capable display monitors by assessing whether stereoscopic viewing improved the characterisation of cerebral aneurysms. METHODS: Nine radiology registrars were shown 40 different volume-rendered (VR) models of cerebral computed tomography angiograms (CTAs), each in both monoscopic and stereoscopic format and then asked to record aneurysm characteristics on short multiple-choice answer sheets. The monitor used was a current model commercially available 3D television. Responses were marked against a gold standard of assessments made by a consultant radiologist, using the original CT planar images on a diagnostic radiology computer workstation. RESULTS: The participants' results were fairly homogenous, with most showing no difference in diagnosis using stereoscopic VR models. One participant performed better on the monoscopic VR models. On average, monoscopic VRs achieved a slightly better diagnosis by 2.0%. CONCLUSIONS: Stereoscopy has a long history, but it has only recently become technically feasible for stored cross-sectional data to be adequately reformatted and displayed in this format. Scant literature exists to quantify the technology's possible contribution to medical imaging - this study attempts to build on this limited knowledge base and promote discussion within the field. Stereoscopic viewing of images should be further investigated and may well eventually find a permanent place in procedural and diagnostic medical imaging.