Diagnostic Sensitivity of Unenhanced CT for Cerebral Venous Thrombosis: Can Clot Density Measurement Replace CT Venogram?

Objectives Cerebral venous sinus thrombosis is an important cause of stroke in young adults. Noncontrast-enhanced CT head (NECT) is almost always the first investigation. Our objectives were as follows: 1. How accurately does venous sinus density on NECT predict the presence of clot on CT venogram (CTV)? 2. Whether repeated measurements changed the confidence? 3. How many venous sinus thrombus would be missed if we do not do a CTV? 4. Can clot density measurement replace CTV? Methods Multicenter case-control study was designed with data from seven hospitals. Inclusion criteria: all CT and magnetic resonance imaging venograms with a prior NECT, performed between 1.1.2018 and 31.12.2018 (12 months), were included. Hounsfield unit (HU) values were calculated at the site of highest density on the NECT. Logistic regression analysis was performed using STATA. Result Two-hundred seventy-seven cases met the criteria with 33 positive cerebral venous thrombosis (density on NECT 60-92 HU) and 244 negative examinations (density on NECT 31-68 HU). Area under the curve for average clot density on NECT was 0.9984. Conclusion We found a strong relationship between sinus density on NECT and outcome of CTV. Repeating density measurements did not add any predictive value or changed outcome. Advances in Knowledge Density 70 HU or higher on NECT always resulted in a positive CTV but would miss a fifth of the positives. Cutoff at 60 HU would not miss any but result in significant false positives. An efficient option could be to limit CTV to sinus densities 60 to 70 HU only. However, a larger study would be required for such change in practice.

Extreme local recycling of moisture via wetlands and forests in North-East Indian subcontinent: a Mini-Amazon.

Moisture recycling in precipitation is an important hydrological process, accounting for ~ 67% globally. North-east India, home to the world's wettest place, boasts vast wetlands and forest-cover. Despite its proximity to the coast, we find locally recycled moisture to be the primary annual source of rainfall (~ 45%). During the pre-monsoon season, the enriched δ18O (~ - 0.7 ‰) and high d-excess (~ 14 ‰) are ascribed to enhanced transpiration, owing to atmospheric instability which causes Nor'westers. During the Monsoon season, oceanic flux provides increased surficial moisture, enabling deep-localised convection via evaporation. Significant localised recycling, even during the Monsoon season is estimated (~ 38%), with predominantly high d-excess in precipitation during latter half of the monsoon with increased moisture contribution from floods in Brahmaputra (high d-excess). The increasing δ18O and d-excess during the post-monsoon season is associated with progressively lesser rainout history and increased localized recycling (~ 67%). In light of the dwindling wetlands and forest-cover, our study highlights their indispensable role in governing regional hydro-meteorology and water availability.

New insights into diffusive kinetic fractionation during liquid condensation under supersaturated environment: an alternative approach for isotope tagging of ground-level water vapour.

Stable water isotopes in ground-level vapour are key to estimating water exchange between geospheres. Their sampling, however, is limited to laser-absorption spectrometers and satellite observations, having inherent shortcomings. This study investigates diffusive kinetic fractionation during liquid condensation under supersaturated environment, providing a cost-effective, reliable way of sampling ground-level vapour isotopes (18O, 2H). Experiments were undertaken at three locations in India with 'liquid' samples collected from condensation of ambient air at 0°C. Simultaneously, pristine 'vapour' was sampled via cryogenic-trapping using liquid nitrogen-alcohol slush at -78°C. The 'liquid' condensed under supersaturation was progressively more depleted in 18O, and less enriched in 2H than expected under equilibrium fractionation, with an increasing degree of supersaturation expressed as saturation index (Si). This study revealed: (1) Si, molecular density, Rh, T together control the extent of isotopic kinetic fractionation. (2) The presence of diffusive concentration gradient inhibits the flow of heavier isotopes during liquid condensation. (3) The stochastic nature of the process cannot be explained using a physics-based model alone. The artificial neural network model is hence deployed to sample δ18O (δ 2H) within -0.24 ± 1.79‰ (0.53 ± 11.23 ‰) of true value. (4) The approach can be extended to ground-validate isotope-enabled general circulation models and satellite observations.

Programmable electronic synapse and nonvolatile resistive switches using MoS2 quantum dots.

Brain-inspired computation that mimics the coordinated functioning of neural networks through multitudes of synaptic connections is deemed to be the future of computation to overcome the classical von Neumann bottleneck. The future artificial intelligence circuits require scalable electronic synapse (e-synapses) with very high bit densities and operational speeds. In this respect, nanostructures of two-dimensional materials serve the purpose and offer the scalability of the devices in lateral and vertical dimensions. In this work, we report the nonvolatile bipolar resistive switching and neuromorphic behavior of molybdenum disulfide (MoS2) quantum dots (QD) synthesized using liquid-phase exfoliation method. The ReRAM devices exhibit good resistive switching with an On-Off ratio of 104, with excellent endurance and data retention at a smaller read voltage as compared to the existing MoS2 based memory devices. Besides, we have demonstrated the e-synapse based on MoS2 QD. Similar to our biological synapse, Paired Pulse Facilitation / Depression of short-term memory has been observed in these MoS2 QD based e-synapse devices. This work suggests that MoS2 QD has potential applications in ultra-high-density storage as well as artificial intelligence circuitry in a cost-effective way.

Thinking beyond hernia: a review of non-hernia groin lumps.

With increasing reliance on imaging, a large number of patients presenting with a groin lump are being referred to radiology to confirm the diagnosis of hernia, usually with an ultrasound in the first instance (occasionally MRI or CT). However, when imaging of the groin was performed, we have encountered many different kinds of non-hernia lesions in our practice. Such lesions can be categorized based on their tissue of origin and pathology. A specific diagnosis can often be reached using ultrasonography, MRI or a combination of imaging modalities. This review article will help general, musculoskeletal and abdominal radiologists to understand the anatomy of the groin, diagnose and characterise soft tissue lesions that may present as a groin lump, provide guidance for further imaging and insight into imaging features which may need specific investigations like core biopsy, tertiary referral and review at multidisciplinary meetings.

Central Metatarsalgia and Walking on Pebbles: Beyond Morton Neuroma.

OBJECTIVE: Central metatarsalgia relates to abnormalities of the second, third, and fourth metatarsals and their respective metatarsophalangeal joints. A variety of disorders present with central forefoot pain; they range from traumatic lesions (acute or chronic repetitive), inflammatory and infective disorders, nonneoplastic soft-tissue lesions, and benign tumors to malignant lesions. Patients often present with symptoms of localized pain in the forefoot that worsens on weight bearing (walking or running), which can be sharp or dull and often is perceived as a lump felt inside or underneath the foot and described as walking on a marble or pebbles. These patients are labeled as having central metatarsalgia and are further evaluated with ultrasound or MRI to establish a diagnosis. CONCLUSION: In this article, we review metatarsal and intermetatarsal lesions of the foot that present with central forefoot pain and a sensation of walking on pebbles, focusing on conditions mimicking Morton neuroma clinically or on imaging. We also briefly review some other plantar lesions and arthropathy that can present with awareness of lump underneath the foot.

Non-small cell lung carcinoma metastasis to the anus.

A 70-year-old man presenting with a lung mass was investigated and treated with pneumonectomy for adenocarcinoma of the lung. He re-presented 3 months later with a large perianal abscess and mass. Subsequent investigations and biopsies showed disseminated metastases from the lung primary. Immunohistochemical staining confirmed the nature of the anal metastasis from the lung adenocarcinoma. Lung cancer is notorious for metastases, hence it is important to be aware of the uncommon modes of spread, which will help obtain early diagnosis and optimise treatment.

Colorectal cancer mimics: a review of the usual suspects with pathology correlation.

Colorectal cancer is the third most commonly diagnosed cancer in men and second most commonly diagnosed cancer in women worldwide. Initial diagnosis of colorectal malignancy is generally made on colonoscopy, sigmoidoscopy or digital rectal examination; however, with increased use of CT as primary investigation in patients with lower gastrointestinal symptoms, the diagnosis of colon cancer is often first apparent to a radiologist prior to more invasive tests. CT can demonstrate a discrete soft-tissue mass that narrows the colonic lumen or focal nodular wall thickening/stricture and a variety of pericolonic changes. Pattern of wall thickening has been described as an aid to differential diagnosis; however, significant overlap remains between primary colonic tumor and non-colonic tumors or benign conditions. Imaging is non-specific, and appropriate clinical history, direct inspection, histological analysis, and sometimes discussion at MDT are essential for accurate diagnosis and treatment planning. In this article, we will review the imaging features of some of these benign and malignant mimics of colorectal cancer, with accompanying histology slides where appropriate.

Lumps and bumps around the foot and ankle: an assessment of frequency with ultrasound and MRI.

Benign and malignant tumours and tumour-like conditions frequently present as lumps in the foot and ankle. Although definitive histological diagnosis cannot be ascertained short of a biopsy, most entities can be confidently characterised on ultrasound and/or MRI. Masses in the foot and ankle present with lump, pain, paraesthesia, restricted mobility or a combination of these. In this review we have focussed on the relative frequency of masses in the foot and ankle that present as focal lumps, with a brief description of their typical appearance on ultrasound and MRI. Ganglions were the largest group in our series representing 24 % of the masses, followed by tendon- and ligament-related lesions and, bony lesions representing 16 % and 11 % of the masses respectively.