Automatic evaluation of atlantoaxial subluxation in rheumatoid arthritis by a deep learning model.

BACKGROUND: This work aims to develop a deep learning model, assessing atlantoaxial subluxation (AAS) in rheumatoid arthritis (RA), which can often be ambiguous in clinical practice. METHODS: We collected 4691 X-ray images of the cervical spine of the 906 patients with RA. Among these images, 3480 were used for training the deep learning model, 803 were used for validating the model during the training process, and the remaining 408 were used for testing the performance of the trained model. The two-dimensional key points' detection model of Deep High-Resolution Representation Learning for Human Pose Estimation was adopted as the base convolutional neural network model. The model inferred four coordinates to calculate the atlantodental interval (ADI) and space available for the spinal cord (SAC). Finally, these values were compared with those by clinicians to evaluate the performance of the model. RESULTS: Among the 408 cervical images for testing the performance, the trained model correctly identified the four coordinates in 99.5% of the dataset. The values of ADI and SAC were positively correlated among the model and two clinicians. The sensitivity of AAS diagnosis with ADI or SAC by the model was 0.86 and 0.97 respectively. The specificity of that was 0.57 and 0.5 respectively. CONCLUSIONS: We present the development of a deep learning model for the evaluation of cervical lesions of patients with RA. The model was demonstrably shown to be useful for quantitative evaluation.

A case of Takayasu arteritis complicated with pulmonary infarction.

Takayasu arteritis (TAK) is a vasculitis that causes inflammation in the arterial walls of large blood vessels. The complication rate of pulmonary artery lesion in TAK has been reported to be relatively high. Severe pulmonary artery stenosis can cause pulmonary infarction in rare cases. A 48-year-old woman had experienced cough and fever persistently for 3 months and visited a city hospital. Contrast-enhanced computed tomography (CT) and positron emission tomography (PET)-CT scans revealed TAK complicated with left pulmonary artery lesion. Contrast-enhanced CT couldn't detect wall thickening in the left smaller bifurcated pulmonary artery branch, but PET-CT did reveal this inflammation. Several weeks after we initiated treatment with high-dose prednisolone, the patient's symptoms and inflammatory findings disappeared. PET-CT may be useful for evaluating the inflammation of the pulmonary artery in TAK, and high-dose steroid monotherapy as induction therapy may be effective for TAK complicated with pulmonary artery lesions causing pulmonary infarction.

Lupus Aortitis Successfully Treated with Moderate-dose Glucocorticoids: A Case Report and Review of the Literature.

Lupus aortitis is a rare and potentially life-threatening disorder. Previous studies have reported the utility of high-dose systemic glucocorticoids or surgery as the treatment, although there have been no related controlled trials. We herein report a 49-year-old woman with a 35-year history of systemic lupus erythematosus who was diagnosed with aortitis. Her symptoms and laboratory and imaging abnormalities rapidly resolved upon the administration of moderate-dose glucocorticoids. We subsequently performed a literature review of similar cases to identify the appropriate treatment and discuss these cases. A study of further cases will be needed to identify the characteristics of patients who would benefit from moderate-dose glucocorticoid therapy.