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Purpose: To report a rare case of isolated lumbar vertebral body infarction following lumbar artery embolization for suspected retroperitoneal haemorrhage. Methods: We present the case of a 75-year-old male who underwent lumbar artery embolization due to a suspected retroperitoneal haemorrhage post-surgery. Magnetic resonance imaging (MRI) was performed to monitor post-embolization severe lumbar pain. Results: Initial MRI two days post-embolization showed no osseous signal changes or epidural abscess. A subsequent MRI 26 days post-embolization was performed because of increasing lumbar back pain and it revealed a new bone infarction at the L3 vertebral body. CT showed embolization deposits within the vertebral body, not present before the procedure. Conclusion: This unique case underscores the importance of considering vertebral body infarction as a potential complication following lumbar artery embolization. MRI was critical in early detection of the bone infarction, while CT confirmed the presence of embolization material. Awareness of this rare complication is crucial for prompt diagnosis and management. [ABSTRACT FROM AUTHOR]

Objective: Reproducibility problems are a known limitation of radiomics. The segmentation of the target lesion plays a critical role in texture analysis variability. This study's aim was to compare the interobserver reliability of manual 2D vs. 3D lung lesion segmentation with and without pre-definition of the volume using a threshold of − 50 HU. Methods: Seventy-five patients with histopathologically proven lung lesions (15 patients each with adenocarcinoma, squamous cell carcinoma, small cell lung cancer, carcinoid, and organizing pneumonia) who underwent an unenhanced CT scan of the chest were included. Three radiologists independently segmented each lesion manually in 3D and 2D with and without pre-segmentation volume definition by a HU threshold, and shape parameters and original, Laplacian of Gaussian–filtered, and wavelet-based texture features were derived. To assess interobserver reliability and identify the most robust texture features, intraclass correlation coefficients (ICCs) for different segmentation settings were calculated. Results: Shape parameters had high reliability (64–79% had excellent and good ICCs). Texture features had weak reliability levels, with the highest ICCs (38% excellent or good) found for original features in 3D segmentation without the use of a HU threshold. A small proportion (4.3–11.5%) of texture features had excellent or good ICC values at all segmentation settings. Conclusion: Interobserver reliability of texture features from CT scans of a heterogeneous collection of manually segmented lung lesions was low with a small proportion of features demonstrating high reliability independent of the segmentation settings. These results indicate a limited applicability of texture analysis and the need to define robust texture features in patients with lung lesions. Key Points: • Our study showed a low reproducibility of texture features when 3 radiologists independently segmented lung lesions in CT images, which highlights a serious limitation of texture analysis. • Interobserver reliability of texture features was low regardless of whether the lesion was segmented in 2D and 3D with or without a HU threshold. • In contrast to texture features, shape parameters showed a high interobserver reliability when lesions were segmented in 2D vs. 3D with and without a HU threshold of − 50. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the utility of non-contrast-enhanced CT texture analysis (CTTA) for predicting the histopathological differentiation of pancreatic ductal adenocarcinomas (PDAC) and to compare non-contrast-enhanced CTTA texture features between primary PDAC and hepatic metastases of PDAC. Methods: This retrospective study included 120 patients with histopathologically confirmed PDAC. Sixty-five patients underwent CT-guided biopsy of primary PDAC, while 55 patients underwent CT-guided biopsy of hepatic PDAC metastasis. All lesions were segmented in non-contrast-enhanced CT scans for CTTA based on histogram analysis, co-occurrence matrix, and run-length matrix. Statistical analysis was conducted for 372 texture features using Mann–Whitney U test, Bonferroni–Holm correction, and receiver operating characteristic (ROC) analysis. A p value < 0.05 was considered statistically significant. Results: Three features were identified that differed significantly between histopathological G2 and G3 primary tumors. Of these, "low gray-level zone emphasis" yielded the largest AUC (0.87 ± 0.04), reaching a sensitivity and specificity of 0.76 and 0.83, respectively, when a cut-off value of 0.482 was applied. Fifty-four features differed significantly between primary and hepatic metastatic PDAC. Conclusion: Non-contrast-enhanced CTTA of PDAC identified differences in texture features between primary G2 and G3 tumors that could be used for non-invasive tumor assessment. Extensive differences between the features of primary and metastatic PDAC on CTTA suggest differences in tumor microenvironment. [ABSTRACT FROM AUTHOR]

Background: Imaging of morphologic changes in the vertebral spine in axial spondyloarthritis (SpA) is routinely performed with conventional radiography limited by superposition in the thoracic segments and radiation exposure. The objective was to assess the reliability of MRI compared to conventional radiography in depicting morphologic vertebral lesions in patients with axial SpA. Forty patients diagnosed with axial SpA were included in this cross-sectional study. Patients underwent MRI of the whole spine with T1-weighted and TIRM sequences in the sagittal plane and conventional radiography of the cervical and lumbar spine in lateral projections. Morphologic changes (syndesmophytes and erosions) in the anterior vertebral endplates on MRI and conventional radiography were independently evaluated by two radiologists. Inter-modality and interobserver agreement were calculated using Cohen's Kappa. Results: Inter-modality agreement was low for cervical and lumbar syndesmophytes and erosions (κ ≤ 0.2 ± 0.07–0.1). Interobserver agreement on conventional radiography was highest for cervical and lumbar anterior syndesmophytes/bridging (κ = 0.92 ± 0.02–0.03). Syndesmophytes in thoracic anterior vertebral units were the most frequent MRI finding with a high interobserver agreement (κ = 0.83 ± 0.05). Conclusions: In imaging morphologic changes in the spine in patients with axial SpA, MRI was shown to be not an equivalent substitute but a complementary imaging modality to conventional radiography. Conventional radiography seems superior to depict morphologic cervical and lumbar vertebral changes compared to MRI, whereas MRI may visualise morphologic lesions in the thoracic spine. [ABSTRACT FROM AUTHOR]

Depending on the serotype, hantavirus infection in humans can affect different vascular beds, such as the capillaries in renal medulla or the pulmonary capillaries, resulting in two clinical syndromes: hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome (caused by Sin Nombre virus and Andes virus) [[52]]. Keywords: Hantavirus; Hypophysitis; Pseudoacute abdomen; Capillary leak; Nephropathia epidemica EN Hantavirus Hypophysitis Pseudoacute abdomen Capillary leak Nephropathia epidemica 1222 1230 9 11/19/21 20211101 NES 211101 Presentation of case Dr. D. Schiller: The patient is a previously healthy 45-year-old truck driver from Upper Austria. In summary, the patient's signs and symptoms (pseudoacute abomen, involvement of the pituitary, photophobia, renal failure, and increased inflammation markers and thrombocytopenia) strongly suggest hantavirus, most likely Puumala virus infection in this case. Suggesting an autochthonous infectious disease in our patient, resulting in sepsis and thrombocytopenia, finally limits the differential diagnosis list to only two candidates: leptospirosis and hantavirus infection. [Extracted from the article]

Aims: Atrial contractile dysfunction contributes to worse prognosis in hypertensive heart disease (HHD), but the role of cardiomyocyte dysfunction in atrial remodelling in HHD is not well understood. We investigated and compared cellular mechanisms of left (LA) and right atrial (RA) contractile dysfunction in pigs with HHD. Methods and results: In vivo electrophysiological and magnetic resonance imaging studies were performed in control and pigs treated with 11‐deoxycorticosterone acetate (DOCA)/high‐salt/glucose diet (12 weeks) to induce HHD. HHD leads to significant atrial remodelling and loss of contractile function in LA and a similar trend in RA (magnetic resonance imaging). Atrial remodelling was associated with a higher inducibility of atrial fibrillation but unrelated to changes in atrial refractory period or fibrosis (histology). Reduced atrial function in DOCA pigs was related to reduced contraction amplitude of isolated LA (already at baseline) and RA myocytes (at higher frequencies) due to reduced intracellular Ca release (Fura 2‐AM, field stimulation). However, Ca regulation differed in LA and RA cardiomyocytes: LA cardiomyocytes showed reduced sarcoplasmic reticulum (SR) [Ca], whereas in RA, SR [Ca] was unchanged and SR Ca2+‐ATPase activity was increased. Sodium–calcium exchanger (NCX) activity was not significantly altered. We used ORM‐10103 (3 μM), a specific NCX inhibitor to improve Ca availability in LA and RA cardiomyocytes from DOCA pigs. Partial inhibition of NCX increased Ca2+ transient amplitude and SR Ca in LA, but not RA cells. Conclusions: In this large animal model of HHD, atrial remodelling in sinus rhythm in vivo was related to differential LA and RA cardiomyocyte dysfunction and Ca signalling. Selective acute inhibition of NCX improved Ca release in diseased LA cardiomyocytes, suggesting a potential therapeutic approach to improve atrial inotropy in HHD. [ABSTRACT FROM AUTHOR]

Objectives The aim of this prospective study was to examine whether ultrasound or clinical abnormalities at enthesal sites predict radiographic progression at entheses in psoriatic arthritis (PsA). Methods Consecutive PsA patients were included and subjected to clinical and ultrasound assessments at 14 entheses at baseline, 6 and 12 months. Radiographs were performed at 0 and 12 months. By US, we investigated structural (erosions, osteophytes) and inflammatory changes [grey scale (0–32) and power Doppler (0–14, range global ultrasound score 0–140)], and radiographs were evaluated for enthesophytes and erosions (score range 0–56). Multivariate regression models were conducted to identify the possible association of clinical and ultrasound findings with radiographic progression. Results We examined 83 patients at baseline, of whom 43 (51.8%) had complete clinical, ultrasound and X-ray data. Twenty-four of 43 patients (55.8%) developed radiographic progression of entheses. These patients were younger (49.6 vs 59.3, P  =0.005), had shorter disease duration (9.7 vs 17.9 years, P =0.015) and lower clinical disease activity at 6-months [disease activity in psoriatic arthritis (DAPSA) 6.7 vs 17.0, P =0.018] as compared with patients without progression. Non-progressors had higher ultrasound enthesophyte scores at baseline than progressors (20 vs 15, P <0.05). The multivariate regression analysis revealed that 48.6% of the variance of the X-ray score at 12-months follow-up (RegcoeffB = 0.827, P =0.000) could be explained by the baseline US enthesophyte score. Conclusion Our data indicate that radiographic progression at entheses is linked with age, disease duration and ultrasound verified enthesophytes at baseline. No other ultrasound parameter predicted radiographic progression at entheses. [ABSTRACT FROM AUTHOR]

Objectives: To analyze alterations in left ventricular (LV) myocardial T1 times in patients with pulmonary hypertension (PH) and to investigate their associations with ventricular function, mass, geometry and hemodynamics.Methods: Fifty-eight patients with suspected PH underwent right heart catheterization (RHC) and 3T cardiac magnetic resonance imaging. Ventricular function, geometry and mass were derived from cine real-time short-axis images. Myocardial T1 maps were acquired by a prototype modified Look-Locker inversion-recovery sequence in short-axis orientations. LV global, segmental and ventricular insertion point (VIP) T1 times were evaluated manually and corrected for blood T1.Results: Septal, lateral, global and VIP T1 times were significantly higher in PH than in non-PH subjects (septal, 1249 ± 58 ms vs. 1186 ± 33 ms, p < 0.0001; lateral, 1190 ± 45 ms vs. 1150 ± 33 ms, p = 0.0003; global, 1220 ± 52 ms vs. 1171 ± 29 ms, p < 0.0001; VIP, 1298 ± 78 ms vs. 1193 ± 31 ms, p < 0.0001). In PH, LV eccentricity index was the strongest linear predictor of VIP T1 (r = 0.72). Septal, lateral and global T1 showed strong correlations with VIP T1 (r = 0.81, r = 0.59 and r = 0.75, respectively).Conclusions: In patients with PH, T1 times in VIPs and in the entire LV myocardium are elevated. LV eccentricity strongly correlates with VIP T1 time, which in turn is strongly associated with T1 time changes in the entire LV myocardium.Key Points: • Native T1 mapping detects left ventricular myocardial alterations in pulmonary hypertension • In pulmonary hypertension, native T1 times at ventricular insertion points are increased • These T1 times correlate strongly with left ventricular eccentricity • In pulmonary hypertension, global and segmental myocardial T1 times are increased • Global, segmental and ventricular insertion point T1 times are strongly correlated. [ABSTRACT FROM AUTHOR]

Background: The hypertensive deoxy-corticosterone acetate (DOCA)-salt-treated pig (hereafter, DOCA pig) was recently introduced as large animal model for early-stage heart failure with preserved ejection fraction (HFpEF). The aim of the present study was to evaluate cardiovascular magnetic resonance (CMR) of DOCA pigs and weight-matched control pigs to characterize ventricular, atrial and myocardial structure and function of this phenotype model. Methods: Five anesthetized DOCA and seven control pigs underwent 3 T CMR at rest and during dobutamine stress. Left ventricular/atrial (LV/LA) function and myocardial mass (LVMM), strains and torsion were evaluated from (tagged) cine imaging. 4D phase-contrast measurements were used to assess blood flow and peak velocities, including transmitral early-diastolic (E) and myocardial tissue (E') velocities and coronary sinus blood flow. Myocardial perfusion reserve was estimated from stress-to-rest time-averaged coronary sinus flow. Global native myocardial T1 times were derived from prototype modified Look-Locker inversion-recovery (MOLLI) short-axis T1 maps. After in-vivo measurements, transmural biopsies were collected for stereological evaluation including the volume fractions of interstitium (VV(int/LV)) and collagen (VV(coll/LV)). Rest, stress, and stress-to-rest differences of cardiac and myocardial parameters in DOCA and control animals were compared by t-test. Results: In DOCA pigs LVMM (p < 0.001) and LV wall-thickness (end-systole/end-diastole, p =0.003/p=0.007) were elevated. During stress, increase of LV ejection-fraction and decrease of end-systolic volume accounted for normal contractility reserves in DOCA and control pigs. Rest-to-stress differences of cardiac index (p = 0.040) and end-diastolic volume (p = 0.042) were documented. Maximal (p =0.042) and minimal (p = 0.012) LA volumes in DOCA pigs were elevated at rest; total LA ejection-fraction decreased during stress (p =0.006) .E' was lower in DOCA pigs, corresponding to higher E/E' at rest (p = 0.013) and stress (p = 0.026). Myocardial perfusion reserve was reduced in DOCA pigs (p = 0.031). T1-times and VV(int/LV) did not differ between groups, whereas VV(coll/LV) levels were higher in DOCA pigs (p =0.044). Conclusions: LA enlargement, E' and E/E' were the markers that showed the most pronounced differences between DOCA and control pigs at rest. Inadequate increase of myocardial perfusion reserve during stress might represent a metrics for early-stage HFpEF. Myocardial T1 mapping could not detect elevated levels of myocardial collagen in this model. Trial registration: The study was approved by the local Bioethics Committee of Vienna, Austria (BMWF-66.010/0091-II/3b/2013). [ABSTRACT FROM AUTHOR]

Background: In patients with pulmonary hypertension (PH), duration of vortical blood flow along the main pulmonary artery enables estimation of the mean pulmonary arterial pressure (mPAP) non-invasively. It remains to date not known, if this method is applicable in patients with pulmonary arterial hypertension (PAH) and abnormal aortic-to-pulmonary shunting. Case presentation: The present case analyzes the effect of a patent ductus arteriosus (PDA) on pulmonary artery flow patterns in PAH (mPAP from right heart catheterization, 75 mmHg). PH-associated vortical blood flow, which is typically observed rotating in a clockwise direction when viewed in right ventricular outflow tract orientation, was found nested in PDA left-to-right shunting. Even though rotating counter-clockwise, duration of vortical flow translated into correct non-invasive mPAP estimate. Conclusions: This case indicates that PH-associated vortex rotation is not restricted to clockwise direction, and that vortex-based estimation of elevated mPAP might also be feasible in patients with PAH and PDA. [ABSTRACT FROM AUTHOR]

The 'renal threshold for glucose' has never been evaluated in critically ill patients. Therefore, we aimed to investigate the renal glucose threshold in this patient group using high-sensitivity urine glucose assays. In this retrospective analysis of prospectively collected data, we analysed 100 consecutive critically ill patients from a medical intensive care unit ( ICU). Arterial blood glucose and spot urine glucose were simultaneously quantified daily during the first week after ICU admission. Three hundred seventy-three pairs of blood/urine glucose were plotted in five pre-defined categories of blood glucose (<80, 80-109, 110-139, 140-179 and ≥180 mg/dL). Urine glucose values of the five categories were compared using the Kruskal-Wallis test to assess the relation with blood glucose. Urine glucose was detected in virtually all of the urine samples. Urine glucose showed a positive nonlinear correlation with blood glucose and was significantly elevated at blood glucose levels of 140-179 and ≥180 mg/dL compared with lower blood glucose ranges. Basal glucosuria is ubiquitous in critically ill patients. A 'soft' renal threshold for glucose is present at blood glucose levels in the range of 140-179 mg/dL. [ABSTRACT FROM AUTHOR]

Systemic sclerosis (SSc) is an intractable autoimmune disease characterized by vasculopathy and organ fibrosis. Autologous hematopoietic stem cell transplantation (AHSCT) should be considered for the treatment of selected patients with rapid progressive SSc at high risk of organ failure. It, however, remains elusive whether immunosuppressive therapies such as rituximab (RTX) are still necessary for such patients after AHSCT, especially in those with bad outcomes. In the present report, a 43-year-old man with diffuse cutaneous SSc received AHSCT. Despite AHSCT, SSc further progressed with progressive symptomatic heart failure with newly developed concomitant mitral and tricuspid valve insufficiency, thus the patient started on RTX 8 months after AHSCT. Shortly after initiation of RTX, clinical symptoms and organ functions ameliorated subsequently. Heart valve regurgitations were reversible after initiation of RTX treatment. Currently, the patient remains in a stable condition with significant improvement of clinical symptoms and organ functions. Reporting about therapies after AHSCT in SSc is a very important issue, as randomized controlled trials are lacking, and therefore this report adds to evidence that RTX can be considered as a treatment option in patients with SSc that do not respond to AHSCT. [ABSTRACT FROM AUTHOR]

Introduction: Glycemic variability as a marker of endogenous and exogenous factors, and glucose complexity as a marker of endogenous glucose regulation are independent predictors of mortality in critically ill patients. We evaluated the impact of real time continuous glucose monitoring (CGM) on glycemic variability in critically ill patients on intensive insulin therapy (IIT), and investigated glucose complexity--calculated using detrended fluctuation analysis (DFA)--in ICU survivors and non-survivors.Methods: Retrospective analysis were conducted of two prospective, randomized, controlled trials in which 174 critically ill patients either received IIT according to a real-time CGM system (n = 63) or according to an algorithm (n = 111) guided by selective arterial blood glucose measurements with simultaneously blinded CGM for 72 hours. Standard deviation, glucose lability index and mean daily delta glucose as markers of glycemic variability, as well as glucose complexity and mean glucose were calculated.Results: Glycemic variability measures were comparable between the real time CGM group (n = 63) and the controls (n = 111). Glucose complexity was significantly lower (higher DFA) in ICU non-survivors (n = 36) compared to survivors (n = 138) (DFA: 1.61 (1.46 to 1.68) versus 1.52 (1.44 to 1.58); P = 0.003). Diabetes mellitus was significantly associated with a loss of complexity (diabetic (n = 33) versus non-diabetic patients (n = 141) (DFA: 1.58 (1.48 to 1.65) versus 1.53 (1.44 to 1.59); P = 0.01).Conclusions: IIT guided by real time CGM did not result in significantly reduced glycemic variability. Loss of glucose complexity was significantly associated with mortality and with the presence of diabetes mellitus. [ABSTRACT FROM AUTHOR]