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Background Prior studies focused on utilization of dual-energy computed tomography (DECT) to better detect intracranial pathology and to reduce artifacts. It is still unclear whether virtual non-contrast (VNC) images of DECT can replace true non-contrast (TNC) images. Purpose To compare attenuation values and image quality of VNC images to TNC images of the brain, obtained using spectral detector CT (SDCT). Material and Methods We retrospectively evaluated patients that underwent head CT with and without contrast material, on a SDCT scanner at our institution (n = 33). The attenuation values of different brain structures were obtained from TNC images, the conventional images of the post-contrast exams (n = 16) or the CT angiography (CTA) (n = 17), and the derived VNC images. In total, 591 regions of interest were obtained, including white and gray matter. Two neuroradiologists independently evaluated the image quality of the VNC and TNC images, using a 5-point Likert scale. Results The mean difference between the attenuation values on the VNC versus the TNC images was Conclusion Our results show minor differences between attenuation values of different brain structures on VNC versus TNC images of SDCT.

Background: Poor body composition metrics (BCM) are associated with inferior cancer outcomes. Alpelisib, a PIK3CA inhibitor, is increasingly used in approximately 40% of hormone receptor positive HER2 negative (luminal) metastatic breast (HR-MBC) patients who carry a somatic mutation in the PIK3CA gene. In the SOLAR-1, the clinical trial that led to FDA approval, serious adverse reactions occurred in 35% patients who were treated with Alpelisib and severe hyperglycemia was reported in 65% of the patients. Alpelisib is given at a fixed dose (300 mg daily) regardless of variables such as high adiposity or low muscle mass also called sarcopenia. In this study we investigated the association of BCM with toxicity and response to Alpelisib. Methods: Eligible HR-MBC patients treated with Alpelisib at Tel Aviv Sourasky Medical Center were identified. Toxicity grading, dose reduction, treatment discontinuation and hospitalizations were recorded. Using computerized tomography (CT) images taken for the evaluation of disease burden, skeletal muscle area (SMA), and skeletal muscle density (SMD) were measured at the third lumbar (L3) vertebrae. Sarcopenia was defined as skeletal muscle index (SMI = SMA/height2) Data and statisticsSarcopenicNon-SarcopenicP-valueLow SMDHigh SMDP-valueHyperglicemia all grades100%80%0.294192.31%100%0.0475Hyperglicemia grade 3-433.33%40%138.46%25%1AEs all grades83.33%20%0.027669.23%50%0.584AEs grade 3-425%00.514715.38%25%1SAE including G3-4 AEs + hospitalization + dose reductions66.67%40%0.592869.23%25%0.25TTF (days)82114187991 Citation Format: Ari Raphael, Rivka Kessner, Rebeka Raphael, Amir Sonnenblick, Shlomit Strulov Shachar. Sarcopenia and skeletal muscle density as predictors of toxicity in patients with metastatic breast cancer receiving alpelisib [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-13-19.

Spectral CT adds a new dimension to radiological evaluation, beyond assessment of anatomical abnormalities. Spectral data allows for detection of specific materials, improves image quality while at the same time reducing radiation doses and contrast media doses, and decreases the need for follow up evaluation of indeterminate lesions. We review the different acquisition techniques of spectral images, mainly dual-source, rapid kV switching and dual-layer detector, and discuss the main spectral results available. We also discuss the use of spectral imaging in abdominal pathologies, emphasizing the strengths and pitfalls of the technique and its main applications in general and in specific organs.

OBJECTIVE The aim of this study was to investigate if Hounsfield unit (HU) values from virtual noncontrast (VNC) images derived from portal venous phase spectral-detector computed tomography can help to differentiate adrenal adenomas and metastases. METHODS Spectral-detector computed tomography datasets of 33 patients with presence of adrenal lesions and standard of reference for lesion origin by follow-up/prior examinations or dedicated magnetic resonance imaging were included. Conventional and VNC images were reconstructed from the same scan. Region of interest-based image analysis was performed in adrenal lesions and contralateral healthy adrenal tissue. RESULTS The 33 lesions consisted of 23 adenomas and 10 metastases. Hounsfield unit values of all lesions in VNC images were significantly lower compared with conventional images (18.2 ± 12.6 HU vs 59.6 ± 21.7 HU, P < 0.001). Hounsfield unit values in adenomas were significantly lower in VNC images (11.3 ± 6.5 HU vs 34.1 ± 9.1 HU, P < 0.001). CONCLUSIONS Virtual noncontrast HU values differed significantly between adrenal adenomas and metastases and can therefore be used for improved characterization of incidental adrenal lesions and definition of adrenal adenomas.

Iodine quantification (IQ) and virtual noncontrast (VNC) images produced by dual-energy CT (DECT) can be used for various clinical applications. We investigate the performance of dual-layer DECT (DLDECT) in different phantom sizes and varying radiation doses and tube voltages, including a low-dose pediatric setting.Three phantom sizes (simulating a 10-year-old child, an average, and a large-sized adult) were scanned with iodine solution inserts with concentrations ranging 0-32 mg/ml, using the DLDECT. Each phantom size was scanned with CTDIvol 2-15 mGy at 120 and 140 kVp. The smallest phantom underwent additional scans with CTDIvol 0.9-1.8 mGy. All scans were repeated 3 times. Each iodine insert was analyzed using VNC and IQ images for accuracy and precision, by comparison to known values.For scans from 2 to 15 mGy mean VNC attenuation and IQ error in the iodine inserts in the small, medium, and large phantoms was 1.2 HU ± 3.2, -1.2 HU ± 14.9, 2.6 HU ± 23.6; and +0.1 mg/cc ± 0.4, -0.9 mg/cc ± 0.9, and -1.8 mg/cc ± 1.8, respectively. In this dose range, there were no significant differences (p ≥ 0.05) in mean VNC attenuation or IQ accuracy in each phantom size, while IQ was significantly less precise in the small phantom at 2 mGy and 10 mGy (p0.05). Scans with CTDIvol 0.9-1.8 mGy in the small phantom showed a limited, but statistically significantly lower VNC attenuation precision and IQ accuracy (-0.5 HU ± 5.3 and -0.3 mg/cc ± 0.5, respectively) compared to higher dose scans in the same phantom size.Performance of iodine quantification and subtraction by VNC images in DLDECT is largely dose independent, with the primary factor being patient size. Low-dose pediatric scan protocols have a significant, but limited impact on IQ and VNC attenuation values.

Since its introduction, contrast-enhanced ultrasound (CEUS) has gained an important role in the diagnosis and management of abdominal and pelvic diseases. Contrast-enhanced ultrasound can improve lesion detection rates as well as success rates of interventional procedures when compared to conventional ultrasound alone. Additionally, CEUS enables the interventionalist to assess the dynamic enhancement of different tissues and lesions, without the adverse effects of contrast-enhanced computed tomography, such as exposure to ionizing radiation and nephrotoxicity from iodinated contrast material. This review article describes the various applications and advantages of the use of CEUS to enhance performance of ultrasound-guided interventions in the abdomen and pelvis.

Kambô is a cleansing ritual involving the application of a toxin produced by the giant leaf frog ( Phyllomedusa bicolor). The Kambô ritual has increasingly been adopted among cancer patients in Europe. Accumulating data indicate various adverse effects. We report another severe adverse reaction to Kambô, a systemic inflammatory response syndrome mimicking disease progression in a patient with cholangiocarcinoma. We describe a systemic reaction to Kambô, manifested as tachycardia, tachypnea, impaired liver cholestatic enzymes, and enlargement of lymphadenopathy mimicking disease progression. The clinical features and onset of symptoms, the rapid reaction, and the lack of other identified causes make the diagnosis of Kambô-induced SIRS highly probable. This case report calls for future studies examining standard oncological care such as chemotherapy, radiotherapy, and immunotherapy in conjunction with alternative therapy. Additionally, greater awareness and physician education should be promoted, encouraging inquiry of oncology patients’ administration of alternative, complementary, and integrative medicine.

OBJECTIVE The objective of this study was to investigate the quantitative and qualitative effects of virtual monoenergetic images (VMIs) by spectral detector computed tomography (SDCT) on metal artifacts in routine examinations. METHODS Fifty-nine patients with metal artifacts (caused by pacemakers, ports, screws, or prosthetic joints) affecting muscular tissue in the chest and/or abdomen were scanned using SDCT. Attenuation values around the metallic device were compared with contralateral unaffected values, for conventional images and 80 to 200 keV VMIs. In addition, general image quality and artifact intensity were rated by 2 readers. RESULTS The VMIs significantly decreased metal artifact intensity in all patients (P < 0.05). In 39 patients (66.1%), the attenuation values of the artifact and the unaffected area on the optimal keV level were very similar (≤5 Hounsfield unit difference). Qualitative analysis showed that high VMIs significantly improved artifact intensity, with best scores at 140 keV. CONCLUSIONS High monoenergetic images of SDCT significantly reduce metal artifacts, with optimal assessment at 140 keV.

Background: To assess the technical success of contrast enhanced ultrasound (CEUS) guided biopsies of liver lesions poorly visualized on B-mode ultrasound. Methods: Patients were selected during the procedure based on the real-time clinical scenario of unsatisfactory B-mode ultrasound lesion visualization and all patients would have otherwise undergone CT guided liver lesion biopsy. A total of 26 patients underwent CEUS guided biopsy and were included in this retrospective analysis. The review of the patients’ files included demographic information, lesion characteristics on imaging, procedural details and pathology outcome. Technical success was defined as concordance between the radiological findings, pathology report and clinical follow-up—demonstrating lack of need for re-biopsy or re-biopsy with identical pathological results. Patients with less than 2 months follow-up were excluded from the study. Results: CEUS guided liver biopsy was successful in 23 out of 26 patients (88.5%). The average procedure time was 30.7±12.3 minutes and the average lesion size was 2.2±1.7 cm. The majority of lesions (80.8%) were hypoenhancing on the delayed phase of CEUS. The mean number of samples taken from each lesion per procedure was 3.2 (±1.7). Conclusions: CEUS guidance biopsies of focal liver lesions (FLL) that were difficult to visualize on B-mode ultrasound demonstrated high success rate and may be an evolving image guidance modality in selected patients to avoid CT guided procedures.

Contrast-enhanced ultrasound (CEUS) is an evolving technique for the detection and characterization of focal liver lesions. Currently, it is recommended mainly for inconclusive cases and for patients with contraindications to computed tomography (CT)/magnetic resonance imaging. For percutaneous liver interventions, image guidance is of utmost importance to detect the target lesion. Primarily, ultrasound guidance is used for liver biopsies and ablations. CT is reserved for challenging cases, for example, when the target or the surrounding structures are not well identified with standard B-mode ultrasound. Instead of CT guidance, CEUS has gained increasing interest for percutaneous liver interventions. CEUS has the advantage of superior target visualization, real-time imaging guidance of probe or needle advancement without exposure to radiation.

Rationale and Objectives This study aims to compare the diagnostic performance of abdominal computed tomography (CT) performed with and without oral contrast in patients presenting to the emergency department (ED) with acute nontraumatic abdominal pain. Materials and Methods Between December 2013 and December 2014, 348 adult patients presenting to the ED of a large tertiary medical center with nontraumatic abdominal pain were evaluated. Exclusion criteria for the study were history of inflammatory bowel disease, recent abdominal operation and suspected renal colic, abdominal aortic aneurysm rupture, or intestinal obstruction. All patients underwent intravenous contrast-enhanced abdominal CT on a Philips Brilliance 64-slice scanner using a routine abdomen protocol. The study group included 174 patients who underwent abdominal CT scanning without oral contrast, recruited using convenience sampling. A control group of 174 patients was matched to the cohort groups' gender and age and underwent abdominal CT with oral contrast material during the same time period. The patients' medical records were reviewed for various clinical findings and for the final clinical diagnosis. The CT exams were initially reviewed by a senior attending radiologist to determine the exams' technical adequacy and to decide whether an additional scan with oral contrast was required. Two senior radiologists, blinded to the clinical diagnosis, later performed consensus reading to determine the contribution of oral contrast administration to the radiologists' diagnostic confidence and its influence on diagnosing various radiological findings. Results Each group consisted of 82 men and 92 women. The average age of the two groups was 48 years. The main clinical diagnoses of the pathological examinations were appendicitis (17.5%), diverticulitis (10.9%), and colitis (5.2%). A normal CT examination was found in 34.8% of the patients. There was no significant difference between the groups regarding most of the clinical parameters that were examined. None of the examinations of all of the 174 study group patients was found to be technically inadequate, and therefore no patient had to undergo additional scanning to establish a diagnosis. The consensus reading of the senior radiologists determined that the lack of oral contrast was insignificant in 96.6% of the cases and that contrast material might have been useful in only 6 of 174 study group patients (3.4%). The radiologists found oral contrast to be helpful only in 8 of 174 control group patients (4.6%). There was no significant difference between the clinical and radiological diagnoses in both groups (study group, P = 0.261; control group, P = 0.075). Conclusions Our study shows that oral contrast is noncontributory to radiological diagnosis in most patients presenting to the ED with acute nontraumatic abdominal pain. These patients can therefore undergo abdominal CT scanning without oral contrast, with no effect on radiological diagnostic performance.

Objectives: To evaluate the added value of spectral results derived from Spectral Detector CT (SDCT) to the characterization of renal cystic lesions (RCL). Methods: This retrospective study was approved by the local Institutional review board. 70 consecutive patients who underwent abdominopelvic SDCT and had at least one RCL were included. 84 RCL were categorized as simple, complex or neoplastic based on attenuation values on single-phase post-contrast images. Attenuation values were measured in each lesion on standard conventional CT images (stCI) and virtual monoenergetic images of 40keV and 100keV. A spectral curve slope was calculated and intra lesional iodine concentration (IC) was measured using iodine-density maps. Reference standard was established using histopathologic correlation, prior and follow-up imaging. Analysis of variance (ANOVA) was used to compare between the groups. Results: Mean attenuation values for benign simple and complex RCL differed significantly (42 ± 16 vs 8 ± 3 HU; p < 0.001). IC was almost identical in benign simple and complex RCL (0.23 ± 0.04 mg ml−1 vs 0.24 ± 0.04 mg ml−1), while IC in neoplastic RCL was significantly higher (2.10 ± 0.08 mg ml−1 ; p < 0.001). The mean spectral curve slope did not differ significantly between simple and complex RCL (0.30 ± 0.03 vs 0.33 ± 0.05) but was significantly higher in neoplastic RCL (2.60 ± 0.10; p < 0.001). Conclusions: Spectral results of SDCT are highly promising in distinguishing benign complex RCL from enhancing neoplastic RCL based on single-phase post-contrast imaging only. Advances in knowledge: SDCT can assist in differentiating between benign complex and neoplastic renal cystic lesions.

To compare the outcomes of combined vitrectomy + scleral buckle (SB) and vitrectomy alone for pseudophakic rhegmatogenous retinal detachment (RRD).Cases included 65 eyes of 63 patients with primary non-complex pseudophakic RRD. The first group underwent combined vitrectomy + SB between January 2010 and August 2012, and the second group was treated with vitrectomy alone between September 2012 and October 2013. The medical records of the patients were reviewed for preoperative examinations, follow-up examinations (including final visual acuity [VA]), appearance of redetachment and complications. The main outcomes were recurrent retinal detachment, complications, and VA improvement.The rate of single-surgery anatomic success was non-significantly lower in the combined vitrectomy + SB group compared with the vitrectomy alone group - 75.8 % versus 84.4 % respectively (P = 0.683). Complications were significantly more frequent in the former compared to the latter (P = 0.014). The final VAs were 0.580 (logMAR) and 0.486, respectively (P = 0.258). VA improvement of ≥3 lines was achieved in 48.5 % and in 50 % of the eyes respectively (P = 0.769).There were no significant differences in single-surgery anatomic success rates and VA improvement between combined vitrectomy + SB and vitrectomy alone for pseudophakic RRD. Significantly more complications occurred in the combination group.

OBJECTIVE The aim of the study was to establish the reference window settings for display of virtual monoenergetic images (VMIs) from spectral detector computed tomography when assessing hypodense liver lesions. METHODS In patients with cysts (n = 24) or metastases (n = 26), objective (HU, signal-to-noise ratio [SNR]) and subjective (overall image quality, lesion conspicuity and noise) were assessed. Furthermore, 2 readers determined optimal window center/width (C/W) for conventional images (CIs) and VMIs of 40 to 120 keV. Center/width were modeled against HUliv with and without respect to the keV level (models A and B). RESULTS Attenuation and SNR were significantly higher in low-keV VMIs and improved overall image quality and lesion conspicuity (P ≤ 0.05). Model B provided valid estimations of C/W, whereas model A was slightly less accurate. CONCLUSIONS The increase in attenuation and SNR on low-keV VMIs requires adjustment of C/W, and they can be estimated in dependency of HUliv using linear models. Reference values for standard display of VMIs of 40 to 120 keV are reported.

The aim of this study was to investigate the quantitative and qualitative effects of virtual monoenergetic images (VMI) by spectral detector computed tomography (SDCT) on calcium blooming in coronary computed tomography angiography.Coronary computed tomography angiography using SDCT was performed on 42 patients with coronary artery calcifications. Stenosis grading by diameter and area of calcified plaques and free lumen using VMI from 70 to 140 keV was performed and compared with measurements by conventional images. In addition, interobserver reliability and subjective image quality were assessed by 2 experienced readers.A total of 61 coronary arteries were evaluated. Stenosis grading by diameter and area showed significant incremental decrease, from 48.86% to 22.82% and from 41.18% to 11.33%, respectively, with increasing VMI (P0.05). Interobserver reliability was excellent (intraclass correlation coefficient0.99). Overall image quality was best at 80 keV.Calcium blooming significantly decreases at higher monoenergetic levels from SDCT, increasing luminal dimensions and decreasing stenotic grading, with best overall subjective image quality using 80-keV VMI.

Since its introduction, contrast-enhanced ultrasound (CEUS) has gained an important role in the diagnosis and management of abdominal and pelvic diseases. Contrast-enhanced ultrasound can improve lesion detection rates as well as success rates of interventional procedures when compared to conventional ultrasound alone. Additionally, CEUS enables the interventionalist to assess the dynamic enhancement of different tissues and lesions, without the adverse effects of contrast-enhanced computed tomography, such as exposure to ionizing radiation and nephrotoxicity from iodinated contrast material. This review article describes the various applications and advantages of the use of CEUS to enhance performance of ultrasound-guided interventions in the abdomen and pelvis.

Introduction: Bone mineral density (BMD) analysis by Dual-Energy x-ray Absorptiometry (DXA) can have some false negatives due to overlapping structures in the projections. Spectral Detector CT (SDCT) can overcome these limitations by providing volumetric information. We investigated its performance for BMD assessment and compared it to DXA and phantomless volumetric bone mineral density (PLvBMD), the latter known to systematically underestimate BMD. DXA is the current standard for BMD assessment, while PLvBMD is an established alternative for opportunistic BMD analysis using CT. Similarly to PLvBMD, spectral data could allow BMD screening opportunistically, without additional phantom calibration. Methodology: Ten concentrations of dipotassium phosphate (K2HPO4) ranging from 0 to 600 mg/ml, in an acrylic phantom were scanned using SDCT in four different, clinically-relevant scan conditions. Images were processed to estimate the K2HPO4 concentrations. A model representing a human lumbar spine (European Spine Phantom) was scanned and used for calibration via linear regression analysis. After calibration, our method was retrospectively applied to abdominal SDCT scans of 20 patients for BMD assessment, who also had PLvBMD and DXA. Performance of PLvBMD, DXA and our SDCT method were compared by sensitivity, specificity, negative predictive value and positive predictive value for decreased BMD. Results: There was excellent correlation (R2 >0.99, p < 0.01) between true and measured K2HPO4 concentrations for all scan conditions. Overall mean measurement error ranged from −11.5 ± 4.7 mg/ml (−2.8 ± 6.0%) to −12.3 ± 6.3 mg/ml (−4.8 ± 3.0%) depending on scan conditions. Using DXA as a reference standard, sensitivity/specificity for detecting decreased BMD in the scanned patients were 100%/73% using SDCT, 100%/40% using PLvBMD provided T-scores, and 90–100%/40–53% using PLvBMD hydroxyapatite density classifications, respectively. Conclusions: Our results show excellent sensitivity and high specificity of SDCT for detecting decreased BMD, demonstrating clinical feasibility. Further validation in prospective clinical trials will be required.

Objectives The well-known boost of iodine associated-attenuation in low-keV virtual monoenergetic images (VMI_low) is frequently used to improve visualization of lesions and structures taking up contrast media. This study aimed to evaluate this concept in reverse. Hence to investigate if increased attenuation within the liver allows for improved visualization of little or not-enhancing lesions. Methods A 3D-printed phantom mimicking the shape of a human liver exhibiting a lesion in its center was designed and printed. Both, parenchyma- and lesion-mimic were filled with different solutions exhibiting 80/100/120HU and 0/15/40/60HU, respectively. Further, a total of 74 contrast-enhanced studies performed on a spectral detector CT scanner (SDCT) were included in this retrospective study. Patients had MRI or follow-up proven cysts and/or hypodense metastases. VMI of 40–200 keV as well as conventional images (CI) were reconstructed. ROI were placed in lesion and parenchyma(-mimics) on CI and transferred to VMI. Signal- and contrast-to-noise ratio were calculated (S-/CNR). Further, two radiologists independently evaluated image quality. Data was statistically assessed using ANOVA or Wilcoxon-test. Results In phantoms, S/CNR was significantly higher in VMI_low. The cyst-mimic in highly attenuating parenchyma-mimic on CI yielded a CNR of 6.4 ± 0.8; using VMI_40 keV, mildly hypodense lesion-mimic in poorly attenuating parenchyma-mimic exhibited a similar CNR (5.8 ± 0.9; p ≤ 0.05). The same tendency was observed in patients (cyst in CI/metastasis in VMI_40 keV: 4.4 ± 1.2/3.9 ± 1.8; p ≤ 0.05). Qualitative analysis indicated a benefit of VMI_40 keV (p ≤ 0.05). Conclusions VMI_low from SDCT allow for an improved visualization of hypodense focal liver lesions exploiting the concept of contrast blooming in reverse.

Objective This study aimed to evaluate image quality (IQ) of virtual monoenergetic images (VMIs) from novel spectral detector computed tomography angiography of the pulmonary arteries and to identify appropriate window settings for each kiloelectron volt level. Materials Forty consecutive patients were included in this institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study.Signal- and contrast-to-noise ratios were calculated within the pulmonary trunk, and pulmonary/lobar/segmental arteries were calculated. The IQ and diagnostic certainty were rated by 2 radiologists on 5-point scales. In addition, they recorded appropriate window settings (center/width) that were linearly modeled against attenuation within the pulmonary trunk to generate generable results. Results Signal- and contrast-to-noise ratios, IQ, and diagnostic certainty are significantly increased in low-kiloelectron volt VMIs (≤60 keV). Interrater agreement was excellent (ĸ = 0.89). We developed 2 linear models (R: 0.91-0.97 and R: 0.43-0.91, respectively, P ≤ 0.01), that suggest appropriate window settings. Conclusions The VMIs from spectral detector computed tomography improve objective and subjective IQ in angiography of the pulmonary arteries, if window settings are adjusted; they can be automatically estimated using reported linear models.

Purpose: To investigate macular changes following strabismus surgery by using optical coherence tomography (OCT). Methods: The authors prospectively evaluated 60 eyes of 30 patients undergoing unilateral extraocular muscle surgery. OCT measurements employing the fast macular thickness mapping protocol were performed 1 day prior to surgery and 1 day postoperatively. Postoperative macular changes in the study eye that was operated on (n = 30) were compared with the fellow control eye (n = 30, controls). Results: There was an increase in mean ± standard deviation central foveal thickness (CFT) in the operated eyes, from 201.63 ± 18.36 µm at baseline to 206.03 ± 22.73 µm postoperatively ( P = .024). Preoperative and postoperative perifoveal outer temporal quadrant thicknesses were 220.10 ± 16.23 and 225.80 ± 14.78 µm, respectively ( P = .009). There were no differences between preoperative and postoperative retinal thickness measurements for all measured areas in the control eyes. Eyes that underwent surgery involving the rectus muscles showed a trend toward a greater CFT increase compared with eyes that had oblique muscle surgery ( P = .070). Conclusions: The authors found subclinical increases in the foveal and perifoveal macular thicknesses following extraocular muscle surgery. These findings could be attributed to change in the mechanical forces caused by the new position of the extraocular muscles and transmitted via the sclera or, alternatively, to postoperative inflammation and alterations in the blood–retinal barrier. The clinical implications of these findings remain to be clarified. [ J Pediatr Ophthalmol Strabismus. 2016;53(1):11-15.]

Purpose To ascertain the leading causes of endophthalmitis at the Tel Aviv Medical Center between 2003 and 2010. Methods The design of the study is retrospective chart review. The medical records of all patients diagnosed with endophthalmitis in our center between 2003 and 2010 were reviewed for visual acuity and results of ophthalmologic examination at admission, treatment, complications, laboratory investigations, and final visual results. The etiologies of endophthalmitis after cataract surgery were compared for each year from 2003 to 2010, and after intravitreal (IVT) injection from 2006 to 2010. Results Eighty patients were diagnosed with endophthalmitis between 2003 and 2010: 46 male and 34 female, average age 70.7 years. A total of 27.5% were treated with IVT antibiotic injection only and 68.8% needed pars plana vitrectomy. Final visual acuity was better than counting fingers in 56.3% of cases. Surgery was almost the sole cause of endophthalmitis until 2005, when IVT injection became an important etiology. The incidence of postcataract endophthalmitis decreased significantly after 2007 and that following IVT injection decreased significantly after 2008. Conclusions The leading etiology of endophthalmitis changed from postoperative endophthalmitis to endophthalmitis after IVT injection from 2003 to 2010, and the incidence of the infection as a complication of those procedures decreased.

Purpose: To describe the spectral-domain optical coherence tomography (SD-OCT) findings in a case of Coats’ disease, with emphasis on the intraretinal exudates. Methods: Case report of a 4.5-year-old girl who presented with total exudative retinal detachment and organized exudates in a stellate configuration. SD-OCT was performed before and after treatment, which included surgical drainage of subretinal fluid and indirect laser application during the surgery. Results: At presentation, the SD-OCT showed an elevation of the foveal contour, with thickening of the retina, many exudates and a large quantity of subretinal fluid. Two months after the surgical treatment, SD-OCT revealed a significant reduction in the amount of subretinal fluids, but with persistence of the exudates. Conclusion: SD-OCT can be used as an important tool in order to describe the changes in each layer of the retina in Coats’ disease. Considering the histopathological findings in Coats’ disease, it is reasonable to assume that the exudates accumulate in the outer plexiform layer.

The K65R mutation in HIV-1 reverse transcriptase (RT) can be selected by the RT inhibitors tenofovir (TDF), abacavir (ABC), and didanosine (DDI). Recently, in vitro studies have shown that K65R is selected in tissue culture more rapidly with subtype C than subtype B viruses. The prevalence of K65R in viruses sequenced at the Tel-Aviv AIDS Center was evaluated. This study analyzed retrospectively sequences from 1999 to 2007 in patients treated with TDF, ABC, and/or DDI and compared rates of mutational prevalence between subtypes. Fisher's exact test was used to determine statistical significance. Forty-four sequences from patients treated with the three above-cited drugs were analyzed. Subtypes A (n = 1), CRF01_AE (n = 4), CRF02_AG (n = 2), B (n = 21), C (n = 11), D (n = 1), F (n = 3), and G (n = 1) were represented. Seven non-B viruses had the K65R mutation, which was only found in one subtype B virus. Of these seven samples four were subtype C, one was subtype CRF01_AE, and two were subtype CRF02_AG. None of the eight viruses with K65R harbored thymidine analogue mutations. In this study, non-subtype B viruses possessed the K65R mutation at higher incidence than subtype B viruses. Subtype C viruses may be especially prone to develop this mutation. Larger studies are needed to confirm these data. Efforts should be intensified to understand better differences in drug resistance between various HIV subtypes.

Meira Neudorfer,1,* Rivka Kessner,1,* Dafna Goldenberg,1 Anat Lavie,1 Ada Kessler21Department of Ophthalmology, 2Radiology Ultrasound Unit, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel*These authors contributed equally to this workPurpose: We sought to assess long-term changes in the flow parameters of retrobulbar vessels in diabetic patients.Methods: The retrobulbar circulation of 138 eyes was evaluated between 1994 and 1995 and 36 eyes were reevaluated between 2004 and 2008 (study group). They were divided into four groups: eyes of diabetic patients without diabetic retinopathy (DR), eyes with nonproliferative DR, eyes with proliferative DR, and eyes of nondiabetic patients (controls). Color Doppler imaging was used to assess the flow velocities in the major retrobulbar vessels. The resistive index (RI) was calculated and compared among the groups and between the two time periods.Results: RI values of the central retinal artery and posterior ciliary artery had increased in the two non-DR groups and in the nonproliferative DR group, with a surprising decrease measured in eyes with proliferative DR (P= nonsignificant [NS]). Combining the nonproliferative DR and proliferative DR groups resulted in a milder increase of the RI of the posterior ciliary artery (P= NS) and the central retinal artery (P=0.02) in the DR group compared to the other groups.Conclusion: Our results demonstrate that an increase of the resistance in the retrobulbar vessels, as a part of DR, can lessen over time and may even be reversed.Keywords: color Doppler imaging, diabetic retinopathy, retrobulbar blood flow