This paper presents an update on cranial nerve imaging with new imaging techniques applied on a nerve by nerve based literature research. Imaging small structures in the human body such as the cranial nerves often poses a challenge in MRI imaging. It requires investment in spatial resolution with acceptable MRI scantimes. The radiologist should also be aware of the anatomical course of all 12 cranial nerves, and know which type of sequence is best used to visualize each part of the cranial nerve from the brainstem to the end-organ. This paper does not cover the complex radiological anatomy of the cranial nerves, this is already available in many other manuscripts. Nor will this paper cover all the possible pathologies that can affect the cranial nerves, this is also described in many other manuscripts. Newer imaging techniques, such as contrast-enhanced black-blood T1-weighted imaging, are increasingly used to improve detection of cranial nerve inflammation. While diffusion tensor imaging is currently used primarily to evaluate the integrity of the cisternal nerve segments, contrast-enhanced black-blood T1-weighted imaging can provide additional information about the cisternal, foraminal, cavernous, and extracranial portions of the cranial nerves. MR neurography techniques have recently been developed with better demonstration of the extracranial course of the cranial nerves. Detection of inflammatory or demyelinating nerve disease will mostly benefit from using these new imaging techniques. Some practical tips to optimize cranial nerve MRI scanning are provided.
AIM:This study aimed to evaluate the significance of a stepped nurse-led low anterior resection syndrome (LARS) clinic for patients. METHODS:A Nurse-Led Clinic (NLC) with a stepped intervention approach for patients with LARS was developed and implemented. An exploratory study was conducted in three hospitals to evaluate the nurse-led clinic. Adult rectal cancer patients experiencing LARS who attended the NLC were recruited via maximum variation sampling for semi-structured interviews. Thematic analysis was performed, employing researcher triangulation to enhance reliability. RESULTS:Seventeen participants were interviewed to evaluate the clinic. Participants described five characteristics: (1) presence of the nurse, (2) accessibility, (3) providing recognition, affirmation and understanding, (4) coordinating and (5) timing of the consultation. In addition, participants outlined four principal tasks: (1) providing information, (2) management of symptoms, (3) support and (4) follow-up and continuity of care. CONCLUSION:The NLC offered meaningful support by addressing patients' concerns comprehensively. It normalised the condition, empowered patients with tailored information and provided effective symptom management strategies. REPORTING METHOD:SRQR checklist.
BACKGROUND & AIMS:Secondary loss of response to ustekinumab is observed in patients with Crohn's disease (CD). Multiple dose-intensification regimens have been proposed. We aimed to test prospectively 2 different dose-intensification regimens with ustekinumab in patients with CD experiencing secondary loss of response. METHODS:This was an investigator-initiated, multicenter, randomized, placebo-controlled trial conducted at 15 hospitals in Belgium. Eligible patients were adults with CD treated with ustekinumab on maintenance dosing of 90 mg subcutaneous every 8 weeks and experiencing a secondary loss of response (Patient-Reported Outcomes 2: abdominal pain score >1 and liquid or very soft stool frequency >3 and an objective documentation of disease). Patients were randomized 1:1 to receiving a single intravenous reinduction with ustekinumab ≈6 mg/kg followed by either subcutaneous ustekinumab 90 mg every 4 weeks or every 8 weeks until week 48. The primary endpoint was the proportion of patients with steroid-free clinical remission at week 48, defined as Patient-Reported Outcomes 2 remission: (abdominal pain ≤ 1 and stool frequency ≤3) and fecal calprotectin <250 μg/g and no steroids in the 90 days before week 48. RESULTS:Between March 2020 and October 2023, 108 patients were randomized. Steroid-free clinical remission at week 48 was reached in 15% vs 19% of patients in the every 4 weeks vs the every 8 weeks group (difference 4%; P = 0.5). Serious adverse events occurred in 17% vs 13% of patients. CONCLUSIONS:In patients with CD and secondary loss of response to ustekinumab, dose intensification with a single intravenous administration and followed by 4 weekly subcutaneous dosing of ustekinumab was not more effective than 1 intravenous administration followed by 8 weekly subcutaneous dosing of ustekinumab. (ClinicalTrials.gov, Number: NCT04245215).
Background In the American College of Rheumatology/European Alliance of Rheumatology Associations 2010 classification criteria for rheumatoid arthritis (RA), rheumatoid factor (RF) and anti-citrullinated protein/peptide antibodies (ACPA) are assigned the same weight, although ACPA have proven more specific than RF. We aimed to refine the serological weight factors for RA classification.Materials and methods Diagnostic samples from 398 patients with RA and 448 diseased controls (DC) were evaluated with RF and ACPA assays from five different manufacturers. A grid search was conducted across all possible integer score pairs for RF and ACPA to identify the weighting combination that optimised the specificity of RA classification. This combination was applied in a refined scoring system (RSS) for three confirmatory cohorts comprising, respectively, 67, 157 and 132 patients with RA and 441, 153 and 193 DC.Findings In the investigative cohort, the optimal combination of weighting scores was characterised by higher scores for ACPA, higher antibody levels and double RF/ACPA positivity.Applying the optimal combination of weighting scores decreased misclassification compared with the 2010 RA classification criteria, minimally affecting sensitivity. For seropositive patients, RSS significantly lowered misclassification from 38.3–55.8% to 15.0–26.9%.The improved specificity of RSS (compared with the 2010 criteria) was validated in the confirmatory cohorts. Considering only seropositive patients, the RSS significantly decreased RA misclassification (8.6–36.8% vs 20.0–78.9%), minimally affecting the sensitivity (86.7–97.3% vs 86.7–96.0%).Interpretation Serological weight factors for RA classification can be improved by taking into account the antibody type, the antibody levels and single or combined positivity. The application of an RSS reduced the number of RA misclassifications.
This study aimed to evaluate the potential of Photon-Counting Detector CT Angiography (PCD-CTA) for the post-interventional assessment of intraaneurysmal flow disrupting devices (IAFD). This retrospective analysis evaluates consecutive patients with intracranial aneurysms treated with IAFD between April 2023 and April 2025, who underwent PCD-CTA, MR angiography and DSA as part of their clinical diagnostic work-up routine. Polyenergetic images, iodine and virtual monoenergetic imaging reconstructions with different keV levels (40 and 80) and with different Head vessel kernels (Hv56 and Hv72) were acquired with and without iterative metal artifact reduction. Three independent readers assessed image quality using a 5-point Likert scale and region of interest analysis. The different kernels, keV and the optimized spectral reconstructions were compared in descriptive analysis. A total of 10 patients (mean age 60.41 ± 11.43 (43–74) years; 6 women) with intracranial aneurysms treated with either Contour device (n = 6) or WEB device (n = 4) were included. Reconstructions using Hv56 and a 40 keV yielded increased signal and contrast to noise ratios and were preferred for visualizing the parent vessel lumen compared to Hv72 and higher keV levels (p < 0.001). Assessing the different spectral reconstructions virtual monoenergetic reconstructions proved to be best to evaluate the parent vessel lumen (p = 0.040). Spectral reconstructions of PCD-CTA with a smoother reconstruction kernel and a low keV level seem to be beneficial to achieve optimal image quality for the diagnostic evaluation of patients with intracranial IAFD.
