Introduction/Purpose Utilizing appropriate projections during cerebral angiography is critical as it can dramatically alter the visualization of key anatomy. Given the unique nature of these projections, a deeper understanding of neurovascular anatomy is needed. Utilizing post imaging processing of CT angiography can be useful to demonstrate this relationship.Historically a common obstacle for CTA image processing is interference from surrounding osseous anatomy, particularly at the skull base. To address this issue, we present a new deep learning algorithm for the automated removal of osseous structures from CTA studies, resulting in superior visualization of vascular anatomy. This processed data can then be easily used for both pre-procedural planning and educational purposes. Materials and Methods A 3D deep convolution neural network was trained to perform bone removal using 50 CTAs of the brain. The model was then tested on a randomly selected set of 100 CTA brains. Qualitative segmentation accuracy was performed comparing automated segmentations to a publicly available skull removal algorithm (Horos, horosproject.com) for 3D visualization of the carotid siphons. Quantitative segmentation accuracy was evaluated on a randomly selected subset of 56 CTA brains by comparing automated segmentations to manually corrected segmentations using the Dice coefficient.This data was then used to create MIP and 3D reconstructions to demonstrate the relationship between angiographic projection and key vascular anatomy. Results After training, the algorithm segmented the carotid siphons more accurately than the Horos bone removal tool in 74 out of 100 CTAs (74%). For the remaining 26 cases the segmentation of the carotids was equivalent between methods.Average Dice overlap between the automated and manually corrected segmentations was 0.97.3D reformats after bone removal were manipulated to clearly demonstrated the relationship between angiographic projections and key vascular anatomy (such as between the Water's projection and the basilar artery, Figure 1). Conclusion The presented algorithm is a rapid and accurate method for identification and removal of the skull from previously acquired CTAs of the head. It outperforms publicly available methods for 3D visualization of skull base vasculature. Using our outlined processing algorithm, pre procedural CTA imaging can help clearly demonstrate the relationship between angiographic projections and key cerebral vascular anatomy. The future implications of such processed data on pre-procedural planning is paramount. Using this methodology, the optimal neuro-angiographic projections can be planned prior to a neuro-interventional procedure, which could, in theory, reduce total procedure time. Disclosures M. Isikbay: None. T. Caton: None. A. Baker: None. E. Smith: None. E. Calabrese: None. M. Amans: None.

Introduction/Purpose Percutaneous sclerotherapy (PS) is an effective treatment for symptomatic ­­lymphatic malformations (LM) of the head/neck. Some LMs present in the neonatal period with fulminant or rapidly progressing symptoms. The purpose of this study was to study the indications, technique, and efficacy of PS for head/neck LM in neonate and infant patients. Methods We reviewed records of a large, single-institution vascular anomalies clinic. Patients who underwent PS for LM of the head/neck at age ≤ 12 months were studied. The clinical, anatomic, and technical aspects of each treatment, rates of procedural and laboratory complications, post-treatment clinical and imaging outcomes were analyzed. Results 22 patients underwent 36 PS treatments during the first year of life. The median age at first PS was 6.2 months (range 2–320 days). Severe airway compromise was the most frequent indication (31.8%) followed by poor feeding, pain/discomfort, motor skill delay, rapid lesion growth (9.1%, each), and retinal hemorrhage (4.5%). 72.7% of LM were DeSerres Grade ≥ 3. Sclerosants included doxycycline (80.5% of cases), sodium tetradecyl (55.5%), bleomycin (11.1%) and ethanol (2.8%). There were no procedural complications; sclerosant-related complications included transient metabolic acidosis (8.3%) and hemolytic anemia (5.5%). Median clinical follow-up duration was 3.7 years, IQR 0.6–4.8 years). 47.6% of patients showed >75% lesion size reduction and 19.0% showed minimal response (<25% lesion reduction). At last follow-up, 71.4% of children were developmentally normal and asymptomatic, 23.8% had mild/intermittent ongoing symptoms, and 4.8% required tracheostomy and long-term care assistance. Conclusion PS is a safe and effective treatment for carefully selected large or symptomatic LM of the head and neck in neonates and infants.­ Disclosures M. Caton: None. M. Duvvuri: None. A. Baker: None. E. Smith: None. K. Narsinh: None. M. Amans: None. S. Hetts: None. R. Higashida: None. D. Cooke: None. C. Dowd: None.

The transradial approach (TRA) is an effective and safe alternative to transfemoral access for diagnostic neuroangiography and craniocervical interventions. While the technical aspects of supraclavicular intervention are well-described, there are little data on the TRA for thoracolumbar angiography and intervention. The authors describe the feasibility of the TRA for preoperative thoracic tumor embolization, emphasizing technique, device selection, navigation, and catheterization of thoracolumbar segmental arteries. This approach extends the benefits of TRA to spinal interventional neuroradiology.

e21519 Background: Anti-PD-1 therapy has become a mainstay of advanced melanoma treatment. However, associated irAEs are common and contribute to significant delays or cessation of treatment. In this retrospective cohort study, we aim to characterize the real-world irAE profile of pembrolizumab at our institution and its prognostic implications. Methods: We evaluated unresectable stage III-IV melanoma patients treated with pembrolizumab between 2011 and 2016 at the University of Arizona Cancer Center (UACC). Information regarding demographics, treatment, irAEs, and hospitalizations were recorded. Adverse events were graded using the common terminology criteria for adverse events v.4.0 (CTCAE). Results: Seventy-three patients were identified, 4 (5.5%) with unresectable stage III and 69 (94.5%) with stage IV melanoma. The median age was 68; 48 (65.8%) patients were male and 25 (34.2%) were female. Nineteen patients (26.0%) had a preexisting autoimmune disorder. 171 irAEs were identified in 58 of the patients. 141 (82.5%) were Grade 1, 24 (14.0%) were Grade 2, and 6 (3.5%) were Grade 3. Incidence and time to onset of significant events is displayed in Table. Eleven (15%) patients were hospitalized, and 8 patients (11.0%) stopped treatment due to an irAE. Sixteen (84.2%) patients with a preexisting autoimmune condition experienced an irAE versus 78% of patients without an autoimmune condition. Twelve patients (75%) had an exacerbation of their autoimmune condition. Response could be assessed in 67 patients . 30 patients of the 67 (45%) had a CR or a PR and 37 patients (55%) had progressive disease (PD). 58 of 67 (87%) experienced an irAE. 29 (50%) of the 58 irAE patients had PD, while 8 (88.9%) of the 9 non-irAE patients had PD. The relative risk of progression in patients who experienced an irAE versus who did not was 0.56 (95% CI: 0.39-0.79, p= 0.001). Conclusions: Experience with pembrolizumab at our institution suggests a similar irAE profile compared to landmark trials, though we observed a higher percentage of patients who required discontinuation of pembrolizumab (11% versus 5% in Phase III trials). In our retrospective study, the risk for progression was significantly higher in patients without irAE versus with any irAE, suggesting that development of irAE could be a positive prognostic sign.[Table: see text]

BACKGROUND AND PURPOSE: Automated CTP software is increasingly used for extended window emergent large-vessel occlusion to quantify core infarct. We aimed to assess whether RAPID software underestimates core infarct in patients with an extended window recently receiving IV iodinated contrast. MATERIALS AND METHODS: We reviewed a prospective, single-center data base of 271 consecutive patients who underwent CTA 6 CTP for acute ischemic stroke from May 2018 through January 2019. Patients with emergent large-vessel occlusion confirmed by CTA in the extended window (.6 hours since last known well) and CTP with RAPID postprocessing were included. Two blinded raters independently assessed CT ASPECTS on NCCT performed at the time of CTP. RAPID software used relative cerebral blood flow of,30% as a surrogate for irreversible core infarct. Patients were dichotomized on the basis of receiving recent IV iodinated contrast (,8hours before CTP) for a separate imaging study. RESULTS: The recent IV contrast and contrast-naive cohorts comprised 23 and 15 patients, respectively. Multivariate linear regression analysis demonstrated that recent IV contrast administration was independently associated with a decrease in the RAPID core infarct estimate (proportional increase = 0.34; 95% CI, 0.12-0.96; P =.04). CONCLUSIONS: Patients who received IV iodinated contrast in proximity (,8 hours) to CTA/CTP as part of a separate imaging study had a much higher likelihood of core infarct underestimation with RAPID compared with contrast-naive patients. Over-reliance on RAPID postprocessing for treatment disposition of patients with extended window emergent large-vessel occlusion should be avoided, particularly with recent IV contrast administration.

Background and Purpose Automated computed tomography perfusion (CTP) software is increasingly utilized to aid in treatment decisions in emergent large vessel occlusion (ELVO), particularly in extended window stroke patients. Neurointerventionalists must be cognizant of pitfalls of these software packages in predicting ischemic core and penumbra. This study aims to assess whether RAPID post-processing software underestimates core infarct in patients who have recently received intravenous iodinated contrast, a common scenario in stroke transfer patients who undergo CTA at an outside hospital to confirm ELVO prior to transfer. Methods We retrospectively reviewed 271 consecutive patients at our institution who underwent CTA ± CTP for symptoms of acute ischemic stroke (AIS) from May 2018 through January 2019. Patient exclusion was predominantly on the basis of lack of anterior circulation ELVO on CTA or lack of performance of CTP with RAPID post-processing. Two blinded raters independently assessed CT Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on the non-enhanced head CT (NECT) at the time of CTP and also collected clinical as well imaging data, including time from last known well (LKW) to CTP, collaterals grade, and core infarct (mL) as predicted by RAPID software. Patients were dichotomized into those who received recent intravenous contrast (within 12 hours of CTP) and contrast naïve patients. Correlation between ASPECTS and core infarct (mL) on RAPID software were analyzed for the two cohorts. Results A total of 48 patients with a mean age of 74.1 years (SD 16.4) were included. The two cohorts comprised 24 patients each. There were baseline differences in mean ASPECTS (8.5 vs 5.6, p<0.001) and time from LKN to CTP acquisition (469 mins vs 740 mins, p<0.001) in the contrast naïve and prior contrast groups, respectively. However, when adjusting for these variables on multivariate regression analysis, there is a statistically significant difference in core infarct per RAPID, with underestimation of core infarct in those patients who received recent contrast (p=0.016). In addition, there was a stronger correlation between ASPECTS and core infarct per RAPID in the contrast naïve patients (r=-0.745) compared to those who received recent contrast (r=-0.42). Conclusion Patients that previously received contrast had a much higher likelihood of underestimation of ischemic core using RAPID than contrast naïve patients. Those involved in the care of ELVO patients should avoid overreliance on RAPID post-processing for treatment disposition, particularly if the patient has received recent intravenous contrast. Disclosures A. Copelan: None. G. Drocton: None. E. Smith: None. R. Khangura: None. D. Murph: None. C. Dowd: None. V. Halbach: None. R. Higashida: None. S. Hetts: None. D. Cooke: None. M. Amans: None.

Purpose. Carbapenemase-producing organisms (CPOs) can be resistant to almost all beta-lactams and represent an increasing threat in healthcare facilities. Detection of these organisms in routine diagnostic laboratories is difficult; here we evaluate four commercially available CPO detection assays and assess their suitability for the clinical laboratory. Methodology. A panel of 95 clinical multidrug-resistant organisms (22 NDM, 24 OXA-48, 19 VIM, 4 OXA-23, 3 KPC, 4 NDM+OXA-48, 1 OXA23+NDM, 1 IMI, 1 IMP-1, 9 ESBL, 3 derepressed AmpC and 4 inducible AmpC producers) were tested by the RESIST-3 O.K.N., RapidEC CarbaNP, Acuitas Resistome and Xpert Carba-R assays. Results/Key Findings. The commercial assays performed well, with high sensitivities (96.2-100 %) and specificities (all, 100 %). The RapidEC CarbaNP and Acuitas Resistome were able to detect the broadest range of carbapenemase genotypes. The RESIST-3 O.K.N. and Xpert CarbaR had the shortest turnaround times, whilst the RapidEC CarbaNP was the only assay included in this study that could detect previously undescribed genotypes. Conclusion. Using an algorithm of the RapidEC CarbaNP, followed by either the RESIST-3 O.K.N. (Enterobacteriaceae) or the Xpert Carba-R (Pseudomonas aeruginosa and Acinetobacter spp.) on suspect CPOs allowed rapid in-house detection and genotyping of a high proportion of CPOs, reducing turnaround time by up to 7 days.

Carbapenemase-producing organisms (CPOs) represent an increasing threat in healthcare facilities and detection of these organisms in the diagnostic laboratory can be challenging. The EntericBio CPE (EBCPE) real-time PCR assay (Serosep Ltd) was evaluated for the detection of NDM, KPC, OXA-48-like, VIM, IMP and GES carbapenemase genes from a panel of 145 multidrug-resistant organisms (29 NDM, 35 OXA-48, 21 VIM, 4 OXA-23, 3 KPC, 5 NDM+OXA-48, 3 GES-5, 1 OXA-23+NDM, 1 IMI, 2 IMP-1 and 41 multidrug-resistant carbapenemase-negative isolates). The EBCPE assay performed well, with 100% sensitivity and specificity for the detection of all genotypes included in the assay. Turnaround time and laboratory workflow were improved compared to culture-based assays. Users must remain aware of the limitations of molecular assays for CPO detection to ensure implementation of the most suitable CPO diagnostic pathways.

Aneurysms of the central nervous system (CNS) are extremely rare in the pediatric population. While the cause of CNS aneurysms in adults is frequently related to chronic conditions or acquired factors, such as hypertension and smoking, the pathogenesis of pediatric aneurysms is often quite different, including trauma, infection, and predisposing genetic disorders. Further differences exist between adult and pediatric aneurysms with regard to location, size, and presentation of the aneurysm. Treatment of these lesions has substantially improved over the years with the advent of significant advancements in surgical techniques and the evolution of endovascular approaches.

Frame dropping is a type of video manipulation where consecutive frames are deleted to omit content from the original video. Automatically detecting dropped frames across a large archive of videos while maintaining a low false alarm rate is a challenging task in digital video forensics. We propose a new approach for forensic analysis by exploiting the local spatio-temporal relationships within a portion of a video to robustly detect frame removals. In this paper, we propose to adapt the Convolutional 3D Neural Network (C3D) for frame drop detection. In order to further suppress the errors due by the network, we produce a refined video-level confidence score and demonstrate that it is superior to the raw output scores from the network. We conduct experiments on two challenging video datasets containing rapid camera motion and zoom changes. The experimental results clearly demonstrate the efficacy of the proposed approach.

Structure-from-motion (SfM) is a well-studied problem in the computer vision field and is of particular interest for aerial imaging applications like mapping, terrain modeling, crop monitoring, etc. With the current rapid growth in the commercial UAV and small satellite markets, aerial SfM is becoming even more important. In recent years, free and open source software has enabled almost anyone to apply SfM to their data at no cost. Existing free packages are oriented toward processing unordered collections of photographs and are less efficient at processing ordered collections or video. They are also prone to failure with nearly planar scenes that often arise in aerial photography. While commercial solutions for aerial SfM exist, they are proprietary and expensive. This paper presents a new open source software toolkit named MAP-Tk that targets SfM for aerial video. It exploits temporal continuity and the aerial nature of the data to speed up and improve feature tracking, loop closure, and bundle adjustment. The system is highly configurable and modular. Dynamic plugins provide state-of-the art algorithms from other open source projects like OpenCV, VXL, and Ceres Solver. This paper presents the modular system design, user interface, novel algorithms exploiting aerial video, and results on various aerial data sets.

This dissertation presents an automatic registration system for aligning combined rangeintensity scans. The approach is designed to handle several challenges including extensive structural changes, large viewpoint differences, repetitive structure, illumination differences, and flat regions.First we present a technique for pairwise registration split into three stages: initialization, refinement, and verification. During initialization, intensity keypoints are backprojected into the scans and matched to form candidate transformations, each based on a single match. We explore methods of improving this image-based matching using the range data. For refinement, we extend the Dual-Bootstrap ICP algorithm for alignment of range data and introduce novel geometric constraints formed by backprojected imagebased edgel features. The verification stage determines if a refined transformation is correct. We treat verification as a classification problem based on accuracy, stability, and a novel boundary alignment measure. Experiments with 14 scan pairs show both the overall effectiveness of the pairwise algorithm and the importance of its component techniques.We also develop a method for directly combining images with range scans for keypoint detection, description, and matching. We extend a 2-D image-based detection and description framework to 3-D using an image backprojected onto a range scan. A key feature of the framework is a physical scale space for detecting keypoints, which eliminates errors in scale during both detection and matching. We develop smoothing, differentiation, and description techniques that are focused on making the keypoint invariant to viewpoint, sampling, and intensity changes. We integrate physical scale keypoints into our pairwise registration algorithm, in turn developing a physical scale keypoint based registration verification measure. We present a new technique for improving physical scale keypoint match ranking by combining an image and a range metric. We demonstrate the power of our algorithm with comparisons to variants of the SIFT algorithm and show that it is able to find and match keypoints in a variety of challenging scan pairs.Finally, we present an algorithm for the registration of an unordered set of combined range-intensity scans. We use a Bayesian network to combine pairwise verification criteria with a many-scan cycle consistency measure for determining the true overlap in the set range-intensity scans. We finish by refining all pairwise registrations at once to produce a single transformation for each range scan that brings all scans into alignment under a single coordinate system. We demonstrate this algorithm on three different datasets.

Acute paraplegia followed a vertebral infection with Mycobacterium fortuitum. There was a satisfactory response to surgery and antibiotics. No predisposing factors for this primary bone infection could be found.

The clinical and pathological details relating to a case of carcinosarcoma of the oesophagus are presented. Evidence for the true mixed nature of the lesion is demonstrated and criteria for distinguishing this from pleomorphic carcinoma are put forward. The literature relating to this rare lesion is reviewed and the problems of identifying its true pathological nature are discussed.

In 1900 Newton Pitt wrote, " There is no refer- ence to spontaneous haemopneumothorax in the Index Catalogue of the U.S. Library, nor is it dis- cussed in any of the standard treatises on medicine, in either English, French, or German."It has remained little discussed even in specialized text- books although about 150 cases, including the present three, have been recorded.Both spon- taneous haemopneumothorax and spontaneous.haemothorax are complications of spontaneous pneumothorax, of which careful follow-up (Kjaer- gaard, 1932; Perry, 1939) has failed to reveal any correlation with tuberculosis.It is also probable that spontaneous haemothorax may at times have no coexistent or immediately antecedent spon- taneous pneumothorax.Both Pitt (1900) and Rolleston (1900) realized that spontaneous haemopneumothorax was poten- tially serious.Each reported a fatal case.Note- worthy contributions to this subject include those of Hyde and Hyde (1951) with 12 case reports, Ross (1952) with six, Louria (1938) with five,