Background: Risk stratification in patients with chronic thromboembolic pulmonary hypertension (CTEPH) relies mainly on functional testing and imaging-based structural assessment. The aim of this study was to investigate the prognostic significance of automated regional attenuation analysis on computed tomography pulmonary angiography (CTPA) as a surrogate of perfusion abnormalities. Methods: We analyzed 52 consecutive patients diagnosed with CTEPH. Patients underwent either surgical [pulmonary endarterectomy (PEA), n=21] or non-surgical treatments [balloon pulmonary angioplasty (BPA) and/or pharmacotherapy, n=31]. Parameters derived from CTPA, including automated lung attenuation analysis and clinical metrics, were correlated with survival outcomes over a median follow-up of 5.0 years. Results: During follow-up, 19 patients (36.5%) died. In the non-surgical group, predictors of survival derived from CTPA included diameter of the ascending aorta [hazard ratio (HR) =1.37, P=0.013] and right atrial area (HR =1.17, P=0.007). Automated attenuation analysis demonstrated that a higher proportion of hyperemic parenchyma in the middle and peripheral regions of the right middle and both lower lobes was associated with increased mortality (HR from 1.38 to 1.69 and P from 0.002 to 0.027). Oligemic parenchyma in similar regions was protective (HR from 0.72 to 0.74 and P from 0.010 to 0.015). In the surgical group, no significant predictors were identified. Conclusions: Automated, region-specific attenuation analysis of CTPA provides quantitative prognostic information in non-surgically treated CTEPH patients. Increased peripheral hyperperfusion in the right middle and lower lobes was associated with decreased survival. We hypothesize that hyperperfusion in these regions may reflect neovascularization and the development of peripheral collaterals.

ObjectivePreoperative localization is essential for the surgical management of primary hyperparathyroidism (PHPT). Ultrasound and 99mTc-sestamibi SPECT/CT are first-line imaging modalities, while MRI’s role is less defined. This study aimed to evaluate MRI for parathyroid adenoma localization in PHPT and compare it with that of ultrasound and SPECT/CT.MethodsIn this prospective single-center study, 103 adults with biochemically confirmed PHPT underwent ultrasound, multiparametric 3T MRI, and SPECT/CT before surgery. MRI examinations were independently evaluated independently evaluated by two blinded radiologists. Surgical and histopathological findings served as the reference standard.ResultsNinety-three patients (90%) had single-gland disease (SGD), and 10 (10%) multiglandular disease (MGD). MRI demonstrated high sensitivity for adenomas in SGD but significantly lower sensitivity in MGD: Reader 1, 0.824 vs 0.476 (p = 0.002) and Reader 2, 0.890 vs 0.524 (p < 0.001). Ultrasound and SPECT/CT showed similar patterns. Specificity did not differ significantly between SGD and MGD. Inter-reader agreement was high for MRI and ultrasound (Krippendorff’s α > 0.8) but decreased when including SPECT/CT. MRI-based size lesion size measurements showed good concordance between readers (ρC = 0.822) but showed low concordance with histology (ρC1 = 0.498; ρC2 = 0.373) due to systematic underestimation (15–18%).ConclusionMultiparametric 3T MRI provides localization sensitivity to that of first-line imaging modalities in SGD, but differentiation between MGD and SGD remains challenging, with MRI showing no clear superiority over standard modalities.

Cathodal transcranial direct current stimulation (C-tDCS) is a potential neuroprotective method in the hyperacute phase of ischemic stroke. We aimed to assess safety, tolerability, feasibility, and potential efficacy of C-tDCS in stroke patients with salvageable penumbra. DICAST-SF was a double-blind, randomized, sham-controlled (3 active: 1 sham), 3 + 3 dose-escalation trial. Inclusion criteria were stroke due to occlusion of the internal carotid or middle cerebral artery, last known well time within 24 h, substantial penumbra on CT perfusion, and ineligibility for mechanical thrombectomy. We applied C-tDCS at six dose tiers over the affected primary motor cortex. The primary safety outcome was the symptomatic intracranial hemorrhage (SICH) rate at 24 h post-stimulation. Secondary outcomes included the rates of asymptomatic intracranial hemorrhage (AICH), early neurological deterioration, serious adverse events, and 90-day mortality. Tolerability was assessed by completion rate and questionnaires. Feasibility threshold was defined as median randomization-to-C-tDCS start time within 10 min in the last ten patients. Twenty five patients were enrolled (19 active, 6 sham), mean age 81 (SD 12) years, 16 women, median NIHSS 8 (IQR 6-16). Ten active and 4 sham patients were treated with thrombolysis. No SICH occurred. Three AICH (2 post-thrombolysis) occurred in the active arm. Rates of early deterioration, serious adverse events, and mortality (4 active vs. 2 sham) were comparable. C-tDCS was well tolerated and feasible, median randomization-to-C-tDCS start time was 8 (7-9) min. C-tDCS in hyperacute stroke was safe, well tolerated, and feasible. Findings support further evaluation in larger efficacy trials. TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04801446.

BACKGROUND Whole-body magnetic resonance imaging (wbMRI) allows general assessment of systemic cancers including lymphomas without radiation burden. AIM To evaluate the diagnostic performance of wbMRI in the staging of diffuse large B-cell lymphoma (DLBCL), determine the value of individual MRI sequences, and assess patients’ concerns with wbMRI. METHODS In this single-center prospective study, adult patients newly diagnosed with systemic DLBCL underwent wbMRI on a 3T scanner [diffusion weighted images with background suppression (DWIBS), T2, short tau inversion recovery (STIR), contrast-enhanced T1] and fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) (reference standard). The involvement of 12 nodal regions and extranodal sites was evaluated on wbMRI and PET/CT. The utility of wbMRI sequences was rated on a five-point scale (0 = not useful, 4 = very useful). Patients received a questionnaire regarding wbMRI. RESULTS Of 60 eligible patients, 14 (23%) were enrolled and completed the study. The sensitivity of wbMRI in the nodal involvement (182 nodal sites) was 0.84, with 0.99 specificity, positive predictive value of 0.96, negative predictive value of 0.97, and 0.97 accuracy. PET/CT and wbMRI were concordant both in extranodal involvement (13 instances) and staging (κ = 1.0). The mean scores of the utility of MRI sequences were 3.71 ± 0.73 for DWIBS, 2.64 ± 0.84 for T1, 2.14 ± 0.77 for STIR, and 1.29 ± 0.73 for T2 (P < 0.0001). Patients were mostly concerned about the enclosed environment and duration of the MRI examination (27% of patients). CONCLUSION The wbMRI exhibited excellent sensitivity and specificity in staging DLBCL. DWIBS and contrast-enhanced T1 were rated as the most useful sequences. Patients were less willing to undergo wbMRI as a second examination parallel to PET/CT, especially owing to the long duration and the enclosed environment.

Introduction: Cathodal transcranial direct current stimulation (C-tDCS) is a potential neuroprotective method in the hyperacute phase of ischemic stroke. In rodent models, C-tDCS reduced final infarct volume and improved functional outcome. Our aim was to assess safety, tolerability, feasibility, and potential efficacy of C-tDCS in stroke patients with salvageable penumbra. Methods: Our study was a single-center, double-blind, randomized, sham-controlled (3 active: 1 sham), 3+3 dose-escalation trial. Inclusion criteria were stroke due to occlusion of the internal carotid or middle cerebral artery, last well-known time within 24 h, evidence of substantial penumbra on baseline CT perfusion, and ineligibility for mechanical thrombectomy. We applied C-tDCS at six dose tiers over the affected primary motor cortex (1 or 2 mA for 20 min in 1 to 3 cycles with 20 min breaks). The primary safety outcome was the symptomatic intracranial hemorrhage (SICH) rate at 24 h post-stimulation. The secondary safety outcomes were the rates of asymptomatic intracranial hemorrhage (AICH), early neurologic deterioration, serious adverse events, and mortality within 90-day follow-up. Tolerability was assessed by the rate of patients completing the entire stimulation period and by structured questionnaires. The success threshold for feasibility was median randomization-to-C-tDCS start time within 10 min in the last ten patients. Exploratory efficacy outcomes included infarct growth at 24 h, and National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale at day 90. Results: A total of 25 patients were enrolled (19 active, 6 sham), mean age (SD) 81 (12) years, 9 males, median NIHSS (Q1–Q3) 8 (6–16) points. Ten active and 4 sham patients were treated with thrombolysis. No SICH and 3 AICH (2 after thrombolysis) occurred in the active arm. We observed no significant difference in serious adverse events. The mortality rate was also comparable (4 active vs 2 sham patients). C-tDCS was well tolerated, all patients completed the stimulation period. Side effects were only mild and transient. C-tDCS was feasible, median randomization-to-C-tDCS start time was 8 (7–9) min. No significant differences in other outcome measures were observed. Conclusions: The application of C-tDCS in hyperacute ischemic stroke was safe, well tolerated, and feasible. Our results support the use of C-tDCS in larger efficacy trials.

This study aims to assess the accuracy of generative pre-trained transformer 4o (GPT-4o) in answering multiple response questions from the European Diploma in Radiology (EDiR) examination, comparing its performance to that of human candidates. Results from 42 EDiR candidates across Europe were compared to those from 26 fourth-year medical students who answered exclusively using the ChatGPT-4o in a prospective study (October 2024). The challenge consisted of 52 recall or understanding-based EDiR multiple-response questions, all without visual inputs. The GPT-4o achieved a mean score of 82.1 ± 3.0

Background:The diagnostic accuracy of prostate magnetic resonance imaging (MRI) is highly dependent on image quality. Although the effects of spasmolytics and rectal preparation have been previously studied, the findings remain inconsistent and fail to address other critical modifiable factors. This study aimed to evaluate the impact of various modifiable factors on prostate MRI image quality and their subsequent influence on Prostate Imaging Reporting and Data System (PI-RADS) scoring. Methods:Fifty-six consecutive patients who underwent 3T multiparametric MRI (mpMRI) with the administration of hyoscine butylbromide (HB+) and at least one 3T mpMRI without HB (HB-) ≤3 years earlier were retrospectively evaluated. Two radiologists performed morphometry of the prostate, bladder, rectum, and abdomen and evaluated image quality, artifacts, and motion on a five-point scale and T2 and diffusion-weighted imaging (DWI) PI-RADS v2.1 scores. The influence of HB, rectum and bladder distension, breathing motion, and examination hour were analyzed. Results:The sharpness and overall image quality of T2 images were significantly better in HB+ compared to HB- (P=0.0047 and P=0.013). T2 motion artifacts were reduced earlier in the day (ρ=0.32, P=0.017). DWI susceptibility artifact correlated with patient diameter (ρ=0.40, P=0.002), but not with rectum diameter (ρ=0.09, P=0.51) or gas content (ρ=0.13, P=0.33). Examinations later in the day were associated with increased motion artifacts on T2 [hazard ratio (HR) =1.36]. T2 and DWI scores were influenced by bladder volume, breathing motion, and rectal air, but not by HB. Breathing motion negatively impacted overall image quality (HR =1.24), and DWI susceptibility artifacts (HR =1.22). Conclusions:HB administration, daytime, and breathing motion have significant influence on image quality of prostate MRI. The gas content of the rectum influences T2 image quality and T2 scores. Bladder filling is associated with reduced breathing motion, subsequently affecting DWI scores.

This work aimed to develop an automated method for quantifying the distribution and severity of perfusion changes on CT pulmonary angiography (CTPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and to assess their associations with clinical parameters and expert annotations. Following automated segmentation of the chest, a machine-learning model assuming three distributions of attenuation in the pulmonary parenchyma (hyperemic, normal, and oligemic) was fitted to the attenuation histogram of CTPA images using Bayesian analysis. The proportion of each component, its spatial heterogeneity (entropy), and center-to-periphery distribution of the attenuation were calculated and correlated with the findings on CTPA semi-quantitatively evaluated by radiologists and with clinical function tests. CTPA scans from 52 patients (mean age, 65.2 ± 13.0 years; 27 men) diagnosed with CTEPH were analyzed. An inverse correlation was observed between the proportion of normal parenchyma and brain natriuretic propeptide (proBNP, ρ = −0.485, p = 0.001), mean pulmonary arterial pressure (ρ = −0.417, p = 0.002) and pulmonary vascular resistance (ρ = −0.556, p < 0.0001), mosaic attenuation (ρ = −0.527, p < 0.0001), perfusion centralization (ρ = −0.489, p = < 0.0001), and right ventricular diameter (ρ = −0.451, p = 0.001). The entropy of hyperemic parenchyma showed a positive correlation with the pulmonary wedge pressure (ρ = 0.402, p = 0.003). The slope of center-to-periphery attenuation distribution correlated with centralization (ρ = −0.477, p < 0.0001), and with proBNP (ρ = −0.463, p = 0.002). This study validates an automated system that leverages Bayesian analysis to quantify the severity and distribution of perfusion changes in CTPA. The results show the potential of this method to support clinical evaluations of CTEPH by providing reproducible and objective measures. Question This study introduces an automated method for quantifying the extent and spatial distribution of pulmonary perfusion abnormalities in CTEPH using variational Bayesian estimation. Findings Quantitative measures describing the extent, heterogeneity, and distribution of perfusion changes demonstrate strong correlations with key clinical hemodynamic indicators. Clinical relevance The automated quantification of perfusion changes aligns closely with radiologists’ evaluations, delivering a standardized, reproducible measure with clinical relevance.

Objective: This study tested the hypothesis that limited subcutaneous adipose tissue (SAT) expansion represents a primary predisposition to the development of type 2 diabetes mellitus (T2DM), independent of obesity, and identified novel markers of SAT dysfunction in the inheritance of T2DM.Methods: First-degree relatives (FDR) of T2DM patients (n = 19) and control individuals (n = 19) without obesity (fat mass < 25%) were cross-sectionally compared. Body composition (bioimpedance, computed tomography) and insulin sensitivity (IS; oral glucose tolerance test, clamp) were measured. SAT obtained by needle biopsy was used to analyze adipocyte size, lipidome, mRNA expression, and inflammatory markers. Primary cultures of adipose precursors were analyzed for adipogenic capacity and metabolism.Results: Compared with control individuals, FDR individuals had lower IS and a higher amount of visceral fat. However, SAT-derived adipose precursors did not differ in their ability to proliferate and differentiate or in metabolic parameters (lipolysis, mitochondrial oxidation). In SAT of FDR individuals, lipidomic and mRNA expression analysis revealed accumulation of triglycerides containing polyunsaturated fatty acids and increased mRNA expression of lysyl oxidase (LOX). These parameters correlated with IS, visceral fat accumulation, and mRNA expression of inflammatory and cellular stress genes.Conclusions: The intrinsic adipogenic potential of SAT is not affected by a family history of T2DM. However, alterations in LOX mRNA and polyunsaturated fatty acids in triacylglycerols are likely related to the risk of developing T2DM independent of obesity.

Background: Deep-learning-based reconstruction (DLR) improves the quality of magnetic resonance (MR) images which allows faster acquisitions. The aim of this study was to compare the image quality of standard and accelerated T2 weighted turbo-spin-echo (TSE) images of the prostate reconstructed with and without DLR and to find associations between perceived image quality and calculated image characteristics. Methods: In a cohort of 47 prospectively enrolled consecutive patients referred for bi-parametric prostate magnetic resonance imaging (MRI), two T2-TSE acquisitions in the transverse plane were acquired on a 3T scanner-a standard T2-TSE sequence and a short sequence accelerated by a factor of two using compressed sensing (CS). The images were reconstructed with and without DLR in super-resolution mode. The image quality was rated in six domains. Signal-to-noise ratio (SNR), and image sharpness were measured. Results: The mean acquisition time was 281 +/- 23 s for the standard and 140 +/- 12 s for the short acquisition (P<0.0001). DLR images had higher sharpness compared to non-DLR (P<0.001). Short and short-DLR had lower SNR than the standard and standard-DLR (P<0.001). The perceived image quality of short-DLR was rated better in all categories compared to the standard sequence (P<0.001 to P=0.004). All domains of subjective evaluation were correlated with measured image sharpness (P<0.001). Conclusions: T2-TSE acquisition of the prostate accelerated using CS combined with DLR reconstruction provides images with increased sharpness that have a superior quality as perceived by human readers compared to standard T2-TSE. The perceived image quality is correlated with measured image contrast.

BACKGROUND:The aim was to evaluate the performance of the Peritoneal Cancer Index (PCI) using imaging (ultrasound, contrast-enhanced computed tomography (CT), and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) in assessing peritoneal carcinomatosis and predicting non-resectability in tubo-ovarian carcinoma patients. METHODS:This was a prospective multicenter observational study. We considered all patients with suspected primary ovarian/tubal/peritoneal cancer who underwent preoperative ultrasound, CT, and WB-DWI/MRI (if available). The optimal cut off value for assessing the performance of the methods in predicting non-resectability was identified at the point at which the sensitivity and specificity were most similar. The reference standard to predict non-resectability was surgical outcome in terms of residual disease >1 cm or surgery not feasible. Agreement between imaging methods and surgical exploration in assessing sites included in the PCI score was evaluated using the Intraclass Correlation Coefficient (ICC). RESULTS:242 patients were included from January 2020 until November 2022. The optimal PCI cut-off for predicting non-resectability for surgical exploration was >12, which achieved the best AUC of 0.87, followed by ultrasound with a cut-off of >10 and AUC of 0.81, WB-DWI/MRI with a cut-off of >12 and AUC of 0.81, and CT with a cut-off of >11 and AUC of 0.74. Using ICC, ultrasound had very high agreement (0.94) with surgical PCI, while CT and WB-DWI/MRI had high agreement (0.86 and 0.87, respectively). CONCLUSION:Ultrasound performed by an expert operator had the best agreement with surgical findings compared to WB-DWI/MRI and CT in assessing radiological PCI. In predicting non-resectability, ultrasound was non-inferior to CT, while its non-inferiority to WB-DWI/MRI was not demonstrated.

BACKGROUND:In addition to the diagnostic accuracy of imaging methods, patient-reported satisfaction with imaging methods is important. OBJECTIVE:To report a secondary outcome of the prospective international multicenter Imaging Study in Advanced ovArian Cancer (ISAAC Study), detailing patients' experience with abdomino-pelvic ultrasound, whole-body contrast-enhanced computed tomography (CT), and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) for pre-operative ovarian cancer work-up. METHODS:In total, 144 patients with suspected ovarian cancer at four institutions in two countries (Italy, Czech Republic) underwent ultrasound, CT, and WB-DWI/MRI for pre-operative work-up between January 2020 and November 2022. After having undergone all three examinations, the patients filled in a questionnaire evaluating their overall experience and experience in five domains: preparation before the examination, duration of examination, noise during the procedure, radiation load of CT, and surrounding space. Pain perception, examination-related patient-perceived unexpected, unpleasant, or dangerous events ('adverse events'), and preferred method were also noted. RESULTS:Ultrasound was the preferred method by 49% (70/144) of responders, followed by CT (38%, 55/144), and WB-DWI/MRI (13%, 19/144) (p<0.001). The poorest experience in all domains was reported for WB-DWI/MRI, which was also associated with the largest number of patients who reported adverse events (eg, dyspnea). Patients reported higher levels of pain during the ultrasound examination than during CT and WB-DWI/MRI (p<0.001): 78% (112/144) reported no pain or mild pain, 19% (27/144) moderate pain, and 3% (5/144) reported severe pain (pain score >7 of 10) during the ultrasound examination. We did not identify any factors related to patients' preferred method. CONCLUSION:Ultrasound was the imaging method preferred by most patients despite being associated with more pain during the examination in comparison with CT and WB-DWI/MRI. TRIAL REGISTRATION NUMBER:NCT03808792.

BACKGROUND:A laparoscopy-based scoring system was developed by Fagotti et al (Fagotti or Predictive Index value (PIV)score) based on the intraoperative presence or absence of carcinomatosis on predefined sites. Later, the authors updated the PIV score calculated only in the absence of one or both absolute criteria of nonresectability (mesenteric retraction and miliary carcinomatosis of the small bowel) (updated PIV model). OBJECTIVE:The aim was to demonstrate the noninferiority of ultrasound to other imaging methods (contrast enhanced computed tomography (CT) and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI)/MRI) in predicting nonresectable tumor (defined as residual disease >1 cm) using the updated PIV model in patients with tubo-ovarian cancer. The agreement between imaging and intraoperative findings as a reference was also calculated. STUDY DESIGN:This was a European prospective multicenter observational study. We included patients with suspected tubo-ovarian carcinoma who underwent preoperative staging and prediction of nonresectability at ultrasound, CT, WB-DWI/MRI, and surgical exploration. Ultrasound and CT were mandatory index tests, while WB-DWI/MRI was an optional test (non-available in all centers). The predictors of nonresectability were suspicious mesenteric retraction and/or miliary carcinomatosis of the small bowel or if absent, a PIV >8 (updated PIV model). The PIV score ranges from 0 to 12 according to the presence of disease in 6 predefined intra-abdominal sites (great omentum, liver surface, lesser omentum/stomach/spleen, parietal peritoneum, diaphragms, bowel serosa/mesentery). The reference standard was surgical outcome, in terms of residual disease >1 cm, assessed by laparoscopy and/or laparotomy. The area under the receiver operating characteristic curve (AUC) to assess the performance of the methods in predicting nonresectability was reported. Concordance between index tests at the detection of disease at 6 predefined sites and intraoperative exploration as reference standard was also calculated using Cohen's kappa. RESULTS:The study was between 2018 and 2022 in 5 European gynecological oncology centers. Data from 242 patients having both mandatory index tests (ultrasound and CT) were analyzed. 145/242 (59.9%) patients had no macroscopic residual tumor after surgery (R0) (5/145 laparoscopy and 140/145 laparotomy) and 17/242 (7.0%) had residual tumor ≤1 cm (R1) (laparotomy). In 80/242 patients (33.1%), the residual tumor was>1 cm (R2), 30 of them underwent laparotomy and maximum surgery was carried out, and 50/80 underwent laparoscopy only, because cytoreduction was not feasible in all of them. After excluding 18/242 (7.4%) patients operated on but not eligible for extensive surgery, the predictive performance of 3 imaging methods was analyzed in 167 women. The AUCs of all methods in discriminating between resectable and nonresectable tumor was 0.80 for ultrasound, 0.76 for CT, 0.71 for WB-DWI/MRI, and 0.90 for surgical exploration. Ultrasound had the highest agreement (Cohen's kappa ranging from 0.59 to 0.79) than CT and WB-DWI/MRI to assess all parameters included in the updated PIV model. CONCLUSION:Ultrasound showed noninferiority to CT and to WB-DWI/MRI in discriminating between resectable and nonresectable tumor using the updated PIV model. Ultrasound had the best agreement between imaging and intraoperative findings in the assessment of parameters included in the updated PIV model. Ultrasound is an acceptable method to assess abdominal disease and predict nonresectability in patients with tubo-ovarian cancer in the hands of specially trained ultrasound examiners.

Background: Neurological damage remains the leading cause of death in cardiac arrest victims with early neuroprognostication being the cornerstone of the decision-making process to continue or discontinue advanced treatments. In this study, we aimed to find markers of favorable and unfavorable outcome on early brain computed tomography (CT) in patients after prolonged out-of-hospital cardiac arrest (OHCA) treated both by conventional and extracorporeal cardiopulmonary resuscitation (ECPR). Methods: In a secondary analysis of the Prague OHCA study, patients who underwent brain CT within 36 hours after cardiac arrest were identified. Qualitative findings (brain edema, hemorrhage) and quantitative measurements [attenuation of grey matter structures and grey-to-white matter attenuation ratio (GWR)] between patients with cerebral performance category (CPC) of 1–2 (favorable outcome) and 3–5 (unfavorable outcome) within 180 days after the event were compared. Results: In 45 eligible patients, intracranial edema (n=16, 50%) was present in patients with CPC 3–5 only (n=32, 71%). Attenuation of brain structures and GWR did not differ between patients with favorable and unfavorable outcomes. However, the GWR in the caudate and putamen of most CPC 1–2 patients was within a narrow range of values (1.18 to 1.30 and 1.20 to 1.33) that separated patients with CPC 1–2 from CPC 3–5 with a sensitivity of 78% and 66% a specificity of 85% and 100%, and area under the curve (AUC) of 0.86 (P=0.0001) and 0.77 (P=0.0053), respectively. Patients treated by ECPR had lower attenuation in the centrum semiovale (28.3±2.7) compared to those who were not (31.0±2.8, P=0.003). The most common causes of death in CPC 3–5 patients were brain death in 13 (41%) patients, multiorgan failure in 12 (38%), and cardiac rearrest in 4 (13%). Conclusions: Both decreased and increased grey-to-white matter differentiation in the putamen and caudate on early non-contrast brain CT after prolonged OHCA indicate poor neurological outcome within 180 days after cardiac arrest.

SESSION TITLE: Diffuse Lung Disease Global Case Report Posters 1 SESSION TYPE: Global Case Reports PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm INTRODUCTION: Sarcoidosis is a systemic granulomatous disease of unknown etiology. It most commonly affects intrathoracic lymph nodes and lung tissue, but can manifest in almost all organs. CASE PRESENTATION: A 69-year-old man with arterial hypertension was evaluated for shortness of breath, cough and fatigue. The radiologist described suspicious sarcoidosis of the lung parenchyma and intrathoracic lymph nodes on chest CT (computer tomography), which was confirmed by bronchoscopy biopsy. The patient's laboratory showed significantly elevated liver enzymes (billirubin: 18.8 Alanine aminotransferase: 2.70 Aspartate transaminase: 1.31 γ-glutamyltransferase: 10.04 Alkaline phosphatase: 6.61 ukat/l), the patient was asymptomatic, abdominal ultrasound without pathological findings, hepatitis negative, drug induced liver injury and toxonutritional etiology unlikely, autoimmunity negative, liver MRI (Magnetic Resonance Imaging) performed, where intrahepatic biliary tract sarcoidosis was suspected, non-targeted liver biopsy was added with histology confirming intrahepatic biliary tract involvement. Steroid therapy was initiated, on which liver enzymes decreased to normal. DISCUSSION: Sarcoidosis of the biliary tract is rare, and only single cases are available in the literature. Both intrahepatic and extrahepatic bile ducts may be affected together with/without involvement of the liver parenchyma. Morfological verification is advisable to exclude other etiologies, especially tumor or autoimmune diseases such as primary biliary cholangitis. Complications include bile duct stenosis in particular, which can be addressed by biliary stenting. Early initiation of treatment minimizes complications and the need for surgical management. CONCLUSIONS: Sarcoidosis predominantly affects the lungs and lymphatic system, but we must not forget that it can affect any organ and consider sarcoidosis in differential diagnosis. REFERENCE #1: Alsayid, Muhammad MD, MPH, MS1; Taftaf, Ahmad MD2; Harmouch, Khaled M. MD3; Alabkaa, Anas MD4; Pappas, Sam G. MD5; Singh, Ajaypal MD1. Sarcoidosis of the Bile Duct. ACG Case Reports Journal 10(1):p e00964, January 2023. | DOI: 10.14309/crj.0000000000000964 REFERENCE #2: Buxbaum J, Papademetriou M, Klipfel N, Selby R, Fong TL, Sharma O. Biliary sarcoidosis: Early diagnosis minimizes the need for surgery. Am J Respir Crit Care Med. 2013;187(5):556–9. REFERENCE #3: Jebran AF, Schmidt WE, Kahraman A, Canbay A, Bulut K. Sarcoidosis of the Intra- and Extrahepatic Bile Ducts with Concomitant Cholangitis in a Patient with Ulcerative Colitis. Case Rep Gastroenterol. 2019 Mar 29;13(1):153-158. doi: 10.1159/000497470. PMID: 31097931; PMCID: PMC6489028. DISCLOSURES: No relevant relationships by Lukáš Lambert No relevant relationships by Lenka Navratova No relevant relationships by Alena Slovakova No relevant relationships by Jiri Votruba