Ascending pharyngeal artery arising from a hypoplastic internal carotid artery

Normal vascular variants often have clinical/surgical significance and can be misinterpreted for pathology. We report a case ascending pharyngeal artery arising from a hypoplastic internal carotid artery. We provide clues to differentiate between dysgenesis and disease/thrombosis of the internal carotid artery

Osteoblastoma of the Frontal Sinuses Presenting with Headache and Blurred Vision: Case Report and Review of the Literature

Osteoblastoma is a rare benign bone tumor that usually arises in the vertebral column and long bones of young adults. Craniofacial involvement is extremely rare. To date, osteoblastoma of the frontal sinus has not been reported in the English literature. We report an osteoblastoma of both frontal sinuses in a 23-year-old male who presented with headache and blurry vision in the left eye. Computed tomography (CT) demonstrated an expansile lesion involving both frontal sinuses with sclerotic and fibrous components, eroding into the roof of the left orbit. On magnetic resonance imaging (MRI) the dense portion of the lesion showed signal void on all sequences, while the fibrous matrix was isointense to grey matter on T1-weighted and T2-weighted images and showed avid enhancement following intravenous contrast administration. Surgical resection was performed and histology was consistent with osteoblastoma

Prognostic factors in patients with advanced cholangiocarcinoma: Role of surgery, chemotherapy and body mass index

AIM: To study the factors that may affect survival of cholangiocarcinoma in Lebanon

Abstract Number: LBA25 Validating Artificial Intelligence Model to Optimize Radiologist Detection of Intracerebral Hemorrhage

Introduction Artificial intelligence (AI) has shown to be able to alert the radiologist to the presence of ischemic stroke secondary to large artery occlusion (LVO) as fast as 1–2 minutes from scan completion hence leading to faster diagnosis and treatment. In addition to acute LVO, AI has become increasingly used for various intracranial pathologies. In particular, accurate and timely detection of intracerebral hemorrhage (ICH) is crucial to provide prompt life‐saving interventions. Therefore, we aimed to validate a new AI application called Viz.ai ICH with the intent to improve diagnostic identification of suspected ICH. Methods We performed a retrospective database analysis of 4,203 consecutive non‐contrast brain CT reports between September 2021 to December 2021 within a single institution. The reports were made by experienced neuroradiologists who reviewed each case for the presence of ICH. Medical students reviewed the neuroradiologists’ reports and identified cases with positive findings for ICH. Each positive case was categorized based on subtype, timing, and size/volume via imaging review by a neuroradiologist. The Viz.ai ICH output was reviewed for positive cases by medical students. This AI model was validated by using descriptive analysis and assessing its diagnostic performance with Viz.ai ICH as the index test compared to the neuroradiologists’ interpretation as the gold standard. Results 387 of 4,203 non‐contrast brain CT reports were positive for ICH according to neuroradiologists. The overall sensitivity of Viz.ai ICH was 68%, specificity was 99%, positive predictive value (PPV) was 90%, and negative predictive value (NPV) was 97%. Subgroup analysis was performed based on hemorrhage subtypes of intraparenchymal, subarachnoid, subdural, and intraventricular. Sensitivities were calculated to be 86%, 57%, 56%, and 42% respectively. Further stratification revealed sensitivity improves with higher acuity and volume/size across all ICH subtypes. Meningioma was found to be a common false‐positive finding (3 of 22, 14%). Table 1 provides a summary of the results. Conclusions Our analysis seems to indicate that AI can accurately detect the presence of ICH particularly for large volume/size ICH

Volumetry in the Assessment of Pituitary Adenoma Resection: Endoscopy versus Microscopy

Background  Assessment of the extent of resection after surgical resection of pituitary adenomas is most commonly reported in terms of the presence or absence of residual tumor. A quantitative comparison of volumetric resection between endonasal endoscopy (EE) and microsurgery (MS) has rarely been done. Methods  A retrospective analysis was performed on a consecutive series of 154 patients with pituitary adenomas treated by the same surgeon at a single institution. We employed volumetric analysis pre- and postoperatively on two cohorts of pituitary adenoma patients treated through MS ( n  = 37) versus EE approach ( n  = 117). Results  Volumetric analysis revealed a higher incidence of complete resection (64.4 vs. 56.8%) and mean volume reduction in the EE cohort (92.7 vs. 88.4%), although not significant. Recurrence rates were significantly lower in the EE group (7.7% vs 24.3%, p  = 0.015). Subgroup analysis identified that patients with preoperative tumor volumes >1 mL were less likely to recur through EE (7.8 vs. MS: 29.6%; p  = 0.0063). A higher incidence of complete resection was also noted in patients with favorable Knosp grades (0-1) (EE: 87.8 vs. MS: 63.2%; p  = 0.036). Postoperative complication rates were not significantly different between both techniques. Conclusion  Both microscopy and endoscopy are well-tolerated, effective approaches in the treatment of pituitary adenomas. Our series demonstrated that EE may be superior to MS in preventing tumor recurrence and achieving a complete resection in certain subsets of patients. EE provides a slight advantage in tumor control outcomes that may justify the paradigm shift to pure endoscopy at our center