Benson, John C.

Abstract Background Evaluation of middle ear prostheses requires high-resolution imaging to assess position and structural integrity. Purpose To assess the diagnostic performance of photon-counting-detector (PCD)-CT for middle ear prosthesis imaging in cadaveric specimens. Materials and Methods Nine different middle ear prostheses were implanted in five fresh-frozen whole-head specimens, both in correct anatomic position and displaced to mimic malposition. Specimens were scanned on PCD-CT (NAEOTOM Alpha, Siemens) and energy-integrating-detector (EID)-CT (SOMATOM Force, Siemens), reconstructed at 0.2mm and 0.4mm, respectively. Eighteen cases (9 prostheses, 2 positions) per scanner were evaluated by two neuroradiologists (36 readings), blinded to scanner and position, who scored prosthesis position, reader confidence, and overall image quality. Agreement with the reference standard and between readers was compared. Results PCD-CT showed higher diagnostic confidence compared with EID-CT, while accuracy and inter-reader agreement did not demonstrate significant differences between scanners. Correct readings, PCD-CT versus EID-CT: lateral contact, 31/36 (86.1%; 95% CI: 58.3%-94.4%) vs. 29/36 (80.6%; 55.6%-91.7%), p = 0.500; medial contact, 30/36 (83.3%; 55.6%-94.4%) vs. 26/36 (72.2%; 50.0%-83.3%), p = 0.250. PCD-CT identified all cases of complete contact loss (score 3), while EID-CT missed one reading per contact. Inter-reader agreement may be higher with PCD-CT vs EID-CT (lateral: κw: 0.804 [0.578-0.941] vs. 0.571 [0.302-0.778], p = 0.250; medial: 0.684 [0.191-0.934] vs. 0.481 [0.024-0.835], p = 0.250). Reader confidence was significantly higher with PCD-CT; mean paired differences for Readers 1 and 2 were 9.4 (1.8-17.1; Holm-adjusted p = 0.019) and 23.1 points (13.4-32.7; p < 0.001) for lateral contact, and 16.4 (10.0-22.8; p < 0.001) and 17.8 points (6.8-28.8; p = 0.007) for medial contact. Readers preferred PCD-CT image quality in 16/18 (88.9%; 65.3%-98.6%) and 17/18 cases (94.4%; 72.7%-99.9%), respectively. Conclusion PCD-CT was associated with significantly higher reader confidence and preferred image quality, without significant differences in diagnostic accuracy or inter-reader agreement. These findings suggest PCD-CT is a promising modality for postoperative middle ear evaluations that warrants further investigations.

Background Carotid artery calcification represents a common feature of atherosclerotic plaques. However, the geometric relationships of calcific clusters have not been systematically investigated. This study aimed to develop a geometry-based atlas, independent of symptom status, characterizing the three-dimensional properties of calcium clusters within carotid plaques and quantifying population-level distributions and data-driven couplings between size, shape, and density. Methods Standardized three-dimensional calcium masks of clinical CT scans were analyzed using connected-component labeling. Extracted features included cluster volume, aspect ratio, eccentricity, compactness, and CT attenuation values (mean μ, standard deviation σ). Associations between cluster features were assessed using Spearman correlations with Benjamini–Hochberg false discovery rate correction. Independent associations were determined using partial Spearman correlation and restricted cubic spline regression. Results Among 107 plaques, 149 distinct clusters were identified, most frequently presenting as a single elongated cluster (aspect ratio = 2.23). Independent associations (all p < 0.001) were identified for: eccentricity with μ (ρ = −0.39), volume with μ (ρ = 0.47), compactness with μ (ρ = 0.39), and volume with eccentricity (ρ = 0.82). Multi-cluster plaques exhibited smaller mean cluster volume (76.1 vs 359.5 mm 3 ; p < 0.001) and lower eccentricity (0.5 vs 1.6; p < 0.001) compared with single-cluster plaques. Conclusion Carotid calcification most frequently manifests as a single elongated cluster, with robust couplings between cluster size, shape, and density. These geometric archetypes provide a quantifiable framework for future biomechanical and biological studies of plaque vulnerability.

Objective: To examine the association of extent of otosclerotic plaque using high-resolution photon-counting computed tomography (PCCT) with hearing and surgical outcomes. Study design: Historical cohort. Setting: Large academic center. Patients: Patients with otosclerosis who completed PCCT imaging at time of initial evaluation. Interventions: Observation, surgery. Main outcome measures: Audiometric data. Results: A total of 53 ears were eligible for study. The mean age at PCCT was 51 years (SD: 14). The mean extent of oval window otosclerotic plaque measured in radial degrees was 112 (SD: 65) and the mean otosclerotic depth was 1.6mm (SD: 0.6). The mean air-bone gap pure-tone average was 18 dB (SD: 12) and the mean Carhart degree was 9 dB (SD: 10). The radial degrees of oval window extent were not significantly associated with air-bone gap (correlation coefficient: 0.14; P =0.3) or Carhart degree (correlation coefficient: 0.04; P =0.8). Likewise, otosclerotic plaque depth was not significantly associated with air-bone gap (correlation coefficient: −0.19; P =0.2) or Carhart degree (correlation coefficient: −0.08; P =0.6). After PCCT, 22 ears underwent surgery. In this subset, oval window extent and plaque depth were not significantly associated with the postoperative changes in air-bone gap or high-frequency thresholds. Conclusions: Despite enhanced visualization of subtle abnormalities with PCCT imaging, the extent of oval window otosclerotic plaque, measured in angular degrees and depth, was not associated with hearing loss at time of initial evaluation or postoperative audiologic changes in patients with otosclerosis.

Objective: Vestibular schwannomas (VSs) treated with stereotactic radiosurgery (SRS) often show transient loss of central tumor enhancement. We hypothesized that this loss of enhancement may correlate with better tumor control on follow-up imaging. Methods: We evaluated 198 consecutive patients from a single center who met eligibility criteria. Tumor volumes on the pre-SRS and post-SRS scans were quantified along with regions of loss of enhancement on the first post-SRS study. The latter was correlated with tumor volumes at follow-up, radiation isocenter density, and loss of serviceable hearing. Results: For the entire cohort, the median loss of enhancement on the first post-SRS scan was 14% (IQR: 6 to 25) and median rate of change in tumor volume was −4.5% per year (IQR: −10.5 to 1.5). Percent loss of central enhancement showed significant negative correlation with tumor growth not only for the entire cohort (correlation coefficient: −0.18, P =0.01), but also for the subset of patients who had available imaging until at least 2 years (n=185) and 4 years (n=179) post-SRS. Loss of enhancement also strongly correlated positively with tumor volumes and number of radiation isocenters and negatively with isocenter density. Finally, patients with greater percent loss of enhancement had an increased likelihood of progression to non-serviceable hearing, although this association was not statistically significant. Conclusions: These findings suggest that loss of central tumor enhancement in VSs post-SRS may be associated with improved tumor control.

Introduction: Carotid artery intraplaque hemorrhage (IPH) is increasingly recognized as a predictive marker of cerebrovascular events. Despite widespread utilization of contrast-enhanced CT angiography (CTA) for the evaluation of carotid atherosclerosis, diagnosis of IPH on CTA is challenging, limiting risk stratification capabilities. We evaluated convolutional neural networks (CNN) for detection of histology-proven IPH in carotid CTA. Methods: The study included carotid endarterectomy patients from our center who had preoperative CTA and available plaque specimens from the Mayo Clinic Carotid Artery Atherosclerosis Trial (MCAT) Biobank. A validated segmentation model localized common and internal carotid arteries (CCA/ICA). CCA bifurcation served as landmark after a large language model, Llama3.0-70B, verified culprit plaque proximity to the bifurcation from CTA reports. A 3×3×4cm box around ipsilateral CCA bifurcation was sampled from CTA volumes and images were labeled IPH by histology study of carotid specimen (Fig 1). Given limited cases with concurrent imaging and histology, we employed a robust cross-validation strategy: 22 cases (20%) held-out for testing, with remaining data 86 cases used for 5-fold cross-validation (stratified by IPH presence). The five resulting models independently generated IPH probability scores, and ensembled predictions calculated by three methods to enhance generalizability: Majority and weighted voting based on binary IPH class and soft voting based on IPH probability scores. Results: Of 418 patients with histological analysis, 130 had CTA studies available. After excluding 22 cases lacking histological consensus, 108 cases were analyzed. In the 22 test cases the mean age was 68.1±8.5 years and 59% were male; In the cross-validation folds age ranged from 67.1±6.9 to 75.3±7.6 years 56-82% were male. Individual models' performance on the test set showed mean ROC-AUC of 0.79 (95% CI: ±0.05) and average precision of 0.85 (±0.05) (Fig 2). The ensemble approach achieved superior performance with soft voting demonstrated 82% ROC-AUC, 77% accuracy, 79% precision, 85% sensitivity, and 82% F1-score for IPH detection, outperforming majority voting and weighted voting (Fig 3). Conclusion: Automated IPH detection in widely available CTA imaging can turn it to a powerful stroke risk assessment tool, supporting personalized prevention strategies and surgical decision-making, ultimately reducing cerebrovascular morbidity and mortality.

Aberrant internal carotid arteries (ICA) are congenital vascular anomalies that occur from involution of the cervical portion of the ICA, which leads to enlargement of the normally small collateral inferior tympanic and caroticotympanic arteries. The inferior tympanic artery is a branch of the external carotid artery, usually the ascending pharyngeal artery, which extends through the inferior tympanic canaliculus (ITC), a small foramen located along the cochlea promontory. Aberrant ICAs can also be associated with a persistent stapedial artery (PSA), which is an abnormal vessel that arises from the petrous ICA and passes through the obturator foramen of the stapes. An aberrant ICA is a very important anomaly to recognize on imaging. Accurately describing its presence is important to help prevent iatrogenic injury during intervention. It is also important to distinguish an aberrant ICA from a lateralized ICA. The improvement of spatial resolution with photon counting detector (PCD)-CT has been proven to provide higher performance in detection of sub-centimeter vascular lesions compared to conventional energy-integrated detector (EID)-CT. PCD-CT also provides superior visualization of small skull-based foramina such as the inferior tympanic canaliculus, which can aid in more accurately characterizing an aberrant ICA (variant course without ITC involvement).

Purpose Spine-related pain disorders commonly require interventions such as spinal injections, which are often image-guided and increase in demand as populations age. This study investigates the impact of lifestyle changes following retirement on the incidence of these procedures, hypothesizing that retirement significantly influences the requirement for such treatments. Methods A review of medical records from XXX County between 2000 and 2023 was conducted, focusing on patients who received spinal injections, including epidural steroid, facet, and sacroiliac joint injections. Data were stratified by age, employment status pre- and post-procedure, and type of injection. Statistical analysis, including segmental linear regression and t-tests, was used to assess changes in incidence rates over time and across demographic subsets. Results Out of 134,318 patients analyzed, a total of 359,224 spinal injections were performed. There was a significant ( p -value <.01) increase in the frequency of procedures among individuals around the age of 60, which coincides with the typical retirement age in the United States. The study also highlighted a subsequent decline in the incidence of these procedures between the ages of 70 and 74, suggesting potential adaptation to chronic conditions or the effectiveness of earlier treatments. Conclusion The findings of this study confirm the hypothesis that retirement significantly impacts the demand for spinal injections, as evidenced by the marked increase in procedures at typical retirement ages. This underscores the importance of integrating preventive care and personalized medical guidance into healthcare strategies for individuals nearing retirement to effectively manage spine-related pain disorders and reduce the necessity for invasive treatments.