Abelwaters1847

Poor nutritional status in children with cancer can impact treatment outcomes and mortality. Nutrition screening is a simple yet effective approach to identify malnutrition risk for early intervention. We aim to improve the identification of children with cancer at high risk of malnutrition, so that nutritional intervention and rehabilitation can commence early for these children. Our multidisciplinary team conducted a root cause analysis and concluded that the generic screening tool did not differentiate malnutrition risk for different cancer types, stage and intensity of treatment. Hence, a screening tool that considered the identified factors was tested for reliability and validity first. Subsequently, we used the Plan, Do, Study, Act model with two improvement cycles to put in place a systematic process to facilitate the implementation. The interventions included (1) instituting the tool in the electronic medical records and (2) direct referral to dietitian based on screening score.We compared pre- and post-implementation cohorts and demonstrated better identification of nutritionally at-risk patients (36.4%-85.7%, p less then 0.001) with the new tool as well as improved timeliness of nutritional intervention (3 days to 1 day from admission, p=0.010). A lower malnutrition rate (17.4%-6.5%, p less then 0.001) in the postimplementation cohort was also demonstrated. Nutritional intervention within 48 hours of admission led to an overall positive weight change at 3 months (+2.68%, IQR -1.14 to 9.09 vs -0.43%, -6.60 to 2.29; p=0.036) in the malnourished patients from both cohorts. Further studies will be conducted to evaluate the scale of the effectiveness of early intervention and close nutritional monitoring, in improving the nutritional status of children with cancer. The collaborative partnership among the doctors, nurses and dietitians has helped to streamline and simplify nutrition screening, making it an efficient and sustainable system in our hospital.

The current Neck Imaging Reporting and Data System (NI-RADS) criteria were designed for contrast-enhanced CT with or without PET. Prior studies have revealed the capability of DWI and T2 signal intensity in distinguishing locoregional tumor residual and recurrence from posttreatment benign findings in head and neck cancers. We aimed to propose MR imaging NI-RADS criteria by adding diffusion criteria and T2 signal intensity to the American College of Radiology NI-RADS template.

This retrospective study included 69 patients with head and neck squamous cell carcinoma (HNSCC) who underwent posttreatment contrast-enhanced MRI imaging surveillance using a 1.5T scanner. The scans were interpreted by 2 neuroradiologists. Image analysis assessed the primary tumor site using the current American College of Radiology NI-RADS morphologic lexicon (mainly designed for contrast-enhanced CT with or without PET). NI-RADS rescoring was then performed based on our proposed criteria using T2 signal and diffusion features. The reference standard was a defined set of criteria, including clinical and imaging follow-up and pathologic assessment.

Imaging assessment of treated HNSCC at the primary tumor site using T2 signal intensity and diffusion features as modifying rules to NI-RADS showed higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy (92.3%, 90.7%, 85.7%, 95.1%, and 91.3%, respectively) compared with the current NI-RADS lexicon alone (84.6%, 81.4%, 73.3%, 89.8%, and 82.6%, respectively).

The addition of diffusion features and T2 signal to the American College of Radiology NI-RADS criteria for the primary tumor site enhances the specificity, sensitivity, positive predictive value, negative predictive value, and NI-RADS accuracy.

The addition of diffusion features and T2 signal to the American College of Radiology NI-RADS criteria for the primary tumor site enhances the specificity, sensitivity, positive predictive value, negative predictive value, and NI-RADS accuracy.

Contrast-enhanced 3D-turbo spin-echo (TSE) black-blood sequence has gained attention, as it suppresses signals from vessels and provides an increased contrast-noise ratio. C381 concentration The purpose was to investigate which among the contrast-enhanced 3D T1 TSE, 3D T1 fast-spoiled gradient echo (FSPGR), and 3D T2 FLAIR sequences can better detect cranial nerve contrast enhancement.

Patients with cranial neuritis based on clinical findings (

= 20) and control participants (

= 20) were retrospectively included in this study. All patients underwent 3T MR imaging with contrast-enhanced 3D T1 TSE, 3D T1 FSPGR, and 3D T2 FLAIR. Experienced and inexperienced reviewers independently evaluated the 3 sequences to compare their diagnostic performance and time required to reach the diagnosis. Additionally, tube phantoms containing varying concentrations of gadobutrol solution were scanned using the 3 sequences.

For the inexperienced reader, the 3D T1 TSE sequence showed significantly higher sensitivity (80% versus 50%,

= .049; 80% versus 55%;

= .040), specificity (100% versus 65%,

= .004; 100% versus 60%;

= .001), and accuracy (90% versus 57.5%,

= .001; 90% versus 57.5%,

= .001) than the 3D T1 FSPGR and 3D T2 FLAIR sequences in patients with cranial neuritis. For the experienced reader, the 3D T1-based sequences showed significantly higher sensitivity than the 3D T2 FLAIR sequence (85% versus 30%,

< .001; 3D T1 TSE versus 3D T2 FLAIR, 85% versus 30%,

< .001; 3D T1 FSPGR versus 3D T2 FLAIR). For both readers, the 3D T1 TSE sequence showed the highest area under the curve (inexperienced reader; 0.91, experienced reader; 0.87), and time to diagnosis was significantly shorter with 3D T1 TSE than with 3D T1 FSPGR.

The 3D T1 TSE sequence may be clinically useful in evaluating abnormal cranial nerve enhancement, especially for inexperienced readers.

The 3D T1 TSE sequence may be clinically useful in evaluating abnormal cranial nerve enhancement, especially for inexperienced readers.

Cervical spine axial MRI T2-hyperintense fluid signal of the anterior median fissure and round hyperintense foci resembling either the central canal or base of the anterior median fissure are associated with a craniocaudad sagittal line, also simulating the central canal. On the basis of empiric observation, we hypothesized that hyperintense foci, the anterior median fissure, and the sagittal line are seen more frequently in patients with Chiari malformation type I, and the sagittal line may be the base of the anterior median fissure in some patients.

Saggital line incidence and the incidence/frequency of hyperintense foci and anterior median fissure in 25 patients with Chiari I malformation and 25 contemporaneous age-matched controls were recorded in this prospective exploratory study as either combined (hyperintense foci+anterior median fissure in the same patient), connected (anterior median fissure extending to and appearing to be connected with hyperintense foci), or alone as hyperintense foci or an anterior median fissure.