A case of Saturday night retinopathy following postoperative orbital compression bandaging: Diagnosis and evaluation using multimodal imaging.

We report a rare case of Saturday Night Retinopathy (SNR) following postoperative orbital compression bandaging, highlighting the value of multimodal imaging in diagnosis and management. A 24-year-old male underwent surgical repair of an inferior orbital wall fracture with an absorbable implant, followed by compression bandaging of the right eye for three days. Upon bandage removal, the patient experienced a significant drop in visual acuity (VA) from 20/20 to 20/200. Multimodal imaging, including diagnostic imaging and angiography, revealed retinal and choroidal ischemia without optic nerve compression, confirming the diagnosis of SNR. The patient received intravenous corticosteroids, which led to a gradual recovery of VA to 20/20 over several weeks. This case underscores the critical role of multimodal imaging in identifying ischemic changes and guiding timely treatment. It also highlights the risk of ischemic complications from postoperative bandaging. To our knowledge, this is the first case of SNR due to compression bandaging, emphasizing the need for cautious postoperative care and the utility of advanced imaging techniques in ophthalmology.

Luan R ，Zhao J ，Liu Z ，Zhu L ，Kong L ，Li X ，Lin T ... -  《-》

Press-Fit Bone-Anchored Prosthesis for Individuals with Transtibial Amputation.

Frölke JPM ，Atallah R ，Leijendekkers R 《-》

Emergency multimodality imaging for a giant cystic renal artery aneurysm in a lung adenocarcinoma patient with iodinated contrast media allergy: A case report.

Renal artery aneurysm (RAA) is a rare, but potentially life-threatening condition. The rarity of malignancy-associated RAAs limits our understanding of their natural history, morphological characteristics, intervention criteria, and available treatment options. When these aneurysms manifest as large cystic formations, they may mimic renal masses or cysts. Managing these aneurysms presents significant challenges, particularly for patients with contraindications to conventional imaging techniques, such as allergies to iodinated contrast agents. This study presents a case of a 36-year-old male patient diagnosed with lung adenocarcinoma accompanied by pleural metastasis, who was suspected of having renal aneurysms. Due to an allergy to iodine contrast agents, the patient was unable to undergo computed tomography angiography (CTA). To address this challenge, we developed an emergency multimodal imaging pathway utilizing non-enhanced computed tomography (CT), Doppler ultrasound, and contrast-enhanced ultrasound (CEUS) for patients allergic to iodine contrast agents. This approach offers significant advantages, including reduced diagnostic time, the use of a safe blood pool microbubble contrast agent, and high spatial resolution. Ultimately, the patient was diagnosed with saccular RAA and underwent immediate surgical intervention, including renal artery reconstruction. The surgery was completed successfully and without complications. After treatment, the patient experienced rapid remission of symptoms related to the renal aneurysm. This case illustrates the efficacy of a multimodal imaging approach-comprising CT, US, and CEUS-in the emergency diagnosis of RAA, particularly for patients with contraindications to iodinated contrast agents. While CTA is often considered the gold standard, it is associated with limitations such as radiation exposure and potential nephrotoxicity. In light of these constraints, the integration of non-contrast CT, conventional US, and CEUS proved to be an optimal strategy, yielding comprehensive diagnostic information without incurring the risks associated with iodinated or gadolinium-based contrast. CEUS, in particular, proves invaluable by providing real-time, high-resolution imaging of blood flow patterns within the RAA, a capability that conventional US alone cannot achieve, which is essential for differential diagnosis and treatment planning. This multimodal approach addresses the limitations of single-modality techniques by delivering anatomical, morphological, and functional data. It is especially advantageous for oncology patients who require frequent imaging and long-term follow-up, as it mitigates cumulative radiation exposure. The use of microbubble contrast agents in CEUS offers an extremely low risk of allergic reactions and is not affected by renal function, providing reliable diagnostic support. The rapid and accurate diagnosis facilitated by this multimodal strategy is critical in emergency settings, potentially averting severe complications such as aneurysm rupture. Nonetheless, this approach may face challenges related to operator dependency and the necessity for specialized equipment. This case highlights the essential role of multimodal imaging in the emergency diagnosis of RAA, especially in oncology patients with a history of severe allergic reactions to iodinated contrast agents. It also underscores the need for rapid diagnosis and intervention for RAA in patients with malignancies, demonstrating how multimodal imaging enhances diagnostic accuracy while minimizing risks associated with contrast agents.

Dai J ，Shen Y 《-》

The value of multimodal imaging fusion in preoperative visualization assessment of neurovascular relationship in hemifacial spasm: a single-center retrospective study.

The neurovascular conflict (NVC) at the brainstem exit zone of the facial nerve is considered the primary etiology of primary hemifacial spasm (HFS). Therefore, microvascular decompression (MVD) has become the preferred treatment for HFS. Successful neurovascular decompression can achieve significant therapeutic effects, and accurately identifying the site of compression is crucial for the success of this surgery. Detailed diagnostic neuroimaging plays an important role in accurately identifying the site of compression.The purpose of this study is to explore the feasibility and predictive value of preoperative visualization assessment of the neurovascular relationship in HFS using 3D Slicer software based on multimodal imaging fusion. This aims to reduce the omission of responsible vessels and lower the incidence of postoperative complications, thereby potentially improving the efficacy and safety of the surgery. This study retrospectively analyzed 80 patients with HFS who underwent MVD surgery. All patients underwent preoperative cranial MRI scans, including the 3D-FIESTA and the 3D-TOF MRA sequences. Three-dimensional models were reconstructed from the multimodal MRI images using 3D Slicer software. Independent observers, who were blinded to the surgical outcomes, evaluated the neurovascular relationships using both the three-dimensional models and multimodal MRI images. The assessment results were compared with intraoperative findings, and statistical analysis was conducted using SPSS 22.0 software. The agreement between preoperative assessment using the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence and intraoperative findings was represented by a Kappa value of 0.343, while the Kappa value for agreement between three-dimensional reconstruction and intraoperative findings was 0.637. There was a statistically significant difference between the two methods ( X2 = 18.852, P = 0.001 ). The sensitivity and specificity of the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence for evaluating neurovascular relationships were 92.4% and 100%, respectively, while for three-dimensional reconstruction, both were 100%. The Kappa value for agreement between preoperative the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence prediction of offending vessels and intraoperative findings was 0.625, while the Kappa value for agreement between three-dimensional reconstruction and intraoperative findings was 0.938, showing a statistically significant difference ( X2 = 317.798, P = 0.000 ). The Kappa value for agreement between preoperative the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence assessment of the anatomical location of facial nerve involvement in neurovascular compression and intraoperative findings was 0.608, while the Kappa value for agreement between three-dimensional reconstruction and intraoperative findings was 0.918, also showing a statistically significant difference ( X2 = 504.647, P = 0.000 ). The preoperative visualization assessment of neurovascular relationships in HFS using 3D Slicer software based on multimodal imaging fusion has been demonstrated to be reliable. It is more accurate than combining the 3D-TOF MRA sequence with the 3D-FIESTA sequence and shows higher consistency with intraoperative findings. This method provides guidance for surgical procedures and thereby potentially enhances the efficacy and safety of surgeries to a certain extent.

Wang Y ，Li Y ，Shi H ，Du Y ，Guo W ，Shi H ，Qian T ... -  《-》

Multimodal imaging analysis of retinal and choroidal microvascular abnormalities in a case of ocular decompression sickness.

Decompression sickness can result in a variety of ocular manifestations due to barotrauma. The retinal complications of this illness are less defined. In this case report, we describe a case of pigment epithelial detachment (PED) with retinal and choroidal microvasculature changes secondary to ocular decompression sickness in a scuba diver. The parafoveal serous pigment epithelial detachment resulted in a scotoma associated with a kaleidoscope-like visual disturbance and mildly decreased vision which started immediately after the accident. Multimodal imaging was obtained revealing a serous PED without exudation, pooling of dye on fluorescein angiography, and decreased flow signal on optical coherence tomography angiography (OCT-A) in the deep capillary plexus and choriocapillaris in the area of the PED. Over the course of three months, the serous PED spontaneously resolved leaving behind subtle retinal pigment epithelium (RPE) alterations. Visual acuity also improved over the same time period however the visual disturbance had not completely resolved at the date of last follow-up. The imaging findings, temporal association with the diving accident, and short timeframe to resolution of this PED favor an etiology related to ocular decompression sickness. PED formation in this context may be secondary to 1) RPE dysfunction due to endothelial cell damage from free radicals and 2) choroidal ischemia resulting from gas emboli. To our knowledge, this is the first reported case where OCT-A has been used to demonstrate choroidal ischemia in ocular decompression sickness. The patient received hyperbaric oxygen treatments for several weeks following the accident which may have contributed to the rapid resolution of the PED supporting the role of choroidal ischemia in its pathogenesis.

Clavell C ，Dossett J ，Yadav S ，Patel A ，Laxson LC ，Ghorayeb G ... -  《-》