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Angiotensin II stimulates intraplaque hemorrhage in animal models, and the angiotensin system is highly regulated by vitamin D. The authors' purpose was to determine whether low vitamin D levels predict carotid intraplaque hemorrhage (IPH). In this cross-sectional study, 65 patients with carotid disease underwent carotid MR imaging and blood draw. Systemic clinical confounders and local lumen imaging markers were recorded. They performed multivariable Poisson regression by using generalized estimating equations to account for up to 2 carotid arteries per patient and backward elimination of confounders. The authors found that low vitamin D levels (<30 ng/mL) were a significant predictor of MRI-detected IPH, along with plaque thickness. They conclude that vitamin D insufficiency was associated with both the presence and volume of carotid IPH in patients with carotid atherosclerosis and that these results link low vitamin D levels with plaque vulnerability.

This case series presents 18 patients with primary and secondary malignant lacrimal sac and nasolacrimal duct tumors and their pattern of tumor spread. Squamous cell carcinoma was the most common histology and, in 15/18 patients tumor involved both the lacrimal sac and duct at the time of diagnosis. In 11/16 patients on CT, the nasolacrimal bony canal was smoothly expanded without erosive changes. Tumor was not observed solely within the nasolacrimal duct in any patient. Only 1 patient presented with nodal metastasis and there was no intracranial tumor extension or perineural tumor spread. The authors conclude that malignant lacrimal sac and nasolacrimal duct tumors tend to expand the nasolacrimal bony canal, rather than erode it. CT was superior to MR imaging in characterizing expansion versus erosion of the nasolacrimal bony canal.