Efficacy of first-line radiofrequency ablation combined with systemic chemotherapy plus targeted therapy for initially unresectable colorectal liver metastases

BACKGROUND/OBJECTIVE

The optimal strategy for patients with colorectal liver metastases is still controversially discussed. This study aimed to evaluate the efficacy of radiofrequency ablation (RFA) combined with systemic chemotherapy plus targeted therapy as first-line treatment in patients with initially unresectable colorectal liver metastases (CRLM), to identify prognostic factors and construct nomograms predicting survival.

METHODS

This retrospective study included patients with initially unresectable CRLM treated with (study group n = 74) or without (control group n = 83) RFA at the National Cancer Center from January 2018 to January 2021. Survival curves were assessed using the Kaplan-Meier method and log-rank test. Univariate and multivariate Cox regression analyses were used to determine prognostic factors and include these factors in the nomograms to predict progression-free survival (PFS) and overall survival (OS).

RESULTS

The study group had significantly better median PFS (17.16 months vs. 8.35 months, p < 0.01) and OS (34.9 months vs. 21.1 months, p < 0.01) than the control group after propensity score matching. Cox regression analyses identified RFA treatment and clinical risk score (CRS) as independent prognostic factors for PFS. The largest diameter of liver metastases, RFA treatment, and CRS were independent prognostic factors for OS. Based on this finding, nomograms with good discrimination and calibration were constructed.

CONCLUSION

RFA combined with systemic chemotherapy plus targeted therapy as first-line treatment could significantly prolong PFS and OS in patients with initially unresectable CRLM compared with systemic chemotherapy plus targeted therapy. The nomograms predicting PFS and OS might help clinicians select personalized treatment.

Optimizing patient outcomes in interstitial lung disease through pre- and post-transplant management strategies

Interstitial lung diseases (ILD) encompass a diverse group of over 200 chronic pulmonary disorders characterized by varying degrees of inflammation and fibrosis, which can lead to severe respiratory impairment. Lung transplantation offers a crucial therapeutic option for patients with advanced ILD, extending survival and improving quality of life. This review explores optimal management strategies in both the pre- and post-transplant phases to enhance patient outcomes. Comprehensive pre-transplant evaluation, including pulmonary function testing, imaging, and comorbidity assessment, is critical for determining transplant eligibility and timing. Post-transplant care must focus on preventing complications such as primary graft dysfunction and chronic lung allograft dysfunction, managed through tailored immunosuppression and proactive monitoring. Recent advancements in diagnostic techniques and therapeutic approaches, including emerging technologies like ex vivo lung perfusion and precision medicine, promise to further improve outcomes. The ultimate goal is to establish an evidence-based, multidisciplinary framework for optimizing ILD management and lung transplantation.

TFKT V2: task-focused knowledge transfer from natural images for computed tomography perceptual image quality assessment

Purpose

The accurate assessment of computed tomography (CT) image quality is crucial for ensuring diagnostic reliability while minimizing radiation dose. Radiologists' evaluations are time-consuming and labor-intensive. Existing automated approaches often require large CT datasets with predefined image quality assessment (IQA) scores, which often do not align well with clinical evaluations. We aim to develop a reference-free, automated method for CT IQA that closely reflects radiologists' evaluations, reducing the dependency on large annotated datasets.

Approach

We propose Task-Focused Knowledge Transfer (TFKT), a deep learning-based IQA method leveraging knowledge transfer from task-similar natural image datasets. TFKT incorporates a hybrid convolutional neural network-transformer model, enabling accurate quality predictions by learning from natural image distortions with human-annotated mean opinion scores. The model is pre-trained on natural image datasets and fine-tuned on low-dose computed tomography perceptual image quality assessment data to ensure task-specific adaptability.

Results

Extensive evaluations demonstrate that the proposed TFKT method effectively predicts IQA scores aligned with radiologists' assessments on in-domain datasets and generalizes well to out-of-domain clinical pediatric CT exams. The model achieves robust performance without requiring high-dose reference images. Our model is capable of assessing the quality of ∼ 30 CT image slices in a second.

Conclusions

The proposed TFKT approach provides a scalable, accurate, and reference-free solution for CT IQA. The model bridges the gap between traditional and deep learning-based IQA, offering clinically relevant and computationally efficient assessments applicable to real-world clinical settings.

Vascular lesions of head and neck region: A pictorial review

Vascular lesions in the head and neck region encompass a wide spectrum of malformations and tumors, ranging from hemangiomas to arteriovenous fistulas. The International Society for the Study of Vascular Anomalies classification system categorizes these anomalies into vascular tumors and malformations. Vascular tumors are further divided into benign, borderline, and malignant types, while vascular malformations are classified based on flow characteristics as high or low flow. Accurate delineation of these lesions is crucial due to their clinical implications, particularly their location and potential involvement of adjacent structures. Imaging modalities such as ultrasound, computed tomography, magnetic resonance imaging, and digital subtraction angiography play a vital role in diagnosis, surgical planning, and follow-up. Ultrasound is useful for superficial lesions, while computed tomography and magnetic resonance imaging provide detailed information on deep-seated anomalies. Vascular tumors include benign lesions like hemangiomas and pyogenic granuloma, borderline tumors such as hemangioendothelioma, and malignant tumors like angiosarcoma and Kaposi sarcoma. Vascular malformations include venous, lymphatic, capillary, arteriovenous malformations and combined lesions like lymphangiohemangioma. Each type has distinct imaging features, with magnetic resonance imaging being particularly valuable for assessing soft tissue involvement and lesion extent. This review highlights the importance of imaging in the diagnosis and management of head and neck vascular anomalies, emphasizing the need for a multidisciplinary approach to optimize patient outcomes.

Education and training satisfaction among radiology residents: Insights from a national survey

OBJECTIVES

This national survey evaluates the perspectives and satisfaction of radiology residents in Greece regarding their educational program, aiming to enhance training at a national level and provide insights applicable to residency programs internationally.

MATERIALS & METHODS

A 77-question online survey was distributed to all registered radiology residents. The survey collected data on demographics and several topics, including working conditions, academic engagement, satisfaction with training, and subspecialty preferences. Responses were analyzed using descriptive statistics, chi-square tests, and Spearman's correlation test.

RESULTS

The survey achieved a response rate of 46.3% (166/358). While 83% of respondents expressed satisfaction with their choice of radiology as a specialty, 67% weren't satisfied with their training program's overall quality. Key areas of dissatisfaction included inadequate working conditions (62%), limited access to structured curricula (45%), and insufficient academic research opportunities (95% lacked protected academic time). Subspecialty training interest in interventional radiology (IR) was rated as the most popular; 22% showed interest in pursuing it over other options. Training in classical radiology, mammography, and MRI received low satisfaction scores. Most respondents supported reforms, including using a logbook, standardizing the curriculum, establishing a more equitable examination process, and extending the residency duration.

CONCLUSION

This survey highlights the state of radiology residency programs in Greece, revealing significant challenges and opportunities for improvement. Key areas requiring attention include the development of a standardized curriculum, improving working conditions, and increasing opportunities for academic and research activities. IR emerged as a popular subspecialty interest. European-level surveys could provide significant insights and guidance.

The effectiveness of mindfulness-based interventions on menopausal symptoms: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Menopause, a crucial transitioning stage for women, can significantly impact mood and wellbeing. We aimed to systematically examine the effectiveness of Mindfulness-based interventions (MBIs) on health outcomes, including menopausal symptoms, quality of life (QOL), sleep quality, anxiety, depressive symptoms, stress, mindfulness levels, and female sexual function index.

METHODS

Eight databases were searched from inception to November 4, 2024 for randomized controlled trials. Two researchers independently selected, extracted, and appraised trials using the Cochrane Collaboration's 'risk of bias' tool. Meta-analysis, subgroup analysis, leave-one-out sensitivity analysis, and meta-regression were performed using Stata 18.0. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence.

RESULTS

A total of 19 studies (1670 participants) published between 2011 and 2024 were identified. Of these, 18 studies were included in the meta-analysis. Compared with control group, The pooled analysis demonstrated that MBIs had statistically significant effects on menopausal symptoms (SMD, -2.10; 95 % CI, -3.49 to -0.70), QOL (SMD, -0.88; 95 % CI, -1.67 to -0.09), sleep quality (SMD, -0.92; 95 % CI, -1.65 to -0.20), anxiety (SMD, -1.03; 95 % CI, -1.42 to -0.66), depressive symptoms (SMD, -0.91; 95 % CI, -1.30 to -0.53), stress (SMD, -0.85; 95 % CI, -1.55 to -0.15), and mindfulness levels (SMD, 1.19; 95 % CI, 0.35 to 2.02). The overall quality of evidence for all pooled estimates were graded as low and moderate due to methodological limitations and small sample size. The low attrition rate (6 %) and relatively high adherence rate (79 %) highlight the acceptability of MBIs.

CONCLUSIONS

This systematic review and meta-analysis support using of MBIs to improve health outcomes in menopausal women. Rigorous randomized controlled trials with extended follow-up are needed to elucidate the mechanisms linking MBIs to menopausal health and strengthen evidence for clinical application.

Accuracy of CT colonography with mannitol preparation for detecting synchronous lesions in obstructive colorectal cancer

OBJECTIVE

Preoperative detection of advanced neoplasms is essential for surgical planning in colorectal cancer (CRC). CT colonography (CTC) has emerged as a reliable alternative when obstructive CRC prevents complete optical colonoscopy (OC). Mannitol, commonly used for OC preparation in some countries, offers potential advantages over polyethylene glycol (PEG), including low cost, reduced ingestion volume, fast action, and a more palatable sweet taste. We evaluated the diagnostic accuracy of mannitol-based CTC for detecting synchronous lesions in CRC, hypothesizing that this low-volume preparation could maintain high accuracy while improving patient tolerability.

METHODS

Of 150 CRC patients with incomplete OC who underwent preoperative CTC following cathartic preparation with mannitol, 62 were retrospectively analyzed. Their CTC findings were compared with postoperative surgical and pathological results and follow-up OC. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed for lesions ≥6 mm. In addition, the quality of bowel preparation with mannitol (amount of liquid and solid residue) was compared with historical data from published studies.

RESULTS

In 62 patients (372 segments), 26 synchronous lesions were identified (9 ≥ 10 mm, 17 sized 6-9 mm). For lesions ≥6 mm, CTC achieved a sensitivity of 92.3 % (95 % CI: 74.9-99.1 %), specificity of 99.1 % (95 % CI: 97.5-99.8 %), PPV of 88.9 % (95 % CI: 70.8-97.6 %), and NPV of 99.4 % (95 % CI: 97.9-99.9 %). Bowel cleansing was adequate, with 82.8 % of segments showing no or minimal residual fluid and 96.3 % with no or minimal solid residue.

CONCLUSION

CTC with a mannitol-based preparation demonstrated high accuracy in detecting synchronous neoplasms among patients with obstructive CRC and incomplete OC. These findings suggest that mannitol is a feasible alternative to PEG, maintaining excellent diagnostic performance while possibly improving tolerability. Additionally, it could streamline surgical planning and improve overall outcomes in modern CRC management.

Reliability of Ultrasound and Shear Wave Elastography in Assessing Lower Extremity Nerve Stiffness and Excursion: A Systematic Review and Meta-Analysis

This study aimed to evaluate the reliability and methodological quality of ultrasonography and ultrasound elastography in assessing neural excursion and stiffness through shear wave elastography (SWE) of lower extremity nerves. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted across MEDLINE, Scopus, Web of Science, CINAHL, and SPORTDiscus databases, covering publications from 2014 to 2024. Out of 270 studies initially identified, 26 met the eligibility criteria, involving a total of 778 participants and 1,448 nerves. Reliability metrics included intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimal detectable change (MDC). Meta-analyses were performed for the sciatic and tibial nerves, incorporating data from studies employing SWE and B-mode ultrasonography. The pooled ICC for SWE in the sciatic nerve was 0.96 (95% CI: 0.93-0.98, I² = 25.6%), indicating excellent reliability. For the tibial nerve, ICCs varied by position, with an overall ICC of 0.87 (95% CI: 0.75-0.99, I² = 84.2%) for supine and prone positions and 0.96 (95% CI: 0.94-0.98, I² = 1.5%) for longitudinal excursion in weight-bearing and side-lying positions. Subgroup analyses revealed no significant differences between the two groups. This systematic review and meta-analysis support the reliability of SWE in assessing sciatic and tibial nerve stiffness, along with tibial nerve excursion in specific positions. However, these findings should be interpreted with caution, as evidence for the saphenous and femoral nerves remains limited.

Diagnostic tools in respiratory medicine (Review)

Recent advancements in diagnostic technologies have significantly transformed the landscape of respiratory medicine, aiming for early detection, improved specificity and personalized therapeutic strategies. Innovations in imaging such as multi-slice computed tomography (CT) scanners, high-resolution CT and magnetic resonance imaging (MRI) have revolutionized our ability to visualize and assess the structural and functional aspects of the respiratory system. These techniques are complemented by breakthroughs in molecular biology that have identified specific biomarkers and genetic determinants of respiratory diseases, enabling targeted diagnostic approaches. Additionally, functional tests including spirometry and exercise testing continue to provide valuable insights into pulmonary function and capacity. The integration of artificial intelligence is poised to further refine these diagnostic tools, enhancing their accuracy and efficiency. The present narrative review explores these developments and their impact on the management and outcomes of respiratory conditions, underscoring the ongoing shift towards more precise and less invasive diagnostic modalities in respiratory medicine.

"Small but mighty" - A radiologists' primer for ultrasound imaging of the smaller peripheral nerves

Peripheral nerve imaging is a powerful tool in evaluating peripheral neuropathy. This review aims to provide an overview of the anatomy, clinical significance and pathologies of small peripheral nerves, typically less than 2 mm in diameter. High frequency ultrasound probes offer the best assessment of these nerves whilst permitting real-time clinical correlation, while the role of MRI is inherently limited by spatial resolution constraints and the lack of patient contact. This review discusses techniques for sonographic identification, strategies for optimal visualization and common ultrasound-guided procedures.

Isolated gastric perforation following blunt abdominal trauma: A case report

Gastric perforation resulting from blunt abdominal trauma is a rare but life-threatening condition, accounting for a small fraction of abdominal injuries in trauma patients. Early identification is crucial due to its nonspecific presentation and diagnostic challenges. We report the case of a 20-year-old male involved in a high-speed motorcycle collision who presented with diffuse abdominal pain and distension. Contrast-enhanced CT imaging revealed pneumoperitoneum and a 4 cm perforation in the anterior gastric antrum, with no associated organ injuries. The patient underwent emergency exploratory laparotomy with primary repair using an omental patch. His postoperative recovery was uneventful, and gastric biopsy results were normal. This case underscores the rarity of isolated gastric perforation in blunt trauma and highlights the pivotal role of CT imaging in diagnosis. It also emphasizes the necessity of prompt surgical intervention to mitigate morbidity and mortality.

Time From Suspected Foreign Body Aspiration to Bronchoscopy at Odense University Hospital During a 5-Year Period

BACKGROUND

Foreign body aspiration (FBA) in children is a critical emergency, particularly for those under 3 years old, with mortality rates as high as 4% for infants. Delayed bronchoscopy is associated with an increased rate of complications. This study evaluates whether bronchoscopy for suspected FBA in children at Odense University Hospital was performed within 24 h, as recommended.

METHODS

This retrospective cohort study was conducted on children under 18 years admitted with suspected FBA from January 2018 to December 2022 at Odense University Hospital. Data were collected on demographics, symptoms, and outcomes. The primary outcome was time from aspiration event to bronchoscopy, with delays defined as procedures performed more than 24 h after the event. Secondary outcomes included complications such as pneumonia, delayed extubation, and admission to the pediatric intensive care unit.

RESULTS

We identified 82 cases of children undergoing bronchoscopy in the study period. The median time to bronchoscopy was 18.8 h (IQR: 8-41), but in 30 cases (37%), the time to bronchoscopy exceeded 24 h. A foreign body was confirmed in 23 cases. Complications, including delayed extubation, pneumonia, oxygen and nebulizer treatments, and admission to the pediatric intensive care unit, occurred in 22 of all 82 cases, with a higher frequency in the delayed than the nondelayed group (37% vs. 22%). All children with confirmed FBA who underwent delayed bronchoscopy experienced complications.

CONCLUSION

Between 2018 and 2022, 63% of children admitted to Odense University Hospital with suspected FBA underwent bronchoscopy within 24 h. Delays occurred in one-third of cases, primarily because FBA was not initially suspected.

EDITORIAL COMMENT

This 5 year analysis of confirmed or suspected aspiration of foreign bodies at Odense University Hospital underlines the importance of timely emergency care of children. Confirmed FBA continues to have a very high morbity in children regardless of time of treatment. A "right patient, right place, right time" approach remains critical to reduce adverse events.

Molecular imaging of psoriatic arthritis

PURPOSE OF REVIEW

Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis. Conventional imaging techniques are used to diagnose the disease and detect long-term structural changes. This review will assess molecular imaging in PsA, to evaluate its potential additive value over conventional and advanced anatomical imaging methods (e.g. ultrasound and MRI).

RECENT FINDINGS

Current research is primarily focused on the molecular imaging technique PET/computed tomography (PET/CT) imaging, in which different tracers have been investigated. Fluorodeoxyglucose (FDG) can visualize disease activity and subclinical inflammation. New tracers targeting inflammatory sites have also been studied, such as FAPI (fibroblast activation protein inhibitor). Moreover, NaF (sodium fluoride) shows promise for imaging of new bone formation. Next to PET/CT, also fluorescence imaging and multispectral optoacoustic tomography have been investigated in the context of PsA.

SUMMARY

Molecular imaging techniques hold promise for early diagnosis, monitoring and management of PsA. Future research is needed to define the role of molecular imaging relative to conventional and anatomical imaging techniques in patient care.

Core-shell hybrid liposomes: Transforming imaging diagnostics and therapeutic strategies

For the last few years, researchers and industry have intensified efforts to develop a diverse array of diagnostic and therapeutic approaches to fight diseases such as cancer, diabetes, and viral infections. Among the emerging technologies, hybrid liposomes (HLs) stand out for their ability to address key limitations of conventional liposomes and deliver multifunctional solutions more effectively. While several novel nanosystems, including polymerlipid conjugates and inorganic nanoparticles (NPs), have shown great potential in the preclinical and clinical phases for the diagnosis and treatment of diseases, particularly cancer, HLs can integrate the best of both worlds, combining drug delivery properties with imaging capabilities. HLs, particularly those with core-shell structures, can surpass conventional liposomes by offering improved physicochemical properties, multifunctionality, and the capacity to overcome critical delivery challenges. The integration of natural and synthetic polymers has rapidly emerged as a preferred strategy in the development of HLs, providing significant advantages, such as enhanced stability, stimuli-responsive drug release, prolonged circulation, and improved therapeutic efficacy. Additionally, the customizable structure of HLs allows the incorporation of diverse materials, such as metals, ligands, and functional lipids, improving diagnosis and enhancing targeted delivery and cellular uptake far beyond what conventional liposomes offer. This review provides a critical and updated analysis of core-shell structure exhibiting HLs, with a focus on their preparation, characterization, and functional enhancements. We also examine in vitro/in vivo outcomes in imaging diagnosis and drug delivery while addressing the current barriers to clinical translation and future prospects for these versatile nanoplatforms.

Challenges, optimization strategies, and future horizons of advanced deep learning approaches for brain lesion segmentation

Brain lesion segmentation is challenging in medical image analysis, aiming to delineate lesion regions precisely. Deep learning (DL) techniques have recently demonstrated promising results across various computer vision tasks, including semantic segmentation, object detection, and image classification. This paper offers an overview of recent DL algorithms for brain tumor and stroke segmentation, drawing on literature from 2021 to 2024. It highlights the strengths, limitations, current research challenges, and unexplored areas in imaging-based brain lesion classification based on insights from over 250 recent review papers. Techniques addressing difficulties like class imbalance and multi-modalities are presented. Optimization methods for improving performance regarding computational and structural complexity and processing speed are discussed. These include lightweight neural networks, multilayer architectures, and computationally efficient, highly accurate network designs. The paper also reviews generic and latest frameworks of different brain lesion detection techniques and highlights publicly available benchmark datasets and their issues. Furthermore, open research areas, application prospects, and future directions for DL-based brain lesion classification are discussed. Future directions include integrating neural architecture search methods with domain knowledge, predicting patient survival levels, and learning to separate brain lesions using patient statistics. To ensure patient privacy, future research is anticipated to explore privacy-preserving learning frameworks. Overall, the presented suggestions serve as a guideline for researchers and system designers involved in brain lesion detection and stroke segmentation tasks.

Magnetic resonance imaging texture analysis for discrimination between malignant and benign lesions in the floor of the mouth

OBJECTIVE

Owing to their overlapping radiological characteristics, distinguishing between malignant and benign lesions of the floor of the mouth (FOM) remains challenging. The aim of this study was to assess the effectiveness of magnetic resonance imaging (MRI) texture analysis in discriminating between malignant and benign lesions.

METHODS

MRI texture analysis was performed in 30 patients with FOM lesions (eight inflammatory diseases, ten cystic lesions, three benign tumors, and nine malignant tumors). Based on the histopathological examinations, the lesions were classified as malignant or benign. The lesion type was considered the predictor variable and MRI texture features were the outcome variables. Short-tau inversion recovery images were used for texture feature extraction, with 10 features selected using Fisher's coefficient. One-way analysis of variance and Tukey's post-hoc test were used to compare the texture features. Receiver operating characteristic (ROC) curves were used to assess the ability of MRI texture features to distinguish between lesions. The significance level was set at P < .05.

RESULTS

ROC curve analysis showed that cystic lesions and malignant lesions could be distinguished with very high accuracy; malignant and benign lesions were differentiated with high accuracy. The accuracy in distinguishing between inflammatory diseases and malignant lesions was relatively low.

CONCLUSIONS

MRI texture features were useful in distinguishing malignant from some benign lesions within the FOM, although were less effective in distinguishing inflammatory from malignant lesions.

Double-sided gastric perforation after a motorcycle accident in Korea: A case report

BACKGROUND

Motorcycle accidents often result in abdominal trauma in patients seeking emergency care. Injuries to the hollow viscera, including the duodenum, jejunum, urinary bladder, and colorectum, are relatively common. In contrast, owing to the protective function of the anterior rib cage, gastric rupture is exceptionally rare, with an incidence of < 1.7%. Gastric rupture typically occurs in the anterior wall and rarely presents as multiple ruptures. This report describes an unusual case of multiple gastric ruptures resulting from blunt trauma.

CASE SUMMARY

A 21-year-old man, who was involved in a motorcycle collision at 70 km/hour after consuming a large meal, presented with hypotension. Physical examination revealed abdominal tenderness. Laboratory test results indicated elevated amylase, lipase, and liver enzyme levels. Computed tomography showed pneumoperitoneum, hemoperitoneum, and gastric wall discontinuation, suggesting gastric perforation alongside pancreatic, splenic, and hepatic injuries. Angiographic embolization was performed because of active contrast leakage in the left gastric and right gastroepiploic arteries. Emergency laparotomy revealed substantial blood loss, hematoma, and gastric contents scattered throughout the abdominal cavity. Two 10 cm gastric perforations in the anterior and posterior walls were identified, as well as severe liver damage, splenic injury, and pancreatic contusion. Surgical interventions included primary closure of the gastric wall, splenectomy, and partial hepatectomy. After temporary abdominal closure, the patient underwent a second surgery without further bleeding. The gastric repair site was resected and reinforced for optimal tissue healing.

CONCLUSION

Gastric rupture following blunt trauma is fatal. However, patients without severe complications can recover through surgical interventions and postoperative care.

Intraneural Ganglion Cysts Arising from the Hip Joint as Rare Causes of Sciatic Neuropathy: A Case Series of 13 Patients Treated with Hip Arthroscopy

BACKGROUND

Sciatic neuropathy can result from pressure, injury, or inflammation around the sciatic nerve. In rare instances, sciatic neuropathy is caused by an intraneural ganglion cyst (IGC) originating from the hip joint. However, an effective treatment modality for this condition has not yet been established. The purpose of the present study was to evaluate the clinical and radiographic outcomes of hip arthroscopy for the treatment of IGCs involving the sciatic nerve.

METHODS

We reviewed the records on a consecutive series of hip arthroscopy procedures that had been performed by a single surgeon for the treatment of sciatic IGCs between July 2016 and February 2022. Thirteen Asian patients (13 hips) with symptomatic sciatic neuropathy were included. During arthroscopic surgery, IGCs were decompressed by enlarging their periarticular connection. Magnetic resonance imaging (MRI) and electrodiagnostic evaluation were routinely performed. The visual analog scale (VAS) for pain and modified Harris hip score (mHHS) were used for clinical evaluations. The mean age at the time of surgery was 57 years (range, 23 to 72 years), and the mean duration of follow-up was 41 months (range, 24 to 87 months).

RESULTS

The mean VAS score decreased from 8.3 preoperatively to 1.9 at the latest evaluation (p < 0.001). Satisfactory pain relief was reported by 12 patients (92%), including 9 patients (69%) who had complete remission. Four of the 6 patients with sensory impairment and 3 of the 4 patients with motor weakness reported complete recovery. The mean mHHS improved from 51.5 to 94.1 (p < 0.001). In MRI comparisons, the mean largest diameter and length of IGCs decreased from 2.6 to 0.5 cm (p < 0.001) and from 6.8 to 0.6 cm (p < 0.001), respectively. IGCs completely disappeared on MRI in 9 patients (69%). The latest electrodiagnostic studies confirmed improvement in all 12 patients with preoperative abnormalities. One patient (8%) with symptomatic recurrence was successfully treated with revision arthroscopic decompression.

CONCLUSIONS

In patients with sciatic neuropathy, the possibility of IGCs arising from the hip should be considered. Our findings suggest that arthroscopic hip surgery is a less-invasive and more-effective treatment for relieving neuropathic pain and neurological deficits associated with sciatic IGCs.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Deep learning without borders: recent advances in ultrasound image classification for liver diseases diagnosis

INTRODUCTION

Liver diseases are among the top global health burdens. Recently, there has been an increasing significance of diagnostics without discomfort to the patient; among them, ultrasound is the most used. Deep learning, in particular convolutional neural networks, has revolutionized the classification of liver diseases by automatically performing some specific analyses of difficult images.

AREAS COVERED

This review summarizes the progress that has been made in deep learning techniques for the classification of liver diseases using ultrasound imaging. It evaluates various models from CNNs to their hybrid versions, such as CNN-Transformer, for detecting fatty liver, fibrosis, and liver cancer, among others. Several challenges in the generalization of data and models across a different clinical environment are also discussed.

EXPERT OPINION

Deep learning has great prospects for automatic diagnosis of liver diseases. Most of the models have performed with high accuracy in different clinical studies. Despite this promise, challenges relating to generalization have remained. Future hardware developments and access to quality clinical data continue to further improve the performance of these models and ensure their vital role in the diagnosis of liver diseases.

Contrast-enhanced ultrasonography (CEUS) in the management of pediatric renal injuries: where are we now?

PURPOSE

Experience with CEUS in management of kidney post-traumatic injuries is limited, especially in pediatric age. This paper aimed to identify: clinical settings in which CEUS could be used as first diagnostic tool, skipping CT; CEUS ability to detect complications during non-operative management (NOM); and CEUS role in patients with collecting system injuries.

METHODS

Patients with renal trauma admitted between 2003 and 2023 were enrolled in a retrospective study. At T0, CT was performed in case of high-energy trauma, CT or CEUS in case of low-energy or/and localized trauma. CEUS was used during follow up (FU) in case of suspected complications and to follow healing of the lesions and urinomas.

RESULTS

Among 22 patients included, at T0 20/22 performed CT, 1/22 CEUS and 1/22 baseline US. During NOM CEUS was necessary: in early FU to rule out complications in 3/22 (1 anemization and 2 hematuria); in middle FU in 14/22 to authorize mobilization/discharge and monitor urinomas; in outpatient setting in 2/22, to authorize return to sport activities. Overall, a collecting system injury was detected in 6 patients by CT and in 1 by CEUS. In 3/7 a perirenal urinoma developed. All were monitored with CEUS or baseline US.

CONCLUSIONS

CEUS is useful as first imaging study in low-energy and localized trauma, but confidence with CEUS is still to be improved and spread, to replace CT in selected cases. CEUS is valuable for detecting complications, avoiding repeat CT in most of cases. In expert hands CEUS can identify and monitor leakage indirectly.

Up-titration of medication in patients with new-onset heart failure with and without atrial fibrillation

AIMS

Differences in guideline-directed medical therapy (GDMT) and clinical outcomes have been observed between heart failure (HF) patients with atrial fibrillation (AF) versus those in sinus rhythm. This study evaluated the effects of up-titration of HF therapies, consisting of beta-blockers, angiotensin-converting-enzyme inhibitors (ACEis)/angiotensin-receptor blockers (ARBs) and mineralocorticoid receptor antagonists (MRAs), in patients with new-onset HF with and without AF.

METHODS

Among 607 patients with new-onset HF (<3 months) from a specialized nurse-led HF clinic in the Netherlands, 187 (31%) patients had AF, and 420 (69%) patients were in sinus rhythm at baseline electrocardiogram. After an up-titration period of 9 months, achieved doses and reasons for not reaching target doses were documented.

RESULTS

Patients with AF were older, less likely to have ischaemic heart disease and had higher baseline N-terminal B-type natriuretic peptide levels (all P < 0.05). Left ventricular ejection fraction (LVEF) at baseline was similar between patients with AF and those in sinus rhythm (37% vs. 36%, P = 0.453). Prescription of GDMT was comparable between patients with AF and those in sinus rhythm, except for a lower ACEi/ARB prescription and higher use of diuretics in patients with AF (79% vs. 86%; P = 0.038; 86% vs. 59%, P < 0.001, respectively, compared with sinus rhythm). Up-titration to guideline-recommended target doses of beta-blocker, ACEi/ARB and MRA therapy was similar between patients with and without AF (31% vs. 24%, P = 0.096; 32% vs. 40%, P = 0.098; 23.7% vs. 30.5%, P = 0.125, respectively). Reasons for not further up-titrating to recommended target doses were consistent across patients with AF and sinus rhythm. LVEF improvement of ≥5% and ≥10% after up-titration was more common in patients with AF than those in sinus rhythm (67% vs. 53%, P = 0.017; 48% vs. 36%, P = 0.043). Achieving target doses of ACEi/ARB and MRA therapies was associated with lower mortality and HF rehospitalization rates at 3 years in both patients with AF and those in sinus rhythm.

CONCLUSIONS

In patients with new-onset HF, up-titration to recommended doses of GDMT was similar in patients with and without AF, but was associated with a greater improvement in LVEF in patients with AF.

Angioembolization within 60 minutes for exsanguinating trauma patients: A meaningful metric with a definition gap

BACKGROUND

Standards on the time from the decision to deploy interventional radiology (IR) to its initiation was recently changed from 30 to 60 ​min, though supporting evidence remains unclear. We aimed to identify the association of IR timing standard compliance with outcomes among trauma patients.

METHODS

This study examined adult trauma patients (≥16 years) requiring angioembolization, stratified by IR initiation within 60 ​min of emergency department discharge (IR60) and beyond. Multivariable regressions were used to evaluate associations of IR timing with clinical and financial outcomes. Variation attributable to hospital-level factors was also determined using multi-level models.

RESULTS

The study included 2793 patients, of which 38.3 ​% were IR60. All risk-adjusted outcomes were similar between the two cohorts. Additionally, notable variation in the proportion of IR60 was attributable to hospital-level factors.

CONCLUSION

Similar clinical outcomes between IR60 and non-IR60 question the validity of the current timing requirement for angioembolization in trauma patients.

Evaluating the role of quantitative computed tomography perfusion parameters in differentiating hepatocellular carcinoma from other hepatic neoplasms

BACKGROUND

Differentiating the various liver tumors is pivotal due to distinct treatments and prognoses. Sometimes, it is difficult to accurately differentiate hepatocellular carcinoma (HCC) from other hepatic neoplasms non-invasively because of overlap in the triple-phase contrast-enhanced computed tomography (CECT) features, contraindication of an invasive biopsy, particularly in multifocal lesions with cirrhosis or ascites or when an MRI is unavailable or not feasible.

OBJECTIVES

To assess the utility of CT perfusion (CTP) parameters in differentiating HCC from other hepatic neoplasms.

METHODS

Forty-eight patients with suspicious liver lesions underwent CTP imaging. Perfusion parameters were assessed within the tumor and the adjacent normal liver using the post-processing software. Statistical significance (p-value), sensitivity, and specificity value of the individual parameters were assessed. The receiver operating characteristic (ROC) curve analysis was done to threshold values of the parameters.

RESULTS

The mean values of perfusion parameters like HAP (hepatic arterial perfusion), PVP (portal venous perfusion), HPI (hepatic perfusion index), BF (blood flow), BV (blood volume), MTT (mean transit time), and TTP (time to peak) were statistically significant (p-value < 0.05) between HCC and other hepatic neoplasms. Among the parameters, BV had the greatest AUC of 0.938. With a threshold value of 8.3 ml/100 ml/min, the sensitivity and specificity were 96.6% and 80%, respectively, in distinguishing HCC from other hepatic neoplasms. HPI, BF, BV, and TTP were statistically significant in differentiating hypervascular metastases from HCCs. HAP, HPI, BF, BV, and TTP were statistically significant in differentiating HCC from hypovascular metastases. BF and BV were significant in differentiating hypervascular from hypovascular metastases. HAP, PVP, HPI, BF, BV, and TTP were statistically significant in differentiating HCCs from intrahepatic cholangiocarcinomas.

CONCLUSION

CTP provides a quantitative, non-invasive method to differentiate HCC from other hepatic neoplasms with high efficacy. It can be a problem-solving tool when a conventional CECT scan cannot characterize a lesion as HCC, where biopsy is not feasible.

Can quantitative perfusion CT-based biomarkers predict renal cell carcinoma subtypes?

PURPOSE

To assess diagnostic accuracy of perfusion CT (pCT) based biomarkers in differentiating clear-cell renal cell carcinoma (ccRCC) from non-ccRCC.

MATERIALS AND METHOD

This retrospective study comprised 95 patients with RCCs (70 ccRCCs and 25 non-ccRCCs) who had perfusion CT (pCT) before surgery between January 2017 and December 2022. Two readers independently recorded PCT parameters [blood flow (BF), blood volume (BV), mean transit time (MTT), and time to peak (TTP)] by drawing a circular ROI on the tumor. The open-source program "Labelme" was used to create a polygonal bounding box to outline tumor borders. The intraclass correlation coefficient (ICC) was used to determine interreader agreement. The pCT model was evaluated using multivariable logistic regression analysis with the STATA 18 program to determine the importance of each of these characteristics in predicting the type of tumor.

RESULTS

Clear cell RCC had significantly greater MIP and lower TTP values than non-clear cell RCC (p < 0.05). RCCs showed considerably higher TTP, MTT, and lower MIP values than the normal renal cortex (p < 0.05). At a threshold of 129 HU, MIP had an AUC of 0.78, sensitivity and specificity of 80% and 70%, respectively, according to ROC analysis.

CONCLUSIONS

pCT has a high diagnostic accuracy in distinguishing between ccRCC and non-ccRCC tumors; Clinical relevance: A non-invasive, accurate, reliable, and reproducible imaging biomarker for RCC subtype prediction is possible on pCT, which may be significant for evaluating the response to antiangiogenic therapy.

The Fifth Element: Is Vascular Dysfunction an Intrinsic Feature of Gout?

Gout, the most common inflammatory arthritis, affects as many as 5.1% of the adult population. Classically, gout is conceived as four sequential phenotypic states: 1) asymptomatic hyperuricemia 2) acute gout flare 3) inter-critical gout (gout between flares); and 4) tophaceous gout. However, these four states are paralleled by a fifth state, consisting of vascular involvement. The mechanisms and consequences of vascular gout are incompletely elucidated. In vitro and animal models indicate that soluble urate adversely affects vascular endothelium and smooth muscle. The recent discovery that soluble urate can be transported intracellularly to alter cell metabolism and epigenetics (trained innate immunity) suggests additional impacts of urate on leukocytes and endothelium. Once gout has progressed to flares, the vasculature is exposed to inflammatory mediators, both during flares and to a lesser but persistent extent inter-critically, suggesting additional mechanisms of gout's effect. We have reported that patients with gout have diminished endothelial function measured by brachial artery flow-mediated dilation. ACR gout guideline-concordant treatment improves endothelial function but is less effective in patients with cardiometabolic comorbidities. Moreover, treatment of gout patients with the anti-inflammatory colchicine and urate lowering therapy improves endothelial function and reduces the risk of both incident coronary artery disease (CAD), and MACE in patients with established CAD.

Microstructural alterations of cerebellar peduncles in multiple sclerosis: a diffusion tensor imaging study

BACKGROUND AND PURPOSE

Ataxia, tremors, dysarthria, and sometimes impaired cognition are the signs of cerebellum involvement in multiple sclerosis (MS). These symptoms affect up to 80% of patients and are usually hard to treat. To find the underlying involvement of the cerebellum in MS, we assessed the microstructural alterations with DTI in the cerebellar peduncles of the affected subjects.

MATERIALS AND METHODS

We included 58 relapsing-remitting MS patients and 27 healthy controls. Patients were divided into 18 patients of relapsing-remitting MS with cerebellar impairment (RRMSc) and 40 without cerebellar impairment (RRMSnc). Using Diffusion Tensor Imaging (DTI), we calculated fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) metrics in all subjects. We also checked if there were associations between DTI metrics and clinical cerebellar measures (i.e., tremor severity and the scale for the assessment and rating of ataxia).

RESULTS

ANOVA and post-hoc results showed significant differences in DTI metrics between RRMSc and HC and between RRMSnc and HC subjects. Inferior peduncle RD remained the only metric with a significant difference across all pairwise comparisons. The general linear model assessing the effects of the three study groups on the association between DTI metrics and clinical cerebellar measures yielded no significant result.

CONCLUSIONS

Our study showed that DTI can mainly reveal significant differences between different MS groups and HCs. Our results imply the role of cerebellar peduncles in the pathophysiology of MS and that this role does not necessarily reflect the severity of cerebellar signs of the patients.

Machine learning can reliably predict malignancy of breast lesions based on clinical and ultrasonographic features

PURPOSE

To establish a reliable machine learning model to predict malignancy in breast lesions identified by ultrasound (US) and optimize the negative predictive value to minimize unnecessary biopsies.

METHODS

We included clinical and ultrasonographic attributes from 1526 breast lesions classified as BI-RADS 3, 4a, 4b, 4c, 5, and 6 that underwent US-guided breast biopsy in four institutions. We selected the most informative attributes to train nine machine learning models, ensemble models and models with tuned threshold to make inferences about the diagnosis of BI-RADS 4a and 4b lesions (validation dataset). We tested the performance of the final model with 403 new suspicious lesions.

RESULTS

The most informative attributes were shape, margin, orientation and size of the lesions, the resistance index of the internal vessel, the age of the patient and the presence of a palpable lump. The highest mean negative predictive value (NPV) was achieved with the K-Nearest Neighbors algorithm (97.9%). Making ensembles did not improve the performance. Tuning the threshold did improve the performance of the models and we chose the algorithm XGBoost with the tuned threshold as the final one. The tested performance of the final model was: NPV 98.1%, false negative 1.9%, positive predictive value 77.1%, false positive 22.9%. Applying this final model, we would have missed 2 of the 231 malignant lesions of the test dataset (0.8%).

CONCLUSION

Machine learning can help physicians predict malignancy in suspicious breast lesions identified by the US. Our final model would be able to avoid 60.4% of the biopsies in benign lesions missing less than 1% of the cancer cases.

Advancements in diagnosing stiffness and vascularization of synovitis in hands and wrists using shear wave elastography and power doppler ultrasound in patients with systemic lupus erythematosus

RATIONALE AND OBJECTIVES

This study aimed to compare synovial joint effusion stiffness and vascularization using shear wave elastography (SWE) and Power Doppler ultrasound (PDU) among systemic lupus erythematosus (SLE) patients with varying joint symptoms and healthy controls and to explore associations with patient characteristics.

METHODS

This cross-sectional study, conducted between February 2021 and April 2023, included 60 SLE patients and a demographically matched healthy control group. The SLE patients were divided into three groups: those with active wrist/hand arthritis (G1), inflammatory arthralgia (G2), and no joint symptoms (G3). B-mode, SWE, and PDU assessments were performed on the non-dominant hand to evaluate synovial joint stiffness. Data on demographics, clinical presentations, serological markers, and patient-reported outcomes were analyzed.

RESULTS

A total of 80 participants were included, with no significant demographic differences between groups. SLE patients exhibited significantly higher stiffness values than controls in the radiocarpal (p = 0.004), ulnocarpal (p = 0.051), and metacarpophalangeal joints (p = 0.038, p = 0.002). Among these, the ulnocarpal joint showed the highest differences in stiffness values. No significant differences in stiffness were observed among SLE groups. However, positive Doppler findings were associated with higher SLICC-SDI scores (p = 0.005), and a positive correlation was found between the number of Doppler-positive joints and SLICC-SDI scores (r = 0.438, p < 0.001). Importantly, subclinical synovitis was observed in asymptomatic patients (G3), as demonstrated by significantly elevated stiffness in key joints compared to controls.

CONCLUSIONS

SLE patients exhibited higher stiffness values compared to controls, indicating subclinical synovitis even in asymptomatic individuals. Key findings suggest that the radiocarpal and ulnocarpal joints are particularly affected and should be prioritized in imaging protocols. The integration of SWE and PDU into routine SLE assessments can facilitate earlier diagnosis, enabling prompt treatment and reducing the risk of cumulative joint damage. SWE and PDU are valuable for the early detection and treatment of musculoskeletal changes. By identifying subclinical synovitis, these techniques not only improve patient monitoring but also help tailor therapeutic strategies to individual disease activity. The correlation with higher SLICC-SDI scores underscores the critical role of joint evaluation in preventing long-term damage and enhancing care management. Moving forward, refining imaging protocols to standardize SWE and PDU application in SLE is essential. Additionally, exploring the utility of these techniques in other joints, such as the knees and ankles, may provide further insights into the extent of subclinical involvement across the musculoskeletal system.

Updated Review of Radiologic Imaging and Intervention for Acute Pancreatitis and Its Complications

This is a current update on radiologic imaging and intervention of acute pancreatitis and its complications. In this review, we define the various complications of acute pancreatitis, discuss the imaging findings, as well as the timing of when these complications occur. The various classification and scoring systems of acute pancreatitis are summarized. Advantages and disadvantages of the 3 primary radiologic imaging modalities are compared. We then discuss radiologic interventions for acute pancreatitis. These include diagnostic aspiration as well as percutaneous catheter drainage of fluid collections, abscesses, pseudocysts, and necrosis. Recommendations for when these interventions should be considered, as well as situations in which they are contraindicated are discussed. Fortunately, acute pancreatitis usually is mild; however, serious complications occur in 20%, and admission of patients to the intensive care unit (ICU) occurs in over 10%. In this paper, we will focus on the imaging and interventional radiologic aspects for the serious complications and patients admitted to the ICU.

Brachytherapy Seed Placement by Robotic Bronchoscopy with Cone Beam Computed Tomography Guidance for Peripheral Lung Cancer: A Human Cadaveric Feasibility Pilot

PURPOSE

This study evaluates the feasibility of using robotic-assisted bronchoscopy with cone beam computed tomography (RB-CBCT) platform to perform low-dose-rate brachytherapy (LDR-BT) implants in a mechanically ventilated human cadaveric model. Postimplant dosimetry was compared with standard stereotactic body radiation therapy (SBRT) plans.

METHODS AND MATERIALS

The RB-CBCT platform was used to place inert LDR-BT seeds into mechanically ventilated human cadavers with percutaneously injected pseudotumors. LDR-BT dosimetry plans were created a priori with a prescription dose of 100 Gy to the pseudotumor plus a 3-mm margin to define a planning target volume. Implant quality was assessed by postimplant dosimetry and seed placement accuracy. BT dosimetry was compared with standard SBRT treatment plans for the same cadaveric tumor volumes.

RESULTS

Eight pseudotumors were planned with a total of 41 LDR-BT seeds, with a median of 5 seeds to achieve appropriate target coverage. All 41 LDR-BT seeds were successfully implanted in the 8 pseudotumors using RB-CBCT. On postimplant analysis, the average (± SD) dosimetry to the pseudotumor was a V95% of 99.4% ± 3.3% and D90% of 128 ± 23 Gy. The average distance between the planned and delivered seed location was 3.8 ± 1.1 mm. In comparison with SBRT plans, LDR-BT dose conformity was superior for the ratio of the V50% to the volume of the planning target volume (2.3-4.0, P < .001) and V25% (5.0 vs 17.5, P < .001).

CONCLUSIONS

RB-CBCT may be a feasible technology for implantation of LDR-BT seeds in peripheral lung tumors and can achieve preplanned dosimetry goals with better dose conformity than SBRT. Further clinical studies are indicated to demonstrate the safety and efficacy of LDR-BT delivered by RB-CBCT for treating early-stage lung cancer.

Moving From the Background Toward the Spotlight: A Critical Review of Radiation Therapy for Locally Advanced Pancreas Cancer

Radiation therapy (RT) for locally advanced pancreatic cancer (LAPC) continues to be controversial. Advances in both systemic therapy and RT techniques have changed the landscape of LAPC management in recent years. Clinical outcomes of ablative RT have been encouraging, and randomized clinical trials may clarify the role of RT for LAPC. We present a contemporary critical review of key aspects regarding optimal patient selection, radiation dose escalation techniques, novel radiosensitizers and radioprotectors, and treatment response assessment for LAPC.

Reliability of shear wave elastography for cervical and lumbar fascia stiffness and thickness in healthy and chronic neck and low back pain subjects

PURPOSE

This study had two primary aims: first, to assess the reliability of shear wave elastography (SWE) in measuring the stiffness of the posterior cervical fascia, the posterior layer of the lumbar fascia, and fascia thickness; and second, to compare these fascial properties between healthy individuals and patients with chronic neck and low back pain (LBP).

METHODS

Thirty participants, including 15 with concurrent neck and LBP and 15 healthy controls, were enrolled. The stiffness and thickness of the fascia, as well as the ratio of fascia stiffness to subcutaneous fat stiffness, were measured in the lumbar and cervical regions. Measurements were performed twice by a single examiner over 1-3 days. Reliability was assessed using the Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), Minimal Detectable Change (MDC), and Bland-Altman plots. Independent t-tests were conducted to compare group differences.

RESULTS

Test-retest reliability for the stiffness of the fascia in the cervical and lumbar regions was excellent, with ICC(3,1) values ≥ 0.90. Fascia thickness and the ratio showed good to excellent reliability (ICC(3,1) ≥ 0.80). The SEM, MDC, and limits of agreement supported these findings. Patients with neck and LBP had significantly thicker lumbar fascia than healthy controls (p = 0.002), while no significant differences were found in stiffness between the groups.

CONCLUSION

This study confirms the reliability of SWE in assessing fascia properties. While the lumbar fascia was thicker in patients with neck and low back pain, no significant differences in stiffness were observed between the groups.

The limbic and extra-limbic encephalitis associated with glutamic acid decarboxylase (GAD)-65 antibodies: an observational study

We aimed to define the clinical features and outcomes of encephalitis associated with anti-GAD65 Abs. In addition, we reviewed cases published in the literature with GAD65 encephalitis. We retrospectively studied 482 consecutive patients attending a tertiary care center for evaluation of an autoimmune neurological disorder. Nineteen patients were enrolled (3.94% of the cohort). Twelve (63.16%) patients were females, and the mean age at onset of the cohort was 31.68 ± 13.88 years. The following clinical-neuroimaging syndromes were identified: limbic encephalitis (n = 10), limbic plus extra-limbic encephalitis (n = 6), meningoencephalitis (n = 1), extralimbic encephalitis (n = 1), and unclassified (n = 1). The mesial temporal lobes were the most frequently affected (n = 13, 68.42%) in the brain magnetic resonance imaging (MRI), followed by frontal lobes (21%), and insular lobes (21%). Epileptiform discharges (94.4%), mostly from temporal lobes, were the most common electroencephalogram (EEG) finding. Most patients received immunotherapy and were followed for a mean duration of 21 months. A total of 73 patients, including 54 from the literature and 19 presented from the current series, were analyzed. Limbic encephalitis was the predominant presentation, and most patients received immunotherapy. Outcomes varied considerably. Considering patients from the literature and this series (n = 70), mortality was 5.7%. Also, 82.8% of patients had persistent neurologic manifestations, including seizures and cognitive impairment following immunotherapy. Limbic encephalitis is the most common form of GAD65 encephalitis, while a smaller proportion of patients may have signs of extra-limbic involvement. Most patients have persistent manifestations following combined immunotherapy with a relatively low mortality rate.

Factors influencing stent graft occlusion in endovascular repair of internal iliac artery aneurysms

OBJECTIVE

This study aimed to evaluate technical factors influencing stent graft occlusion following endovascular repair of internal iliac artery aneurysms (IIAAs), with a specific focus on the longitudinal length of unsupported stent graft segments and connecting stent grafts.

METHODS

A retrospective single-center analysis was performed on 61 IIAAs treated with endovascular techniques between 2010 and 2022. Anatomical and technical factors, including the unsupported stent graft length within the aneurysm sac (Distance A) and the length of the distal sealing zone (Distance B), were assessed. Statistical analyses were conducted to identify factors associated with stent graft occlusion, type Ib endoleaks, and clinical outcomes.

RESULTS

The primary technical success rate was 90.2%, with a stent graft occlusion rate of 23% documented over a mean follow-up period of 25.7 months. A longer unsupported stent graft length (Distance A) was significantly associated with increased risk of occlusion (53.7 vs 37.0 mm in nonoccluded cases; P = .017). Occlusion rates were also higher in cases with a greater number of connecting stent grafts used to extend the iliac branched device to healthy vessel segments (P = .015). Type Ib endoleaks occurred in 6.6% of cases and were significantly associated with shorter distal sealing zones (≤15 mm; odds ratio, 18.0). Despite these technical challenges, clinical success was achieved in 83.3% over the follow-up period, with low rates of ischemic complications. Buttock claudication occurred in 12.9% of cases, and erectile dysfunction was reported in one patient.

CONCLUSIONS

Endovascular repair of IIAAs is effective and provides a viable option for patients unfit for open surgery. However, it carries risks of stent graft occlusion and endoleaks, particularly when the unsupported stent graft length is extended or when multiple connecting stents are used. Optimizing graft configurations and minimizing unsupported segments may reduce occlusion risks. Furthermore, ensuring an adequate distal sealing zone length is critical to minimizing the occurrence of type Ib endoleaks. These findings highlight the importance of careful procedural planning and technical considerations to improve long-term outcomes and enhance durability in endovascular management of IIAAs.

Three-dimensional volumetric analysis of the temporomandibular joint space using a standard conical object

OBJECTIVE

The objective was to present a novel method for the assessment of the temporomandibular joint space volume (TMJSV) in cone beam computed tomography (CBCT) examinations with TMJ region landmarks. The significance of differences in measurements of mandibular head width (MHW) and volume (MHV) as well as TMJSV was calculated comparing right vs. left sides and males vs. females.

STUDY DESIGN

CBCT images from 50 Angle Class I adults were evaluated using 3D image software. MHW and MHV were obtained from each TMJ. The representative TMJSV was found through Boolean subtraction using a standard conical object in .stl format. Paired t-tests were used to compare right and left sides. The Pearson correlation coefficient was used to assess the correlation between numerical variables. Student t-tests were used to compare MHW, MHV, and TMJSV between males and females. P < .05 indicated significant difference.

RESULTS

The right and left mean MHW, MHV, and TMJSV values were 19.46 and 19.47 mm, 1431.51 and 1401.39 mm3, and 475.51 and 461.13 mm3, respectively, with no significant differences between sides (P ≥ .381). Correlation of these measurements with ipsilateral and contralateral values was moderate to strong (.70 - .89). Males presented higher mean values for all measurements (P ≤ .023).

CONCLUSIONS

The results are comparable to those of other studies, indicating the reliability of our method as a nuanced analysis of the intricate TMJ anatomy.

Parathyroid Adenoma at the Parapharyngeal Space Detected on 99m Tc-Sestamibi SPECT/CT

ABSTRACT

A 77-year-old woman was diagnosed with primary hyperparathyroidism, and initial cervical ultrasonography found no parathyroid lesion, and she was referred to the nuclear medicine unit for dual-phase 99m Tc-sestamibi (MIBI) scan. The scintigraphy unveiled heterogeneous uptake patterns across bilateral thyroid lobes, corresponding to the thyroid nodules, alongside a marked focal uptake with delayed tracer washout in the right oral region. The SPECT/CT pinpointed a MIBI-avid nodule within the right parapharyngeal space, indicative of parathyroid ectopia. An ectopic parapharyngeal parathyroid adenoma is exceptionally rare. MIBI scan plays a pivotal role in detection of ectopic parathyroid adenoma at unexpected sites.

PET imaging of atherosclerosis: artificial intelligence applications and recent advancements

PET imaging has become a valuable tool for assessing atherosclerosis by targeting key processes such as inflammation and microcalcification. Among available tracers, 18F-sodium fluoride has demonstrated superior performance compared to 18F-fluorodeoxyglucose, particularly in detecting coronary artery disease. However, the role of other tracers remains underexplored, requiring further validation. Emerging technologies such as artificial intelligence show potential in enhancing diagnostic speed and accuracy. Furthermore, the integration of the Alavi-Carlsen Calcification Score offers a novel approach to evaluating global disease burden, presenting a more clinically applicable method for predicting outcomes. Techniques such as total-body PET provide faster and more comprehensive imaging of the entire vascular system with reduced radiation exposure, representing a significant advancement in early detection and intervention. The combination of molecular imaging and advanced computational tools may revolutionize the management of atherosclerosis, facilitating earlier identification of at-risk individuals and improving long-term cardiovascular outcomes.

Artificial intelligence in pediatric osteopenia diagnosis: evaluating deep network classification and model interpretability using wrist X-rays

Osteopenia is a bone disorder that causes low bone density and affects millions of people worldwide. Diagnosis of this condition is commonly achieved through clinical assessment of bone mineral density (BMD). State of the art machine learning (ML) techniques, such as convolutional neural networks (CNNs) and transformer models, have gained increasing popularity in medicine. In this work, we employ six deep networks for osteopenia vs. healthy bone classification using X-ray imaging from the pediatric wrist dataset GRAZPEDWRI-DX. We apply two explainable AI techniques to analyze and interpret visual explanations for network decisions. Experimental results show that deep networks are able to effectively learn osteopenic and healthy bone features, achieving high classification accuracy rates. Among the six evaluated networks, DenseNet201 with transfer learning yielded the top classification accuracy at 95.2 %. Furthermore, visual explanations of CNN decisions provide valuable insight into the blackbox inner workings and present interpretable results. Our evaluation of deep network classification results highlights their capability to accurately differentiate between osteopenic and healthy bones in pediatric wrist X-rays. The combination of high classification accuracy and interpretable visual explanations underscores the promise of incorporating machine learning techniques into clinical workflows for the early and accurate diagnosis of osteopenia.

Assessment of organ dose for adult undergoing CT examinations: Comparison of three software applications using Monte Carlo simulation

Understanding organ dose during CT scans is crucial due to cancer risks from low-level radiation exposure. This study aims to analyze and compare different methods for estimating CT organ doses in adult male and female patients, assessing the compatibility of NCICT with standard phantoms and NCICT with body size adjustment with GEANT4 simulations. It also evaluates the impact of different CT manufacturers on organ dose calculations. Previous research used various phantoms to represent organ doses across age groups. This study utilizes DICOM images from real adult patients undergoing CT scans to evaluate organ dose using the GEANT4 simulation toolkit. A retrospective analysis of 240 CT scans (head, chest, and abdomen-pelvis) compared GEANT4 dose estimates to the software tool NCICT. Data from Siemens and Philips CT scanners were included. Organ doses for 34 organs were calculated using Siemens patient DICOM data, while Philips estimates made using only NCICT with body size adjustment. Statistical analysis assessed differences in organ doses by gender and scanner type. Organ doses for the brain, spinal cord, and liver were higher in females (48.1, 4.9, and 6.7 mGy) compared to males (42.5, 4.4, and 6.3 mGy). NCICT with body size adjustment estimates were more consistent with GEANT4 (differences up to 18%) compared to NCICT with standard phantoms (differences up to 46%). Notable variations were found between Siemens and Philips scanners, despite identical detector rows. Accurate models and scanner-specific differences are critical for reliable radiation dose assessments, emphasizing the need for tailored dosimetry to enhance patient safety.

Concurrent pancreatic ductal adenocarcinoma and poorly differentiated neuroendocrine carcinoma: A case report and review of the literature

INTRODUCTION

Concurrent pancreatic ductal adenocarcinoma (PDAC) and poorly differentiated neuroendocrine carcinoma (NEC) is a rare condition. This simultaneous occurrence poses significant diagnostic and therapeutic challenges due to the unique characteristics and treatment protocols of each cancer. An accurate diagnosis is crucial to optimizing treatment outcomes and prognosis.

PRESENTATION OF CASE

We present a case of a 55-year-old male with type 2 diabetes and psoriatic arthritis, referred for an elevated serum CA 19-9 level found during a check-up. Imaging studies, including CT and EUS, revealed a 6 cm mass in the pancreatic head. EUS-guided biopsy confirmed PDAC. After a Whipple procedure, pathology showed concurrent poorly differentiated NEC with a 30 % neuroendocrine component. After surgery, the patient received gemcitabine-based chemotherapy and was disease-free at six months post-surgery.

DISCUSSION

This case illustrates the diagnostic intricacy of simultaneous PDAC and poorly differentiated NEC. Effective management in such scenarios benefits from a collaborative approach among surgeons, oncologists, and pathologists. Due to the limited number of documented cases, there is insufficient evidence to inform the best treatment strategies, particularly concerning the most effective chemotherapy options. This case adds to the growing body of literature on rare concurrent pancreatic tumors and highlights the need for further research to enhance understanding and develop comprehensive clinical guidelines.

CONCLUSION

The combination of PDAC and poorly differentiated NEC poses unique diagnostic and treatment challenges. This case underscores the importance of a multidisciplinary approach and calls for further research to develop evidence-based management protocols for these rare malignancies.

Gastrointestinal and genitourinary fluoroscopy: a pictorial essay of a useful evergreen technique

Until recently, the use of direct contrast examinations with oral or intracavitary contrast agents was widespread in all general radiology departments. It provided significant answers to multiple clinical questions on the enteric organs and their mucosal surfaces. With the increased availability of CT and MRI, which also allow for the study of walls, as well as the accessibility of endoscopic examinations, the request and execution of fluoroscopy contrast studies have fallen considerably. Despite this, fluoroscopy contrast exams are still useful in specific clinical queries; therefore, radiologists should be able to provide their diagnostic contributions. This pictorial essay of clinical cases collected in our radiology department demonstrates the current demand for these examinations, the variety of the clinical questions we are called upon to answer and the need for continued expertise in execution and diagnostic interpretation of such studies.

Contrast-enhanced ultrasound for differentiation of gallbladder sludge from polyp: A case report demonstrating clinical utility

Gallbladder lesion characterization remains a common diagnostic dilemma in abdominal imaging, particularly when differentiating between polyps and organized sludge. Findings on conventional gray-scale ultrasound may be equivocal, especially when typical imaging features such as mobility are absent. We present a case of a 65-year-old patient who presented with a concerning nonmobile 3.7 cm gallbladder lesion on initial ultrasound assessment. Due to the superior sensitivity of contrast-enhanced ultrasound (CEUS) for blood flow compared to other imaging modalities, CEUS was able to demonstrate complete absence of enhancement within the lesion, consistent with tumefactive sludge rather than solid tissue, and averting the need for additional cross-sectional imaging. Surgical pathology following cholecystectomy confirmed these findings. This case highlights the utility of CEUS as a valuable tool in gallbladder imaging, potentially reducing healthcare costs and expediting appropriate patient care while avoiding the risks associated with other contrast-enhanced imaging modalities.

Diffusion-prepared imaging with amplitude navigation for correction of motion-induced signal loss

PURPOSE

Diffusion-prepared imaging is a flexible alternative to conventional spin-echo diffusion-weighted EPI that allows selection of different imaging readouts and k-space traversals, and permits control of image contrast or image artifacts. We investigate a new signal model and reconstruction for diffusion-prepared imaging that addresses signal variations caused by motion-sensitizing diffusion gradients.

METHODS

A signal model, sampling theory, and reconstruction framework were developed assuming that motion-induced phases and the measured signals are random variables. The reconstruction incorporates real-valued amplitude weights estimated from low-resolution images into a linear system. A diffusion-prepared sequence was applied in phantom and in vivo acquisitions using different methods for managing phase errors from eddy currents or motion. This acquisition was performed with a high number of NEX and retrospectively undersampled to analyze errors in ADC estimation, and compared to spin-echo diffusion-weighted EPI, as well as conventional diffusion-prepared methods. The B1 sensitivity of the sequence was investigated using simulation and phantom experiments.

RESULTS

Images reconstructed using the proposed method had similar image structures when compared to conventional spin-echo diffusion-weighted EPI, and demonstrated improved SNR efficiency compared to previous diffusion-prepared approaches. ADC errors followed a trend consistent with the derived signal model, sampling theory, and expected B1 sensitivity. The sampling requirement was shown to depend on the magnitude of motion-induced phases, as well as phases from residual eddy currents.

CONCLUSION

Employing amplitude weights in the reconstruction of a diffusion-prepared sequence can improve SNR efficiency at the cost of a greater minimum sampling time and increased sensitivity to B1 inhomogeneity.

Ureter development and associated congenital anomalies

Malformations of the ureter are among the most common birth defects in humans. Although some of these anomalies are asymptomatic, others are clinically relevant, causing perinatal lethality or progressing to kidney failure in childhood. The genetic causes and developmental aetiology of ureteral anomalies are difficult to study in humans; however, embryological and genetic analyses in the mouse have provided insights into the complex developmental programmes that govern ureter formation from simple tissue primordia, and the pathological consequences that result from disruption of these programmes. Abnormalities in the formation of the nephric duct and ureteric bud lead to changes in the number of ureters (and kidneys), whereas the formation of ectopic ureteric buds, failure of the nephric duct to target the cloaca or failure of the distal ureter to mature underlie vesicoureteral reflux, ureter ectopia, ureterocoele and subsequent hydroureter. Alterations in ureter specification, early growth or cyto-differentiation programmes have now also been associated with various forms of perinatal hydroureter and hydronephrosis as a consequence of functional obstruction. The characterization of cellular processes and molecular drivers of ureterogenesis in the mouse may not only aid understanding of the aetiology of human ureteral anomalies, improve prognostication and benefit the development of therapeutic strategies, but may also prove important for efforts to generate a bioartificial organ.

Prognostic assessment of osteolytic lesions and mechanical properties of bones bearing breast cancer using neural network and finite element analysis☆

The management of skeletal-related events (SREs), particularly the prevention of pathological fractures, is crucial for cancer patients. Current clinical assessment of fracture risk is mostly based on medical images, but incorporating sequential images in the assessment remains challenging. This study addressed this issue by leveraging a comprehensive dataset consisting of 260 longitudinal micro-computed tomography (μCT) scans acquired in normal and breast cancer bearing mice. A machine learning (ML) model based on a spatial-temporal neural network was built to forecast bone structures from previous μCT scans, which were found to have an overall similarity coefficient (Dice) of 0.814 with ground truths. Despite the predicted lesion volumes (18.5 ​% ​± ​15.3 ​%) being underestimated by ∼21 ​% than the ground truths' (22.1 ​% ​± ​14.8 ​%), the time course of the lesion growth was better represented in the predicted images than the preceding scans (10.8 ​% ​± ​6.5 ​%). Under virtual biomechanical testing using finite element analysis (FEA), the predicted bone structures recapitulated the loading carrying behaviors of the ground truth structures with a positive correlation (y ​= ​0.863x) and a high coefficient of determination (R2 ​= ​0.955). Interestingly, the compliances of the predicted and ground truth structures demonstrated nearly identical linear relationships with the lesion volumes. In summary, we have demonstrated that bone deterioration could be proficiently predicted using machine learning in our preclinical dataset, suggesting the importance of large longitudinal clinical imaging datasets in fracture risk assessment for cancer bone metastasis.

Diagnostic and therapeutic challenges in xanthogranulomatous cholecystitis: A rare case report

INTRODUCTION AND IMPORTANCE

Xanthogranulomatous cholecystitis (XGC) is a rare, aggressive gallbladder condition marked by chronic inflammation, fibrosis, and lipid-laden macrophages. It often mimics gallbladder carcinoma clinically and radiologically, complicating diagnosis and treatment. Early differentiation from malignancy is essential for proper management. This case emphasizes the diagnostic challenges of XGC and the need for a multidisciplinary approach.

CASE PRESENTATION

A 61-year-old man presented with four months of intermittent right upper quadrant abdominal pain radiating to the back, without fever, jaundice, or weight loss. Examination revealed right hypochondrial tenderness, and labs showed elevated inflammatory markers. Imaging indicated gallstones, gallbladder wall thickening, and ill-defined liver boundaries, raising malignancy concerns. A biopsy confirmed xanthogranulomatous cholecystitis (XGC), ruling out carcinoma. He underwent successful laparoscopic cholecystectomy, with histopathology confirming XGC. Recovery was uneventful, and he remained symptom-free at six-month follow-up.

CLINICAL DISCUSSION

XGC is a diagnostic challenge due to its nonspecific symptoms and imaging findings that overlap with malignancy. Preoperative biopsy, as performed in this case, can be invaluable in guiding management. Laparoscopic cholecystectomy, though technically demanding due to dense adhesions and local invasion, is feasible in selected cases. Histopathology remains the gold standard for definitive diagnosis, revealing chronic inflammation and lipid-laden macrophages without malignancy.

CONCLUSION

This case underscores the importance of considering XGC in the differential diagnosis of gallbladder masses, particularly when imaging suggests local invasion. Preoperative biopsy and histopathology play pivotal roles in distinguishing XGC from malignancy. Successful laparoscopic management, despite its challenges, highlights the potential for minimally invasive surgery in carefully selected cases.

Improved NTCP model for late radiation-induced aspiration based on dose delivered to specific aspiration-related OARs

BACKGROUND AND PURPOSE

Radiation-induced aspiration is a serious complication following (chemo)radiation for head and neck cancer. The standard set of swallowing organs at risk (SWOARs) does not include all aspiration-related organs (OARs). An alternative proposed in earlier work includes a definition and delineation atlas for additional OARs, called Functional Swallowing Units (FSU). The purpose of this study was to compare two NTCP models for late aspiration, based on either SWOARs only or the FSU concept.

METHODS AND MATERIALS

Data from 189 patients were analysed. Aspiration at baseline (Asp_T0) and 6 months after treatment (Asp_T6) were scored according to Penetration Aspiration Scale (PAS). All SWOARs and FSUs were delineated and the DVH was recorded. Clinical factors and average dose (Dmean) to all aspiration-related OARs were included in multivariable analysis. Two models were built, model 1: including clinical factors and SWOARs only and model 2: including clinical factors, SWOARs and FSUs.

RESULTS

Both final models included Asp_T0 and Dmean to the supraglottic larynx as predictors. Model 2 included the dose to three additional OARs as a predictor: 1) Anterior Segment (floor of mouth/ thyrohyoid muscles) 2) hyoglossus/styloglossus muscles complex (HSG) 3) upper oesophageal sphincter (UES). Adding FSUs to model 1 resulted in significant model updates and model 2 performed better than model 1 (AUC 0.79 vs. 0.75).

CONCLUSION

NTCP models for late aspiration may be improved by including the dose to aspiration-related OARs, defined by the FSU concept. In addition to the supraglottic larynx, sparing of the Anterior Segment, HSG and UES could further decrease the risk of radiation-induced aspiration, but this remains to be confirmed in clinical studies.

Classification of the temporomandibular joint disc displacement without reduction using MRI in the mouth-opening position

OBJECTIVES

This study aimed to analyze the positional characteristics of the temporomandibular joint (TMJ) disc in patients with anterior disc displacement without reduction (ADDWoR) using magnetic resonance imaging (MRI).

MATERIALS AND METHODS

2,827 MRI images from 2,168 ADDWoR patients were collected and categorized into two groups: without limited opening (WoLO) group and with limited opening (WLO) group. The position of TMJ disc and their distribution characteristics in these two groups were analyzed from the oblique sagittal planes of MRI.

RESULTS

The disc positions were classified into 11 types based on oblique sagittal MRI images during maximum mouth opening. Anterior displacement was the most common in both groups, with 39.65% in WoLO and 41.96% in WLO. Anteroinferior displacement and anteroinferior displacement in the lateral part were also prevalent, particularly in the WLO group. While the MRI imaging features of superior displacement did not appear in the WLO group, due to mouth opening limitation. The effect of masticatory muscles and condylar excursion during mouth opening play a crucial role in the displacement of TMJ disc.

CONCLUSIONS

ADDWoR patients of WoLO group primarily manifest disc anterior displacement, anteroinferior in the lateral part, and anteroinferior displacement. ADDWoR patients of WLO group are more likely to exhibit disc anterior displacement and anteroinferior displacement, without the manifestation of superior displacement.

CLINICAL RELEVANCE

The position of the anterior displaced disc can guide treatment strategies, conservative treatment alleviating restricted mouth opening for anteroinferior displacement patients, or controlling excessive mouth opening to relieve ligamentous laxity for anterosuperior displacement patients.

A multicenter prospective study evaluating use of EmboCube™ Embolization Gelatin alone or in combination with other embolic agents to control bleeding

BACKGROUND

Embolization is a vital endovascular procedure that can be used to quickly achieve hemostasis in patients experiencing uncontrolled bleeding. This study was conducted to describe real-world outcomes following embolization with a pre-cut absorbable gelatin sponge to control bleeding.

METHODS

This prospective study was conducted across five hospitals in Australia and France. Inclusion criteria included adults ≥ 18 years who required embolization with EmboCube™ Embolization Gelatin for bleeding. Primary performance and safety endpoints were the proportion of patients that achieved clinical success (i.e., cessation of bleeding post-embolization, the absence of rebleeding at the treated site requiring reintervention within 24 h), and the absence of unanticipated serious adverse device effects within 24 h of the initial embolization, respectively. Secondary endpoints included technical success and serious device- and/or procedure-related adverse events 28 days post-initial embolization.

RESULTS

A total of 101 patients (54 males) were enrolled and treated. Sixty-six patients were treated with EmboCube only, 35 patients were treated with an additional embolic to control bleeding. Technical and clinical success rates were 100% and 99%, respectively. No patient experienced an unanticipated serious event related to the embolic. The mean time to hemostasis was 3.4 (± 3.96) minutes. Of the 90 patients that completed 28 days of follow-up, 4 (4.4%) experienced an adverse event (access site hematoma, n = 2; ischemic colitis, n = 1, peritonitis, n = 1).

CONCLUSION

EmboCube is safe and effective for control of acute and sub-acute arterial bleeding, alone or in combination with other embolic agents, when rapid hemostasis is required.

TRIAL REGISTRATION

Clinicaltrials.gov. Registered 23 March 2022, https://clinicaltrials.gov/study/NCT05307783 .

Endoscopic Interlaminar Standalone Decompression for Lumbar Lateral Recess Stenosis With Subligamentous Disc Herniation: A Disc-Preserving Alternative to Discectomy

OBJECTIVE

Lumbar lateral recess stenosis (LRS) with subligamentous disc herniation often causes debilitating radicular pain. While discectomy is commonly performed, it risks disc degeneration and spinal instability. This study aimed to evaluate the clinical and radiographic outcomes of full-endoscopic interlaminar standalone decompression as a minimally invasive, disc-preserving alternative to discectomy for treating single-level LRS with subligamentous disc herniation.

METHODS

We retrospectively reviewed 55 patients with single-level lumbar LRS and subligamentous disc herniation who underwent full-endoscopic interlaminar standalone decompression between 2013 and 2021. Inclusion criteria required radicular pain refractory to conservative treatment and magnetic resonance imaging (MRI) confirmation of subligamentous herniation. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for leg and back pain, Oswestry Disability Index (ODI), and Short Form-12 Physical and Mental Component Scores (SF-12 PCS/MCS). Radiographic evaluations included disc height index (DHI) measurements and Bartynski grading for lateral recess stenosis. Pre- and postoperative data were compared using the Wilcoxon signed-rank test.

RESULTS

At the 2-year follow-up, leg and back pain VAS scores improved significantly from 8.8 and 8.5 preoperatively to 1.0 and 0.9, respectively. ODI scores declined from 66.9 to 10.6, while SF-12 PCS and MCS improved from 30.1 to 42.5 and 26.3 to 42.6, respectively. According to the modified MacNab criteria, 96.3% of patients achieved "good" or "excellent" outcomes. Postoperative DHI remained stable, and no reoperations were required during follow-up.

CONCLUSIONS

Full-endoscopic interlaminar standalone decompression offers substantial symptom relief and functional improvement for single-level lumbar LRS with subligamentous disc herniation. By preserving disc integrity, this minimally invasive technique avoids the risks associated with discectomy, such as disc degeneration and instability. These findings suggest a paradigm shift in treating LRS, supporting the use of this disc-preserving approach as a viable alternative to conventional surgical methods in properly selected patients. Further research with larger cohorts and longer follow-up is warranted to validate these results.