Risk factors and outcomes after surgery for malignant neoplasm of the parotid gland: An ACS-NSQIP study

BACKGROUND

Malignant neoplasms of the parotid gland (MPG) are clinically challenging due to aggressive growth and metastasis. Despite tumor resection being the primary treatment, there is a paucity of studies on postsurgical outcomes and preoperative risk factors for MPG.

MATERIALS AND METHODS

We queried the American College of Surgeons National Surgical Quality Improvement Program database to identify patients who underwent MPG surgery between 2008 and 2021. 30-day postoperative outcomes and risk factors predisposing to the occurrence of complications were assessed.

RESULTS

The study population included 3052 patients, the majority of whom were males (n = 1842; 60%) and White (n = 2017; 66%). The average age was 63 ± 16 years. The most common comorbidities were obesity (n = 1182; 39%) and hypertension (n = 1533; 50%). Surgical procedures were performed predominantly in the inpatient setting (n = 1773; 58%) by ENT surgeons (n = 2767; 91%). Overall, complications were reported in 6.8% (n = 209) of patients. Inpatient setting (p < 0.001), renal failure (p < 0.001), smoking (p = 0.012), as well as increased creatinine (p < 0.001) and blood urea nitrogen (BUN) levels (p = 0.001) were identified as risk factors for complications. In addition, concurrent microsurgical procedures such as flap surgery and/or nerve grafting significantly increased the risk of postoperative adverse events (p < 0.001).

CONCLUSIONS

Our analysis revealed that complication rates were associated with high creatinine and BUN levels, inpatient surgery, renal failure, higher American Society of Anesthesiology classes, and smoking. We also found that concurrent microsurgical procedures were predictive factors for complications. These findings can inform patient counseling, preoperative planning, and risk stratification.

Assessment of bystander coronary artery disease in transcatheter aortic valve replacement (TAVR) patients using noncoronary-dedicated planning computed tomography angiography (CTA): diagnostic accuracy in a retrospective real-world cohort

AIM

To assess the diagnostic potential of a noncoronary-dedicated pre-TAVR CT angiography (CTA) conducted as a prospective ECG-gated scan without premedication and standard cardiac reconstructions in evaluating bystander coronary artery disease (CAD) against invasive coronary angiography (ICA) as the gold standard.

MATERIALS AND METHODS

This retrospective study included 232 patients who underwent both CTA and ICA as part of their pre-TAVR evaluation. Exclusion criteria included prior stent, pacemaker, coronary artery bypass, or valve surgery. Coronary arteries were analysed solely through thin-slice axial reconstructions, with observers blinded to ICA results. Stenosis was categorised as mild (< 50%), moderate (50%-69%), or severe (≥70%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for 50% and 70% diameter stenosis (DS) thresholds.

RESULTS

At the 50% DS threshold, CTA demonstrated 71% sensitivity, 74% specificity, 92% NPV, and 38% PPV. At the 70% DS threshold, results included 46% sensitivity, 91% specificity, 93% NPV, and 41% PPV. The highest vessel-specific NPV at 50% DS was for the left main (98%) and left anterior descending (LAD) (91%); at 70% DS, left main (LM) (98%) and left circumflex (LCX) (94%) showed the highest NPV. Image quality impacted NPV, with excellent or very good image quality linked to higher diagnostic performance.

CONCLUSION

Noncoronary-dedicated pre-TAVR CTA shows promise for ruling out significant CAD effectively and may act as a gatekeeper for ICA, aligning with typical coronary CT angiography (CCTA) outcomes.

Intraoperative tumor capsule injury in patients with renal cell carcinoma receiving partial nephrectomy

OBJECTIVE

We investigated the impact of intraoperative tumor capsule injury (TCI) during robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) on oncological outcomes, as well as underlying factors of intraoperative TCI for improving surgical outcomes.

METHODS

A total of 253 patients who underwent RAPN or LPN between 2010 and 2022 were retrospectively analyzed and were divided into two groups: non-TCI and TCI groups. The background was compared between two groups. We investigated the surgical records or video to evaluate TCI and seek the possible causes for TCI. Multivariate logistic regression analysis was performed to identify prognostic factors for cancer recurrence.

RESULTS

Of the 253 patients, 227 have renal cell carcinoma (RCC), with 29 patients having TCI. The TCI group had larger tumors, a lower rate of trifecta achievement, higher bleeding, higher T stage, and a lower rate of clear cell RCC (ccRCC) histological types as compared to non-TCI group. Disease recurrence rate was 13.8% with TCI and 1.0% with non-TCI (odds ratio 15.7; 95% confidence interval, 2.73-90.1; p = 0.003). Univariate and multivariate analyses confirmed TCI as an independent prognostic factor for disease-free survival. Compared with ccRCC, non-clear cell RCC (non-ccRCC) was found to have a higher probability of TCI and a significantly thinner capsule thickness on pathological evaluation.

CONCLUSION

TCI had a negative impact on oncological outcomes. Surgeons should consider thickness of tumor capsules, especially in cases with non-ccRCC, to minimize the risk of TCI during partial nephrectomy.

Design and Characterisation of a Novel Z-Shaped Inductor-Based Wireless Implantable Sensor for Surveillance of Abdominal Aortic Aneurysm Post-Endovascular Repair

PURPOSE

An abdominal aortic aneurysm (AAA) is a dilation of the aorta over its normal diameter (> 3 cm). The minimally invasive treatment adopted uses a stent graft to be deployed into the aneurysm by a catheter to flow blood through it. However, this approach demands frequent monitoring using imaging modalities that involve radiation and contrast agents. Moreover, the multiple follow-ups are expensive, time-consuming, and resource-demanding for healthcare systems. This study proposes a novel wireless implantable medical sensor (WIMS) to measure the aneurysm growth after the endovascular repair.

METHODS

The proposed sensor is composed of a Z-shaped inductor, similar to a stent ring. The proposed design of the sensor is explored by investigating the inductance, resistance, and quality factor of different possible geometries related to a Z-shaped configuration, such as the height and number of struts. The study is conducted through a combination of numerical simulations and experimental tests, with the assessment being carried out at a frequency of 13.56 MHz.

RESULTS

The results show that a higher number of struts result in higher values of inductance and resistance. On the other hand, the increase in the number of struts decreases the quality factor of the Z-shaped inductor due to the presence of high resistance from the inductor. Moreover, it is observed that the influence of the number of struts present in the Z-shaped inductor tends to decrease for larger radii.

CONCLUSIONS

The numerical and experimental evaluation concludes the ability of the proposed sensor to measure the size of the aneurysm.

Dual-Energy Computed Tomography Iodine Maps: Application in the Diagnosis of Periprosthetic Joint Infection in Total Hip Arthroplasty

BACKGROUND

The challenge of early and rapid diagnosis of periprosthetic joint infection (PJI) remains important. This study aimed to assess the efficacy of dual-energy computed tomography (DECT) iodine maps for diagnosing PJI in total hip arthroplasty.

METHODS

We prospectively enrolled 68 patients who had postoperative joint pain after hip arthroplasty. All patients underwent preoperative DECT iodine imaging to quantify iodine concentration (IC) in periprosthetic tissues during arterial and venous phases. The diagnostic efficacy of DECT iodine maps was evaluated by constructing receiver operating characteristic curves according to the Musculoskeletal Infection Society criteria.

RESULTS

Compared with erythrocyte sedimentation rate (area under the curve [AUC] = 0.837), polymorphonuclear cell percentage (AUC = 0.703), and C-reactive protein (AUC = 0.837), periprosthetic tissue venous-phase IC (AUC = 0.970) and arterial-phase IC (AUC = 0.964) exhibited outstanding discriminative capability between PJI and aseptic failure. The PJI cut-off point was venous IC = 1.225 mg/mL, with a sensitivity of 92.31% and specificity of 90.48%; for arterial IC = 1.065 mg/mL, the sensitivity was 96.15% and specificity was 90.70%.

CONCLUSIONS

This study demonstrates the great potential of DECT iodine maps for the diagnosis of PJI around hip arthroplasty, which helps to differentiate between periprosthetic infection and aseptic failure after hip arthroplasty.

Extracorporeal membrane oxygenation for prevention of barotrauma in patients with respiratory failure: A scoping review

BACKGROUND

Barotrauma is a frequent complication in patients with severe respiratory failure and is associated with poor outcomes. Extracorporeal membrane oxygenation (ECMO) implantation allows to introduce lung-protective ventilation strategies that limit barotrauma development or progression, but available data are scarce. We performed a scoping review to summarize current knowledge on this therapeutic approach.

METHODS

We systematically searched PubMed/MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies investigating ECMO as a strategy to prevent/limit barotrauma progression in patients with respiratory failure. Pediatric studies, studies on perioperative implantation of ECMO, and studies not reporting original data were excluded. The primary outcome was the rate of barotrauma development/progression.

RESULTS

We identified 21 manuscripts presenting data on a total of 45 ECMO patients. All patients underwent veno-venous ECMO. Of these, 21 (46.7%) received ECMO before invasive mechanical ventilation. In most cases, ECMO implantation allowed to modify the respiratory support strategy (e.g., introduction of ultraprotective/low pressure ventilation in 12 patients, extubation while on ECMO in one case, and avoidance of invasive ventilation in 15 cases). Barotrauma development/progression occurred in <10% of patients. Overall mortality was 8/45 (17.8%).

CONCLUSION

ECMO implantation to prevent barotrauma development/progression is a feasible strategy and may be a promising support option.

Spontaneous transomental hernia: a rare cause of closed loop bowel obstruction

Transomental hernias are the rarest subtype of internal hernias, accounting for 0.5%-3% of bowel obstructions. We report an unusual case of a spontaneous transomental hernia in a 47-year-old male presenting with non-specific obstructive symptoms. A CT scan revealed a closed-loop small bowel obstruction, but the diagnosis of a spontaneous transomental hernia was confirmed during emergency diagnostic laparoscopy. The small bowel remained viable, avoiding the need for resection, and the patient had an uncomplicated postoperative recovery. Clinical suspicion for transomental hernias is crucial, especially in patients with no prior abdominal surgery, to ensure early surgical intervention and reduced morbidity.

The role of MRI in perianal fistulizing disease: diagnostic imaging and classification systems to monitor disease activity

Perianal fistulizing disease, commonly associated with Crohn's disease, poses significant diagnostic and therapeutic challenges due to its complex anatomy and high recurrence rates. Radiological imaging plays a pivotal role in the accurate diagnosis, classification, and management of this condition. This article reviews the current radiological modalities employed in the evaluation of perianal fistulizing disease, including magnetic resonance imaging (MRI), endoanal ultrasound, and computed tomography (CT). MRI, recognized as the gold standard, offers superior soft tissue contrast and multiplanar capabilities, facilitating detailed assessment of fistula tracts and associated abscesses. CT, although less detailed than MRI, remains valuable in acute settings for detecting abscesses and guiding drainage procedures. This article discusses the advantages and limitations of each modality, highlights the importance of standardized imaging protocols, and underscores the need for interdisciplinary collaboration in the management of perianal fistulizing disease. Future directions include advancements in imaging techniques and the integration of artificial intelligence to enhance diagnostic accuracy and treatment outcomes.

Optimizing autonomous artificial intelligence diagnostics for neuro-ocular health in space missions

Spaceflight-Associated Neuro-Ocular Syndrome (SANS) presents a critical risk in long-duration missions, with microgravity-induced changes that threaten astronaut vision and mission outcomes. Current SANS monitoring, limited to pre- and post-flight exams, lacks in-flight diagnostics, highlighting an urgent need for autonomous tools capable of real-time assessment. Grok, an AI platform by xAI, offers promising potential as an advanced diagnostic tool for space-based health monitoring. Originally developed for broader applications, Grok's high-resolution imaging capabilities could be adapted to detect early SANS indicators such as optic nerve edema and shifts in globe morphology, changes linked to fluid redistribution in space. However, realizing this vision requires algorithmic and hardware adjustments to address the unique physiological shifts astronauts experience. By advancing Grok's diagnostic capability, we strongly believe astronauts could manage SANS autonomously, bringing much-needed real-time, high-accuracy diagnostics to isolated, high-stakes environments-essential as humanity embarks on increasingly ambitious missions to Mars and beyond.

CT perfusion and MRI: A combined approach for hepatocellular carcinoma diagnosis and follow-up after locoregional treatment

OBJECTIVE

CT liver perfusion (CTLP) has been well validated for hepatocellular carcinoma (HCC) detection, characterization, and treatment response evaluation. However, its role in HCC management algorithms remains unclear. This study aims to assess the diagnostic performance of CTLP alone or as an adjunct to MRI in patients considered for- or undergoing locoregional treatment for HCC.

MATERIAL AND METHODS

Thirty-nine patients under HCC surveillance (36 male, 31 cirrhotic, 16 pretreatment, 19 post-transarterial chemoembolization, 2 post-ablation) underwent MRI and CTLP in a single center within a 45-day interval. Two readers identified and characterized all observations on MRI using Liver Imaging Reporting and Data System (LI-RADS) v2018 criteria. CTLP assessment was based on Mean Slope of Increase (MSI), Time To Peak (TTP), Hepatic arterial Blood Flow (HaBF) and Hepatic Arterial Fraction (HAF) maps and established cut-offs. Diagnostic performance of MRI, CTLP, and their combination was evaluated for treated and untreated lesions using imaging or pathology as reference standard.

RESULTS

Of the total 33 treated and 61 untreated lesions, 13 and 41 were considered viable HCCs. CTLP demonstrated 75.9 % sensitivity and 95 % specificity compared to 72.2 % and 100 % for MRI (p > 0.05). Combining both modalities increased sensitivity to 85.2 % (p < 0.05) and maintained specificity at 97.5 % (p > 0.05). The combined approach led to an LR category change in 5 treated and 19 untreated lesions and affected management in 5 cases.

CONCLUSION

CTLP and MRI have comparable diagnostic performance for HCC. A combined approach improves sensitivity, without sacrificing specificity. This approach might enable more efficient patient selection for early and individualized loco-regional treatment.

The Impact of Insufficient Sleep on White Matter Development in Late Childhood and Early Adolescence

PURPOSE

Sleep is vital for brain development. Animal models have suggested that insufficient sleep affects axons and dendrites (known as neurites). However, the effects of insufficient sleep on neurites during brain development in humans remain understudied. Deriving neurite density index and orientation dispersion index (ODI) in a large sample (N = 1,016; 47.44% girls), we aimed to identify the effects of insufficient sleep on white matter development between late childhood (mean age [standard deviation] = 9.96 [0.62] years) and early adolescence (mean age [standard deviation] = 11.94 [0.64] years).

METHODS

Longitudinal Latent Class Analysis was used to derive longitudinal classes based on sleep duration from the Sleep Disturbance Scale for Children. The Child Behavior Checklist characterized behavioral (internalizing: anxious/depressed, withdrawn/depressed, somatic; externalizing: social, thought, attention, rule-breaking, and aggressive) problems. Regression analyses evaluated the effects of sleep classes on neurite density index, ODI, and standard tensor-based metrics (Fractional Anisotropy) changes over time, the focal or widespread effects along the tracts, and whether these effects were associated with behavioral problems.

RESULTS

Insufficient (<9 hours; N = 569) and sufficient sleep (>9 hours; N = 447) groups were identified. Insufficient sleep was associated with worsening fiber coherence (greater ODI) in most tracts, including cingulum bundle (F(1,982) = 9.22, p = .002, Q = 0.009), forceps minor (F(1,982) = 5.30, p = .021, Q = 0.026), and superior longitudinal fasciculus (F(1,982) = 7.41, p = .007, Q = 0.015). These effects were focal, particularly in the frontal portions of the tracts. No other metric was affected (p > .050). In addition, greater ODI in the cingulum bundle was associated with more anxious/depressed problems (β = 0.10, p = .012, Q = 0.036).

DISCUSSION

Our findings suggest that insufficient sleep during this sensitive period affects white matter development, which in turn affects internalizing problems. Our findings support the importance of promoting sufficient sleep during early adolescence.

Gallbladder and biliary pathology: lessons learned from multidisciplinary conference

The radiologic diagnosis of biliary disease can be challenging due to atypical or delayed presentation, rare or less common entities, and imaging overlap of benign and malignant processes. Establishing a specific diagnosis, when possible, is important to avoid progression of infections to sepsis and multiorgan failure, and for appropriate staging and management in cases of malignancy. Gallstones are the most common biliary disease, and along with stone-related complications, including cholecystitis and choledocholithiasis, constitute the majority of acute biliary pathology. Late and atypical manifestations of acute cholecystitis demonstrate imaging overlap with primary gallbladder cholangiocarcinoma, especially with cases of exuberant inflammatory reaction such as xanthogranulomatous cholecystitis. Additional challenging scenarios related to gallbladder disease, that may be benign or malignant, include adjacent fistulas and lymphadenopathy. Dropped gallstones, especially in atypical locations, may be misdiagnosed as neoplastic. Recurrent cholecystitis after cholecystectomy, whether related to subtotal cholecystectomy or to stumpitis, is another entity that can be confusing to the radiologist with a documented history of cholecystectomy. Inflammatory and autoimmune conditions, such as pseudotumors and IgG4 disease, are a less common but not infrequent cause of diagnostic dilemma. Furthermore, biliary strictures and hepatobiliary cystic lesions can be benign or malignant and could constitute a diagnostic and management challenge. The goal of this manuscript is to present the lessons learned from multidisciplinary conferences on the above entities and suggest tips and pearls to maximize the value of radiologists' contribution to patient management.

The Value of Necrotic Area Features in Contrast-Enhanced Ultrasound for Distinguishing Between Benign and Malignant Subpleural Pulmonary Lesions

OBJECTIVE

To analyze Necrotic Area Features of subpleural pulmonary lesions (SPLs) demonstrated by contrast-enhanced ultrasound (CEUS) and investigate their value in differentiating between malignant and benign SPLs.

METHODS

Patients with SPLs who underwent CEUS at our hospital from January to May 2021. The following patient information was recorded: (i) age, (ii) sex, (iii) lesion size, (iv) lesion location, (v) size of necrotic areas and (vi) necrotic area morphology, including sieve-like necrosis, necrotic area with septal enhancement, necrotic area with annular enhancement margins, and necrotic area with burr-like enhancement margins. These parameters were analyzed using univariate and multivariate logistic regression. Subgroup analyses based on lesion size were further conducted using the collected data.

RESULTS

A total of 212 patients with 212 SPLs were enrolled, comprising 99 benign and 113 malignant cases. Significant differences were observed between malignant and benign groups in terms of age, sex, lesion size and necrotic area morphology (all, p < 0.05).

CONCLUSION

Necrotic area's features observed on CEUS were valuable for distinguishing between benign and malignant SPLs. Age, sex, lesion size and the presence of burr-like enhancement margins are identified as independent predictors of malignant lesions.

Human Tooth Crack Image Analysis with Multiple Deep Learning Approaches

Tooth cracks, one of the most common dental diseases, can result in the tooth falling apart without prompt treatment; dentists also have difficulty locating cracks, even with X-ray imaging. Indocyanine green (ICG) assisted near-infrared fluorescence (NIRF) dental imaging technique can solve this problem due to the deep penetration of NIR light and the excellent fluorescence characteristics of ICG. This study extracted 593 human cracked tooth images and 601 non-cracked tooth images from NIR imaging videos. Multiple imaging analysis methods such as classification, object detection, and super-resolution were applied to the dataset for cracked image analysis. Our results showed that machine learning methods could help analyze tooth crack efficiently: the tooth images with cracks and without cracks could be well classified with the pre-trained residual network and squeezenet1_1 models, with a classification accuracy of 88.2% and 94.25%, respectively; the single shot multi-box detector (SSD) was able to recognize cracks, even if the input image was at a different size from the original cracked image; the super-resolution (SR) model, SR-generative adversarial network demonstrated enhanced resolution of crack images using high-resolution concrete crack images as the training dataset. Overall, deep learning model-assisted human crack analysis improves crack identification; the combination of our NIR dental imaging system and deep learning models has the potential to assist dentists in crack diagnosis.

Radiomics analysis of dual-energy CT-derived iodine maps for differentiating malignant from benign thyroid nodules

BACKGROUND

Many thyroid nodules are detected incidentally with the widespread use of sensitive imaging techniques; however, only a fraction of these nodules are malignant, resulting in unnecessary medical expenditures and anxiety. The major challenge is to differentiate benign thyroid nodules from malignant ones. The application of dual-energy computed tomography (DECT) and radiomics provides a new diagnostic approach. Studies applying radiomics from primary tumours on iodine maps to differentiate malignant from benign thyroid nodules are still lacking.

PURPOSE

To determine the ability of an iodine map-based radiomic nomogram in the venous phase for differentiating malignant thyroid nodules from benign nodules.

METHODS

A total of 141 patients with thyroid nodules who underwent DECT were enrolled and randomly assigned to the training and test cohorts between January 2018 and January 2019. The radiomic score (Rad-score) was derived from nine quantitative features of the iodine maps. Stepwise logistic regression analysis was used to develop radiomic, clinical and combined models. Age, normalized iodine concentration (NIC), and cyst changes were used to construct the clinical model. Receiver operating characteristic (ROC) curve analysis, sensitivity and specificity were performed to analyse the ability of the models to predict malignant thyroid nodules. Calibration analysis was used to test the fitness of the models. Decision curve analysis (DCA) and nomogram construction were also performed.

RESULTS

According to the clinical model, age (0.989 [0.984, 0.995]; p < 0.001), NIC (0.778 [0.640, 0.995]; p = 0.01), and cyst changes (0.617 [0.507, 0.751]; p < 0.001) were independently associated with malignant thyroid nodules. According to the combined model, age (0.994 [0.989, 0.999]; p = 0.01), NIC (0.797 [0.674, 0.941]; p = 0.008), cyst changes (0.786 [0.653, 0.947]; p = 0.01), and the rad-score (1.106 [1.070, 1.143]; p < 0.001) were independently associated with malignant thyroid nodules. The combined model achieved satisfactory discrimination in predicting malignant thyroid nodules and had greater predictive value in the training (AUC [areas under the curve], 0.96 vs. 0.87; p = 0.01) and test (AUC, 0.90 vs. 0.79; p = 0.04) cohorts than did the clinical model.

CONCLUSIONS

The radiomics nomogram based on iodine maps is useful to distinguish malignant thyroid nodules from benign thyroid nodules.

Magnetic resonance imaging does not distinguish Kallmann syndrome from normosmic isolated hypogonadotropic hypogonadism

Introduction and objectives

Isolated hypogonadotropic hypogonadism (IHH) may be associated with pituitary gland and olfactory system disorders. We aimed to correlate findings of magnetic resonance imaging (MRI) of the pituitary gland and olfactory system in IHH patients with the patients' olfactory phenotype.

Patients and methods

The present research was a single-center retrospective case-control study. MRI patterns of the pituitary gland and olfactory system were studied in 46 patients, of whom 29 (63%) were classified on the basis of olfactometry as having Kallmann syndrome (KS) (16 patients with anosmia and 13 patients with hyposmia) and 17 (37%) as having normosmic IHH (nIHH). Results were compared with age- and sex-matched healthy controls. Genetic diagnosis was conducted in all IHH patients based on next-generation sequencing.

Results

Almost 70% prevalence of pituitary hypoplasia was observed in IHH subjects. Olfactory bulb (OB) abnormalities were identified in 80.4% of all patients, both the KS (82.8%) and the nIHH (76.5%) subjects. Incidence of unilaterally abnormal, hypoplastic olfactory sulcus (OS) was equally frequent in nIHH and KS. Statistically, piriform cortical thickness was significantly lower in all patient groups than in controls.

Conclusions

MRI cannot exclusively differentiate between KS and nIHH, as both conditions may present with OB and OS abnormalities. A surprisingly high frequency of olfactory system abnormalities was observed in nIHH patients, while anterior pituitary hypoplasia was prevalent across all IHH patients. Notably, OB abnormalities were more predominant in KS patients than in those with nIHH.

The Relevance and Potential Role of Orbital Fat in Inflammatory Orbital Diseases: Implications for Diagnosis and Treatment

The orbit is an important structure within the skull that houses the eye, optic nerve, and extraocular muscles. It also contains adipose/fat tissue, which provides a protective cushion for these components. Inflammatory orbital disease can affect any or all components of the orbit, often arising from various underlying pathologic conditions, including autoimmune, infectious, and vascular diseases. Typical signs and symptoms of orbital inflammation include swelling, redness, pain, discomfort, and potential loss of function. The role of orbital fat in the pathogenesis of inflammatory orbital diseases has not been fully explored. This review aims to provide a comprehensive description of orbital fat, its relevance and the potential role in inflammatory diseases of the orbit, and the use of radiologic imaging studies for evaluating this fat depot in cases of as inflammatory orbital diseases. Additionally, this review discusses the various procedures available for the treatment and management of these conditions. A range of interventions, including pharmacotherapy and surgical procedures, will be evaluated as promising therapeutic options. This review also explores the characteristics and potential applications of orbital fat-derived stem cells, with an emphasis on their regenerative abilities and anti-inflammatory effects. Understanding the role of orbital fat and its contribution to inflammatory orbital diseases is essential for optimizing diagnostic and treatment strategies.

Designing a meditation module to affect etiological and preventive factors in primary hypertensive patients-A pilot study

The aim of the present pilot study is to design, validate, and check the feasibility and efficacy of the designed meditation module on etiological and preventive factors in primary hypertensive patients (PHP). The systematic and detailed meditation module was formulated to prevent the complications of hypertension. The designed module was validated by 5 subject experts in the field of complementary and alternative therapy and research. Content Validity Ratio (CVR), Average Congruency Percentage (ACP), and Content Validity Index were calculated. The intervention was given for 5 days a week for 4 weeks, to 9 PHP to check the feasibility and the efficacy of the module by analyzing biochemical and psychological parameters. A randomized controlled trial is planned ahead with this module as intervention. The designed meditation module had 19 concepts with CVR >0.49 and ACP > 90% which were retained, 2 were modified (CVR 0.6, ACP 80) and 1 was deleted as CVR was <0.49 and ACP < 70%. The feasibility test mean was 93.33 ± 8.66 and the efficacy was tested by increase in the brain-derived neurotrophic factor (BDNF) (p = 0.022) and decrease in anxiety (p = 0.022) and perceived stress (p = 0.016), improvement in emotional quotient (p = 0.011), mental state (p = 0.044), quality of sleep (p = 0.001), quality of life (p = 0.011), and happiness state (p = 0.003). The designed meditation module was found valid by the experts, feasible to patients, and efficient in improving biochemical and psychological parameters among PHP to affect the hypertensive etiological factors and check the progress and complications of the disorder. Trial Registration: CTRI/2022/09/045421.

Treatment of metastatic melanoma with anti-PD-1 and anti-LAG-3 in a kidney transplant recipient

Immune checkpoint inhibitors (ICI) have quickly emerged as standard therapy in multiple cancers, yet their application in organ transplant recipients (OTRs) remains challenging due to risk of graft rejection. In this case, report, we highlight the successful use of a lymphocyte activation gene 3 (LAG-3) inhibitor, relatlimab, in combination with nivolumab (a programmed cell death protein 1 [PD-1] inhibitor) for the treatment of metastatic melanoma in a kidney transplant recipient. The patient developed a complete metabolic response to therapy. LAG-3 expression was notably positive in the renal graft, but negative in the metastatic melanoma tumor tissue. Although the outcome resulted in rapid renal graft rejection, this underscores the need for further research into LAG-3's dual role in cancer therapy and allograft rejection in organ transplant recipients.

Solitary necrotic nodule of the liver: imaging features, differential diagnosis and management

Solitary necrotic nodule of the liver (SNNL) is a rare and benign liver lesion often discovered incidentally. Despite its occurrence, the exact cause of SNNL remains unknown, with various theories proposing traumatic, infectious, degenerative or transformative origins. The variable imaging characteristics of SNNLs frequently lead to misdiagnosis as malignant tumors, prompting patients to undergo unnecessary and high-risk procedures such as biopsies and surgeries. Moreover, biopsies often yield inconclusive results due to the presence of necrotic tissue within the lesion, posing challenges for accurate histologic diagnosis. This review aims to offer guidance on differentiating SNNLs from other liver lesions using multimodality imaging approaches. It will analyze essential imaging steps that should be performed and highlight those that should be avoided to enhance diagnostic accuracy and prevent unnecessary interventions.

The role of the radiologist in the evaluation of male infertility: recommendations of the European Society of Urogenital Radiology-Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for scrotal imaging

OBJECTIVES

The Scrotal and Penile Imaging Working Group (SPIWG) of the European Society of Urogenital Radiology (ESUR) aimed to produce recommendations on the role of the radiologist in the evaluation of male infertility focused on scrotal imaging.

METHODS

The authors independently performed an extensive literature Medline search and a review of the clinical practice and consensus opinion of experts in the field.

RESULTS

Scrotal ultrasound (US) is useful in investigating male infertility. US abnormalities related to abnormal sperm parameters (sperm concentration, total count, motility, and morphology) are low testicular volume (TV), testicular inhomogeneity (TI), cryptorchidism, testicular microlithiasis (TML), high-grade varicocele, bilateral absence of vas deferens, bilateral dilation and echotexture abnormalities of the epididymis. The proposed ESUR-SPIWG recommendations for imaging in the evaluation of male infertility are therefore: to measure TV; investigate TI; perform annual (US) follow-ups up to age 55 in men with a history of cryptorchidism/orchidopexy and/or in men with TML plus "additional risk factors" or with "starry sky" TML; perform scrotal/inguinal US in men with nonpalpable testis; perform scrotal US in men with abnormal sperm parameters to investigate lesions suggestive of tumors; evaluate varicocele in a standardized way; evaluate the presence or absence of vas deferens; investigate the epididymis to detect indirect signs suggesting obstruction and/or inflammation.

CONCLUSIONS

The ESUR-SPIWG recommends investigating infertile men with scrotal US focusing on TV, inhomogeneity, localization, varicocele, vas deferens, and epididymal abnormalities. Cryptorchidism, TML, and lesions should be detected in relation to the risk of testicular tumors.

CLINICAL RELEVANCE STATEMENT

The ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility are useful to standardize the US examination, focus on US abnormalities most associated with abnormal semen parameters in an evidence-based manner, and provide a standardized report to patients.

KEY POINTS

So far, ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility were not available. The ESUR-SPIWG recommends investigating infertile men with scrotal US focusing on testicular volume, inhomogeneity, localization, varicocele, vas deferens and epididymal abnormalities, and assessing cryptorchidism, testicular microlithiasis and lesions in relation to the risk of testicular tumors. The ESUR-SPIWG recommendations on scrotal imaging in the assessment of male infertility are useful to standardize the US examination, focus on US abnormalities most associated with abnormal sperm parameters in an evidence-based manner, and provide a standardized report to patients.

Splenic artery embolization for variceal bleeding in portal hypertension: a systematic review and metanalysis

PURPOSE

Splenic artery embolization (SAE) has emerged as a promising alternative for managing variceal bleeding secondary to portal hypertension (PH). This study aims to elucidate the significance of SAE in managing esophageal variceal bleeding in patients with PH, providing an overview of its efficacy, safety, and role in PH management.

METHODS

A systematic review and meta-analysis were conducted in accordance with PRISMA standards. EMBASE, PubMed, Scopus, and Web of Science databases were searched from inception until April 14, 2024. Original observational and clinical studies on SAE in managing variceal bleeding due to PH were included. Meta-analyses were performed using a random-effects model, and publication bias was assessed using regression and rank correlation tests for funnel plot asymmetry.

RESULTS

Eighteen studies met the inclusion criteria, encompassing 531 patients. The meta-analysis revealed a significant reduction in variceal bleeding post-SAE (RD = -0.86; 95% CI: -0.97, -0.75; p < 0.001). Complete resolution of varices was observed in 26% of patients (95% CI: 11%, 45%; p = 0.006), and 78% showed improvement in variceal grade (95% CI: 43%, 88%; p < 0.001). SAE significantly increased platelet counts (SMD = 1.15; 95% CI: 0.63, 1.68; p < 0.001). Common complications included post-embolization syndrome, and the overall complication rate was low.

CONCLUSIONS

This systematic review and meta-analysis study supports the efficacy and safety of SAE in managing variceal bleeding due to PH, demonstrating significant reductions in bleeding, improvements in variceal grade, and increases in platelet counts.

Value of Contrast-Enhanced Ultrasound in the Diagnosis of Clear Cell Renal Cell Carcinoma: A Meta-Analysis

This meta-analysis aims to evaluate the accuracy of contrast-enhanced ultrasound (CEUS) in diagnosing clear cell renal cell carcinoma (ccRCC). Literature published in five databases was searched. Twelve studies were included. The pooled results showed sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CEUS were 79% (95% CI: 75%-83%), 84% (95% CI: 80%-88%), 4.97 (95% CI: 3.86-6.39), 0.24 (95% CI: 0.20-0.30), and 20.32 (95% CI: 13.84-29.84), respectively. The area under the summary receiver operating characteristic curve was 0.86. In conclusion, CEUS demonstrates high sensitivity and specificity in diagnosing ccRCC, showing good diagnostic accuracy.

Ultrasound innovations in abdominal radiology: multiparametic imaging in liver transplantation

PURPOSE

Ultrasound plays a central role in liver transplant evaluation. Acute, subacute, and chronic complications can be readily identified using grayscale and color Doppler ultrasound. Contrast-enhanced ultrasound adds a new dimension to liver transplant evaluation, depicting vascular and parenchymal processes with exquisite detail. In addition, emerging evidence suggests that contrast-enhanced ultrasound may allow for localization of biliary leak in select patients. We aimed to assess the use of multiparametric ultrasound-including grayscale, color and spectral Doppler, and contrast-enhanced ultrasound-in the setting of liver transplantation.

METHODS

A literature review was performed using the MEDLINE bibliographic database through the National Library of Medicine. The following terms were searched and relevant citations assessed: "abdominal ultrasound," "contrast-enhanced ultrasound," "liver transplant," and "ultrasound."

RESULTS

Grayscale and color Doppler ultrasound represent the mainstay imaging modalities for postoperative liver transplant evaluation. The addition of contrast enhancement plays a complementary role and can provide valuable information related to the allograft vasculature, parenchyma, and biliary tree. The appropriate implementation of grayscale, color Doppler, and contrast-enhanced ultrasound can optimize sensitivity, specificity, and accuracy for the detection of liver transplantation complications, including hepatic artery stenosis, biliary leakage, and infection.

CONCLUSION

Multimodal sonographic evaluation is essential to identify postoperative complications in liver transplant recipients. Contrast-enhanced ultrasound may be of value in challenging cases, providing excellent anatomic delineation and reducing the risk of false-positive and false-negative diagnoses. A broad familiarity with appropriate applications of both nonenhanced and contrast-enhanced ultrasound may help radiologists optimize allograft assessment and improve patient outcomes.

Clinical scenarios of unusual FDG uptake in muscle

Glucose is essential for muscle function and its uptake is influenced by aerobic conditions, hormonal regulations, and exercise. 18F-Fluorodeoxyglucose (FDG), a glucose analog used in PET/CT scans, can show incidental uptake in muscles, and thus careful interpretation is required to avoid misdiagnosis. Proper patient preparation and understanding of the clinical scenarios affecting FDG uptake are crucial for accurate PET/CT interpretation, thus ensuring precise diagnoses and avoiding unnecessary interventions. This review emphasizes the need to consider patient-specific factors in evaluating incidental FDG uptake in muscle.

Attention-Based Q-Space Deep Learning Generalized for Accelerated Diffusion Magnetic Resonance Imaging

Diffusion magnetic resonance imaging (dMRI) is a non-invasive method for capturing the microanatomical information of tissues by measuring the diffusion weighted signals along multiple directions, which is widely used in the quantification of microstructures. Obtaining microscopic parameters requires dense sampling in the q space, leading to significant time consumption. The most popular approach to accelerating dMRI acquisition is to undersample the q-space data, along with applying deep learning methods to reconstruct quantitative diffusion parameters. However, the reliance on a predetermined q-space sampling strategy often constrains traditional deep learning-based reconstructions. The present study proposed a novel deep learning model, named attention-based q-space deep learning (aqDL), to implement the reconstruction with variable q-space sampling strategies. The aqDL maps dMRI data from different scanning strategies onto a common feature space by using a series of Transformer encoders. The latent features are employed to reconstruct dMRI parameters via a multilayer perceptron. The performance of the aqDL model was assessed utilizing the Human Connectome Project datasets at varying undersampling numbers. To validate its generalizability, the model was further tested on two additional independent datasets. Our results showed that aqDL consistently achieves the highest reconstruction accuracy at various undersampling numbers, regardless of whether variable or predetermined q-space scanning strategies are employed. These findings suggest that aqDL has the potential to be used on general clinical dMRI datasets.

An intuitive guidewire control mechanism for robotic intervention

PURPOSE

Teleoperated Interventional Robotic systems (TIRs) are developed to reduce radiation exposure and physical stress of the physicians and enhance device manipulation accuracy and stability. Nevertheless, TIRs are not widely adopted, partly due to the lack of intuitive control interfaces. Current TIR interfaces like joysticks, keyboards, and touchscreens differ significantly from traditional manual techniques, resulting in a shallow, longer learning curve. To this end, this research introduces a novel control mechanism for intuitive operation and seamless adoption of TIRs.

METHODS

An off-the-shelf medical torque device augmented with a micro-electromagnetic tracker was proposed as the control interface to preserve the tactile sensation and muscle memory integral to interventionalists' proficiency. The control inputs to drive the TIR were extracted via real-time motion mapping of the interface. To verify the efficacy of the proposed control mechanism to accurately operate the TIR, evaluation experiments using industrial grade encoders were conducted.

RESULTS

A mean tracking error of 0.32 ± 0.12 mm in linear and 0.54 ± 0.07° in angular direction were achieved. The time lag in tracking was found to be 125 ms on average using pade approximation. Ergonomically, the developed control interface is 3.5 mm diametrically larger, and 4.5 g. heavier compared to traditional torque devices.

CONCLUSION

With uncanny resemblance to traditional torque devices while maintaining results comparable to state-of-the-art commercially available TIRs, this research successfully provides an intuitive control interface for potential wider clinical adoption of robot-assisted interventions.

Improved image quality and micronodule detection in thyroid spectral computed tomography using modified swimmer's position

Background

Spectral computed tomography (CT) can be used as a valuable complement to ultrasound (US) in the detection of thyroid nodules. This study sought to investigate the effects of various arm positions during thyroid spectral CT scans in terms of radiation exposure, image quality, and micronodule detection (≤10 mm).

Methods

A total of 180 patients (mean age: 48 years; 136 females) who underwent thyroid spectral CT were assigned to the traditional position (TDN; n=60), swimmer's position (SWIM; n=60), and modified swimmer's position (M-SWIM; n=60) groups. Image quality in the plain, arterial, and venous phases was assessed using a 4-point grading scale, the signal-to-noise ratio (SNR), and the contrast-to-noise ratio (CNR). Radiation exposure was assessed using the volume computed tomography dose index (CTDIvol), dose-length product (DLP), effective dose of the neck (EDN), and effective dose of the thyroid (EDT). The micronodule detection rates for spectral CT and US were compared using the pathology detection rate as a reference.

Results

The M-SWIM group had a significantly higher proportion of 4-point grading, SNR, and CNR than the TDN and SWIM groups (all P<0.001). The CTDIvol, DLP, EDN, and EDT were similar among the three groups (all P>0.05). The micronodule detection rate was higher in the M-SWIM group than the TDN and SWIM groups (total: 90.6% vs. 70.1% vs. 46.8%; benign: 89.1% vs. 66.7% vs. 45.5%; malignant: 94.3% vs. 79.5% vs. 51.5%; all P<0.001), but comparable to that of the US group (total: 90.6% vs. 91.2%; benign: 89.1% vs. 90.6%; malignant: 94.3% vs. 92.5%; all P>0.05).

Conclusions

The proposed M-SWIM improved the image quality of thyroid spectral CT without increasing the radiation dose, and significantly enhanced the micronodule detection rate.

Imaging-based noninvasive liver disease assessment for staging liver fibrosis in chronic liver disease: A systematic review supporting the AASLD Practice Guideline

BACKGROUND AND AIMS

Transient elastography (TE), shear wave elastography, and/or magnetic resonance elastography (MRE), each providing liver stiffness measurement (LSM), are the most studied imaging-based noninvasive liver disease assessment (NILDA) techniques. To support the American Association for the Study of Liver Diseases guidelines on NILDA, we summarized the evidence on the accuracy of these LSM methods to stage liver fibrosis (F).

APPROACH AND RESULTS

A comprehensive search for studies assessing LSM by TE, shear wave elastography, or MRE for the identification of significant fibrosis (F2-4), advanced fibrosis (F3-4), or cirrhosis (F4), using histopathology as the standard of reference by liver disease etiology in adults or children from inception to April 2022 was performed. We excluded studies with <50 patients with a single disease entity and mixed liver disease etiologies (with the exception of HCV/HIV coinfection). Out of 9447 studies, 240 with 61,193 patients were included in this systematic review. In adults, sensitivities for the identification of F2-4 ranged from 51% to 95%, for F3-4 from 70% to 100%, and for F4 from 60% to 100% across all techniques/diseases, whereas specificities ranged from 36% to 100%, 74% to 100%, and 67% to 99%, respectively. The largest body of evidence available was for TE; MRE appeared to be the most accurate method. Imaging-based NILDA outperformed blood-based NILDA in most comparisons, particularly for the identification of F3-4/F4. In the pediatric population, imaging-based NILDA is likely as accurate as in adults.

CONCLUSIONS

LSM from TE, shear wave elastography, and MRE shows acceptable to outstanding accuracy for the detection of liver fibrosis across various liver disease etiologies. Accuracy increased from F2-4 to F3-4 and was the highest for F4. Further research is needed to better standardize the use of imaging-based NILDA, particularly in pediatric liver diseases.

Preclinical testing of a new radiofrequency ablation device in a porcine perianal fistula model

PURPOSE

Anorectal fistulas present a treatment challenge, with conventional surgical methods potentially resulting in complications such as fecal incontinence. To improve patient outcomes, more effective and minimally invasive therapies are critically needed. In this study, an optimal porcine model for the creation of anorectal fistulas was developed and used to evaluate the efficacy of radiofrequency ablation (RFA) therapy.

METHODS

Two distinct but related experiments were conducted. In the first experiment, a reliable and standardized porcine anorectal fistula model was developed. In the second, the healing process was assessed, and outcomes were compared between the RFA-treated group and the control group using the established porcine model.

RESULTS

The results indicated that a 3.5-cm fistula tract length and a 14-day evaluation period following seton removal are optimal for the porcine anorectal fistula model. In the second experiment, the RFA group tended to exhibit better outcomes regarding fistula closure, although the differences were not statistically significant. Histopathologically, no significant difference in inflammation grade was observed between groups; however, scar tissue was more predominant in the RFA group.

CONCLUSIONS

The findings suggest that RFA therapy may offer potential benefits in the treatment of anorectal fistulas, as demonstrated using a porcine model. To validate these results and explore the mechanisms of action underlying RFA therapy for anorectal fistulas, further research involving larger sample sizes and a more robust study design is required.

Partial splenic embolization with embosphere microspheres (700-900 µm) for the treatment of hypersplenism: comparison of selective superior splenic artery embolization and inferior splenic artery embolization

OBJECTIVE

To compare clinical outcomes of superior versus inferior splenic artery embolization in partial splenic embolization (PSE) and identify predictors of major complications.

MATERIAL AND METHODS

This retrospective case-control study included 73 patients who underwent PSE between May 2005 and April 2021. They were divided into two groups: the superior and middle splenic artery embolization group (Group A, n = 37) and the inferior and middle splenic artery embolization group (Group B, n = 36). Outcome differences and major complications between the groups were assessed. Logistic regression was used to analyze potential predictors of major complications, and the optimal cutoff value for splenic embolization rates was determined using the Youden index.

RESULTS

There were no significant differences in laboratory and radiological outcomes between the two groups. Group A had a significantly lower incidence of major complications than Group B (p = 0.049), a lower Visual Analog Scale (VAS) score for pain (p = 0.036), and a shorter hospital stay (p = 0.022). Independent risk factors for major complications included inferior and middle splenic artery embolization (odds ratio [OR] = 3.672; 95% confidence interval [CI] = 1.028-13.120; p = 0.045) and a higher spleen embolization rate (OR = 1.108; 95% CI = 1.003-1.224; p = 0.044). The optimal cutoff for spleen embolization rate to predict major complications was 59.93% (sensitivity 77.8%, specificity 63.6%).

CONCLUSION

Using 500-700 µm microspheres for PSE, targeting the middle and superior splenic artery yields similar effects to targeting the middle and inferior artery, but results in lower rates of major complications and shorter hospital stays. To effectively minimize the risk of major complications, the embolization rate should be kept below 59.93%, regardless of the target vessel.

18F-FDG PET/CT in Inflammation and Infection: Procedural Guideline by the Korean Society of Nuclear Medicine

Abstract

This guideline outlines the use of 18F-fluoro-2-deoxyglucose positron emission tomography / computed tomography for the diagnosis and management of infectious and inflammatory diseases. It provides detailed recommendations for healthcare providers on patient preparation, imaging procedures, and the interpretation of results. Adapted from international standards and tailored to local clinical practices, the guideline emphasizes safety, quality control, and effective use of the technology in various conditions, including spinal infections, diabetic foot, osteomyelitis, vasculitis, and cardiac inflammation. The aim is to assist nuclear medicine professionals in delivering accurate diagnoses and improving patient outcomes while allowing flexibility to adapt to individual patient needs, technological advancements, and evolving medical knowledge. This document is a comprehensive resource for enhancing the quality and safety of 18F-fluoro-2-deoxyglucose positron emission tomography / computed tomography for the evaluation of infectious and inflammatory diseases.

Preamble

The Korean Society of Nuclear Medicine (KSNM) was established in 1961 to promote the clinical and technological advancement of nuclear medicine in South Korea, with members that include nuclear medicine physicians and associated scientists. The KSNM regularly formulates and revises procedural guidelines for nuclear medicine examinations to enhance the field and improve the quality of patient care. These guidelines are designed to support healthcare professionals in providing appropriate medical care to patients. However, they are not immutable rules or mandatory requirements for conducting examinations.Therefore, KSNM states that these guidelines should not be used in legal actions challenging a healthcare professional's medical decisions. The ultimate judgment regarding specific procedures or appropriate measures should be made by nuclear medicine physicians, considering the unique circumstances of each case. Deviation from these guidelines does not imply substandard medical practice. Rather, reasonable judgments differing from the guidelines can be made based on the patient's condition, available resources, and advancements in knowledge or technology. Due to the diversity and complexity of patients, it is often challenging to predict the most appropriate diagnostic and accurate therapeutic responses. Thus, adherence to these guidelines does not always guarantee an exact diagnosis or successful outcomes.The purpose of this guideline is to assist healthcare providers in making reasonable decisions and conducting effective and safe examinations based on current medical knowledge, available resources, and patient needs when performing 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) examinations for infectious/inflammatory diseases.

Prediction of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy based on multifrequency magnetic resonance elastography

BACKGROUND

Clinically relevant postoperative pancreatic fistula (CR-POPF) is the major complication of pancreatoduodenectomy, and the pancreatic texture is one of the potential affecting factors. Multifrequency magnetic resonance elastography (MRE) is a novel technique for measuring tissue stiffness, but its value in predicting CR-POPF preoperatively has not been well documented.

METHODS

A total of 70 patients who underwent multifrequency MRE before pancreatoduodenectomy between July 2021 and April 2024 were retrospectively recruited into the study. The parameters of MRE, shear wave speed (c) and phase angle (φ), and clinical data were collected. Logistic regression and the receiver operating characteristic curve analyses were used to assess the performance of multifrequency MRE in predicting CR-POPF.

RESULTS

CR-POPF was developed in 14 of 70 patients (20%), all categorized as grade B. The CR-POPF group had significantly lower c (1.339 ± 0.210 m/s) and longer hospital stays (21 [IQR, 15.50-37.75] days) than the no-CR-POPF group. The MRE parameters, c and φ, were moderately correlated with pancreas stiffness (eta2 for φ = 0.189 and eta2 for c = 0.106). Dilated major pancreatic duct (MPD ≥ 3 mm) and higher c were independently associated with a lower risk of CR-POPF in univariant and multivariant analyses (odds ratio [OR] for c, 0.041 [95% CI, 0.002-0.879]; OR for dilated MPD, 0.129 [95% CI, 0.022-0.768]). The area under the curve (AUC) of the predictive model based on c and MPD diameter was 0.786, which was better than the fistula risk score (FRS) (AUC = 0.587) and alternative FRS (AUC = 0.556) in our center, with the DeLong test P = .028 and P = .002, respectively.

CONCLUSION

The MRE parameters were associated with pancreatic stiffness, and c was an independent predictor of CR-POPF after pancreatoduodenectomy.

Appearance of the Upper Urinary System After Treatment

Renal cell carcinoma and upper tract urothelial cancer are increasing in incidence. Rates of local recurrence and complications vary with the treatment modality, but the imaging appearance of recurrence and complications is similar no matter the method of local treatment. The use of contrast-enhanced, multiphase imaging is recommended to best evaluate the treatment bed for recurrence and complications. In this article, we cover the most common current local treatments for these cancers along with the patterns of recurrence and complications.

Relationship of Structural Abnormalities of Papillary Muscles to the Site of Origin of Ventricular Arrhythmias

BACKGROUND

Arrhythmias originating from papillary muscles (PAPs) can be challenging when targeted with catheter ablation. The prevalence and impact of structural abnormalities on PAPs in patients with focal PAP arrhythmias is unknown.

OBJECTIVES

The purpose of this study was to analyze, in a consecutive patient series with focal PAP arrhythmias, the impact of structural abnormalities detected by multimodality imaging.

METHODS

In a series of 43 consecutive patients with focal PAP arrhythmias referred for ablation, the prevalence and location of structural abnormalities on PAPs were assessed with cardiac magnetic resonance imaging, computed tomographic angiography and intracardiac echocardiography (ICE). Sites of origin of ventricular arrhythmias (VAs) were correlated with structural abnormalities.

RESULTS

On PAPs, late gadolinium enhancement (LGE) was present on cardiac magnetic resonance imaging in 19 of 43 patients, calcifications on computed tomography in 2 of 43 and on ICE in 3 of 43 patients, and increased echogenicity on ICE in 39 of 43 patients. A total of 141 focal PAP arrhythmias were identified, and VA target sites were localized adjacent to areas with increased echogenicity on ICE for 59 of 141 (44%) VAs, adjacent to LGE for 35 of 141 (25%) VAs, and adjacent to calcifications for 14 of 141 (10%) VAs. At least one VA target site was localized to areas of structural abnormalities in 32 of 43 (74%) patients.

CONCLUSIONS

Multimodality imaging identifies arrhythmogenic PAPs preprocedurally and in real time during the ablation procedure in most patients. Increased echogenicity, LGE, and calcifications are often seen on PAPs in patients with focal PAP arrhythmias and can indicate the site of origin.

Reduction of Streak Artifacts in the Superior Vena Cava for Better Visualization of Mediastinal Structures Through Virtual Monoenergetic Reconstructions Using a Photon-counting Detector Computed Tomography

PURPOSE

Computed tomography (CT) is crucial in oncologic imaging for precise diagnosis and staging. Beam-hardening artifacts from contrast media in the superior vena cava can degrade image quality and obscure adjacent structures, complicating lymph node assessment. This study examines the use of virtual monoenergetic reconstruction with photon-counting detector CT (photon-counting CT) to mitigate these artifacts.

MATERIALS AND METHODS

The retrospective study included 50 patients who underwent thoracoabdominal scans. Virtual monoenergetic reconstructions at nine keV levels (60 to 140 keV) were analyzed for Hounsfield Unit (HU) stability, image noise, and artifact index in various regions of interest (ROIs): mediastinal adipose tissue (ROI 1 to 3) and vascular stations (ROI 4 to 6) were compared with reference tissue (ROI 7 to 8). The diagnostic image quality of the keV levels was assessed using a 5-point Likert Scale.

RESULTS

Lower keV values (60 to 80) exhibited higher image noise and lower HU stability in mediastinal adipose tissue compared with higher energies, with optimal noise reduction observed at 130 keV (ROI 1 to 3). HU stability in vascular structures (ROI 4 to 6) significantly improved above 80 keV, with the best performance at 140 keV. Artifact levels decreased progressively from 60 to 140 keV. Visually, keV levels of 110 keV (96% Likert ≥4) and 120 keV (60% Likert 4) were rated most diagnostically valuable, consistent with technical findings.

CONCLUSION

Virtual monoenergetic reconstructions with photon-counting CT effectively reduce beam-hardening artifacts near the superior vena cava, enhancing the visualization of lymph nodes and adjacent structures. This technology advances oncologic imaging by improving diagnostic accuracy in areas previously affected by artifact-related image degradation.

Ratio of Skeletal Muscle Mass to Visceral Fat Area Is a Useful Marker for Assessing Left Ventricular Diastolic Dysfunction among Koreans with Preserved Ejection Fraction: An Analysis of the Random Forest Model

Background

Although the presence of both obesity and reduced muscle mass presents a dual metabolic burden and additively has a negative effect on a variety of cardiometabolic parameters, data regarding the associations between their combined effects and left ventricular diastolic function are limited. This study investigated the association between the ratio of skeletal muscle mass to visceral fat area (SVR) and left ventricular diastolic dysfunction (LVDD) in patients with preserved ejection fraction using random forest machine learning.

Methods

In total, 1,070 participants with preserved left ventricular ejection fraction who underwent comprehensive health examinations, including transthoracic echocardiography and bioimpedance body composition analysis, were enrolled. SVR was calculated as an index of sarcopenic obesity by dividing the appendicular skeletal muscle mass by the visceral fat area.

Results

In the random forest model, age and SVR were the most powerful predictors of LVDD. Multivariate logistic regression analysis demonstrated that older age (adjusted odds ratio [OR], 1.11; 95% confidence interval [CI], 1.07 to 1.15) and lower SVR (adjusted OR, 0.08; 95% CI, 0.01 to 0.57) were independent risk factors for LVDD. SVR showed a significant improvement in predictive performance and fair predictability for LVDD, with the highest area under the curve noted in both men and women, with statistical significance. In non-obese and metabolically healthy individuals, the lowest SVR tertile was associated with a greater risk of LVDD compared to the highest SVR tertile.

Conclusion

Decreased muscle mass and increased visceral fat were significantly associated with LVDD compared to obesity, body fat composition, and body muscle composition indices.

A Case Series Focusing on Blunt Traumatic Diaphragm Injury at a Level 1 Trauma Center

Introduction: Detection of blunt traumatic diaphragm injury (TDI) can be challenging in the absence of surgical exploration. Our objective is to study the mechanisms of injury and detection modes for patients with blunt TDI. Methods: This is a single-center, retrospective review conducted in a level 1 trauma center from 2016 to 2023, inclusive. We identified seven patients with blunt TDI using the primary mechanisms and trauma type. Results: Out of seven patients, two were associated with motor vehicle collisions, four were pedestrians struck, and one fell down the stairs. The mean ISS was 48.4 (29-75). Of the seven patients with blunt TDI, four died in the trauma bay-two from traumatic arrest and two died spontaneously. Multiple rib fractures were one of the common injury patterns in six cases, whereas in the remaining case, blunt TDI was confirmed at laparotomy and repaired. One patient died two days after admission. Of the two patients who survived, one had a TDI identified during video-assisted thoracic surgery (VATS) for retained hemothorax, and one patient had a TDI repaired during emergent exploratory laparotomy for other injuries. In the remaining four patients, blunt TDI was confirmed based on their autopsy reports. Conclusions: Injuries in all seven cases were sustained with a high-energy injury mechanism. Multiple rib fractures were reported in six cases. Based on our findings, we recommend that clinicians maintain a high level of suspicion for blunt TDI in patients with thoracoabdominal trauma, especially in cases with rib fractures or high-impact trauma.

Trends in dentomaxillofacial radiology

Oral and maxillofacial diagnostic imaging is of paramount importance in dental clinical diagnosis, treatment planning, and follow-up procedures. Periapical radiographic examination and numerous panoramic systems are used in routine clinical dental practice. Cone beam CT is widely used and currently the method of choice in oral and maxillofacial implantology, endodontics, maxillofacial surgery, periodontics, degenerative temporomandibular joint disease, orthodontics, airway studies, sleep disorders, and forensic dentistry. Another innovative laboratory research tool that offers three-dimensional (3D) detailed high-resolution images of in vitro teeth and neighboring structures with submicrometric accuracy is microcomputed tomography. Ultra-high radiation doses, long scanning times, and high costs preclude its routine clinical use. In response to the high demand for a technique that could provide real-time images using a cost-effective, rapid, user-friendly, and portable technique without ionizing radiation, some authors proposed ultrasound imaging methods as an alternative to X-ray imaging techniques. Ultrasonography can be used in the dentomaxillofacial region for various diagnostic purposes such as salivary gland and superficial tissue examination. Recently, dedicated dental magnetic resonance imaging with appropriate software, hardware, sequences, and field of view tailored to fit dentomaxillofacial anatomy was introduced. Lately, 3D printing technologies and their application in dentistry has attracted attention. During 3D printing a given material is added in successive layers to create a 3D object. The application of this technology has the potential to decrease operation time and minimize operator bias and the possibility of procedural errors. Another hot topic regarding dentomaxillofacial radiology is artificial intelligence, which is a field related to computer science dedicated to developing systems or machines that can perform tasks traditionally associated with human intelligence. It is obvious that further investigation and research in the field of dentomaxillofacial radiology will make great contributions to diagnostic imaging for various dental specialties.

Comparison of the effectiveness of intra-infrapatellar fat pad and intra-articular glucocorticoid injection in knee osteoarthritis patients with Hoffa's synovitis: protocol for a multicentre randomised controlled trial

INTRODUCTION

The infrapatellar fat pad and synovium are the sites of immune cell infiltration and the origin of proinflammation. Studies have shown that Hoffa's synovitis may be a sign of early-stage osteoarthritis (OA). However, there have been no effective interventions specifically for Hoffa's synovitis.

METHODS AND ANALYSIS

We will conduct a multicentre, multi-blind (participant, physician, outcome assessor and data analyst blinded) randomised controlled trial to compare the effectiveness of an intra-infrapatellar fat glucocorticoid versus an intra-articular injection for Hoffa's synovitis in patients with knee OA. We will recruit 236 knee OA patients with Hoffa's synovitis at outpatient clinics in three centres. We will randomly allocate them to two groups in a 1:1 ratio. One group will receive ultrasound-guided injection of 40 mg (1 mL) triamcinolone acetonide into the infrapatellar fat pad; the other group will receive ultrasound-guided injection of 40 mg (1 mL) triamcinolone acetonide into the knee joint cavity. All patients will be followed up at 2, 4, 8, 12 and 24 weeks after the injection. Primary outcomes are (1) Hoffa's synovitis improvement rate, measured with the MRI Osteoarthritis Knee Score system (superiority outcome) at 24 weeks and (2) pain intensity, measured with the Western Ontario and McMasters University Osteoarthritis Index (WOMAC) at 2 weeks post-injection. Secondary outcomes include Hoffa's synovitis score at 2 weeks post-injection, pain intensity with the numerical rating scale, WOMAC questionnaire score improvements (function, joint stiffness and total score), improvement rates in effusion synovitis at 2 and 24 weeks, articular cartilage thickness changes at 2 and 24 weeks, Intermittent and Constant Osteoarthritis Pain score, quality of life measured with the EuroQol-5D, OARSI-OMERACT response indicators, co-interventions and side effects at 2, 4, 8, 12 and 24 weeks.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the Medical Ethics Committee of the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (2023-178). Written informed consent will be obtained from all patients prior to data collection. The findings of this research will be shared through presentations at academic conferences and publications in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ChiCTR2400080474.

Precision oncology: The role of minimally-invasive ablation therapy in the management of solid organ tumors

Solid organ tumors present a significant healthcare challenge, both economically and logistically, due to their high incidence and treatment complexity. In 2023, out of the 1.9 million new cancer cases in the United States, over 73% were solid organ tumors. Ablative therapies offer minimally invasive solutions for malignant tissue destruction in situ, often with reduced cost and morbidity compared to surgical resection. This review examines the current Food and Drug Administration-approved locoregional ablative therapies (radiofrequency, microwave, cryogenic, high-intensity focused ultrasound, histotripsy) and their evolving role in cancer care. Data were collected through a comprehensive survey of the PubMed-indexed literature on tumor ablation techniques, their clinical indications, and outcomes. Over time, emerging clinical data will help establish these therapies as the standard of care in solid organ tumor treatment, supported by improved long-term outcomes and progression-free survival.

Embolization of indirect carotid cavernous fistulas via the vein of Labbé using contralateral approach

In our report, we present the case of a 60-year-old adult with symptomatic indirect carotid-cavernous fistulas (CCFs). All venous outflow routes from the cavernous sinus were absent except for an engorged left superficial middle cerebral vein, which extended through the left vein of Labbé to the left transverse sinus and then to right transverse-sigmoid sinus. We approached the diseased cavernous sinus retrogradely, starting from the right femoral vein and passing through the right transverse-sigmoid sinus, left transverse sinus, and left vein of Labbé, ultimately reaching the left CCFs. Embolization was performed using coils, successfully obliterating the fistulas without complications. This case represents the second reported approach through the vein of Labbé for CCFs and the first using a trans-Labbé vein from a contralateral approach (video 1), proving advantageous by avoiding an acute angle between the vein of Labbé and the ipsilateral sigmoid sinus.1-6neurintsurg;jnis-2024-022311v3/V1F1V1Video 1Embolization of CCF using a Trans-Labbé vein from a contralateral approach.‍.

Comparison of the diagnostic performance of non-contrast MR angiography and planar V/Q scintigraphy for pulmonary embolism: a systematic review and meta-analysis

OBJECTIVES

To conduct a meta-analysis of the diagnostic performance of non-contrast magnetic resonance pulmonary angiography (NC-MRPA) and ventilation-perfusion (V/Q) scintigraphy for the detection of acute pulmonary embolism (PE).

MATERIALS AND METHODS

Systematic searches of electronic databases were conducted from 2000 to 2024. Primary outcomes were per-patient sensitivity and specificity of NC-MRPA and V/Q scintigraphy. The pooled sensitivities, specificities, and 95% confidence intervals (95% CI) were calculated using a random-effect analysis. Summary receiver-operating characteristic (SROC) curves and the area under the curve (AUC) were obtained.

RESULTS

A total of 3709 studies (1941 NC-MRPA studies) were identified through systematic searches, with eight published MRI and nine published V/Q investigations meeting inclusion criteria. The results showed that NC-MRPA had a pooled sensitivity of 0.88 (95% CI: 0.83-0.91) and specificity of 0.97 (95% CI: 0.93-0.98), yielding an AUC of 0.92 (95% CI: 0.85-0.96). V/Q scanning had a pooled sensitivity of 0.81 (95% CI: 0.76-0.85) and specificity of 0.84 (95% CI: 0.74-0.91), yielding an AUC of 0.87 (95% CI: 0.75-0.91). The pooled proportion of non-diagnostic tests for V/Q scans (34.7%, 95% CI: 30.8-38.7) was greater than that of NC-MRPA studies (3.31%, 95% CI: 1.65-4.97).

CONCLUSION

This meta-analysis suggests that NC-MRPA is more specific than V/Q scintigraphy for the detection of PE, with comparable accuracy and sensitivity. NC-MRPA yielded fewer non-diagnostic scans than V/Q scintigraphy and is a feasible alternative imaging modality for diagnosing PE in patients for whom intravenous contrast administration poses a substantive risk.

KEY POINTS

Question V/Q lung scintigraphy has been used as a reserve, alternative modality for patients who cannot undergo CT pulmonary angiography. Findings Non-contrast MR angiography (MRA) is a feasible alternative for diagnosing PE in patients for whom intravenous iodinated contrast administration poses a substantial risk. Clinical relevance Non-contrast MRA provides similar sensitivity and superior specificity to V/Q scintigraphy for diagnosing PE, without ionizing radiation exposure.

Radiological and anatomical evaluation of the internal venous system in the context of access to the third ventricle - proposal of a new classification

BACKGROUND

The internal venous system of the brain is a crucial anatomical landmark during accesses to the third ventricle through the foramen of Monro. Many classifications based on radiological assessment of the system have been developed, but they tend to be descriptive and do not highlight favorable anatomical variants. The aim of our study was to create a system based on morphometric measurements to facilitate preoperative decision-making regarding access to third ventricle tumors.

METHODS

We conducted an analysis of 119 MRI scans with SWI sequence using BrainLab software to create a model of the ventricular system, which allowed us to perform radiological measurements. We then validated these findings anatomically using 32 human brain specimens. The analyzed structures included the foramen of Monro (FM), the anterior septal vein (ASV), the thalamostriate vein (TSV), the venous angle (VA), the internal cerebral vein (ICV), and the distance between the FM and VA.

RESULTS

Based on the radiological analysis, we identified 9 internal venous systems, accounting for variations in each analyzed structure. The statistical analysis revealed no differences in the frequency of subtypes between radiological and anatomical studies (p = 0.097), nor in the occurrence of false venous angles (p = 0.520). We identified venous configurations that, in our assessment, are unfavorable in the context of accessing the third ventricle.

CONCLUSION

The resulting classification accounts for significant clinical anatomical variations and, for the first time, provides specific morphometric values for each anatomical subtype. Consequently, it serves as a reproducible reference framework for preoperative planning of access to the third ventricle.

Quality of referrals and adherence to guidelines for adult patients with minimal to moderate head injuries in a selection of Norwegian hospitals

PURPOSE

This study aimed to assess adherence to the Scandinavian guidelines, the justification of referrals, and the quality of referrals of patients with mild, minimal, and moderate head injuries in a selection of Norwegian hospitals.

METHODS

We collected 283 head CT referrals for head trauma patients at one hospital trust in Norway in 2022. The data included the patients' sex, age, and the referral text. Six radiologists independently assessed all referrals using a registration form developed based on the Scandinavian guidelines for patients with mild, minimal, and moderate head injuries and general referral guidelines. Descriptive statistics was used to analyze data on adherence to guidelines, while Gwet's AC1/2 was used to test the agreement between the raters.

RESULTS

This study found that 65% of referrals were assessed to be justified according to the guideline by at least one rater, while 17% were rated justified outside the guideline. In 52%, at least one rater required more information. There was good to moderate interrater agreement.

CONCLUSIONS

Adherence to the Scandinavian guidelines and the quality of referrals of patients with mild, minimal, and moderate head injuries are low. Training and using S100B is recommended to improve the justification rate and quality of patient care.

Molecular imaging of viral pathogenesis and opportunities for the future

Molecular imaging is used in clinical and research settings. Since tools to study viral pathogenesis longitudinally and systemically are limited, molecular imaging is an attractive and largely unexplored tool. This review discusses molecular imaging probes and techniques for studying viruses, particularly those currently used in oncology that are applicable to virology. Expanding the repertoire of probes to better detect viral disease may make imaging even more valuable in (pre-)clinical settings.

Distinguished Frontal White Matter Abnormalities Between Psychotic and Nonpsychotic Bipolar Disorders in a Pilot Study

BACKGROUND/OBJECTIVES

Recent studies indicate extensive shared white matter (WM) abnormalities between bipolar disorder (BD) and schizophrenia (SZ). However, the heterogeneity of WM in BD in terms of the presence of psychosis remains a critical issue for exploring the boundaries between BD and SZ. Previous studies comparing WM microstructures in psychotic and nonpsychotic BDs (PBD and NPBD) have resulted in limited findings, probably due to subtle changes, emphasizing the need for further investigation.

METHODS

Diffusion tensor imaging measures were obtained from 8 individuals with PBD, 8 with NPBD, and 22 healthy controls (HC), matched for age, gender, handedness, and educational years. Group comparisons were conducted using tract-based spatial statistics (TBSS). The most significant voxels showing differences between PBD and HC in the TBSS analyses were defined as a TBSS-ROI and subsequently analyzed.

RESULTS

Increased radial diffusivity (RD) in PBD compared to NPBD (p < 0.006; d = 1.706) was observed in TBSS-ROI, distributed in the confined regions of some WM tracts, including the body of the corpus callosum (bCC), the left genu of the CC (gCC), and the anterior and superior corona radiata (ACR and SCR). Additionally, NPBD exhibited significant age-associated RD increases (R2 = 0.822, p < 0.001), whereas the greater RD observed in PBD compared to NPBD remained consistent across middle age.

CONCLUSIONS

Preliminary findings from this small sample suggest severe frontal WM disconnection in the anterior interhemispheric communication, left fronto-limbic circuits, and cortico-striatal-thalamic loop in PBD compared to NPBD. While these results require replication and validation in larger and controlled samples, they provide insights into the pathophysiology of PBD, which is diagnostically located at the boundary between BD and SZ.

An Isolated Hydatid Cyst of the Spleen with High Serum Levels of CA 19-9-A Meaningful Association or Just a Challenge for Diagnosis? A Case Report

An isolated hydatid cyst of the spleen represents an exceptional pathology, and its association with high CA 19-9 serum levels was not previously reported. This case presents a patient with an isolated hydatid cyst of the spleen, with preoperative high CA 19-9 serum levels in the absence of other pathologies and normalization of CA 19-9 serum levels after surgery (i.e., splenectomy). The source and clinical value of high serum levels of CA 19-9 in hydatid cysts of the spleen remains unclear. High serum levels of CA 19-9 in the context of a splenic cyst may complicate diagnosis and challenge the therapeutic strategy.

Deep learning-based synthetic CT for dosimetric monitoring of combined conventional radiotherapy and lattice boost in large lung tumors

PURPOSE

Conventional radiotherapy (CRT) has limited local control and poses a high risk of severe toxicity in large lung tumors. This study aimed to develop an integrated treatment plan that combines CRT with lattice boost radiotherapy (LRT) and monitors its dosimetric characteristics.

METHODS

This study employed cone-beam computed tomography from 115 lung cancer patients to develop a U-Net +  + deep learning model for generating synthetic CT (sCT). The clinical feasibility of sCT was thoroughly evaluated in terms of image clarity, Hounsfield Unit (HU) consistency, and computational accuracy. For large lung tumors, accumulated doses to the gross tumor volume (GTV) and organs at risk (OARs) during 20 fractions of CRT were precisely monitored using matrices derived from the deformable registration of sCT and planning CT (pCT). Additionally, for patients with minimal tumor shrinkage during CRT, an sCT-based adaptive LRT boost plan was introduced, with its dosimetric properties, treatment safety in high dose regions, and delivery accuracy quantitatively assessed.

RESULTS

The image quality and HU consistency of sCT improved significantly, with dose deviations ranging from 0.15% to 1.25%. These results indicated that sCT is feasible for inter-fraction dose monitoring and adaptive planning. After rigid and hybrid deformable registration of sCT and pCT, the mean distance-to-agreement was 0.80 ± 0.18 mm, and the mean Dice similarity coefficient was 0.97 ± 0.01. Monitoring dose accumulation over 20 CRT fractions showed an increase in high-dose regions of the GTV (P < 0.05) and a reduction in low-dose regions (P < 0.05). Dosimetric parameters of all OARs were significantly higher than those in the original treatment plan (P < 0.01). The sCT based adaptive LRT boost plan, when combined with CRT, significantly reduced the dose to OARs compared to CRT alone (P < 0.05). In LRT plan, high-dose regions for the GTV and D95% exhibited displacements greater than 5 mm from the tumor boundary in 19 randomly scanned sCT sequences under free breathing conditions. Validation of dose delivery using TLD phantom measurements showed that more than half of the dose points in the sCT based LRT plan had deviations below 2%, with a maximum deviation of 5.89%.

CONCLUSIONS

The sCT generated by the U-Net +  + model enhanced the accuracy of monitoring the actual accumulated dose, thereby facilitating the evaluation of therapeutic efficacy and toxicity. Additionally, the sCT-based LRT boost plan, combined with CRT, further minimized the dose delivered to OARs while ensuring safe and precise treatment delivery.