Clinical and imaging aspects associated with persistent apical periodontitis: subsides for the treatment decision-making process

OBJECTIVES

To evaluate cases of persistent apical periodontitis (PAP) and what are the imaging and clinical aspects that could be considered in the PAP diagnosis and in their treatment decision-making process.

METHODOLOGY

423 patients with apical periodontitis at the time of non-surgical root canal treatment (NSRCT) were followed-up for at least 1 year. Periapical radiographic images were used to compare and determine periapical status at each time using the PAI scoring system. Cases scored as PAI 5 at the follow-up appointment were evaluated by CBCT, using the CBCTPAI scoring system. Associated, the data from imaging exams and from clinical evaluation were considered to make a decision for PAP treatment.

RESULTS

Regarding sample composition, it was observed an association with ethnicity and PAP (p = 0.045). After follow-up, cases classified as PAI Score 1 and 2 and absence of symptoms/complaint were classified as successful. Cases classified as PAI Score 3 and absence of symptoms/complaint were referred for new follow-up visits until complete resolution of PAP. Cases scored as PAI 4 with clinical symptoms were indicated for non-surgical root canal retreatment. Cases scored as PAI 5 were assessed by CBCT, and in the presence of symptoms/complaint and a CBCTPAI score 3 were related to non-surgical root canal retreatment, while CBCTPAI scores 4 and 5 were refereed for endodontic surgery.

CONCLUSIONS

Clinical data, PAI and CBCTPAI scoring systems from image exams can be useful for PAP diagnosis and their treatment.

CLINICAL RELEVANCE

In the decision-making process, clinical and imaging data are fundamental for the choose of an ideal protocol for treating PAP.

Advancements in Tissue-Equivalent Gel Dosimeters

Tissue-equivalent hydrogel dosimeters represent a class of tools that hold significant promise, particularly in the precise measurement of three-dimensional dose distributions in radiotherapy. Due to their physical properties closely resembling those of human soft tissue, these dosimeters effectively replicate the energy transfer phenomena resulting from radiation interactions, such as atomic ionization and scattering by nuclei or electrons. Consequently, tissue-equivalent dosimeters, characterized by their linear energy transfer properties, have been extensively applied in medical physics, radiation oncology, and nuclear safety. Future advancements focusing on developing more stable, less toxic, normoxic, and cost-effective dosimeters could enable their broader adoption. This review provides a comprehensive overview of the key characteristics that make hydrogel dosimeters tissue-equivalent, highlighting their benefits, limitations, and primary application areas. Additionally, it explores current advancements in polymeric gel technology and discusses future directions aimed at optimizing their performance and accessibility for broader adoption.

The role of partial splenic artery embolization in the management of refractory esophageal variceal bleeding due to portal vein thrombosis

BACKGROUND

Gastro-esophageal variceal hemorrhage (GEVH) is one of the major causes of life-threatening gastrointestinal bleeding in children. Medical, endoscopic, angiographic, and surgical interventions can be utilized in treatment. In this case report, we describe partial splenic artery embolization for refractory GEVH due to portal vein thrombosis.

CASE PRESENTATION

A 3-year-old male patient was admitted with abdominal distension. He had been followed up for hepatosplenomegaly for 2 years. The patient's body weight was 15.5 kg (50-75th percentile, 0.69 SDS) and height was 96 cm (50-75th percentile, 0.27 SDS). The general condition was moderate, and the skin appeared pale. The liver was palpable 2 cm, and the spleen was palpable 6 cm below the costal margin. Other system examinations were normal. Laboratory findings included hemoglobin (Hgb) of 7.1 g/dL, hematocrit (Hct) of 24%, white blood cell count of 9800/mm3, platelets of 67000/mm3, and INR of 1.3. Abdominal CT angiography demonstrated a hypodense thrombus at the portal confluence, almost completely occluding the lumen. Endoscopy revealed esophageal varices at the 2 and 7 o'clock positions in the distal esophagus, which became more prominent with insufflation and had red spots on them. Hyperemia was observed in the corpus and antrum of the stomach. Findings were consistent with stage 3 esophageal varices and increased vascularity in the duodenum due to portal vein thrombosis. Medical treatment with a proton pump inhibitor and beta-blocker was initiated. The patient underwent endoscopic band ligation (EBL) three times over 9 months. Despite EBL, the patient presented with GEVH three times during a 1.5-year follow-up. Due to newly developed multiple varices observed on control endoscopy a decision was made to perform splenic artery embolization. Interventional radiology performed selective lower splenic pole embolization. Six months later, the patient underwent another selective embolization. The patient has been followed up for 3 years without GEVH.

CONCLUSIONS

In this case, splenic artery embolization was observed to be an effective, repeatable, and safe treatment method for patients with hypersplenism caused by portal hypertension and refractory esophageal variceal bleeding.

Whey Protein-Based Hydrogel Microspheres for Endovascular Embolization

Transarterial embolization (TAE) is an image-guided, minimally invasive procedure for treating various clinical conditions by delivering embolic agents to occlude diseased arteries. Conventional embolic agents focus on vessel occlusion but can cause unintended long-term inflammation and ischemia in healthy tissues. Next-generation embolic agents must exhibit biocompatibility, biodegradability, and effective drug delivery, yet some degradable microspheres degrade too quickly, leading to the potential migration of fragments into distal blood vessels causing off-target embolization. This study presents the development of whey protein hydrogel microspheres (WPHMS) made from methacrylated whey protein, which successfully withstood terminal sterilization by autoclaving. In vitro characterization revealed that sterile WPHMS are suspensible in iodine-containing contrast agents, injectable through standard catheters and microcatheters, and can be temporarily compressed by at least 12.8% without permanent deformation. Cytocompatibility was confirmed using NIH/3T3 cells, while enzymatic degradation was assessed with proteinase K. Preliminary drug loading and release studies demonstrated the potential for doxorubicin hydrochloride (Dox-HCl) as a model drug. In vivo assessments in rabbit renal models showed that WPHMS successfully occluded the renal arteries in the acute study and remained in the renal arteries for up to 3 weeks in the chronic study, with signs of early degradation. Fibrous tissue anchored the degraded residues, minimizing the risk of migration. These findings indicate that WPHMS holds significant promise as endovascular embolization agents for minimally invasive therapies.

Nanotechnology-based biomedical devices in the cancer diagnostics and therapy

Nanotechnology has significantly transformed the field of cancer diagnostics and therapeutics by introducing advanced biomedical devices. These nanotechnology-based devices exhibit remarkable capabilities in detecting and treating various cancers, addressing the limitations of traditional approaches, such as limited specificity and sensitivity. This review aims to explore the advancements in nanotechnology-driven biomedical devices, emphasizing their role in the diagnosis and treatment of cancer. Through a comprehensive analysis, we evaluate various nanotechnology-based devices across different cancer types, detailing their diagnostic and therapeutic effectiveness. The review also discusses FDA-approved nanotechnology products, patents, and regulatory trends, highlighting the innovation and clinical impact in oncology. Nanotechnology-based devices, including nanobots, smart pills, and multifunctional nanoparticles, enable precise targeting and treatment, reducing adverse effects on healthy tissues. Devices such as DNA-based nanorobots, quantum dots, and biodegradable stents offer noninvasive diagnostic and therapeutic options, showing high efficacy in preclinical and clinical settings. FDA-approved products underscore the acceptance of these technologies. Nanotechnology-based biomedical devices offer a promising future for oncology, with the potential to revolutionize cancer care through early detection, targeted treatment, and minimal side effects. Continued research and technological improvements are essential to fully realize their potential in personalized cancer therapy.

Implementation of Two-pulse Phase-modulated (TPPM) 1H Decoupling in a Clinical MR Scanner for the Detection of the C1-glycogen Peak in 13C MRS

Two-pulse phase-modulated (TPPM) 1H-decoupling pulse sequence repeats a pair of 180o RF pulses while changing the signs of the RF phase modulation angle and has been widely used for the 13C NMR of organic solids. TPPM was introduced into the 13C MRS pulse sequence on a clinical 3T MR scanner, and the 1H-decoupling performance was compared with conventional 1H-decoupling schemes using aqueous solutions containing glucose and oyster glycogen. The 13C C1-glucose peaks were 1H-decoupled using TPPM with B2 = 500 Hz, and the optimal RF phase modulation angle was up to 30o. Cycling sidebands were not observed when TPPM was used but were observed when WALTZ-16 was used. The 13C C1-glycogen peak was 1H-decoupled even with reducing TPPM duration to 8 ms, which reduced simulated specific absorption rate (SAR) to 39%. In conclusion, the TPPM 1H decoupling is applicable to clinical MR scanners, and the low-SAR sequence may be more valuable at 7T.

Practical approach to extracardiac findings in CT and MR for the non-radiologist

Cross-sectional cardiac imaging plays an essential role in the evaluation of pediatric patients with congenital and acquired heart disease. While the focus of cardiac imaging is primarily on evaluating cardiac structures, it also provides valuable insights into extracardiac structures and associated abnormalities. The radiologists and cardiologists interpreting these exams play a critical role in recognizing these findings and providing recommendations for follow-up testing when indicated. Due to the excellent soft tissue resolution of cardiac magnetic resonance imaging (MRI) and computed tomography (CT), incidental findings can often be diagnosed without further imaging. Incidental findings are generally defined as lesions or masses detected by imaging that is performed for a different reason. In other cases, further imaging evaluation and testing may be necessary. This article aims to explore the spectrum of extracardiac findings encountered in pediatric cardiac imaging studies, their clinical significance, and the potential implications for patient care.

Hepatic encephalopathy in non-cirrhotic portal hypertension

Hepatic encephalopathy (HE) is traditionally associated with hepatic parenchymal diseases, such as acute liver failure and cirrhosis. Its prevalence in non-cirrhotic portal hypertension (NCPH) patients, extrahepatic portal vein obstruction (EHPVO), and non-cirrhotic portal fibrosis (NCPF) is less well described. HE in NCPH allows one to study the effect of portosystemic shunting and ammonia without significant hepatic parenchymal injury. The current review narrates the spectrum and management of hepatic encephalopathy in NCPH patients. We synthesized data from various studies on the occurrence and management of HE in NCPH, mainly EHPVO, idiopathic non-cirrhotic portal hypertension (INCPH), and porto-sinusoidal vascular disease (PSVD). The prevalence of minimal hepatic encephalopathy (MHE) in NCPH is reported from 12 to 60%, depending on the condition and diagnostic criteria. MHE was reported in nearly a third of EHPVO patients. Studies show that venous ammonia levels are significantly elevated in patients with MHE and spontaneous shunts (82.4 ± 20.3 vs. 47.1 ± 16.7 µmol/L, P = 0.001). Large portosystemic shunts substantially increase the risk of HE, with 46-71% of patients with persistent or recurrent HE having identifiable shunts. Management of HE in NCPH primarily focuses on reducing ammonia levels through lactulose, which has shown improvement in 53% of patients with MHE after three months (P = 0.001). Shunt occlusion in patients with large portosystemic shunts is helpful in selected cases. HE in NCPH, particularly in EHPVO, is associated with elevated ammonia levels and spontaneous shunts. Despite the high prevalence of HE in NCPH, this is still a neglected aspect in the care of NCPH. A high index of suspicion and the application of appropriate screening tools are crucial for timely diagnosis and management. HE screening tools that are well-studied in cirrhosis, are also valid in NCPH. Effective management strategies include lactulose, rifaximin, dietary modifications, and shunt embolisation in some cases. Future research should focus on the long-term natural history and efficacy of treatment strategies in this population.

Associations of Maternal Prenatal Zinc Consumption with Infant Brain Tissue Organization and Neurodevelopmental Outcomes

BACKGROUND/OBJECTIVES

While studies in rat pups suggest that early zinc exposure is critical for optimal brain structure and function, associations of prenatal zinc intake with measures of brain development in infants are unknown. This study aimed to assess the associations of maternal zinc intake during pregnancy with MRI measures of brain tissue microstructure and neurodevelopmental outcomes, as well as to determine whether MRI measures of the brain mediated the relationship between maternal zinc intake and neurodevelopmental indices.

METHODS

Forty-one adolescent mothers were recruited for a longitudinal study during pregnancy. Maternal zinc intake was assessed during the third trimester of pregnancy using a 24 h dietary recall. Infant MRI scans were acquired at 3 weeks postpartum using a 3.0 Tesla scanner to measure fractional anisotropy (FA) and mean diffusivity (MD). Cognitive, language, and motor skills were assessed at 4, 14, and 24 months postpartum using the Bayley Scales of Infant Development.

RESULTS

Greater prenatal zinc intake was associated with reduced FA in cortical gray matter, particularly in the frontal lobe [medial superior frontal gyrus; β (95% CI) = -1.0 (-1.5, -0.5)], in developing white matter, and in subcortical gray matter nuclei. Greater prenatal zinc intake was associated with reduced MD in cortical gray matter and developing white matter [superior longitudinal fasciculus; -4.4 (-7.1, -1.7)]. Greater maternal zinc intake also was associated with higher cognitive development scores at 14 [0.1 (0.0, 0.1)] and 24 [0.1 (0.0, 0.2)] months of age; MRI indices of FA and MD did not mediate this relationship.

CONCLUSIONS

Maternal prenatal zinc intake was associated with more favorable measures of brain tissue microstructural maturation and cognitive development during infancy.

Diagnostic value of CT scans in pediatric patients with acute non-traumatic altered mental status: a systematic review and meta-analysis

BACKGROUND

Computed tomography (CT) scans are widely used for evaluating children with acute atraumatic altered mental status (AMS) despite concerns about radiation exposure and limited diagnostic yield. This study aims to assess the efficacy of CT scans in this population and provide evidence-based recommendations.

METHODS

A systematic review was conducted according to PRISMA guidelines. Comprehensive searches were performed in PubMed, Embase, Cochrane Library, Scopus, and Web of Science for studies involving pediatric patients with acute atraumatic AMS undergoing head CT scans. Two independent reviewers conducted the literature search, extracted data, and assessed study quality.

RESULTS

From 4,739 identified studies, 13 met the inclusion criteria. The overall positive diagnostic yield of head CT scans was 35.9% (95% CI: 6.1%-65.7%). Subgroup analyses revealed that the diagnostic yield varied by clinical setting, age group, and presenting symptoms.

CONCLUSION

Head CT scans are frequently performed in pediatric patients with AMS, but their diagnostic usefulness is limited. Evidence-based guidelines and risk stratification methods are necessary to improve imaging utilization and minimize radiation exposure risks. What is Known • Computed tomography (CT) scans are commonly used to evaluate pediatric patients with acute atraumatic altered mental status (AMS). • There are concerns about radiation exposure from CT scans, especially in children due to their increased sensitivity and longer life expectancy. • Previous studies suggest a low diagnostic yield of CT scans in certain pediatric conditions, indicating potential overuse. What is New • This systematic review and meta-analysis specifically assess the diagnostic value of CT scans in pediatric patients with acute atraumatic AMS. • Findings reveal a relatively low positive diagnostic yield, indicating that CT scans may be overutilized in this population. • Subgroup analyses highlight variability in outcomes based on clinical setting, patient age, and presenting symptoms. • The study underscores the need for evidence-based guidelines and risk stratification tools to optimize imaging decisions and reduce unnecessary radiation exposure in children.

Monte Carlo Simulations in Nanomedicine: Advancing Cancer Imaging and Therapy

Monte Carlo (MC) simulations have become important in advancing nanoparticle (NP)-based applications for cancer imaging and therapy. This review explores the critical role of MC simulations in modeling complex biological interactions, optimizing NP designs, and enhancing the precision of therapeutic and diagnostic strategies. Key findings highlight the ability of MC simulations to predict NP bio-distribution, radiation dosimetry, and treatment efficacy, providing a robust framework for addressing the stochastic nature of biological systems. Despite their contributions, MC simulations face challenges such as modeling biological complexity, computational demands, and the scarcity of reliable nanoscale data. However, emerging technologies, including hybrid modeling approaches, high-performance computing, and quantum simulation, are poised to overcome these limitations. Furthermore, novel advancements such as FLASH radiotherapy, multifunctional NPs, and patient-specific data integration are expanding the capabilities and clinical relevance of MC simulations. This topical review underscores the transformative potential of MC simulations in bridging fundamental research and clinical translation. By facilitating personalized nanomedicine and streamlining regulatory and clinical trial processes, MC simulations offer a pathway toward more effective, tailored, and accessible cancer treatments. The continued evolution of simulation techniques, driven by interdisciplinary collaboration and technological innovation, ensures that MC simulations will remain at the forefront of nanomedicine's progress.

Diagnostic performance of CT for extrarenal fat invasion in renal cell carcinoma: a meta-analysis and systematic review

OBJECTIVES

Renal cell carcinoma (RCC) with extrarenal fat (perinephric or renal sinus fat) invasion is the main evidence for the T3a stage. Currently, computed tomography (CT) is still the primary modality for staging RCC. This study aims to determine the diagnostic performance of CT in RCC patients with extrarenal fat invasion.

METHODS

The PubMed, Web of Science, Cochrane Library, and EMBASE databases were systematically searched up to October 11, 2023. Study quality was assessed by the QUADAS-2 tool. Standard methods recommended for meta-analyses of diagnostic evaluation were used. Heterogeneity was analyzed through meta-regression analysis.

RESULTS

Fifteen studies were included in this meta-analysis. Among them, six studies focused on perinephric fat invasion (PFI) only, four on renal sinus fat invasion (RSFI) only, and five on both. Pooled weighted estimates of sensitivity, specificity, area of SROC curve, PLR, and negative likelihood ratio (NLR) of CT for PFI were 0.69 (95% CI: 0.55-0.79), 0.82 (95% CI: 0.69-0.90), 0.81 (95% CI: 0.77-0.84), 3.85 (95% CI: 2.22-6.67), and 0.38 (95% CI: 0.27-0.55). Pooled weighted estimates of sensitivity, specificity, area of SROC curve, PLR, and NLR of CT for RSFI were 0.81 (95% CI: 0.76-0.85), 0.79 (95% CI: 0.66-0.88), 0.82 (95% CI: 0.78-0.85), 3.91 (95% CI: 2.26-6.77), and 0.24 (95% CI: 0.18-0.31).

CONCLUSION

CT has the ability to detect the PFI and RSFI in patients with RCC. However, the diagnostic performance of CT has suffered from the limitation of slightly lower accuracy, resulting from the low positive sample in the current studies. Additionally, the current PLR is low.

CRITICAL RELEVANCE STATEMENT

This study provides radiologists and urologists with a systematic and comprehensive summary of CT and CT-related morphological features in assessing extrarenal fat invasion in patients with RCC.

KEY POINTS

CT can detect extrarenal fat invasion in patients with RCC, but the diagnostic performance is inconsistent. The diagnostic performance of CT is acceptable, but primarily affected by the low positive rate of included patients. Further large-scale trials are necessary to determine the true diagnostic capabilities of CT for extrarenal fat invasion.

Audiovisual Breathing Guidance for Improved Image Quality and Scan Efficiency of T2- and Diffusion-Weighted Liver MRI

OBJECTIVES

Impaired image quality and long scan times frequently occur in respiratory-triggered sequences in liver magnetic resonance imaging (MRI). We evaluated the impact of an in-bore active breathing guidance (BG) application on image quality and scan time of respiratory-triggered T2-weighted (T2) and diffusion-weighted imaging (DWI) by comparing sequences with standard triggering (T2S and DWIS) and with BG (T2BG and DWIBG).

MATERIALS AND METHODS

In this prospective study, random patients with clinical indications for liver MRI underwent 3 T MRI with standard and BG acquisitions. The audiovisual BG application received the respiratory signal from the scanner, and animated breathing instructions were displayed using a mirror and screen behind the MRI bore. Prior to the DWIBG and T2BG acquisition, patients received a short video instruction about MRI with BG. Suitable parameters for desired breathing pattern for T2BG and DWIBG were set individually for each patient based on the patient's physical respiratory ability (ie, 4 seconds breathing followed by 4.5 seconds breath holding). Artifacts, sharpness, lesion conspicuity, and overall image quality were assessed using a Likert scale from 1 (nondiagnostic) to 5 (excellent). Scan time, apparent contrast-to-noise ratio, and apparent signal-to-noise ratio (aSNR) for all sequences were analyzed. Paired t test and Wilcoxon test were used for statistical analysis.

RESULTS

Thirty-two patients (mean age: 55 ± 13 years, 13 female) were included. T2BG showed less artifacts (4.5 ± 0.7 vs 4.1 ± 0.8, P < 0.001) and better sharpness, lesion conspicuity, and overall image quality (eg, overall image quality 4.6 ± 0.7 vs 4.4 ± 0.7, P = 0.004) compared with T2S. DWIBG demonstrated improved image quality in all categories compared with DWIS (eg, overall image quality 4.5 ± 0.5 vs 4.3 ± 0.5, P = 0.005) and less artifacts (4.1 ± 0.5 vs 3.8 ± 0.7, P = 0.007). Scan times of T2BG (286 ± 23 vs 345 ± 68 seconds, P < 0.001) and DWIBG (160 ± 4 vs 252 ± 70 seconds, P < 0.001) were reduced by 17% and 37%, respectively. aSNR and apparent contrast-to-noise ratio (eg, aSNR: 23.45 ± 11.31 [T2BG] vs 25.84 ± 10.76 [T2S]; P = 0.079) were similar for both sequences for both approaches.

CONCLUSIONS

Active BG for respiratory-triggered liver T2w and DWI sequences led to significant reduction of breathing artifacts, improved image quality, and shorter scan time compared with standard acquisitions.

Post-Traumatic Left Subclavian Artery Pseudoaneurysm Secondary to Clavicular Fracture: A Case Report and Literature Review

Subclavian artery pseudoaneurysms are rare but potentially life-threatening vascular injuries frequently associated with trauma such as clavicle fractures. In this paper we describe the case of a 49-year-old male who developed a post-traumatic pseudoaneurysm of the subclavian artery after a bicycle accident. The diagnosis was delayed due to non-specific symptoms and an initially missed aneurysm on computed tomography imaging. Persistent pain, swelling, and erythema in the subclavian region prompted further detailed diagnostics, which ultimately revealed the pseudoaneurysm. The patient was successfully treated with endovascular stent-graft implantation. We screened the PubMed database to identify similar cases managed exclusively through endovascular intervention. Reports of iatrogenic pseudoaneurysms and those treated with open surgery were excluded. Variables such as time to diagnosis, clinical presentation, features of pseudoaneurysms, and complications were analyzed to highlight the role of endovascular techniques as a minimally invasive and effective treatment option. These cases pose both a diagnostic and a therapeutic challenge, as early recognition of symptoms is crucial to prevent serious complications including thrombosis, neurological deficits, and even limb loss.

Barriers affecting the quality and consistency of barium studies in radiologists and registrars

The barium swallow study is a fluoroscopic study which provides valuable insights into the motility, function and morphology of the pharynx, oesophagus, gastroesophageal junction, proximal stomach and duodenum. It has been observed that the skill of radiology doctors with barium swallow studies in adults has diminished. This reduced proficiency with barium swallow study is closely linked to and perpetuated by the heterogeneity of technique amongst radiologists. Factors pertaining to the individual radiologist, patient factors, healthcare factors, and the widespread use of alternative investigations have led to this increased variance in performing the barium swallow study. Despite this reduction in its usage, the study remains a valuable tool in the care of patients. We advocate for standardised guidelines to increase consistency and improve radiologist familiarity with this procedure.

TOM500: A Multi-Organ Annotated Orbital MRI Dataset for Thyroid Eye Disease

This study presents TOM500, a comprehensive multi-organ annotated orbital magnetic resonance imaging (MRI) dataset. It includes clinical data, T2-weighted MRI scans, and corresponding segmentations from 500 patients with thyroid eye disease (TED) during their initial visit. TED is a common autoimmune disorder with distinct orbital MRI features. Segmentations of nine orbital structures, including the optic nerve, orbital fat, lacrimal gland, eyeball, and five extraocular muscles (superior rectus and levator palpebrae superioris complex, inferior rectus, medial rectus, lateral rectus, and superior oblique), were generated by three junior annotators and reviewed by an expert radiologist. The consistency of the segmentations was evaluated using the intraclass correlation coefficient. Clinical data, including sex, age, disease duration, and smoking status, are also provided for disease diagnosis and classification. TOM500, the largest publicly available orbital MRI dataset with expert annotations, is designed to facilitate the development of advanced computational tools for TED diagnosis, classification, and observation.

Volatile Organic Metabolites as Potential Biomarkers for Genitourinary Cancers: Review of the Applications and Detection Methods

Cancer is one of the leading causes of death globally, and is ranked second in the United States. Early detection is crucial for more effective treatment and a higher chance of survival rates, reducing burdens on individuals and societies. Genitourinary cancers, in particular, face significant challenges in early detection. Finding new and cost-effective diagnostic methods is of clinical need. Metabolomic-based approaches, notably volatile organic compound (VOC) analysis, have shown promise in detecting cancer. VOCs are small organic metabolites involved in biological processes and disease development. They can be detected in urine, breath, and blood samples, making them potential candidates for sensitive and non-invasive alternatives for early cancer detection. However, developing robust VOC detection methods remains a hurdle. This review outlines the current landscape of major genitourinary cancers (kidney, prostate, bladder, and testicular), including epidemiology, risk factors, and current diagnostic tools. Furthermore, it explores the applications of using VOCs as cancer biomarkers, various analytical techniques, and comparisons of extraction and detection methods across different biospecimens. The potential use of VOCs in detection, monitoring disease progression, and treatment responses in the field of genitourinary oncology is examined.

The potential role of machine learning and deep learning in differential diagnosis of Alzheimer's disease and FTD using imaging biomarkers: A review

INTRODUCTION

The prevalence of neurodegenerative diseases has significantly increased, necessitating a deeper understanding of their symptoms, diagnostic processes, and prevention strategies. Frontotemporal dementia (FTD) and Alzheimer's disease (AD) are two prominent neurodegenerative conditions that present diagnostic challenges due to overlapping symptoms. To address these challenges, experts utilize a range of imaging techniques, including magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), functional MRI (fMRI), positron emission tomography (PET), and single-photon emission computed tomography (SPECT). These techniques facilitate a detailed examination of the manifestations of these diseases. Recent research has demonstrated the potential of artificial intelligence (AI) in automating the diagnostic process, generating significant interest in this field.

MATERIALS AND METHODS

This narrative review aims to compile and analyze articles related to the AI-assisted diagnosis of FTD and AD. We reviewed 31 articles published between 2012 and 2024, with 23 focusing on machine learning techniques and 8 on deep learning techniques. The studies utilized features extracted from both single imaging modalities and multi-modal approaches, and evaluated the performance of various classification models.

RESULTS

Among the machine learning studies, Support Vector Machines (SVM) exhibited the most favorable performance in classifying FTD and AD. In deep learning studies, the ResNet convolutional neural network outperformed other networks.

CONCLUSION

This review highlights the utility of different imaging modalities as diagnostic aids in distinguishing between FTD and AD. However, it emphasizes the importance of incorporating clinical examinations and patient symptom evaluations to ensure comprehensive and accurate diagnoses.

Artificial Intelligence in Pancreatic Intraductal Papillary Mucinous Neoplasm Imaging: A Systematic Review

Background

Based on the Fukuoka and Kyoto international consensus guidelines, the current clinical management of intraductal papillary mucinous neoplasm (IPMN) largely depends on imaging features. While these criteria are highly sensitive in detecting high-risk IPMN, they lack specificity, resulting in surgical overtreatment. Artificial Intelligence (AI)-based medical image analysis has the potential to augment the clinical management of IPMNs by improving diagnostic accuracy.

Methods

Based on a systematic review of the academic literature on AI in IPMN imaging, 1041 publications were identified of which 25 published studies were included in the analysis. The studies were stratified based on prediction target, underlying data type and imaging modality, patient cohort size, and stage of clinical translation and were subsequently analyzed to identify trends and gaps in the field.

Results

Research on AI in IPMN imaging has been increasing in recent years. The majority of studies utilized CT imaging to train computational models. Most studies presented computational models developed on single-center datasets (n=11,44%) and included less than 250 patients (n=18,72%). Methodologically, convolutional neural network (CNN)-based algorithms were most commonly used. Thematically, most studies reported models augmenting differential diagnosis (n=9,36%) or risk stratification (n=10,40%) rather than IPMN detection (n=5,20%) or IPMN segmentation (n=2,8%).

Conclusion

This systematic review provides a comprehensive overview of the research landscape of AI in IPMN imaging. Computational models have potential to enhance the accurate and precise stratification of patients with IPMN. Multicenter collaboration and datasets comprising various modalities are necessary to fully utilize this potential, alongside concerted efforts towards clinical translation.

Point-of-Care Ultrasound in Gastroenterology and Hepatology

Point-of-care ultrasound (POCUS) is changing the practice of nearly all specialties and is increasingly being incorporated as a bedside tool by more gastroenterologists and hepatologists. POCUS is most often used to answer focused diagnostic questions, supplement the traditional physical examination, and guide performance of invasive bedside procedures. This review describes several common POCUS applications used in gastroenterology and hepatology, as well as some novel applications that warrant further investigation.

Developments and clinical experiences in collagenase chemonucleolysis for lumbar disc herniation: a narrative review

Lumbar disc herniation (LDH) affects millions globally, with annual healthcare costs exceeding $100 billion in the United States alone, driving increasing interest in minimally invasive radiological interventions as treatment alternatives. This narrative review examines developments in collagenase chemonucleolysis for LDH, integrating a literature analysis with clinical experience. Key advancements include the transition from single-agent to combination therapies, exploration of diverse injection routes, and the progression from C-arm fluoroscopy to multi-slice CT guidance. The synergistic use of collagenase, oxygen-ozone, and anti-inflammatory analgesics has enhanced efficacy. Safety measures such as aspiration tests, contrast agent tests, and lidocaine tests implemented to mitigate procedural risks. However, challenges persist, including non-standardized dosages and potential complications arising from intradiscal injections. Future research should focus on establishing accreditation systems, refining patient selection criteria, optimizing drug dosages, and exploring advanced image-guided technologies. While chemonucleolysis offers advantages such as minimal invasiveness and cost-effectiveness, its complexity necessitates a multidisciplinary approach. Key findings demonstrate that combination therapy achieves superior outcomes compared to monotherapy, with long-term efficacy rates reaching 90% and 6-month success rates of 95%. Additionally, CT guidance has significantly improved procedural precision and safety compared to traditional fluoroscopy. This review provides insights for clinicians and researchers, highlighting the potential of chemonucleolysis in LDH management to ensure its safe and effective integration into mainstream treatment protocols.

Advancements in diagnosing Post-concussion Syndrome: insights into epidemiology, pathophysiology, neuropathology, neuroimaging, and salivary biomarkers

Post-Concussion Syndrome (PCS) represents a complex constellation of symptoms that persist following a concussion or mild traumatic brain injury (mTBI), with significant implications for patient care and outcomes. Despite its prevalence, diagnosing PCS presents considerable challenges due to the subjective nature of symptoms, the absence of specific diagnostic tests, and the overlap with other neurological and psychiatric conditions. This review explores the multifaceted diagnostic challenges associated with PCS, including the heterogeneity of symptom presentation, the limitations of current neuroimaging techniques, and the overlap of PCS symptoms with other disorders. We also discuss the potential of emerging biomarkers and advanced imaging modalities to enhance diagnostic accuracy and provide a more objective basis for PCS identification. Additionally, the review highlights the importance of a multidisciplinary approach in the diagnosis and management of PCS, integrating clinical evaluation with innovative diagnostic tools to improve patient outcomes. Through a comprehensive analysis of current practices and future directions, this review aims to shed light on the complexities of PCS diagnosis and pave the way for improved strategies in the identification and treatment of this condition.

Serum autotaxin level: a promising diagnostic biomarker in differentiating Graves' disease and thyroiditis

BACKGROUND

Recent studies have suggested that serum autotaxin (ATX) may be a promising diagnostic biomarker in differentiating between Graves' disease (GD) and thyroiditis, as well as serving as a monitoring biomarker for GD. This study will evaluate the use of serum ATX as a diagnostic biomarker in these conditions.

METHODS

In this prospective interventional study, blood samples were collected from the patients who met both inclusion and exclusion criteria, and serum ATX levels were measured by using the MyBioSource human Autotaxin ELISA kit.

RESULTS

A total of 32 patients were enrolled, of which 18.8% were newly diagnosed with GD, 21.9% were thyroiditis, and 59.3% were on treatment for GD. Serum autotaxin antigen was significantly higher in GD patients than in thyroiditis (603.3217 ± 444.24 v/s 214.74 ± 55.91, P = <.005). Serum ATX measurement successfully discriminated GD patients from thyroiditis (AUC = 0.952, 95%CI: 0.00-1.00) with an optimal cutoff value of ≥257.20 ng/L (sensitivity = 100 and specificity = 81.71). Monitoring the efficacy of serum ATX was analyzed and showed a significant difference.

CONCLUSION

The serum ATX was higher in subjects with GD as compared to thyroiditis, and ATX levels were found to be decreased during the treatment period. In conclusion, serum ATX can be used as a diagnostic and monitoring biomarker in GD.

Case Report: Recurrent cardiogenic shock caused by inter-arterial left coronary artery originating from the right coronary sinus, successfully rescued by mechanical circulatory support

A young female patient suffered cardiogenic shock after undergoing surgery for an ectopic pregnancy. Coronary artery computed tomography angiography (CTA) revealed a left main artery (LM) originating from the right coronary sinus and traveling between the aorta and pulmonary artery. We successfully resuscitated the patient with mechanical circulatory support using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and an intra-aortic balloon pump (IABP). The patient subsequently underwent surgery thereafter. When sudden cardiogenic shock occurs in a young patient, it is important to be vigilant for anomalous aortic origin of a coronary artery (AAOCA).

Cardiac arrest following blunt trauma-induced tension viscerothorax mimicking tension pneumothorax: A rare case report

RATIONALE

Tension viscerothorax is a severe condition characterized by significant increases in thoracic pressure due to the herniation of abdominal organs into the thoracic cavity. It is commonly observed in children with congenital diaphragmatic hernias or as a postoperative complication, while tension viscerothorax resulting from blunt trauma is rare.

PATIENT CONCERNS

A 48-year-old male was urgently admitted to the emergency department with dyspnea following a fall from a height of 15 m.

DIAGNOSES

The patient, presenting in shock and based on clinical signs, was initially diagnosed with a tension pneumothorax (TPT). Bedside point-of-care ultrasound (POCUS) revealed substantial parenchymal echo abnormalities in the left thoracic cavity and cardiac displacement to the right, suggesting a left-sided tension viscerothorax. Thoracic and abdominal computed tomography confirmed the diagnosis of a rare left-sided tension viscerothorax.

INTERVENTIONS

Due to the delayed diagnosis, the patient experienced a cardiac arrest. Following cardiopulmonary resuscitation and advanced life support, the patient regained spontaneous circulation and underwent an emergency laparotomy to reduce abdominal organs and repair a diaphragmatic hernia. Postoperatively, the patient received comprehensive medical care.

OUTCOMES

The patient recovered well postsurgery and was discharged after an 18-day hospital stay. Follow-up over 2 years revealed no significant complications.

LESSONS

Blunt trauma-induced tension viscerothorax is rare and can easily be confused with TPT, leading to misdiagnosis. Early use of bedside POCUS is recommended for suspected cases to expedite identification and management, thereby improving survival rates.

Multiparametric cardiovascular magnetic resonance in patients with myocarditis with consecutive follow-up and a comparison between non-COVID-19 and COVID-19-associated myocarditis

Background

The pattern of myocardial injury and dysfunction development during follow-up is unclear in patients with myocarditis. This study aims to explore the developmental pattern of myocardial injury and cardiac dysfunction during the follow-up of myocarditis by cardiac magnetic resonance (CMR) and differences in short-term follow-up CMR performance between patients with coronavirus disease 2019 (COVID-19)-associated myocarditis (CAM) and non-COVID-19-associated myocarditis (NCAM).

Methods

Data of patients with clinically diagnosed myocarditis who underwent follow-up CMR were retrospectively collected. Patients were divided into the NCAM follow-up and CAM follow-up groups. A portion of patients with normal CMR and volunteers was categorized as control. Qualitative and quantitative assessments of CMR images were used to analyze cardiac structure, function and myocardial damage; compare the differences between the groups; and reveal the developmental pattern in the consecutive follow-up for patients with myocarditis.

Results

This study included 75 patients with NCAM, 25 patients with CAM and 75 cases as control group. Compared with the control group, there was an increase in left ventricular volume, right ventricular volume, extracellular volume in the NCAM follow-up (the last time) group, left ventricular volume, right ventricular ejection fraction, global radial strain (GRS), global circumferential strain, global longitudinal strain (GLS), post-contrast T1 value were decreased. The area under the curve of the GLS was the best (0.836) in discriminating between the two groups, with 78.7% sensitivity and 84.0% specificity. The discriminatory efficacy of the combined right ventricular ejection fraction, GRS, and GLS multiparameter showed the best area under the curve at 0.847, with 80.0% sensitivity and 85.3% specificity. Between the CMR parameter of short- (3 months), medium-, and long-term follow-up (>6 months) for patients with NCAM, a decrease in native T1 (1,256.50±18.63 vs. 1,248.30±17.87 ms, P=0.007) and T2 (49.00±1.34 vs. 47.50±0.97 ms, P=0.015) values was noted in the short-term follow-up group. The short-term follow-up group showed increased ventricular volume, decreased ejection fraction, and impaired myocardial strain in CAM and NCAM compared with the control group. The CAM short-term follow-up group showed an increased T2 value (52.56±3.64 vs. 49.08±3.84 ms, P=0.008) compared with the NCAM short-term follow-up group, and the T2 value was identified with an area under the curve of 0.772, 76% sensitivity, and 83% specificity for the discrimination.

Conclusions

This study revealed that myocarditis led to myocardial damage, cardiac remodeling, and dysfunction during follow-up. An improvement in myocardial edema in the medium- and long-term follow-up groups was observed. In the short-term follow-up, CAM showed more severe myocardial edema. These findings may contribute to the clinical assessment and management of post-myocarditis status.

Comparative evaluation of non-contrast MRI versus gadoxetic acid-enhanced abbreviated protocols in detecting colorectal liver metastases

PURPOSE

This study compares the diagnostic efficacy of non-contrast abbreviated MRI protocols with Gadoxetic acid-enhanced abbreviated MRI for detecting colorectal liver metastasis (CRLM), focusing on lesion characterization and surveillance.

METHODS

Ninety-four patients, including 55 with pathologically verified CRLM, were enrolled, totaling 422 lesions (287 metastatic, 135 benign). Two independent readers assessed three MRI protocols per patient: Protocol 1 included non-contrast sequences (T2-weighted turbo spin-echo, T1-weighted Dixon, diffusion-weighted imaging (DWI), and ADC mapping). Protocol 2 included gadoxetic acid enhancement with hepatobiliary phase imaging, T2 TSE, DWI, and ADC maps. Protocol 3 utilized the standard Gadoxetic Acid-enhanced MRI sequence, which included pre-contrast T1-weighted imaging, T1-weighted Dixon sequences, post-contrast T1-weighted imaging (including arterial, portal venous, transitional and hepatobiliary phases), and additional T2-weighted and DWI sequences. Diagnoses were scored on a 5-point scale (benign = 1; malignant = 5), with scores ≥ 3 indicating CRLM. ROC curves analyzed diagnostic accuracy, comparing area under the curve (AUC) values across protocols.

RESULTS

No significant difference in AUCs was observed between Protocol 1 (0.899-0.909) and Protocol 2 (0.906-0.931) versus Protocol 3 (0.935-0.939) (p = 0.091-0.195). For lesions ≤ 10 mm, Protocol 1 was slightly inferior to Protocol 3 (p = 0.002-0.032), while Protocol 2 remained comparably effective (p = 0.096-0.179). These findings held when using a threshold of ≥ 4 to define CRLM.

CONCLUSION

The non-enhanced abbreviated MRI protocol is as effective as the gadoxetic acid-enhanced protocol in identifying CRLM. The proposed Ab-MRI approach may be a viable alternative for CRLM surveillance.

CRITICAL RELEVANCE STATEMENT

The non-enhanced abbreviated MRI (Ab-MRI) protocol is as effective as the gadoxetic acid-enhanced protocol in identifying colorectal liver metastasis (CRLM). The proposed Ab-MRI approach may be a viable alternative for CRLM surveillance.

KEY POINTS

Two abbreviated protocols are proposed for colorectal liver metastasis (CRLM) surveillance. The non-enhanced protocol showed equivalent efficacy and was more cost-effective. The non-enhanced protocol may be a viable alternative for CRLM surveillance.

Automated tooth segmentation in magnetic resonance scans using deep learning - A pilot study

OBJECTIVES

The main objective was to develop and evaluate an artificial intelligence model for tooth segmentation in magnetic resonance (MR) scans.

METHODS

MR scans of 20 patients performed with a commercial 64-channel head coil with a T1-weighted 3D-SPACE (Sampling Perfection with Application Optimized Contrasts using different flip angle Evolution) sequence were included. Sixteen datasets were used for model training and 4 for accuracy evaluation. Two clinicians segmented and annotated the teeth in each dataset. A segmentation model was trained using the nnU-Net framework. The manual reference tooth segmentation and the inferred tooth segmentation were superimposed and compared by computing precision, sensitivity, and Dice-Sørensen coefficient. Surface meshes were extracted from the segmentations, and the distances between points on each mesh and their closest counterparts on the other mesh were computed, of which the mean (average symmetric surface distance) and 95th percentile (Hausdorff distance 95%, HD95) were reported.

RESULTS

The model achieved an overall precision of 0.867, a sensitivity of 0.926, a Dice-Sørensen coefficient of 0.895, and a 95% Hausdorff distance of 0.91 mm. The model predictions were less accurate for datasets containing dental restorations due to image artefacts.

CONCLUSIONS

The current study developed an automated method for tooth segmentation in MR scans with moderate to high effectiveness for scans with respectively without artefacts.

Clinical performance of a simulated abbreviated liver magnetic resonance imaging in combination with contrast-enhanced computed tomography for the baseline evaluation of the liver in patients with colorectal cancer

AIM

To assess the diagnostic accuracy and inter-reader agreement of a simulated abbreviated gadoxetate liver magnetic resonance imaging (MRI) protocol together with contrast-enhanced computed tomography (CE-CT) against a standard gadoxetate MRI for the detection of colorectal liver metastases at baseline.

MATERIALS AND METHODS

Three readers independently evaluated two sets of images per patient, recording number and location of metastases and benign lesions. Set 1 comprised T1w, T2w, DWI, multiphase CE-T1w, and hepatobiliary phase (HBP) images (standard). Set 2 included T2w, HBP, DWI (from Set 1) and CE-CT (simulated abbreviated). Diagnostic performance was compared using McNemar's test. The level of agreement between sets 1 and 2 was determined with Cohen kappa. For agreement in the number of benign lesions and metastases, we applied intraclass correlation coefficient (ICC).

RESULTS

Seventy-five patients (245 metastases, 122 benign lesions) were evaluated. There was no significant difference in diagnostic accuracy between set 1 and 2 for each reader (mean P = 0.74). The total number of metastases and benign lesions showed high agreement between reading set 1 and 2 (κ = 0.81, 0.78). The total number of metastases showed substantial agreement between readers for set 1 and 2 (ICC = 0.99, 0.99). Good agreement was seen for metastatic segmental involvement (κ = 0.84-0.99).

CONCLUSION

At baseline, using a simulated abbreviated liver MRI together with CE-CT showed excellent agreement with standard MRI protocol for liver metastasis detection.

Complete foot drop due to atypical peroneal ganglion in a 13 ½ year old boy

INTRODUCTION

Peroneal nerve palsy due to compression by an intraneural ganglion is an uncommon entity in the pediatric setting with a need for surgical treatment. Uniquely in this case, the ganglion presented as an elongated instead of a typical round cyst, delaying diagnosis and treatment.

CASE PRESENTATION

We present the case of a 13 ½ year old boy with increasing peroneal nerve palsy due to an atypically shaped intraneural ganglion. An MRI of the knee revealed an elongated peroneal ganglion compressing the nerve between the lateral insertion of the gastrocnemius muscle and fibular head over a length of 10 cm. After surgical decompression and physiotherapy the peroneal nerve recovered well, achieving M 4-5 one year after surgery.

CONCLUSION

The atypical shape of the present peroneal ganglion delayed diagnosis and correct treatment. Though rare in the pediatric setting, this entity must be specifically looked for during the diagnostic workup of peroneal palsy, for time to surgery determines neurological outcome.

Temporomandibular joint assessment in MRI images using artificial intelligence tools: where are we now? A systematic review

OBJECTIVES

To summarize the current evidence on the performance of artificial intelligence (AI) algorithms for the temporomandibular joint (TMJ) disc assessment and TMJ internal derangement diagnosis in magnetic resonance imaging (MRI) images.

METHODS

Studies were gathered by searching 5 electronic databases and partial grey literature up to May 27, 2024. Studies in humans using AI algorithms to detect or diagnose internal derangements in MRI images were included. The methodological quality of the studies was evaluated using the Quality Assessment Tool for Diagnostic of Accuracy Studies-2 (QUADAS-2) and a proposed checklist for dental AI studies.

RESULTS

Thirteen studies were included in this systematic review. Most of the studies assessed disc position. One study assessed disc perforation. A high heterogeneity related to the patient selection domain was found between the studies. The studies used a variety of AI approaches and performance metrics with CNN-based models being the most used. A high performance of AI models compared to humans was reported with accuracy ranging from 70% to 99%.

CONCLUSIONS

The integration of AI, particularly deep learning, in TMJ MRI, shows promising results as a diagnostic-assistance tool to segment TMJ structures and classify disc position. Further studies exploring more diverse and multicentre data will improve the validity and generalizability of the models before being implemented in clinical practice.

[Percutaneous ultrasound-guided neurolysis with local administration of betamethasone in the treatment of Morton's neuroma]

Morton's neuroma is one of the most common entrapment mononeuropathies of peripheral nerves. The main clinical manifestation is neuropathic pain syndrome in the foot. Currently, many methods of treatment are proposed. Despite the advantages of each method, the main disadvantages are low effectiveness, aggravation of symptoms due to scar-related complications, or relatively high incidence of complications following surgical invasion.

OBJECTIVE

To evaluate the effectiveness of percutaneous ultrasound-guided neurolysis with local administration of betamethasone in patients with Morton's neuroma.

MATERIAL AND METHODS

The study included 14 female patients aged 24-56 years (mean 44.7±6.4). We analyzed VAS scores of pain syndrome (mean 7.1±1.1) and DN4 scores of neuropathic pain (mean 4.9±0.9). Ultrasound imaging was performed to estimate localization and volume of neuroma. Mean volume of neuroma was 226±142 mm3.

RESULTS

Mean follow-up was 12 months. In 12 out of 14 patients, there was a significant decrease in pain intensity to VAS score 1.1±0.6 and regression of neuropathic pain to DN4 score 0.5±0.5. In 2 cases, neuropathic pain recurred after 6 months with enlargement of neuromas (to 429 and 452 mm3). There were no complications in any patient.

CONCLUSION

Percutaneous ultrasound-guided neurolysis of Morton's neuroma with local administration of betamethasone is an effective and promising minimally invasive method. Selection criterion for this procedure may be small volume of neuroma. Further research is required to clarify the indications for this procedure.

Capsule Endoscopy in Inflammatory Bowel Disease: Evolving Role and Recent Advances

Capsule endoscopy has been proven as an efficient and accurate tool in the diagnosing and monitoring patients with inflammatory bowel disease, especially Crohn's disease (CD). The current European Crohn's and Colitis Organization guidelines recommend small bowel disease assessment in newly diagnosed CD, wherein small bowel capsule endoscopy (SBCE) is of prime importance. SBCE plays an essential role in assessing mucosal healing in patients with CD, serving as a monitoring tool in a treat to target strategy, and is capable of identifying high-risk patients for future flares.

Intraosseous Nontraumatic Median Nerve Entrapment at the Elbow: A Case Report

Intraosseous median nerve entrapment at the level of the elbow can occur after a traumatic event such as fracture and/or dislocation of the elbow. It is considered a rare and severe entity. We present a rare case of nontraumatic median nerve entrapment inside the distal humerus. No article about atraumatic intraosseous entrapment was encountered in literature.

Lumbosacral posterior meningocele in adult patient: a case report

Spinal dysraphism is the incomplete fusion of the neural arch, which can be seen as an occult or open neural tube defect. Meningoceles are a form of open neural tube defect characterized by cystic dilatation of the meninges containing cerebrospinal fluid without the involvement of neural tissue. Neurosurgical intervention is necessary in the newborn period since survival in advancing ages is often impossible. Therefore, meningoceles are rarely reported in adulthood. Here, we discussed a case of a 23-year-old female who presented with a meningocele in the lumbosacral area since birth, which had not been operated on. Surgical management and intraoperative findings are also discussed.

Use of Magnetic Resonance Neurography for Sensory Nerve Injuries of the Head and Neck

Background

Identification of peripheral nerve injuries of the head and neck can be challenging due to a broad spectrum of symptoms from neuropathic pain to headaches and migraine. This article aimed to present the clinical features and diagnostic workup of patients with acute and chronic peripheral nerve injuries of the head and neck using magnetic resonance neurography (MRN), to demonstrate potential advantages compared with conventional magnetic resonance imaging (MRI).

Methods

Patients who presented with suspected peripheral nerve injury were either referred for a conventional MRI or MRN. Patients who underwent nerve exploration for suspected nerve transection and/or neuroma formation on imaging were included in this study. Imaging findings were correlated with intraoperative observations.

Results

Four patients (3 women, 1 man, age range: 34-70 years) were included. Three subjects had a history of head and neck surgery and 1 experienced direct trauma to the medial eyebrow. Clinical symptoms included numbness, allodynia, positive Tinel sign, and pain relief following nerve blocks. Two patients underwent conventional MRI and 2 underwent MRN. MRI provided a vague indication of potential neuromas and failed to accurately depict their locations. MRN offered a comprehensive visualization of the entire nerve path, identifying nerve transection and neuromas, as well as precise location, dimensions, and relation to adjacent bones and muscles.

Conclusions

High-resolution 3-dimensional MRN provides clear visualization of acute and chronic peripheral nerve injuries of the head and neck region, facilitating early diagnosis of nerve injuries in this region and improving diagnostic accuracy, as well as surgical planning and execution.

Let's unravel the association between renal stones and renal variant vasculature in patients with duplex collecting system: A retrospective single institute study

Background

Our study aims to explore the association of duplex collecting systems with variable renal vasculature and renal calculi, given the paucity of published data on the subject.

Methodology

Between 2020 and 2023, retrospective research on patients with a duplex collecting system detected by CT scans was conducted at the radiology department of Shifa International Hospital. We assessed any gender bias and ascertained the frequency of this unilateral or bilateral duplex system abnormality. Furthermore, in patients who had received post-contrast imaging, the prevalence of renal calculi and varied renal vasculature was evaluated. In individuals with a duplex collecting system, the correlation between renal stones and renal variant vasculature was computed. SPSS version 25 was used to conduct the chi-square test.

Results

We retrospectively gathered data on patients with duplex collecting systems that showed only 65 patients. According to our research, bilateral participation is uncommon but the duplex collecting system is not side-specific. According to our statistics, this aberration has been more common in men as compared to women. Only 36 of the 65 patients in total had post-contrast imaging to check for variances in the vasculature. Of the 36 patients with renal vein variations, 11 had renal vein variations and 25 did not have any anatomical variations. Of the 25 individuals who did not have a renal vein variation, 19 did not have calculus, 2 had calculus involving the lower pole, and 4 had calculus involving the upper pole. 8 individuals with renal variations did not have renal calculus, 2 patients had lower pole calculus, and 1 patient had upper pole calculus. A negative uncertainty coefficient was seen between renal vein vasculature and calculus formation. 17 of the 36 patients had renal artery variations, whereas 19 patients had no anatomic variation of the renal artery. 12 of the 19 individuals without a renal artery variation had no calculus, 2 had calculus involving the lower pole, and 5 had calculus involving the upper pole. 2 individuals had calculus affecting the lower pole, 0 patients had calculus on the upper pole, and 15 patients with renal artery variations had no renal calculus. A positive uncertainty coefficient was seen between renal arterial vasculature and calculus formation.

Conclusion

Understanding renal vasculature patterns is vital for effective vascular interventions as well as kidney transplantations. Patients with a duplex collecting system are at increased risk of stasis, infections, and stone formation. For urologists and nephrologists, awareness of the association with variant renal vasculature is critical for managing complications related to this anomaly.

Enhancing deep-seated hepatocellular carcinoma detection: assessing the added value of high mechanical index setting in sonazoid-based contrast-enhanced ultrasound during post-vascular phase

PURPOSE

This retrospective study aimed to investigate the role of an additional high mechanical index (MI) setting scan during the post-vascular phase (PVP) in detecting deep-seated hepatocellular carcinoma (HCC) lesions.

METHODS

A total of 805 confirmed HCCs, which underwent Sonazoid-based contrast-enhanced ultrasound (CEUS) between January 2014 and October 2021, were included. Low MI scan was initially employed for lesion detection during the PVP, followed by high MI scan. Propensity score matching (PSM) was utilized to address confounding variables.

RESULTS

Of the 805 study lesions, 668 were detected as perfusion defects at the initial low MI setting, while 137 remained undetected. Among these 137 undetected lesions, 77 were identified at the subsequent high MI setting, whereas 60 remained undetected. Lesions that were larger (18.69 ± 11.27 mm vs. 16.55 ± 7.42 mm, p = 0.006), more superficial (6.06 ± 2.41 cm vs. 7.40 ± 2.74 cm, p < 0.001), and hypoechoic (482/668 vs. 62/137, p < 0.001) were detectable at the initial low MI setting. Male patients benefited more from the additional high MI scan (63/97 vs. 14/40, p < 0.001). Lesions identified with additional high MI were larger (18.30 ± 8.76 mm vs. 14.30 ± 4.34 mm, p < 0.001) and deeper than undetected ones (8.48 ± 2.48 cm vs. 6.02 ± 2.43 cm, p < 0.001). After PSM, depth was shown to be an independent predictor in multivariate analysis (odds ratio: 1.557, 95% confidence interval: 1.249-1.941). The depth cutoff was 7.75 cm, with a sensitivity of 0.681, specificity of 0.851, and area under the curve of 0.774.

CONCLUSIONS

The additional high MI setting scan during the PVP of Sonazoid-based CEUS leads to enhanced detection of deep-seated HCCs.

Successful implementation of prophylactic veno-venoarterial extracorporeal membrane oxygenation in high-risk trauma surgery: A case report

INTRODUCTION

Extracorporeal Membrane Oxygenation (ECMO) is increasingly utilized in trauma care, yet its elective use during high-risk surgeries remains unreported.

CASE REPORT

We report a successful instance of prophylactic ECMO support via a Veno-Venoarterial (V-VA) configuration during high-risk surgery in a patient with extensive trauma, including severe thoracic damage and a highly unstable thoracic spine fracture. V-VA ECMO prevented complications such as hemodynamic and respiratory collapse associated with chest compression during the surgical procedure, as the patient should be in a prone position.

DISCUSSION

The potential of ECMO as prophylactic support in high-risk surgery amongst trauma patients underscores a novel application of this technology. Complex configurations must be evaluated to avoid associated ECMO complications.

CONCLUSION

Our case highlights the potential of prophylactic ECMO hybrid modes, indicating their safe application during high-risk procedures in select trauma patients.

Conservative management of grade 5 renal injury: Case report

Blunt trauma is a common cause of renal injuries, usually managed conservatively unless there's hemodynamic instability, which warrants surgery. We present a case of a 22-year-old male with isolated Grade 5 renal injury, diagnosed via CT scan after blunt trauma. Despite the severity, he was successfully treated without surgery through conservative management in the ICU, with frequent monitoring and stabilization of his condition. While the best approach for hemodynamically stable Grade 5 renal injuries remains debated, our case suggests that conservative management is a viable option when patients are carefully monitored for any signs of instability.

Hystero-Salphingography in current clinical practice-old flames, die hard!

Hysterosalpingography (HSG) remains a valuable diagnostic tool in current clinical practice, offering crucial insights into endometrial cavity, fallopian tubes and the adjoining part of the pelvic peritoneal cavity. Despite the emergence of alternative imaging and non-imaging options, HSG continues to be widely utilized due to its diagnostic accuracy, cost-effectiveness, and easy accessibility. Due attention to the correct technique and optimal image interpretation will further enhance its diagnostic accuracy and precision in the work-up of patients with fertility problems.

Ultrasound of the Upper Urinary Tract

Ultrasound (US) plays a primary role in the assessment and diagnosis of renal and ureteral pathologies and their management. It is considered the first-line imaging modality for evaluation of urinary obstruction, nephrolithiasis, and urinary retention among other indications. US is also essential for evaluation of renal vasculature and assessment of renal transplantation. Contrast-enhanced US is an advanced application of US gaining its acceptance in evaluation of the renal masses.

Advancing Antenatal Care in Ethiopia: The Impact of Tele-Ultrasound on Antenatal Ultrasound Access in Rural Ethiopia

Introduction: Access to antenatal ultrasound is limited in low-income countries such as Ethiopia. Virtual care platforms that facilitate supervision and mentoring for ultrasound scanning may improve patient access by facilitating task-sharing of antenatal ultrasound with midlevel providers. The purpose of this study was to assess the feasibility of a large volume tele-ultrasound program in Ethiopia, its impact on antenatal care (ANC) and patient access, and its sustainability as it transitioned from a pilot project to a continuing clinical program. Methods: Health care providers at two health centers in the North Shoa Zone, Ethiopia, performed antenatal tele-ultrasound exams with remote guidance from obstetricians located in urban areas. Data regarding ANC and ultrasound utilization, participant travel, ultrasound findings, specialist referrals, and participant experience were collected through a mobile app. Results: Between November 2020 and December 2023, 7,297 tele-ultrasound exams were performed. Of these, 489 tele-ultrasound exams were performed during the period of data collection from October to December 2022. The availability of tele-ultrasound at the two health centers significantly reduced participant travel distance (4.2 km vs. 10.2 km; p < 0.01; one-way distance). Most participants (99.2%) indicated the tele-ultrasound service was very important or important, with high levels of satisfaction. Clinically significant findings were identified in 26 cases (5.3%), leading to necessary referrals. Conclusion: This study demonstrated the feasibility of a large volume tele-ultrasound program in Ethiopia, its impact on improving the quality of ANC, and its sustainability. These findings lay a foundation upon which low-income countries can develop tele-ultrasound programs to improve antenatal ultrasound access.

Comparison of computed tomographic findings for radiolucent lesions of the mandibular ameloblastoma, odontogenic keratocyst, dentigerous cyst, and simple bone cyst

Background/purpose

Radiolucent lesions of the mandible, including ameloblastoma, odontogenic keratocyst (OKC), dentigerous cyst (DC) and simple bone cyst (SBC), are frequently encountered in clinical practice. However, they vary in type and occasionally in appearance. Each lesion needs a different treatment and approach; therefore, accurate diagnosis is crucial before treatment. However, the radiographic findings, including computed tomography (CT), are often similar. This study aimed to compare the CT findings of 41 ameloblastomas, 74 OKCs, 87 DCs, and 13 SBCs in the mandible.

Materials and methods

Patients were evaluated on initial CT images focusing on features such as long/short diameters, relationship with adjacent teeth, cortex appearance, locularity, scalloped margins, and sclerotic rims. Multivariate logistic regression analysis was performed to determine the most useful features for differential diagnosis. Criteria for differential diagnosis were finally established for three lesions, excluding SBC, which had a relatively small number of cases.

Results

The relationship with the affected tooth, short diameters, sclerotic rims, and locularity were found to be significant features in the differential diagnosis. Ameloblastomas were characterized by relatively larger short diameters, frequently accompanied by root resorption and adjacent tooth displacement, while SBCs lacked these features. Sclerotic rims were commonly observed in OKCs and DCs, and most DCs were unilocular, containing a crown within the lesion. Based on these results, criteria were established for differential diagnosis with a diagnostic accuracy of 84.2%.

Conclusion

This is the first study to attempt to characterize each lesion's radiological features, and these criteria are likely to assist in clinical diagnosis.

Clinical benefits of partial splenic embolization for cancer patients

Partial splenic embolization (PSE) has developed as an alternative to surgical splenectomy, mainly to improve hypersplenism and esophagogastric varices in cirrhotic patients. We proposed the novel concept that splenic infarction volume, rather than the splenic infarction ratio, is essential for patients receiving PSE. A splenic infarction volume between 388 and 540 mL is suitable for a sufficient increase in platelet count and less severe PSE-related complications. When restricted to patients with massive splenomegaly >700 mL, the noninfarcted volume of the spleen plays an important role in increasing platelet counts. Based on the splenic volume concept, PSE or laparoscopic splenectomy should be selected. Partial splenic embolization is effective for cancer patients with hypersplenism. Hypersplenism can occur due to portal vein congestion by thrombosis or tumor thrombosis, and hepatic sinusoidal obstruction syndrome after oxaliplatin-including chemotherapy other than liver cirrhosis. Therefore, PSE has been emphasized as a pretreatment intervention for invasive treatments for cancer patients and is applied synchronously with systemic chemotherapy or chemoembolization for patients with liver malignancies. It was reported that additional PSE on chemoembolization can prolong progression-free survival for patients with hepatocellular carcinoma. Moreover, PSE can improve liver function and fibrosis, promote liver regeneration, and activate host immunity. Partial splenic embolization can result in thrombocytosis (<200 × 109/L), but this platelet count is unlikely to promote cancer progression. Partial splenic embolization can improve hypersplenism caused by various factors related to the patient's comorbidity and cancer treatment. Our splenic volume concept helps identify appropriate treatment procedures. A proper understanding of PSE and its dissemination is strongly required.

Radiographers' perspective of patient safety at ultrasound units in radiology departments

INTRODUCTION

The radiology department plays an important role in healthcare settings, facilitating diagnoses using different imaging modalities, including ultrasound. However, this high-tech environment can pose various risks to patients. In this study, we aimed to describe the risk of patient safety incidents, and factors associated with the prevention of risks related to ultrasound examinations and the diagnostic work, from the perspective of Swedish radiographers.

METHODS

We conducted a qualitative study, based on the written answers to three open-ended questions addressed to Swedish radiographers in ultrasound units of radiology departments, between March 2022 and May 2023. Data from the responses were analyzed using content analysis.

RESULTS

A total of 22 radiographers participated in this study. The described risks were categorized into two groups: risk of tissue damage; and risk of missed, delayed, or incorrect diagnoses. Participants stated that patient safety relied on good organizational conditions-such as having enough time for ultrasound examinations and the diagnostic work, together with adequate technical equipment and new ultrasound devices not older than 5 years. As risk-prevention factors, the radiographers recommended ensuring adequate individual competence-for example, through recurrent mandatory education in ultrasound physics and safety performed by the hospital physicist, and by implementing a certificate with an identified level of expertise at every level of the ultrasound examination.

CONCLUSIONS

Within ultrasound units in Sweden, collaborative individual, organizational, and technical factors are important for reducing the risks of tissue damage and of missed, delayed, or incorrect diagnoses.

IMPLICATIONS FOR PRACTICE

In ultrasound diagnostics, risk-preventing factors include the use of adequate technical equipment and ultrasound devices not older than 5 years, sufficient time for ultrasound examinations and diagnostic work, thoroughly education in all ultrasound methods and recurrent mandatory education in ultrasound physics performed by hospital physicists.

Phenotypic impact of CFTR mutations on male reproductive tract agenesis in a Chinese cohort with congenital absence of the vas deferens

PURPOSE

To investigate the genotype-phenotype correlations of cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations and their impact on male reproductive tract development in a cohort of Chinese patients with congenital absence of the vas deferens (CAVD).

METHODS

A total of 121 Chinese CAVD patients underwent genetic testing for CFTR and ADGRG2 mutations, semen analysis, scrotal and transrectal ultrasound examinations, and reproductive hormone measurements. The genotype-phenotype correlations were analyzed, focusing on the impact of CFTR variants on the presence or absence of the epididymis, vas deferens, seminal vesicles, and other related structures.

RESULTS

CFTR mutations were identified in 72.7% (88/121) of CAVD patients, with the IVS9-5 T variant being the most prevalent (54.5%, 66/121). Six novel CFTR variants (CFTR: L218Ffs*15, V1007Ffs*40, V938M, A566V, S605P, H949P) were identified in Chinese men. Patients with CFTR homozygous IVS9-5 T variants had a significantly lower rate of epididymal absence compared to those with one 5 T and one non-5 T variant or two non-5 T variants (p = 0.016). Notably, patients carrying at least one non-5 T variant were associated with an 8.17-fold increased risk of epididymal partial absence compared to those having the homozygous 5 T mutation (95% confidence interval 1.52-59.58, p = 0.009).

CONCLUSION

This study provides novel insights into the genotype-phenotype correlations of CFTR variants in Chinese CAVD patients, highlighting the differential impact of 5 T and non-5 T variants on male reproductive tract development. These findings provide additional information that may be helpful for genetic counseling, clinical management, and the development of personalized diagnostic and therapeutic strategies for CAVD patients.

An observational study comparing the dosimetry and clinical effects of conventional versus hypofractionated radiotherapy in elderly patients of early breast cancer

INTRODUCTION

Hypofractionated radiation therapy after Breast Conserving Surgery in patients of early breast carcinoma results in equivalent clinical outcome but better cosmesis as compared to conventional therapy. In this study we have compared the dosimetry and clinical outcome between Hypofractionated and Conventional whole breast radiation followed by boost therapy after patients had undergone breast conserving surgery for early breast cancer.

AIMS AND OBJECTIVES

1. Dosimetric analysis and toxicity assessment between conventional and Hypofractionated radiation therapy.2. Comparative analysis of late toxicity between two groups.

MATERIALS AND METHODS

In the department of Radiation Oncology in a Tertiary Care Hospital, 100 patients between the age group 65-75 years were selected as per inclusion criteria of the study and there were 60 patients in the conventional group and 40 in the hypofractionated group respectively. All the patients underwent treatment in Varian Truebeam Linear accelerator with appropriate radiation planning after undergoing Breast Conserving Surgery along with adjuvant chemotherapy when indicated.The conventional group received a dose of 50 Gy in 25# followed by boost of 10 Gy in 5 # and the hypofractionated arm received a dose of 42.5Gy in 16# followed by a boost of 12.5Gy in 5 # . The post-operative tumour cavity was irradiated along with axillary lymph nodes when indicated. All the patients in both arms were assessed for toxicity related to therapy and quality of life as per EORTC Q45 in 2 years following treatment completion. All statistical tests were done by SPSS version 23. Unpaired t-test was used for dosimetric comparison. Comparison of QOL and toxicity was done by Chi-square test respectively between two groups. A p-value of < 0.05 was taken to be significant.

RESULTS

At the end of 2 years, 54 patients in conventional group and 38 patients in hypofractionated group could be assessed respectively and rest in both groups had lost to follow-up due to logistical reasons. There was no significant difference in dosimetry between the two groups as per unpaired t-test (P value >0.05). In terms of Quality of Life assessment in two years following the completion of therapy the conventional arm had more toxicity than hypofractionated arm as per Chi-square test (P value <0.05). Chi-square test revealed patients who had conventional therapy had worse cosmetic outcome and increased incidence of myelotoxicity than in those who received hypofractionated therapy, both statistically significant (P value < 0.05). There was no incidence of locoregional relapse in either groups.

CONCLUSION

Hypofractionated whole breast Radiation therapy followed by boost therapy with can result in less toxicity and thus better cosmetic outcome and almost equal dosimetric results compared to Conventional Radiotherapy in patients after breast conserving surgery, thus comparatively increasing their quality of life.

Intracranial Air Absorption through Arachnoid Granulation: New Considerations from Transsphenoidal Surgery and Implications for Neurofluid Dynamics

Postsurgery intracranial air usually diminishes, presumably merging with cerebrospinal fluid (CSF) and venous circulation. Our study presents two transsphenoidal surgery cases, highlighting potential air absorption by arachnoid granulation (AG)-an underexplored phenomenon. AG has long been deemed pivotal for CSF absorption, but recent perspectives suggest a significant role in waste clearance, neuroinflammation, and neuroimmunity. These cases may stimulate renewed research on the multifaceted role of AG in neurofluid dynamics and potentially elucidate further AG functions.