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.

Massive Pulmonary Hemorrhage in a Patient With Multiple Pulmonary Cavitary Lesions: A Case Report and Literature Review

In this article, we present a rare case of a patient who presented with multiple pulmonary cavitary lesions. The hospital course was complicated by massive pulmonary hemorrhage and subsequent cardiac arrest, during which return of spontaneous circulation was not achieved. Bronchoalveolar lavage (BAL) cultures taken during the hospital stay only resulted positive for Candida albicans posthumously. Blood cultures, sputum cultures, and remaining BAL cultures were negative. This is a rare case of multiple pulmonary cavitary lesions in the setting of a non-immunocompromised patient without evidence of precipitating disseminated disease. Pulmonary echinococcosis is proposed as a possible differential diagnosis in this patient based on clinical, laboratory, and imaging findings.

Effectiveness of ozone nucleolysis in alleviating pain and enhancing function in lumbar sciatica due to disc herniation: a minimally invasive approach

OBJECTIVES

Ozone (O2-O3) nucleolysis is emerging as a promising minimally invasive therapy for treating lumbosciatica due to herniated discs. This study aims to evaluate changes in pain and functional abilities before and after ozone disc nucleolysis in patients with lumbar disc herniation (LDH).

MATERIALS AND METHODS

This study included 34 patients (15 males, 19 females; age range 17-76, average age 46.7 ± 11.2 years) treated between April 2018 and May 2022. A single dose of an O2-O3 mixture (5 ml, 30 µg/ml) was injected into the disc under fluoroscopic guidance via a lateral approach, followed by an additional periradicular injection of the same mixture (5 ml) combined with a corticosteroid (2 ml). Pain and patient satisfaction were assessed using the VAS score and modified MacNab criteria, while MRI findings evaluated treatment-related changes, including herniated disc surface and disc height.

RESULTS

VAS scores indicated pain improvement in 85% of patients, with 82% achieving satisfactory outcomes per modified MacNab criteria. Patients under 50 years of age showed greater responsiveness to ozone therapy. Central LDH responded more favorably than larger foraminal herniations, and hernias with a larger surface area than the average also showed better outcomes. No complications were observed.

CONCLUSION

Ozone therapy is a cost-effective, simple, and safe minimally invasive technique that provides significant pain relief and functional improvement. It may be a reliable and competitive treatment option for patients with persistent symptoms after conservative treatment and before considering surgical intervention. Key Points •Ozone nucleolysis provides a minimally invasive treatment for lumbosciatica with reduced recovery time. •Injecting oxygen-ozone into the disc decreases its volume and inflammation, easing nerve pressure. •Initial results show significant pain relief and improved mobility in patients following treatment. •This method appears safe, with fewer complications than traditional surgery for herniated discs.

Radiographic Assessment of Osteosclerotic Lesions in Mice with Bone Metastasis

More than 80% of patients with advanced prostate cancer experience bone metastasis, which negatively impacts overall survival and patients' quality of life. To elucidate underlying mechanisms and devise effective treatments for bone-metastatic disease, the development of animal models is imperative. However, fully replicating human conditions proves challenging as bone metastasis rarely occurs in spontaneous prostate cancer mouse models. Therefore, to investigate the interaction between bone-metastatic cancer cells and the bone microenvironment, mouse models with direct intraosseous injection (e.g., intrafemoral injection) have been widely used. Assessing bone remodeling is key to understanding the underlying mechanisms and pathology behind this disease. As such, longitudinal radiographic analysis for assessing progressive structural changes of the bone has been used since this method presents as a more cost-effective, accessible imaging modality compared to magnetic resonance imaging and computed tomography. Here, we describe a method of analysis that primarily focuses on scoring the osteoblastic phenotype (solid and spiculated) in our prostate cancer bone-metastatic mouse models, given the predominance of osteosclerotic activity in prostate cancer patients.

E-Brachy: New dosimetry package for electronic brachytherapy sources

BACKGROUND

Large reported variability in the material composition and geometrical components of the Xoft electronic high dose rate brachytherapy causes inter-source discrepancy in the source output. This variability is due to the manual manufacturing and assembly of the sources.

PURPOSE

This study aimed to develop a dosimetry software tool called E-Brachy to characterize the Xoft source and quantify the discrepancies in its photon spectrum and dosimetric properties.

METHODS

E-Brachy is based on the Geant4 Monte Carlo toolkit and consists of two parts. In part one, the geometry and material composition for the source received in the computer-aided design format from the vendor were converted to the geometry description markup language format using the GUIMesh Python tool and integrated into the E-Brachy software. There was a large variation in material composition and thickness for some of the tube components. The simulation started from electrons and resulted in x-ray generations in the anode region. Multithreading, a track length estimation, and the uniform bremsstrahlung splitting variance reduction techniques were used to decrease the simulation time and increase the x-ray production. The photon energy, position, and momentum were saved into a phase space file as the photon exited the source, but before interacting with the external environment. The obtained x-ray energy spectrum was compared with measurements from the National Institute of Standards and Technology (NIST). In part two, by sampling from the generated photons, the dose rates and dosimetric parameters according to the TG-43 protocol were calculated for model S7500 and compared to the ones previously calculated for model S700 source, which were deemed identical by the manufacturer.

RESULTS

The material composition that resulted in the most similar spectrum as the measured NIST spectrum with Pearson's correlation coefficient of 0.99 and a calculated Euclidean difference of0.061 ± 0.001 $0.061\,\pm \,0.001$  keV was chosen for further dosimetric analysis of the model S7500 source. Characteristic peaks showed the presence of tungsten, yttrium, and silver in the source components. Differences in dose rates between the two source models surpassed 20% for polar anglesθ ≥ 150 ∘ $\theta \,\ge \,150^\circ$ , reaching a peak atr = 3 $r\,=\,3$  cm andθ = 175 ∘ $\theta \,=\,175^\circ$ . The differences in the radial dose function values were within 5%. The relative difference in percentage between the anisotropy function values of the two models was closer to 0 for smaller θ $\theta$ values, but at higher polar angles, they increased to 300%.

CONCLUSIONS

A software package called E-Brachy was successfully developed for the characterization and dosimetry of Xoft electronic brachytherapy sources. E-Brachy can be combined with spectral measurements to investigate the inter- and intra-source variability. The software package was tested by comparing the simulated spectra from the S7500 Xoft source model with NIST measurements and its TG-43 parameters with the S700 model. The TG-43 parameters between the two sources significantly exceed the recommendations of TG-56.

Artifacts at Cardiac MRI: Imaging Appearances and Solutions

Cardiac MRI (CMR) is an important imaging modality in the evaluation of cardiovascular diseases. CMR image acquisition is technically challenging, which in some circumstances is associated with artifacts, both general as well as sequence specific. Recognizing imaging artifacts, understanding their causes, and applying effective approaches for artifact mitigation are critical for successful CMR. Balanced steady-state free precession (bSSFP), the most common CMR sequence, is associated with band and flow artifacts, which are amplified at 3-T imaging. This can be mitigated by targeted shimming, by short repetition time, or by using a frequency-scout sequence. In patients with cardiac arrhythmias or poor breath hold, the quality of cine imaging can be improved with a non-electrocardiographically gated free-breathing real-time sequence. Motion artifacts on late gadolinium enhancement (LGE) images can be mitigated by using single-shot technique with motion compensation and signal averaging. LGE images are also prone to partial-volume averaging and incomplete myocardial nulling. In phase-contrast imaging, aliasing artifact is seen when the velocity of blood is higher than the encoded velocity. Aliasing can be mitigated by increasing the encoded velocity or using postprocessing software. In first-pass perfusion imaging, a dark rim artifact due to Gibbs ringing can be distinguished from a true perfusion defect based on earlier appearance and fading after a few cardiac cycles. With implanted cardiac devices, artifactual high signal intensity mimicking scar is seen on LGE images, which can be mitigated using a wide-band sequence. With devices and metallic artifacts, traditional gradient-recalled echo sequence has fewer artifacts than bSSFP. CMR at 3 T requires adaptation of sequences to minimize artifacts. ©RSNA, 2025 Supplemental material is available for this article.

Outcomes in Pediatric Cholesteatoma

OBJECTIVE

The objective of the study is to evaluate the outcomes of surgical management options for cholesteatoma using a national database.

STUDY DESIGN

Database analysis of the Pediatric Health Information System database to identify children undergoing surgical intervention for cholesteatoma from October 2015 to December 2022.

METHODS

Patients were categorized by initial surgical modality: tympanoplasty (TM), tympanoplasty with canal wall-up tympanomastoidectomy (TM-CWU), and tympanoplasty with canal wall-down tympanomastoidectomy (TM-CWD). Group comparisons were done on number of surgical revisions and number of patients identified with recommendations for hearing aids.

RESULTS

A total of 6304 patients were identified in the database who underwent surgery for cholesteatoma. Of these children, 3405 underwent TM (54.0%), 3116 underwent TM-CWU (49.4%), and 825 underwent TM-CWD (8.2%). The estimated difference in mean number of procedures was significantly higher in the TM-CWU group compared to TM-CWD (-0.34, 95% confidence interval [CI] -0.406,-0.279, P < .0001) and the TM group (9.352, 95% CI 0.315, 0.390, P < .0001). The rate of significant hearing loss necessitating hearing aids was significantly lower in the TM group, but there was no difference between the TM-CWU and TM-CWD groups (1.2%, P < .03, 1.9% vs 2.7%, P = .13). There was no difference in the number of speech delays/therapy diagnoses between TM and TM-CWU or TM-CWU and TM-CWD (3.5%vs 4.4% P = .07, 4.4% vs 5.2%., P = .38).

CONCLUSION

TM and TM-CWD had lower total surgical procedures than the TM-CWU group, and the TM group had a lesser rate of recommendation for hearing aids. The difference between number of procedures is likely due to the complexity of the disease; for instance, TM was likely chosen for small, less severe disease cases, whereas TM-CWD was chosen as more definitive treatment in aggressive cases. TM-CWD is associated with a lower rate of recidivism and recurrence, which also likely contributed to the lower number of procedures.

Xanthogranulomatous Cholecystitis in a 15-Year-Old Girl: A Case Report and Literature Review

Xanthogranulomatous cholecystitis (XGC) is a rare and severe variant of cholecystitis that poses significant diagnostic and surgical challenges. While predominantly seen in adults, its occurrence in pediatric patients is exceedingly rare, with very few cases documented in the literature. We present the case of a 15-year-old girl initially diagnosed with acute calculous cholecystitis who underwent a laparoscopic cholecystectomy. Intraoperatively, extensive pseudo-tumorous inflammation was identified, with fusion of the gallbladder into the omentum, duodenum, and colon, necessitating a subtotal cholecystectomy. Her postoperative recovery was complex, requiring endoscopic retrograde cholangiopancreatography (ERCP), and she was ultimately discharged after a prolonged hospital stay. Histopathological examination confirmed the diagnosis of XGC. This case highlights the complexities of managing this rare entity in pediatric patients.

The Wolf in Sheep's Clothing: Incidental Pulmonary Hydatidosis masquerading as Constitutional Symptoms

Hydatid disease, caused by Echinococcus granulosus, remains a significant health concern in endemic regions. This case report aims to highlight the diagnostic challenges of pulmonary hydatid cysts in non-endemic areas, presenting a unique case of an incidental pulmonary hydatid cyst in a 31-year-old lactating female discovered during evaluation of non-specific constitutional symptoms.

[Pneumomediastinum as a rare complication in connective tissue disease]

Otherwise known as mediastinal emphysema, pneumomediastinum (PNM) in connective tissue diseases is a rare clinical entity. Few cases have been described in the literature. In fact, it only exceptionally complicates the evolution of connective tissue diseases. In this paper report, two cases of spontaneous PNM secondary to scleroderma and Sjogren's syndrome. Based on the data in the literature, we discuss the etiology, frequency of occurrence, and the pathophysiological mechanisms of this unusual complication.

Differentiating carcinoma from benign causes of nonspecific gall bladder wall thickening: A prospective observational study on the role of multiparametric MRI and proposition of an MpMRI-based criteria

BACKGROUND

In nonspecific gall bladder (GB) wall thickening on ultrasonography (USG) or computed tomography (CT), the patient undergoes a more major surgery for a benign cause or a redo surgery for malignancy if diagnosed inaccurately.

PURPOSE

To evaluate whether malignant and benign causes of nonspecific GB wall thickening can be accurately differentiated on multiparametric magnetic resonance imaging (MpMRI) and to propose MpMRI-based diagnostic criteria.

METHODS

Thirty-six of 94 nonspecific GB wall thickening patients underwent MpMRI in a 1.5 T scanner. The MRI characterization was compared with histopathology. Statistical analysis calculated various MRI parameters' sensitivity, specificity, and accuracy in distinguishing benign and malignant lesions. The receiver operating curve analysis provided the apparent diffusion coefficient (ADC) cut-off value.

RESULTS

MpMRI had 100% sensitivity and 92.31% specificity in detecting malignant wall thickening. The sensitivity and specificity of various parameters like intact mucosa on T2-weighted imaging (T2WI), smooth-enhancing mucosa, identification of wall layers on T2WI, and diffusion-weighted imaging (DWI) were 100% and 84.62%, 100% and 92.31%, 100% and 96.15%, and 100% and 53.85%, respectively, in differentiating benign from malignant thickening. Malignancy showed lower ADC values; the cut-off was 1.107 × 10-3 mm2/s. Intramural nodule/cyst on T2WI, chemical shift imaging, and dynamic contrast-enhanced MRI (DCE-MRI) showed 100% positive predictive value for benign wall thickening.

CONCLUSION

MpMRI accurately differentiates benign from malignant GB wall thickening and is recommended when USG or CT are inconclusive. This will help decide the type of surgery, simple cholecystectomy for benign or radical surgery for a malignant cause. Accurate prediction by MpMRI will reduce patient morbidity and improve survival.

Evaluation of Low-dose Computed Tomography Images Reconstructed Using Artificial Intelligence-based Adaptive Filtering for Denoising: A Comparison with Computed Tomography Reconstructed with Iterative Reconstruction Algorithm

Purpose

Awareness of radiation-induced risk led to the development of various dose optimization techniques in iterative reconstruction (IR) algorithms and deep learning algorithms to improve low-dose image quality. PixelShine (PS) by AlgoMedica Inc., USA, is a vendor-neutral deep learning denoising tool for low-dose studies, and this study analyzed its images.

Aim

The aim of this study was to assess the diagnostic value of PS-reconstructed images obtained at various low doses (LDs).

Materials and Methods

A retrospective study qualitatively and quantitatively evaluated the low-dose PS-reconstructed images by comparing them with other reconstruction methods and standard dose (SD) images. A total of 85 cases were evaluated, of which 32 cases were scanned on a scanner with filtered back projection (FBP) reconstruction with LD scans performed at 70%-50% of SD. The remaining 53 cases were performed on the scanner with IR, 35 of them had LD scan at 50% of SD and 18 cases had LD scan at 33% of SD.

Results

Qualitative image analysis - The quality of low-dose images with PS and IR was almost equivalent in terms of noise magnitude and texture at 50% dose, and PS images were slightly better at 33% dose reduction. Quantitative image analysis - Low-dose PS-reconstructed images and low-dose iterative reconstructed images had similar contrast-to-noise ratio at 50% dose reduction; however, at 33% of the SD, PS-reconstructed images outperformed. The SD FBP images were equivalent to LD PS-reconstructed images (50% dose reduction).

Conclusions

Artificial intelligence-based denoising algorithms produce similar images as IR at 50% dose reduction and outperform it at 33% of the SD.

Hyperechogenicity and histopathological features of focal liver lesions

The identification and accurate diagnosis of focal liver lesions are important in modern medicine, where diagnostic radiology plays an essential role. This review aimed to examine the hyperechogenicity and histopathological features of focal liver lesions. Hyperechogenic liver lesions can be either benign or malignant. Evidence shows that hyperechogenicity is caused by factors such as fat deposition, sinusoidal dilation, peliotic changes, and pseudoglandular patterns. Fat deposition is a common cause of increased echogenicity in hepatocellular carcinoma (HCC). Meanwhile, sinusoidal dilation and peliotic changes are more frequently observed in larger HCC nodules. Pseudoglandular patterns, characterized by the reflection of ultrasound waves at the walls of numerous acini, are associated with hyperechogenicity in well-to-moderately differentiated HCCs. Moreover, this review comprehensively examined the histological features that may cause hyperechogenic internal echoes in not only HCCs but also localized liver lesions (metastases of adenocarcinoma and neuroendocrine neoplasm, intrahepatic cholangiocarcinoma, cavernous hemangioma, focal nodular hyperplasia, and angiomyolipoma). To make an accurate diagnosis and provide appropriate management, it is important to understand the histopathological basis for hyperechogenicity in focal liver lesions. By maximizing the accuracy of imaging studies and enhancing the radiology-pathology correlation, unnecessary biopsies can be avoided, thereby reducing potential complications and mortality. This review can help facilitate the effective management of patients with focal liver lesions, thereby resulting in timely and appropriate treatment decision-making.

Ghost Sign on Diffusion-Weighted Imaging Generated Apparent Diffusion Coefficient Map: Additional MRI Diagnostic Marker for Extremity Osteomyelitis

Objective  The aim of this study was to determine the sensitivity and specificity and inter-reader reliability of previously known "ghost sign" and "penumbra sign" on T1-weighted (T1W) imaging and "ghost sign" on apparent diffusion coefficient (ADC) map in osteomyelitis (OM) of the extremities. Materials and Methods  In this cross-sectional retrospective study, two fellowship-trained musculoskeletal readers blinded to final diagnosis of OM versus no OM were asked to report the penumbra sign and ghost sign on T1W images and ghost sign on ADC map, as well as diagnosis of OM. Cohen's kappa was used. Diagnostic performance measures including sensitivity, specificity, and accuracy were calculated. Results  A sample of 178 magnetic resonance imaging (MRI) scans of pathology-proven cases were included in this study, with 41 being positive for OM and 137 being negative for OM. There was a fair inter-reader agreement for imaging signs, and moderate agreement of 0.60 for OM. The sensitivities of the penumbra sign on T1W imaging, ghost sign on T1W imaging, and ghost sign on ADC map for OM are 3.7, 9.8, and 19.5%, respectively, while their respective specificities are 98.9, 97.8, and 94.5%, respectively. All three imaging signs showed a similar (good) accuracy of 76 to 78%. Conclusion  The ghost sign on ADC can be used as an additional marker for OM and is a similarly highly specific but a more sensitive sign for OM than the conventionally used penumbra sign and ghost sign on T1W imaging. Key Points The ghost sign on ADC can be used as a helpful indicator of osteomyelitis.Across two fellowship-trained musculoskeletal readers, there was a fair inter-reader agreement for imaging signs and moderate agreement for OM.The ghost sign on ADC is a similarly highly specific but a more sensitive sign for osteomyelitis than the conventionally used penumbra sign and ghost sign on T1W imaging. All three imaging signs showed a similar (good) accuracy of 76 to 78%.

Portal-Vein Compression Caused by Double-Pigtail Plastic Biliary Stent

Introduction

Reports of pseudoaneurysms associated with biliary self-expandable metallic stent (SEMS) placement have been increasing. Recently, cases of hepatic pseudoaneurysm rupture caused by double pigtail plastic stents (DPS) have also been reported. The symptoms of pseudoaneurysms are often non-specific, and many cases are diagnosed only after rupture. Therefore, early detection and appropriate treatment are required.

Case Presentation

A 45-year-old woman presented with obstructive jaundice caused by pancreatic head cancer, with imaging revealing common bile duct stenosis and intrahepatic bile duct dilation. Endoscopic retrograde cholangiopancreatography (ERCP) was performed to place a DPS in the left hepatic duct, relieving jaundice. However, follow-up contrast-enhanced computed tomography (CE-CT) revealed differences in arterial-phase blood flow between the liver lobes without reduction in portal vein blood flow. Therefore, the compression and stenosis of the left branch of the portal vein caused by the DPS were clearly identified using three-dimensional computed tomography (3D-CT). The DPS was replaced with a straight-type stent, preventing further complications. The patient subsequently underwent successful pancreaticoduodenectomy without any surgical complications.

Conclusion

This is a case of portal vein compression caused by double-pigtail plastic biliary stent. By promptly recognizing the differences in arterial-phase blood flow between the liver lobes and replacing the DPS with a straight-type plastic stent, complications, such as portal vein pseudoaneurysm formation, rupture, embolism, or thrombosis, were successfully avoided.

Electrochemical biosensors for early detection of breast cancer

Breast cancer continues to be a significant contributor to global cancer deaths, particularly among women. This highlights the critical role of early detection and treatment in boosting survival rates. While conventional diagnostic methods like mammograms, biopsies, ultrasounds, and MRIs are valuable tools, limitations exist in terms of cost, invasiveness, and the requirement for specialized equipment and trained personnel. Recent shifts towards biosensor technologies offer a promising alternative for monitoring biological processes and providing accurate health diagnostics in a cost-effective, non-invasive manner. These biosensors are particularly advantageous for early detection of primary tumors, metastases, and recurrent diseases, contributing to more effective breast cancer management. The integration of biosensor technology into medical devices has led to the development of low-cost, adaptable, and efficient diagnostic tools. In this framework, electrochemical screening platforms have garnered significant attention due to their selectivity, affordability, and ease of result interpretation. The current review discusses various breast cancer biomarkers and the potential of electrochemical biosensors to revolutionize early cancer detection, making provision for new diagnostic platforms and personalized healthcare solutions.

The effect of manual lymphatic drainage on intraneural edema of the median nerve in patients with carpal tunnel syndrome: A randomized controlled trial

BACKGROUND

Intraneural edema is an important factor in the pathophysiology of carpal tunnel syndrome (CTS). Manual Lymphatic Drainage (MLD) is a manual treatment widely used to treat edema in a variety of conditions.

PURPOSE

This study aimed to evaluate the effect of MLD on intraneural edema of the median nerve in CTS patients, as well as its impact on symptom severity and hand function.

STUDY DESIGN

Randomized controlled study.

METHODS

Twenty-seven patients (aged 48.9 ± 9.9) with mild-to-moderate bilateral CTS were recruited for the study. One hand of each subject was allocated to the experimental group and the other hand in the control group randomly. The experimental group underwent MLD, myofascial release (MFR) therapy and conventional physiotherapy (CP). The control group received sham MLD, MFR and CP. Interventions were performed 2 days a week for 6 weeks. The distal motor latency (DML), motor nerve (MNCV), and sensory nerve (SNCV) conduction velocity of the median nerve were evaluated using electrodiagnostic techniques. As secondary evaluations, grip strength, pressure pain threshold, pain intensity, symptom severity, and hand functions were assessed. The cross-sectional area (CSA) of the median nerve was measured by ultrasound. All assessments were performed at baseline and 6 weeks after intervention.

RESULTS

According to the analysis of a two-way repeated measures of ANOVA, the experimental group showed greater improvement in CSA (p < 0.001; η2 = 0.510), DML (p < 0.001; η2 = 0.549), sensory (p < 0.001; η2 = 0.408), and motor conduction velocity (p < 0.001; η2 = 0.419) of the median nerve than the control group. There was no significant difference between the groups in the secondary evaluation results (p > 0.05).

CONCLUSION

MLD may contribute to symptom relief in CTS by reducing intraneural edema in the median nerve.

Soft tissue tumor imaging in adults: whole-body staging in sarcoma, non-malignant entities requiring special algorithms, pitfalls and special imaging aspects. Guidelines 2024 from the European Society of Musculoskeletal Radiology (ESSR)

OBJECTIVES

The revised European Society of Musculoskeletal Radiology (ESSR) consensus guidelines on soft tissue tumor imaging represent an update of 2015 after technical advancements, further insights into specific entities, and revised World Health Organization (2020) and AJCC (2017) classifications. This second of three papers covers algorithms once histology is confirmed: (1) standardized whole-body staging, (2) special algorithms for non-malignant entities, and (3) multiplicity, genetic tumor syndromes, and pitfalls.

MATERIALS AND METHODS

A validated Delphi method based on peer-reviewed literature was used to derive consensus among a panel of 46 specialized musculoskeletal radiologists from 12 European countries. Statements that had undergone interdisciplinary revision were scored online by the level of agreement (0 to 10) during two iterative rounds, that could result in 'group consensus', 'group agreement', or 'lack of agreement'.

RESULTS

The three sections contain 24 statements with comments. Group consensus was reached in 95.8% and group agreement in 4.2%. For whole-body staging, pulmonary MDCT should be performed in all high-grade sarcomas. Whole-body MRI is preferred for staging bone metastasis, with [18F]FDG-PET/CT as an alternative modality in PET-avid tumors. Patients with alveolar soft part sarcoma, clear cell sarcoma, and angiosarcoma should be screened for brain metastases. Special algorithms are recommended for entities such as rhabdomyosarcoma, extraskeletal Ewing sarcoma, myxoid liposarcoma, and neurofibromatosis type 1 associated malignant peripheral nerve sheath tumors. Satisfaction of search should be avoided in potential multiplicity.

CONCLUSION

Standardized whole-body staging includes pulmonary MDCT in all high-grade sarcomas; entity-dependent modifications and specific algorithms are recommended for sarcomas and non-malignant soft tissue tumors.

CLINICAL RELEVANCE STATEMENT

These updated ESSR soft tissue tumor imaging guidelines aim to provide support in decision-making, helping to avoid common pitfalls, by providing general and entity-specific algorithms, techniques, and reporting recommendations for whole-body staging in sarcoma and non-malignant soft tissue tumors.

KEY POINTS

An early, accurate, diagnosis is crucial for the prognosis of patients with soft tissue tumors. These updated guidelines provide best practice expert consensus for standardized imaging algorithms, techniques, and reporting. Standardization can improve the comparability examinations and provide databases for large data analysis.

The celiac ganglia and trunk: an assessment of anatomical variants and their clinical relevance

The celiac ganglia are a network of nerve fibers that regulate various functions related to digestion, while the celiac trunk is a major artery that supplies oxygenated blood to the stomach, small intestine, and other organs in the upper abdominal region. Anatomical variants of these structures are common and can have significant implications for surgical and medical procedures. This prospective observational study was conducted over one year and included 300 patients (aged 45-75 years) with a history of peripheral arterial disease, evaluated at Dr. Carol Davila Central Military Emergency Hospital Bucharest, Romania, using a Philips Spectral CT 7500. The study identified three major anatomical variants of the celiac trunk, each associated with different positional distributions of the celiac ganglia. In cases where the celiac trunk presented as a hepatosplenic trunk with the left gastric artery originating from the abdominal aorta, the lateral position of the celiac ganglia was most prevalent. When the hepatosplenic trunk included the left gastric artery arising from the splenic artery, the postero-lateral position of the celiac ganglia was the most frequently observed. In patients with a hepatogastric trunk, where the splenic artery originated from the superior mesenteric artery, the lateral position of the celiac ganglia was again the most common. Statistical analysis reveals a t-statistic of 7.391 and 11.319 with a P value of 0.002. This article reviewed the anatomical variants of the celiac ganglia and their anatomical variants, highlighting their prevalence, clinical significance, and implications for surgical and interventional procedures.

Single-Center Mid-term Experience with E-Liac Branched Device from Artivion®

BACKGROUND

The use of iliac branch device (IBD) is increasing due to the less invasive character and accumulated experience of physicians in this endovascular technique. Clinical data regarding the E-liac stent graft from Artivion®, however, are scarce. This study shows the mid-term outcomes of the E-liac stent graft from a large single center.

METHODS

Patients treated with IBD for (aorto-)iliac aneurysms between September 2015 and December 2022 with follow-up in our center were included. (Post)operative (technical success, reintervention, 30-day mortality) and mid-term outcomes (endoleak, reintervention, hypogastric patency, mortality) were analyzed.

RESULTS

63 patients (60 male, median age 70 years (IQR 66-76)) were treated with 82 E-liac stent grafts for aorto-iliac aneurysms with a median follow-up of 38 months (IQR 22-51). The technical success rate was 95%. Ninety-seven point six percent of the interal iliac arteries remained patent during follow-up. No 30-day mortality was encountered. During follow-up one patient had an endoleak type 1b of both hypogastric arteries, however the patient refused additional interventions. One other patient had a type 2 endoleak with contained rupture. Palliative treatment was chosen because of the patient's severe comorbidities. One (1.6%) IBD-related reintervention was performed with relining of the stent graft. Secondary patency of the interal iliac artery was 95.1% and the mortality was 25.4% during follow-up.

CONCLUSIONS

This study shows high technical success rates for the E-liac stent graft, with corresponding good mid-term outcomes. The E-liac stent graft is a feasible, safe and effective stent graft in the treatment of aorto-iliac aneurysms.

Acupuncture gone awry: surgical management of a popliteal artery pseudoaneurysm with concurrent abdominal aortic aneurysm

Popliteal artery pseudoaneurysms are rare, especially from acupuncture-related trauma. We report a 67-year-old male with hypertension, diabetes, chronic kidney disease, and an abdominal aortic aneurysm (AAA), who developed a popliteal pseudoaneurysm after acupuncture. Imaging confirmed the pseudoaneurysm and a 55 mm AAA. Urgent surgical repair with a Gore-Tex graft led to a smooth recovery. This case emphasizes the vascular risks of acupuncture and the importance of early diagnosis, multidisciplinary care, and personalized follow-up in patients with complex comorbidities.

Reassessment of the possible size, form, weight, cruising speed, and growth parameters of the extinct megatooth shark, Otodus megalodon (Lamniformes: Otodontidae), and new evolutionary insights into its gigantism, life history strategies, ecology, and extinction

Otodus megalodon (Lamniformes: Otodontidae) is an iconic Neogene shark, but the lack of well-preserved skeletons has hampered our understanding of various aspects of its biology. Here, we reassess some of its biological properties using a new approach, based on known vertebral specimens of O. megalodon and 165 species of extinct and extant neoselachian sharks across ten orders. Using the median neurocranial and caudal fin proportions relative to the trunk proportion among non-mitsukurinid/non-alopiid lamniforms, we show that O. megalodon could have had a slender body and possibly reached about 24.3 m in length. Allometric considerations indicate that a stout body plan like the extant white shark (Carcharodon carcharias) for O. megalodon could have incurred excessive hydrodynamic costs, further supporting the interpretation that O. megalodon likely had a slenderer body than C. carcharias. A 24.3-m-long O. megalodon may have weighed around 94 t, with an estimated cruising speed of 2.1-3.5 km h-1. A reanalysis of vertebral growth bands suggests a size at birth of 3.6-3.9 m for O. megalodon, supporting the previous interpretations of its ovoviviparity and embryos' intrauterine oophagous behavior, but less likely the need for nursery areas. Additional inferred growth patterns corroborated by the known fossil record support the hypothesis that the emergence of C. carcharias during the Early Pliocene is at least partly responsible for the demise of O. megalodon due to competition for resources. These interpretations are working hypotheses expected to serve as reasonable reference points for future studies on the biology of O. megalodon.

Orbital Myositis and Strabismus: Clinical Profile, Management, and Predictive Factors for Recurrence

PURPOSE

To study the clinical profile of patients with orbital myositis and their management modalities and predictive factors for recurrence.

METHODS

The records of all consecutive patients diagnosed as having orbital myositis from 2010 to 2022 were reviewed. Patient demographics, presenting complaints, visual function, primary gaze deviation, and extraocular muscle involved were studied in the clinical profile. The radiological modalities and their management along with the recovery status and need for surgical intervention were documented.

RESULTS

Fifty-two patients (55 eyes) (69% women) were diagnosed as having orbital myositis with a mean age of 36 ± 16 years presenting with periocular pain (55%) followed by diplopia (49%). Disease was unilateral in 94%. Sixty percent had ocular misalignment in primary gaze. The medial rectus was the most involved muscle (58%), with abduction limitation in 73%. Computed tomography (42%), magnetic resonance imaging (42%), and combined imaging (16%) were used in localizing the disease. Muscle biopsy was done in 38% of patients. Systemic immunomodulators were required in 16%. Strabismus surgery was planned in 15% of patients and done in 11%. Recurrence was noted in 43%. Abrupt cessation of steroids was a significant risk factor in recurrence of the disease (P = .046). Recovery was partial in 44% of patients and complete in 47%.

CONCLUSIONS

Systemic steroids with slow taper has satisfactory outcomes in orbital myositis. Patients refractory to treatment ideally should undergo biopsy and begin taking steroid-sparing agents. Once the disease is in remission, residual disease can be surgically treated for better functional outcome. [J Pediatr Ophthalmol Strabismus. 2025;62(1):57-66.].

Intestinal Ultrasound in Common Gastrointestinal Disorders: An Evidence-Based Approach

Patients with abdominal symptoms are among the most common to present both urgently and non-urgently for medical evaluation. While intestinal ultrasound (IUS) is useful to aid management of these patients, it is not routinely taught, performed, or included as part of the core set of point-of-care ultrasound competencies. The authors present an approach to performing a systematic, but focused, IUS at the bedside and diagnostic accuracies for small bowel obstruction inflammatory bowel disease, appendicitis, and diverticulitis. An approach on how to integrate IUS findings and common pitfalls will also be discussed.

Natriuretic Peptides in Gastrointestinal Cancer: Biomarkers and Potential Therapeutic Targets

Gastrointestinal (GI) cancers are an important health problem globally. Natriuretic peptides are hormones that have a crucial role in human physiology. There are a variety of treatments for GI cancer, but conventional therapies have side effects and low efficacy. Studies have demonstrated that natriuretic peptides are therapeutic in different cancer types. Natriuretic peptides are best known for their involvement in regulating blood pressure and blood volume. The anti-tumor effect exerted by natriuretic peptides is via their inhibitory effects on DNA synthesis and by their effects on apoptosis. The anti-proliferative role of natriuretic peptides has been shown in human breast cancer, prostate, colon, pancreatic, lung, ovarian, and other tumors. The roles of natriuretic peptides in these cancers are diverse and not well understood. Therefore, we have reviewed the recent literature on natriuretic peptides in GI cancers as a common malignancy in adults to assess the pathways that NPs are involved in the progression of GI cancers and its effect on the prevention or treatment of GI cancers.

The Society of Thoracic Surgeons Expert Consensus on the Multidisciplinary Management and Resectability of Locally Advanced Non-small Cell Lung Cancer

BACKGROUND

The contemporary management and resectability of locally advanced lung cancer are undergoing significant changes as new data emerge regarding immunotherapy and targeted treatments. The objective of this document is to review the literature and present consensus among a group of multidisciplinary experts to guide the determination of resectability and management of locally advanced non-small cell lung cancer (NSCLC) in the context of contemporary evidence.

METHODS

The Society of Thoracic Surgeon Workforce on Thoracic Surgery assembled a multidisciplinary expert panel composed of thoracic surgeons and medical and radiation oncologists with established expertise in the management of lung cancer. A focused literature review was performed, and expert consensus statements were developed using a modified Delphi process to address 3 major themes: (1) assessing resectability and multidisciplinary management of locally advanced lung cancer, (2) neoadjuvant (including perioperative) therapy, and (3) adjuvant therapy.

RESULTS

A consensus was reached on 19 recommendations. These consensus statements reflect updated insights on resectability and multidisciplinary management of locally advanced lung cancer based on the latest literature and current clinical experience, mainly focusing on the appropriateness of surgical therapy and emerging data regarding neoadjuvant and adjuvant therapies.

CONCLUSIONS

Despite the complex decision-making process in managing locally advanced lung cancer, this expert panel agreed on several key recommendations. This document provides guidance for thoracic surgeons and other medical professionals in the optimal management of locally advanced lung cancer based on the most updated evidence and literature.

Clinical significance of CD155 expression in surgically resected lung squamous cell carcinoma

BACKGROUND

Cluster of differentiation 155 (CD155) is expressed in many tumor types. CD155 is involved in the immune avoidance of tumor cells and contributes to tumor development and progression. Therefore, CD155 is a novel target for cancer immunotherapy. The clinical significance of CD155 expression in lung squamous cell carcinoma (LUSC) has not been fully elucidated.

MATERIALS AND METHODS

We performed a retrospective analysis of 264 patients with surgically resected LUSC. Immunohistochemistry was used to evaluate CD155 expression. The association of CD155 expression with clinicopathological features and clinical outcomes was assessed. We also analyzed the relationship between CD155 expression and programmed cell death-ligand 1 (PD-L1) expression and tumor-infiltrating lymphocytes.

RESULTS

Among the 264 patients, 137 patients (51.9%) were classified in the high CD155 expression group. High CD155 expression was significantly associated with pleural invasion, vascular invasion, PD-L1 positivity, and high CD3, CD4, and CD8 expressions. In multivariate analysis, the presence of pleural invasion and PD-L1 positivity were independent predictors of high CD155 expression. Kaplan-Meier curve analysis showed that high CD155 expression was significantly associated with shorter disease-free survival and overall survival. In multivariate analysis, high CD155 expression was an independent poor prognostic factor for overall survival, but not for disease-free survival. Subgroup analyses revealed that the prognostic effect of CD155 expression was observed in the PD-L1 positive group but not the PD-L1 negative group.

CONCLUSION

Our analysis revealed that high CD155 expression significantly predicted poor prognosis in patients with surgically resected LUSC, especially in patients with PD-L1-positive tumors.

Evaluation of the Articular Disc Using the Magnetic Resonance Cartigram in Asymptomatic and Symptomatic Temporomandibular Disorders

Objectives  The study is aimed to perform magnetic resonance (MR) cartigram of the articular disc in patients with asymptomatic and symptomatic temporomandibular disorders (TMD). Materials and Methods  Thirty-nine volunteers were divided into three groups: 16 symptomatic TMD, 16 asymptomatic TMD, and 7 controls. The articular disc was divided into three segments (anterior, middle, and posterior) and analyzed using morphological magnetic resonance imaging (MRI) and T2 mapping sequences. T2 relaxation values were measured and assessed by an experienced radiologist and two observers. The T2 values in the discs were compared between the control, asymptomatic, and symptomatic groups using the Kruskal-Wallis test. The right and left discs were compared using the Wilcoxon signed rank test. Inter-examiner reliability among different examiners was evaluated. Results  The controls had the highest T2 values compared with the other groups. The comparison among the right and left sides of all the groups revealed statistically significant results in the anterior portion in the asymptomatic group and the middle portion in the symptomatic group ( p  < 0.05). The inter-examiner reliability coefficients among the three examiners were consistently high, with values of 0.921, 0.920, and 0.930. Conclusion  Our study found the T2 relaxation time span was shorter than that reported in previous studies, which could be attributed to the early stage of cartilage deterioration in the individuals with TMD inferring treatment at this phase may be eventually effective with a good prognosis.

Beyond strong labels: Weakly-supervised learning based on Gaussian pseudo labels for the segmentation of ellipse-like vascular structures in non-contrast CTs

Deep learning-based automated segmentation of vascular structures in preoperative CT angiography (CTA) images contributes to computer-assisted diagnosis and interventions. While CTA is the common standard, non-contrast CT imaging has the advantage of avoiding complications associated with contrast agents. However, the challenges of labor-intensive labeling and high labeling variability due to the ambiguity of vascular boundaries hinder conventional strong-label-based, fully-supervised learning in non-contrast CTs. This paper introduces a novel weakly-supervised framework using the elliptical topology nature of vascular structures in CT slices. It includes an efficient annotation process based on our proposed standards, an approach of generating 2D Gaussian heatmaps serving as pseudo labels, and a training process through a combination of voxel reconstruction loss and distribution loss with the pseudo labels. We assess the effectiveness of the proposed method on one local and two public datasets comprising non-contrast CT scans, particularly focusing on the abdominal aorta. On the local dataset, our weakly-supervised learning approach based on pseudo labels outperforms strong-label-based fully-supervised learning (1.54% of Dice score on average), reducing labeling time by around 82.0%. The efficiency in generating pseudo labels allows the inclusion of label-agnostic external data in the training set, leading to an additional improvement in performance (2.74% of Dice score on average) with a reduction of 66.3% labeling time, where the labeling time remains considerably less than that of strong labels. On the public dataset, the pseudo labels achieve an overall improvement of 1.95% in Dice score for 2D models with a reduction of 68% of the Hausdorff distance for 3D model.

Feasibility of low contrast volume and low injection flow rate in CT pulmonary angiography

BACKGROUND

Computed Tomography Pulmonary Angiography (CTPA) is currently the gold standard for diagnosing Pulmonary Embolism (PE), with a high flowrate (>4.5ml/s) for contrast media (CM) administration recommended for sufficient pulmonary artery opacification. However, this may not be achievable for patients with challenging IV access.

AIM

To determine if a low volume CM, low flowrate (LVLF) CTPA protocol produces images of similar image quality compared to a standard protocol in two aspects, in terms of peak arterial enhancement through the quantitative measurement of Hounsfield unit (HU) and based on subjective overall image quality.

METHODS

Retrospective collection of 151 patients who underwent CTPA via 320 slice multi-detector CT due to clinical suspicion of PE. 80 patients underwent the standard protocol, with a fixed flowrate of 4.5ml/s and 50ml of CM, while 71 patients underwent the LVLF protocol with up to a 37% and 30% reduction in flowrate and CM administered, respectively. Two independent radiographers measured the attenuation of multiple pulmonary arteries in HU, with ≥200HU being considered diagnostic. Overall image quality was also reviewed using a 5-point close-ended questionnaire by two independent radiologists.

RESULTS

There was no significant difference in terms of attenuation measured in HU for the seven regions of interest (main pulmonary trunk, right and left pulmonary arteries, right and left lobar arteries, and right and left subsegmental arteries (RSA and LSA)) between the LVLF and standard CTPA protocol. Similarly, there were no significant differences in the overall image quality score obtained from standard and LVLF protocols reported by both radiologists.

CONCLUSION

The LVLF protocol can achieve similar enhancement and subjective image quality as the standard CTPA protocol, potentially allowing for further optimisation in the CM dosage.

Evaluation of masticatory muscles in patients with different sagittal direction skeletal anomalies by ultrasonography and ultrasonographic elastography

OBJECTIVES

The aim of this study was to evaluated the masseter, anterior digastric and geniohyoid muscles of individuals with similar growth and developmental periods but different sagittal skeletal malocclusions using ultrasonography and ultrasonographic elastography and to make interclass assessments.

METHODS

In this study, ultrasonography and ultrasonographic elastography records of 30 Class I individuals (17 females, 13 males), 30 Class II individuals (14 females, 16 males), and 27 Class III individuals (12 females, 15 males) in the normodivergent and growth development period were used. The masseter, anterior digastric, and geniohyoid muscles of individuals were examined using ultrasonography and ultrasonographic elastography, and comparisons were made between the classes. Statistical analysis was accomplished by Mann Whitney U, One-way ANOVA, Kruskal Wallis H tests.

RESULTS

Interclass differences were found in ultrasonography and elastography measurements of the masseter muscle. However, no differences were observed in ultrasonography measurements of the auxiliary masticatory muscles, whereas differences were seen only in the geniohyoid muscle in elastography measurements among the classes (p < 0.05).

CONCLUSION

Individuals with different sagittal skeletal malocclusions during growth and development exhibited similar muscle sizes and elasticities, approximately close to each other.

The statistical fragility of vertebroplasty outcomes: A systematic review of randomized controlled trials

Randomized clinical trials (RCTs) on vertebroplasty are crucial for guiding the treatment of vertebral compression fractures, but their overlooked statistical fragility can undermine clinical reliability. Minor outcome changes may overturn significant findings, risking unreliable evidence, and impacting patient care. This study assessed the fragility of significant outcomes in vertebroplasty RCTs, hypothesizing high sensitivity to such changes. PubMed, Embase, and MEDLINE were searched for RCTs on vertebroplasty reporting dichotomous outcomes. The fragility index (FI) and reverse FI quantified the number of outcome reversals needed to change statistical significance for significant and nonsignificant results, respectively. The fragility quotient (FQ) was calculated as the FI divided by the study sample size. Subgroup analysis was conducted by outcome category. A total of 276 outcomes from RCTs were analyzed. The median FI was 5 (interquartile range [IQR]: 4-5), with a FQ of 0.053 (IQR: 0.019-0.088). Statistically significant outcomes (n = 36) had a median FI of 3 (IQR: 2-4) and FQ of 0.034 (IQR: 0.018-0.051), whereas nonsignificant outcomes (n = 240) showed a median FI of 5 (IQR: 4-5) and FQ of 0.062 (IQR: 0.021-0.088). Fracture-related outcomes were the most robust (FI: 5, FQ: 0.088), whereas cement leakage was the most fragile (FI: 3, FQ: 0.041). Pain outcomes had an FI of 5 (FQ: 0.062), and complications and vertebroplasty versus kyphoplasty outcomes were more robust (FI: 5, FQ: 0.013). Patients lost to follow-up exceeded the FI in 79% of outcomes. The statistical findings in vertebroplasty RCTs are fragile and warrant cautious interpretation. A small number of outcome reversals or consistent postoperative follow-up can shift the significance of the results. Standardized reporting of P values alongside FI and FQ metrics is recommended to help clinicians evaluate the robustness of study findings.

Surgical planning of small intestine neuroendocrine tumors: the concept of mesenteric tumor deposits

The mesenteric extension of small neuroendocrine tumors is the surgical limiting factor because of the risk of postoperative short bowel syndrome due to superior mesenteric artery involvement. Recent pathological studies have shown that this vascular involvement is due to mesenteric tumor deposits, differentiated from lymph node metastases. The aim of this study was to evaluate the performances of computed tomography (CT) for the surgical planning of small intestine neuroendocrine tumors. This was a retrospective observational study, and all patients undergoing surgery for small intestine neuroendocrine tumor between January 2014 and March 2019 were included. Preoperative CTs were reviewed, blinded from surgical and pathological data, by two radiologists. Diagnostic accuracy and interobserver reliability analysis were performed. We included 45 patients (mean age: 61 years (28-84 years); 23 men). The CT sensitivity to identify the mesenteric mass was 97% (37/38) with a ĸ of 0.73. The positive predictive value of CT to anticipate a right colic resection was 86% (18/21). The negative predictive value of CT was high (97% (34/35) to 100% (35/35)) for duodenal resection (ĸ = 0.78). Regarding retropancreatic lymph node invasion, the CT sensitivity was poor (24%, 4/17), with a high ĸ (0.88). The level of involvement by the mesenteric mass was correlated with the length and the percentage of the remaining small bowel. CT is essential for the surgical planning of small intestine neuroendocrine tumors, being accurate in defining the mesenteric tumor deposits, allowing one to anticipate, with a good reproducibility, the length and percentage of the remaining small bowel and the necessity for a right colectomy.

A comprehensive exploration of gallbladder health: from common to rare imaging findings

This comprehensive review explores a wide range of imaging findings associated with the gallbladder (GB), from anatomic variants to rare diseases. Through an in-depth review of diagnostic modalities including ultrasound, magnetic resonance cholangiopancreatography, CT, and MRI, we aim to highlight the crucial role of imaging techniques in diagnosing GB disorders, as congenital anomalies, inflammatory diseases, neoplasms, and surgical complications. Employing a detailed analysis and comparison of imaging findings across various modalities, this review seeks to improve diagnostic accuracy for GB-related pathologies, facilitating optimal patient management.

Diagnostic Role of Tomography in Addison's Disease due to Adrenal Tuberculosis: A Case Report

INTRODUCTION

Adrenal tuberculosis remains the main cause of primary adrenal insufficiency (PAI) in tuberculosis (TB)-prevalent regions. This case report details the presentation of PAI due to adrenal TB, where the etiological diagnosis involves Abdominal Computed Tomography (CT).

CASE REPORT

A 37-year-old Peruvian woman with a history of TB contact displayed symptoms of adrenal insufficiency. PAI diagnosis was established, and CT imaging unveiled bilateral adrenal enlargement with calcifications. Treatment with prednisone and anti-TB therapy led to symptomatic improvement. Unfortunately, she succumbed to pneumonia after ten months of follow-up.

DISCUSSION

Adrenal TB must be considered in endemic regions and in the presence of a TB history. CT serves as a valuable diagnostic tool, particularly in settings with limited resources, revealing adrenal enlargement and calcifications.

CONCLUSION

In patients with PAI, epidemiological history of TB, and when a rapid biopsy is not feasible, CT proves to be a valuable diagnostic method.

Comprehensive Review of Coronary Artery Anatomy Relevant to Cardiac Surgery

In order to perform safe cardiac surgery, a knowledge of applied coronary artery anatomy and its variants is essential for cardiac surgeons. In normal individuals, the right and the left coronary arteries arise from the corresponding sinuses of Valsalva within the aortic root. From the cardiac surgical perspective, the coronary artery is divided into the left main coronary artery, its branches (the left anterior descending artery and the circumflex artery), and the right coronary artery. With high-risk cardiac surgeries, including redo procedures, becoming increasingly performed, abnormal courses and variations of the coronary arteries, if not recognized, can predispose the patient to avoidable coronary injuries, resulting in adverse outcomes of cardiac surgical procedures. We aim to describe normal and applied coronary anatomy, common coronary artery variants previously reported, and their clinical relevance to both adult and paediatric cardiac surgery.

Sequential irradiation does not improve fatigue crack propagation resistance of human cortical bone at 15 kGy

Sequential irradiation has been advocated for mitigating the reduction in fatigue properties of tendon compared to a single dose. However, to our knowledge, its capability of mitigating fatigue losses in bone is unknown. Recently, we reported that sequential irradiation did not mitigate losses in high-cycle S-N fatigue life of cortical bone at 15 kGy; however, it is unclear if sequential irradiation provides a benefit to fatigue crack propagation resistance. Our previous study also showed that radiation-induced collagen chain fragmentation and crosslinking increased from 0 to 15 kGy, suggesting that both likely contribute to the reduction in high-cycle S-N fatigue life within this dose range. Our objectives were: 1) to evaluate the fatigue crack propagation resistance of cortical bone and the effect of radiation on fracture plane damage zone thickness (DZT) at the crack tip in the dose range of 0-15 kGy, and 2) to evaluate whether sequential irradiation at 15 kGy mitigates the loss of fatigue crack propagation resistance of cortical bone compared to a single irradiation dose. Compact tension specimens from four male donor femoral pairs (ages 21-61 years old) were divided into 5 treatment groups (0 kGy, 5 kGy, 10 kGy, 15 kGy, and a 15 kGy sequential irradiation dose of 5 kGy sequentially irradiated with 10 kGy) and subjected to fatigue crack propagation testing (n = 3-4 specimens per group) where fatigue crack growth rate da/dN and cyclic stress intensity factor ΔK were determined. Following testing, specimens were bulk stained in basic fuchsin, embedded in poly(methylmethacrylate), sectioned, and mounted on acrylic slides to evaluate fracture plane DZT at known crack lengths. Sections were then imaged with a fluorescence microscope, and fracture plane DZT was measured using ImageJ (n = 3-4 specimens per group) and analyzed as a function of ΔK. We observed a decrease in fatigue crack propagation resistance at 15 kGy compared to doses of 10 kGy or lower (p ≤ 0.013). Fracture plane DZT decreased overall with increasing radiation dose from 0 to 15 kGy. Sequential irradiation offered no improvement in fatigue crack propagation resistance (p = 0.98). Radiation-induced collagen chain fragmentation and crosslinking in this dose range likely contribute to a decrease in energy dissipation capability with increasing radiation dose. Other alternative radiation sterilization methods besides sequential irradiation may be warranted to mitigate radiation-induced tissue damage and extend the functional lifetime of structural cortical bone allografts.

Potential Neuroimaging Biomarkers for Autism Spectrum Disorder: A Comprehensive Review of MR Imaging, fMR Imaging, and PET Studies

Autism spectrum disorder (ASD) is a characteristically heterogeneous disorder, as multiple neurodevelopmental disorders are characterized by similar symptomology and behavior. Research has shown that individuals with ASD benefit from early intervention; neuroimaging data may reveal information that cannot be obtained from traditional behavioral analysis. This review discusses the use of structural MR imaging, functional MR imaging (fMR imaging), and PET in the detection of ASD. Larger datasets, standardized methods of collection and analysis, and more robust meta-analyses are required to implement the observed biomarkers and improve the lives of patients living with AUD.

Surgery for Patients With cT3/4N2M0, Stage IIIB NSCLC. Is It Time to Redefine Resectability?

Introduction

Chemoradiation followed by durvalumab is considered a standard approach for patients with locally advanced NSCLC. With improvements in perioperative and neoadjuvant approaches, there is renewed interest in offering surgery to carefully selected patients with cT3/4N2 stage IIIB cancer. We sought to assess survival outcomes after surgery as part of a multimodality treatment regimen for these patients.

Methods

Patients with cT3/T4N2M0 NSCLC who received surgery (S) as part of a multimodality approach and patients receiving multimodality treatment without surgery (chemoradiation [CRT] or systemic therapy only) were identified in the National Cancer Database (2010-2019). We evaluated factors associated with the receipt of S (logistic regression). After propensity matching, we estimated the overall survival (OS) of patients who received S and compared with those who received CRT (Kaplan-Meier and Cox regression).

Results

A total of 44,756 patients were identified, of whom 3928 (8.8%) underwent S, 29,798 (66.6%) CRT, and 11,030 (24.6%) systemic therapy only. Fewer comorbidities (Charlson-Deyo index 0 or 1, adjusted OR [aOR]: 1.22, 95% confidence interval [CI]: 1.05-1.42), treatment at an academic facility (aOR: 1.70, 95% CI: 1.52-1.89), private insurance (aOR: 2.44, 95% CI: 1.61-3.69), adenocarcinoma histology (aOR: 1.48, 95% CI: 1.22-1.79), and clinical T3 stage (<7 cm, aOR: 1.70, 95% CI: 1.53-1.89) were associated with S. In well-balanced, propensity-matched cohorts, patients selected for S had better OS compared with those who underwent CRT (hazard ratio 0.59, 95% CI: 0.56-0.63, p < 0.001) (median OS 49.7 versus 25.0 mo).

Conclusions

In this retrospective cohort analysis, patients with cT3/4N2, stage IIIB NSCLC who underwent surgical resection had better OS compared with those patients treated with CRT. Careful patient selection is undoubtedly critical, but stage IIIB designation alone should not exclude patients from surgical consideration.

Machine learning-derived peripheral blood transcriptomic biomarkers for early lung cancer diagnosis: Unveiling tumor-immune interaction mechanisms

Lung cancer continues to be the leading cause of cancer-related mortality worldwide. Early detection and a comprehensive understanding of tumor-immune interactions are crucial for improving patient outcomes. This study aimed to develop a novel biomarker panel utilizing peripheral blood transcriptomics and machine learning algorithms for early lung cancer diagnosis, while simultaneously providing insights into tumor-immune crosstalk mechanisms. Leveraging a training cohort (GSE135304), we employed multiple machine learning algorithms to formulate a Lung Cancer Diagnostic Score (LCDS) based on peripheral blood transcriptomic features. The LCDS model's performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC) in multiple validation cohorts (GSE42834, GSE157086, and an in-house dataset). Peripheral blood samples were obtained from 20 lung cancer patients and 10 healthy control subjects, representing an in-house cohort recruited at the Sixth People's Hospital of Chengdu. We employed advanced bioinformatics techniques to explore tumor-immune interactions through comprehensive immune infiltration and pathway enrichment analyses. Initial screening identified 844 differentially expressed genes, which were subsequently refined to 87 genes using the Boruta feature selection algorithm. The random forest (RF) algorithm demonstrated the highest accuracy in constructing the LCDS model, yielding a mean AUC of 0.938. Lower LCDS values were significantly associated with elevated immune scores and increased CD4+ and CD8+ T-cell infiltration, indicative of enhanced antitumor-immune responses. Higher LCDS scores correlated with activation of hypoxia, peroxisome proliferator-activated receptor (PPAR), and Toll-like receptor (TLR) signaling pathways, as well as reduced DNA damage repair pathway scores. Our study presents a novel, machine learning-derived peripheral blood transcriptomic biomarker panel with potential applications in early lung cancer diagnosis. The LCDS model not only demonstrates high accuracy in distinguishing lung cancer patients from healthy individuals but also offers valuable insights into tumor-immune interactions and underlying cancer biology. This approach may facilitate early lung cancer detection and contribute to a deeper understanding of the molecular and cellular mechanisms underlying tumor-immune crosstalk. Furthermore, our findings on the relationship between LCDS and immune infiltration patterns may have implications for future research on therapeutic strategies targeting the immune system in lung cancer.

Diagnosing Bone Metastases in Breast Cancer: A Systematic Review and Network Meta-Analysis on Diagnostic Test Accuracy Studies of 2-[18F]FDG-PET/CT, 18F-NaF-PET/CT, MRI, Contrast-Enhanced CT, and Bone Scintigraphy

This systematic review and network meta-analysis aimed to compare the diagnostic accuracy of 2-[18F]FDG-PET/CT, 18F-NaF-PET/CT, MRI, contrast-enhanced CT, and bone scintigraphy for diagnosing bone metastases in patients with breast cancer. Following PRISMA-DTA guidelines, we reviewed studies assessing 2-[18F]FDG-PET/CT, 18F-NaF-PET/CT, MRI, contrast-enhanced CT, and bone scintigraphy for diagnosing bone metastases in high-stage primary breast cancer (stage III or IV) or known primary breast cancer with suspicion of recurrence (staging or re-staging). A comprehensive search of MEDLINE/PubMed, Scopus, and Embase was conducted until February 2024. Inclusion criteria were original studies using these imaging methods, excluding those focused on AI/machine learning, primary breast cancer without metastases, mixed cancer types, preclinical studies, and lesion-based accuracy. Preference was given to studies using biopsy or follow-up as the reference standard. Risk of bias was assessed using QUADAS-2. Screening, bias assessment, and data extraction were independently performed by two researchers, with discrepancies resolved by a third. We applied bivariate random-effects models in meta-analysis and network meta-analyzed differences in sensitivity and specificity between the modalities. Forty studies were included, with 29 contributing to the meta-analyses. Of these, 13 studies investigated one single modality only. Both 2-[18F]FDG-PET/CT (sensitivity: 0.94, 95% CI: 0.89-0.97; specificity: 0.98, 95% CI: 0.96-0.99), MRI (0.94, 0.82-0.98; 0.93, 0.87-0.96), and 18F-NaF-PET/CT (0.95, 0.85-0.98; 1, 0.93-1) outperformed the less sensitive modalities CE-CT (0.70, 0.62-0.77; 0.98, 0.97-0.99) and bone scintigraphy (0.83, 0.75-0.88; 0.96, 0.87-0.99). The network meta-analysis of multi-modality studies supports the comparable performance of 2-[18F]FDG-PET/CT and MRI in diagnosing bone metastases (estimated differences in sensitivity and specificity, respectively: 0.01, -0.16 - 0.18; -0.02, -0.15 - 0.12). The results from bivariate random effects modelling and network meta-analysis were consistent for all modalities apart from 18F-NaF-PET/CT. We concluded that 2-[18F]FDG-PET/CT and MRI have high and comparable accuracy for diagnosing bone metastases in breast cancer patients. Both outperformed CE-CT and bone scintigraphy regarding sensitivity. Future multimodality studies based on consented thresholds are warranted for further exploration, especially in terms of the potential role of 18F-NaF-PET/CT in bone metastasis diagnosis in breast cancer.

EANM/SNMMI guideline/procedure standard for [18F]FDG hybrid PET use in infection and inflammation in adults v2.0

INTRODUCTION

Hybrid [18F]FDG PET imaging is currently the method of choice for a wide variety of infectious and inflammatory disorders and was recently adopted in several clinical guidelines. A large amount of evidence-based articles, guidelines and appropriate use criteria have been published since the first version of this guideline in 2013.

PURPOSE

To provide updated evidence-based information to assist physicians in recommending, performing and interpreting hybrid [18F]FDG PET examinations for infectious and inflammatory disorders in the adult population.

METHODS

A systematic literature search of evidence-based articles using whole-body [18F]FDG hybrid imaging on the indications covered within this guideline was performed. All systematic reviews and meta-analyses published within the last 10 years until January 2023 were identified in PubMed/Medline or Cochrane. For each indication covered in this manuscript, diagnostic performance was provided based on meta-analyses or systematic reviews. If not available, results from prospective or retrospective studies were considered based on predefined selection criteria. RESULTS AND CONCLUSIONS: Hybrid [18F]FDG PET is extremely useful in the work-up and management of adults with infectious and inflammatory diseases, as supported by extensive and rapidly growing evidence-based literature and adoption in clinical guidelines. Practical recommendations are provided describing evidence-based indications as well as interpretation criteria and pitfalls. Monitoring treatment response is the most challenging but insufficiently studied potential application in infection and inflammation imaging.

The many faces of pediatric hydatid disease: a pictorial review

Hydatid disease, caused by the larval stages of Echinococcus species, poses a significant public health challenge, especially in resource-limited cattle-producing areas of South America. The number of cases in children under the age of 15 is nearly 16% of the total cases in South America according to the latest report of the Pan American Health Organization (PAHO). The presentation of the disease depends on the anatomic location and correlates with the parasitic life stage. The liver is the most commonly affected organ in children, followed by the lungs, kidney, bone, and brain. The classification of hydatid cysts varies based on the parasite's stage, from purely cystic lesions to solid masses. The radiological approach varies by cyst location. Clinically, hydatid disease symptoms are nonspecific and organ-dependent, with imaging playing a crucial role in diagnosis. Complications include cyst rupture and superinfection, with potential severe consequences. This pictorial essay aims to illustrate the manifestations of hydatid cysts in an endemic population and highlight atypical signs for radiologists evaluating pediatric cysts in endemic regions.

Deciphering brain activation during wrist movements: comparative fMRI and fNIRS analysis of active, passive, and imagery states

Understanding the complex activation patterns of brain regions during motor tasks is crucial. Integrated functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS) offers advanced insights into how brain activity fluctuates with motor activities. This study explores neuronal activation patterns in the cerebral cortex during active, passive, and imagined wrist movements using these functional imaging techniques. Data were collected from 10 right-handed volunteers performing a motor task using fMRI and fNIRS. fMRI utilized a 3T scanner and a 20-channel head coil, while fNIRS recorded data with a 48-channel device at 765 nm and 855 nm. Analysis focused on key motor and sensory cortices using NIRS-SPM and SPM12, applying a significance threshold of p < 0.05 and a minimum cluster size of 10 voxels for group analysis. Super-threshold voxels were identified with FWE thresholding in SPM12. For activation map extraction we focused on the primary motor cortex, primary somatosensory cortex, somatosensory association cortex, premotor cortex, and supplementary motor cortex. Both fMRI and fNIRS detected activation in the primary motor cortex (M1). The primary somatosensory cortex was found to influence movement direction coding, with smaller activation sizes for upward movements. Combining fNIRS with fMRI provided clearer differentiation of brain activation patterns for wrist movements in various directions and conditions (p < 0.05). This study highlights variations in left motor cortex activity across different movement states. fNIRS proved effective in detecting brain function and showed strong correlation with fMRI results, suggesting it as a viable alternative for those unable to undergo fMRI.

Study on the MRI features of normal postoperative glenoid labrum compared to recurrent tears

The study evaluates the effectiveness of MRI and MR arthrograms in detecting recurrent glenoid labral tears, highlighting MRI's ability to visualize soft tissues and assess postoperative repair integrity, crucial for diagnosing labral injuries and ensuring appropriate treatment. The study included 25 patients (72% male, 28% female) with recurrent shoulder repair. Recurrent labral tears were observed in 14 patients on MR arthrogram with 81-91% sensitivity and 76-86% specificity based on age. In 12% of patients, paralabral cysts were observed. Overhead activity was present in 44% of patients and most frequently in males under 30. Recurrent labral tear is seen in most of the patients with MRI imaging. The study found that MRI and MR arthrogram are useful diagnostic instruments with comparatively high sensitivity and specificity for detecting recurrent labral tears in postoperative patients, especially in patients between 35-40 years. This retrospective study evaluates the diagnostic accuracy of MR arthrograms in detecting recurrent glenoid labral tears after surgery, analyzing sensitivity, specificity, demographics, recurrence causes and secondary findings.

Quantitative imaging for early detection and risk stratification of cardiovascular disease using 4D flow MRI and arterial spin labelling

Heart failure (HF) significantly burdens global healthcare, necessitating early detection and precise risk stratification. Advanced imaging techniques like 4D flow Magnetic resonance imaging (MRI) and arterial spin labelling (ASL) provide crucial insights into cardiac function by capturing complex flow patterns and measuring myocardial blood flow. Hence, this study explores how these modalities can enhance early detection and risk assessment of cardiovascular diseases, aiming to improve patient outcomes. Ten patients aged ≤ 65 with clinically compensated cardiomyopathy were recruited. MRI examinations included 4D flow MRI using a 1.5 T Philips Achieva Scanner and ASL imaging on a 3 Tesla scanner. Data analysis for 4D flow MRI involved segmenting the left ventricle and categorizing pathlines into flow components, while ASL data were analyzed using Buxton's model to quantify myocardial blood flow (MBF). The study population had a mean age of 49 ± 14 years, predominantly female (6:4). Average heart rate was 61 ± 11 bpm and blood pressures averaged 122/77 mmHg. Left ventricular end-diastolic volume was 179 ± 33 mL with an ejection fraction of 42 ± 5%. Patients showed lower direct flow volume and kinetic energy in early diastolic phases compared to healthy individuals. In conclusion, 4D flow MRI and accelerated ASL is effective for early detection and risk stratification in cardiovascular disease, offering enhanced cardiovascular assessment and potential improvements in patient care.