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.

Ultrasonographic Evaluation of Solid Organ Sizes in Children with Primary Malnutrition: A Preliminary Study

Objectives: Malnutrition is a common health problem affecting overall body functions, growth, and development. The aim of the present study was to explore any potential changes in solid organ sizes due to malnutrition and, if so, their correlation with the degree of malnutrition. Materials and Methods: Solid organ sizes (liver, spleen, and kidneys) in patients with primary malnutrition were measured prospectively using ultrasonography. Results: A correlation was observed between changes in liver, spleen, and kidney sizes and left kidney parenchymal thickness and the degree of malnutrition in patients. Conclusions: The presence and degree of malnutrition were directly proportional to significant decreases in organ sizes. The present study is the first to reveal a positive correlation between anthropometric measurement Z scores and organ sizes.

Innovative Therapies Targeting Drug-Resistant Biomarkers in Metastatic Clear Cell Renal Cell Carcinoma (ccRCC)

A thorough study of Clear Cell Renal Cell Carcinoma (ccRCC) shows that combining tyrosine kinase inhibitors (TKI) with immune checkpoint inhibitors (ICI) shows promising results in addressing the tumor-promoting influences of abnormal immunological and molecular biomarkers in metastatic Clear Cell Renal Cell Carcinoma (ccRCC). These abnormal biomarkers enhance drug resistance, support tumor growth, and trigger cancer-related genes. Ongoing clinical trials are testing new treatment options that appear more effective than earlier ones. However, more research is needed to confirm their long-term safety use and potential side effects. This study highlights vital molecular and immunological biomarkers associated with drug resistance in Clear Cell Renal Cell Carcinoma (ccRCC). Furthermore, this study identifies a number of promising drug candidates and biomarkers that serve as significant contributors to the enhancement of the overall survival of ccRCC patients. Consequently, this article offers pertinent insights on both recently completed and ongoing clinical trials, recommending further toxicity study for the prolonged use of this treatment strategy for patients with metastatic ccRCC, while equipping researchers with invaluable information for the progression of current treatment strategies.

Allergic bronchopulmonary aspergillosis: radiological and microbiological profile of patients presented in an outpatient pulmonary clinic in a developing country

There is limited data available about allergic bronchopulmonary aspergillosis (ABPA) in Pakistan. The aim of the study was to describe the radiological and microbiological profile of ABPA patients presenting to the outpatient pulmonary clinic of a tertiary care hospital in Karachi, Pakistan. A retrospective study was conducted on ABPA patients who presented to the pulmonary outpatient clinic at Aga Khan University Hospital, Karachi, Pakistan, from January 2017 to December 2019. Data was collected on microbiology and radiology features on a predesigned proforma. A total of 7759 asthmatic patients presented at the outpatient pulmonology clinic during the study period. Of the 245 patients labeled as ABPA, 167 fulfilled the inclusion criteria, and 91 (54.5%) were female (mean age 41.9±13.0 years). A high-resolution computed tomography scan of the chest was available for 126 patients. Of these, 104 (82.5%) patients had bronchiectasis. Central bronchiectasis was noted in 98 (94.2%) patients, mucus plugging in 71 (56.3%), and hyperinflation was seen in 30 (23.4%). Microbiological testing was available in 103/167 (61.7%) patients. The most common bacterial pathogen was Pseudomonas aeruginosa 32 (31.1%), followed by Hemophilus influenzae 16 (15.5%), and Moraxella catarrhalis 7 (9.7%). Aspergillus fumigatus 17 (23.6%) was the most common mold, followed by Aspergillus flavus 16 (22.2%) and Aspergillus niger 11 (15.3%). Co-infection (bacterial and fungal) was found in 18 (17.45%) patients. Bronchiectasis was frequently observed in our cohort of patients with ABPA. P. aeruginosa was found to be common among bacterial pathogens. Isolation of fungus is not uncommon in these patients.

Recent developments in translational imaging of in vivo gene therapy outcomes

Gene therapy achieves therapeutic benefits by delivering genetic materials, packaged within a delivery vehicle, to target cells with defective genes. This approach has shown promise in treating various conditions, including cancer, metabolic disorders, and tissue-degenerative diseases. Over the past 5 years, molecular imaging has increasingly supported gene therapy development in both preclinical and clinical studies. High-quality images from positron emission tomography (PET), single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), and computed tomography (CT) enable quantitative and reliable monitoring of gene therapy. Most reported studies have applied imaging biomarkers to non-invasively evaluate the outcomes of gene therapy. This review aims to inform researchers in molecular imaging and gene therapy about the integration of these two disciplines. We highlight recent developments in using imaging biomarkers to monitor the outcome of in vivo gene therapy, where the therapeutic delivery vehicle is administered systemically. In addition, we discuss prospects for further incorporating imaging biomarkers to support the development and application of gene therapy.

Relationship between imaging changes of the pancreas and islet beta-cell function

Imaging changes in the pancreas can provide valuable information about the status of islet beta-cell function in different pancreatic diseases, such as diabetes, pancreatitis, pancreatic cancer, fatty pancreas, and insulinoma. While imaging cannot directly measure beta-cell function; it can be used as a marker of disease progression and a tool to guide therapeutic interventions. As imaging technologies continue to advance, they will likely play an increasingly important role in diagnosing, monitoring, and managing diabetes.

The complex anatomy of the bronchial arteries: a meta-analysis with potential implications for thoracic surgery and hemoptysis treatment

The present meta-analysis aimed to provide the most detailed and comprehensive anatomical description of bronchial arteries (BAs) using data available in the literature. Adequate knowledge of the normal anatomy and morphological variations of BAs can be clinically significant; for example, this approach can prevent potential risks while undertaking bronchial artery embolization (BAE) procedures and, ultimately, lead to better patient outcomes. Major medical databases such as PubMed, Scopus, Embase, Web of Science, Google Scholar, and the Cochrane Library were searched. The overall search process was conducted in three main stages. The number of BAs varied from one to six, and 16 arterial patterns were observed. The most common variation was in one right BA and one left BA, with a pooled prevalence of 19.54% (95% CI 6.69-36.44%). The pooled prevalence of BAs originating separately from the aorta was 41.42% (95% CI 37.42-45.48%). The number and location of BAs are highly inconsistent. However, the most prevalent pattern involved two BAs: one in the right BA and one in the left BA. Although BAs most frequently originate from the descending aorta, the cooccurrence of at least one ectopic BA is relatively high. The results of our meta-analysis can serve as a source of comprehensive information for thoracic surgeons and physicians performing endovascular procedures, especially BAE, a treatment for life-threatening hemoptysis.

Challenges in Diagnosing Focal Liver Lesions Using Contrast-Enhanced Ultrasound

Background: Contrast-enhanced ultrasound (CEUS) has become the preferred method for many clinicians in evaluating focal liver lesions (FLLs) initially identified through standard ultrasound. However, in clinical practice, certain lesions may deviate from the typical enhancement patterns outlined in EFSUMB guidelines. Methods: This study aims to assess FLLs that remained inconclusive or misdiagnosed after CEUS evaluation, spanning eight years of single-center experience. Following CEUS, all FLLs underwent secondary imaging (CT, MRI) or histopathological analysis for diagnostic confirmation. Results: From the initial 979 FLLs, 350 lesions (35.7%) were either inconclusive or misdiagnosed by CEUS, with hepatocellular carcinoma (HCC) and liver metastases constituting the majority of these cases. The most frequent enhancement pattern in inconclusive lesions at CEUS was hyper-iso-iso. Factors such as advanced liver fibrosis, adenomas, and cholangiocarcinoma were significantly associated with higher rates of diagnostic inaccuracies. Conclusions: Advanced liver fibrosis, adenomas, and cholangiocarcinoma were significantly associated with increased diagnostic challenges, emphasizing the need for supplementary imaging techniques.

Metabolic-Modulating Effects of Radiation: Undetectable Yet Deadly-A Review on Radiotherapy

From a cancer-centric perspective, radiotherapy has been primarily viewed as a localised treatment modality, targeting cancer tissues with ionising radiation to induce DNA damage and cell death [...].

The Thermal Ablation with MRgFUS: From Physics to Oncological Applications

The growing interest in minimal and non-invasive therapies, especially in the field of cancer treatment, highlights a significant shift toward safer and more effective options. Ablative therapies are well-established tools in cancer treatment, with known effects including locoregional control, while their role as modulators of the systemic immune response against cancer is emerging. The HIFU developed with magnetic resonance imaging (MRI) guidance enables treatment precision, improves real-time procedural control, and ensures accurate outcome assessment. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) induces deep coagulation necrosis within an elliptical focal area, effectively encompassing the entire tumor site and allowing for highly targeted radical ablation. The applications of MRgFUS in oncology are rapidly expanding, offering pain relief and curative treatment options for bone metastatic lesions. Additionally, the MRgFUS plays an effective role in targeted optional therapies for early prostate and breast cancers. Emerging research also focuses on the potential uses in treating abdominal cancers and harnessing capabilities to stimulate immune responses against tumors or to facilitate the delivery of anticancer drugs. This evolving landscape presents exciting opportunities for improving patient outcomes and advancing cancer treatment methodologies. In neuro-oncology, MRgFUS utilizes low-intensity focused ultrasound (LIFU) along with intravenous microbubbles to open the blood-brain barrier (BBB) and enhance the intra-tumoral delivery of chemotherapy drugs.

Education Research: Feasibility, Reliability and Educational Value of Neuromuscular Ultrasound Training in a Canadian Neurology Residency Program: A Pilot Study

Background and Objectives

Point-of-care neuromuscular ultrasound (NMUS) is increasingly used in the evaluation of peripheral nervous system disorders; however, there remains a gap in education and training for neurology residents. We evaluated whether neurology residents can feasibly be trained in basic NMUS skills and nerve cross-sectional area (CSA) measurement and whether they value incorporation of this training into their curriculum.

Methods

Participants included neurology residents (postgraduate years 1-5) at the University of Alberta (Edmonton, Alberta, Canada). All completed pretraining and posttraining surveys using a Likert scale, rating their confidence in independently performing NMUS and their degree of agreement regarding the educational value of NMUS training. Residents underwent training (7 hours) comprising 1 didactic and 2 hands-on sessions, detailing NMUS of median, ulnar, and fibular nerves. Participants could then opt-in to a posttraining testing session where CSA measurements (mm2) of the median, ulnar, and fibular nerve at multiple sites were independently performed on 3 healthy volunteers and compared with measurements obtained by the trainer.

Results

Eighteen residents participated in training and pretraining/posttraining surveys. Nine completed the testing component. Nerve CSA measurement reliability between the trainer and trainees across all nerve sites combined was very good (intraclass correlation coefficient [ICC] 0.93, 95% CI 0.83-0.96) but varied by nerve and site. ICC was good to very good (0.62-0.95) except for the ulnar nerve-distal forearm/wrist (0.39-0.58) and fibular nerve-fibular head (0.12) sites. The coefficient of variation (CoV) across all sites was 19.6% (95% CI 17.3-21.8) and best for the median nerve-wrist site at 15.5% (9.8-20.8). The mean absolute difference between trainer and trainee measurements was low (<0.5 mm2 across all sites). Comparing pretraining and posttraining survey responses, there was a significant increase in agreement that basic NMUS operational skills were obtained and in confidence in independently measuring each nerve. NMUS training was considered a valuable component of a neurology residency program curriculum (median rating: strongly agree).

Discussion

Neurology residents across stages of training can acquire basic NMUS and CSA measurement skills of the median and ulnar nerves after 2 half-days of training and value incorporation of NMUS training in their educational curriculum.

Imaging in Periprosthetic Joint Infection Diagnosis: A Comprehensive Review

Various imaging methods assist in diagnosing periprosthetic joint infection (PJI). These include radiological techniques such as radiography, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US); as well as advanced nuclear medicine techniques including bone scintigraphy (BS), anti-granulocyte antibody imaging (AGS), leukocyte scintigraphy (LS), and fluorodeoxyglucose positron emission tomography (FDG-PET and FDG-PET/CT). Each imaging technique and radiopharmaceutical has been extensively studied, with unique diagnostic accuracy, limitations, and benefits for PJI diagnosis. This review aims to detail and describe the most commonly used imaging techniques and radiopharmaceuticals for evaluating PJI, focusing particularly on knee and hip arthroplasties.

Advances in Imaging of Traumatic Nerve Injuries

Traumatic peripheral nerve injuries represent a spectrum of conditions and remain challenging to diagnose and prognosticate. High-resolution ultrasonography and magnetic resonance neurography have emerged as useful diagnostic modalities in the evaluation of traumatic peripheral nerve and brachial plexus injuries. Ultrasonography is noninvasive, is able to rapidly interrogate large areas and multiple nerves, allows for a dynamic assessment of nerves and their surrounding anatomy, and is cost-effective. It allows for the prompt differentiation of neurotmetic versus axonotmetic traumatic nerve injuries, which informs surgical decision making. Magnetic resonance neurography yields images of peripheral nerves with high structural resolution down to the level of fascicles, is able to evaluate difficult anatomic areas that may not be reached by ultrasonography, and can detect signs of acute and chronic muscle denervation. Advanced preclinical techniques, such as second-harmonic generation microscopy, use multiphoton microscopy to visualize the internal collagenous structure of peripheral nerves, while third-harmonic generation microscopy can image myelin. One potential future application for multiphoton microscopy is the in vivo real-time assessment of nervous tissue. Near-infrared fluorescence also has the potential to assist with intraoperative peripheral nerve identification and assessment of pathology, but many challenges remain in identifying or designing the ideal contrast agent.

The benefits of contrast-enhanced ultrasound in the differential diagnosis of suspicious breast lesions

Background

Contrast-enhanced ultrasound (CEUS) shows potential for the differential diagnosis of breast lesions in general, but its effectiveness remains unclear for the differential diagnosis of lesions highly suspicious for breast cancers.

Objective

This study aimed to evaluate the diagnostic value of CEUS in differentiating pathological subtypes of suspicious breast lesions defined as category 4 of US-BI-RADS.

Methods

The dataset of 150 breast lesions was prospectively collected from 150 patients who underwent routine ultrasound and CEUS examination and were highly suspected of having breast cancers. All lesions were pathologically confirmed by US-guided needle biopsy and surgery. The qualitative features and the quantitative parameters of CEUS of these breast lesions were analyzed. The CEUS and biopsy examinations were performed after informed consent.

Results

In the qualitative features, crab clam-like enhancement, the presence of more than two enhanced vessels within lesions, and surrounding enriched vessels inserting into lesions were able to differentiate atypical fibroadenomas (FIB) and mass-like non-puerperal mastitis (NPM) from invasive ductal carcinomas (IDC) and ductal carcinomas in situ (DCIS) (p < 0.05). The enlarged scope, irregular shape, and perfusion deficiency were valuable to the differential diagnosis of FIB from the others (p < 0.05). In the four quantitative parameters of CEUS, only the peak intensity (IMAX) contributed to the differential diagnosis between malignant and benign tumors (p < 0.05, ROCAUC: 0.61, sensitivity: 60.4% and specificity: 65.9%, accuracy: 62.1%). However, IMAX did not show any difference in the paired comparison of IDC, DCIS, FIB, and NPM (p > 0.05). The logistic regression analysis results showed that heterogeneous perfusion, crab clam-like enhancement, and partial_ IMAX were independent risk factors for benign and malignant breast lesions (p < 0.05). The area under a receiver operating characteristic of the integrated model was 0.89. In the diagnosis of benign and malignant pathological subtypes of breast lesions, independent risk factors and integrated models had no statistical significance in the diagnosis of IDC and DCISs, FIB, and NPM (p > 0.05).

Conclusion

Some qualitative risk features of CEUS can distinguish malignant breast lesions from NPM and atypical FIB with a high score of US-BI-RADS, aiding physicians to reduce the misdiagnosis of suspicious breast lesions in clinical practice.

Multi-band vs. conventional diffusion-weighted MRI of the abdomen in children and young adults

OBJECTIVES

Implementation of diffusion-weighted imaging (DWI) for abdominal imaging in children has challenges due to motion artifacts exacerbated by long acquisition times. We aimed to compare acquisition time and image quality between conventional DWI and multi-band (MB) DWI of the liver in children and young adults.

METHODS

Clinical MRI exams from May 2023 to January 2024 were reviewed, including four DWI sequences: respiratory-triggered (RTr, clinical standard), free-breathing (FB), MB-DWI with shift factor 1 (MBsf1), and MB-DWI with shift factor 2 (MBsf2). Acquisition times were recorded, and signal intensity and apparent signal-to-noise ratio (aSNR) were calculated for the liver and spleen. Six blinded pediatric radiologists independently assessed image quality, artifacts, and lesion visualization on a 5-point Likert scale and identified their preferred sequence. Statistical comparisons were made using Kruskal-Wallis and ANOVA tests.

RESULTS

Median acquisition times were significantly reduced with MB-DWI (43 s for MBsf1/MBsf2) compared to FB (84 s) and RTr (240 s). Image quality and artifact scores were highest for RTr and FB sequences (p < 0.0001). Mean image quality scores were 3.7 (RTr, FB), 3.4 (MBsf1), and 3.5 (MBsf2), while artifact scores followed a similar trend (higher score = fewer artifacts). Lesion visualization scores were comparable across sequences (p = 0.11), and reviewers expressed no preference in 47% of cases. Apparent diffusion coefficient (ADC) values were consistent across all sequences (p > 0.05).

CONCLUSION

MB-DWI significantly reduces acquisition time while maintaining acceptable image quality and lesion visualization, making it a valuable option for pediatric abdominal MRI.

Bulgarian Experience in Vaginal Electronic Brachytherapy for Gynecologic Cancers' Treatment-First Results

Background/Objectives: The objective of this study is to prospectively collect dosimetric and clinical data on vaginal cuff electronic brachytherapy and propose a protocol for the procedure. Methods: Twenty-five patients who had proven endometrial or cervical carcinoma and had undergone radical hysterectomy have been treated with vaginal cuff electronic brachytherapy. Treatment session durations and doses to the targets and the organs at risk have been extracted from the treatment planning software. Patients have been followed up for early side effects for 3 months. Results: Treatment session times ranged from 3.0 to 6.6 min. Mean coverage of the planned treatment volume with 100% of the prescribed dose was 90%, and with 95% of the prescribed dose was 95%. Doses in the bladder were lower than those achieved in previously published studies with a mean D2cc of 4.7 Gy, and doses in the rectum were higher with a mean D2cc of 5.3 Gy. The first-month adverse events included eight G1 and three G2 toxicities, while the events registered on the third month were two G2 vaginal dryness events and one G1 urinary tract obstruction, of which only one patient with vaginal dryness did not respond to local treatment. No local relapses have been detected. Conclusions: Vaginal cuff electronic brachytherapy has demonstrated safety and effectiveness.

Response to clozapine in treatment resistant schizophrenia is related to alterations in regional cerebral blood flow

PET and SPECT studies in treatment-resistant schizophrenia (TRS) have revealed significant alterations in regional cerebral blood flow (CBF) during clozapine treatment, which may vary according to the clinical response. Here, we used the more recent MRI approach of arterial spin labelling (ASL) to evaluate regional CBF in participants with TRS (N = 36) before starting treatment with clozapine compared to in healthy volunteers (N = 16). We then compared CBF in the TRS group, before and after 12 weeks of treatment with clozapine (N = 24); and examined the relationship of those differences against changes in Positive and Negative Syndrome Scale for Schizophrenia (PANSS) scores over the treatment period. We observed widespread reductions in CBF in TRS compared to in healthy volunteers (p < 0.05). After covarying for global CBF and age, lower CBF in frontal and parietal regions was still evident (p < 0.05, FWE corrected). Clozapine treatment was associated with longitudinal decreases in CBF in the anterior cingulate cortex (ACC) (p < 0.05). Higher striatal CBF at baseline was associated with greater improvement in total and general symptoms following clozapine, and higher hippocampal CBF was associated with greater improvement in total and positive symptoms. Longitudinal reductions in CBF in the ACC and thalamus were associated with less improvement in negative (ACC), positive (thalamus), and total (thalamus) symptoms. These findings suggest that changes in CBF on clozapine administration in TRS may accompany symptomatic improvement, and that CBF prior to clozapine initiation may determine the degree of clinical response.

Is Ultrasonography an Effective Method for Diagnosing Degenerative Changes in the Temporomandibular Joint?

BACKGROUND

The accurate diagnosis of degenerative joint diseases (DJDs) of the temporomandibular joint (TMJ) presents a significant clinical challenge due to their progressive nature and the complexity of associated structural changes. These conditions, characterized by cartilage degradation, subchondral bone remodeling, and eventual joint dysfunction, necessitate reliable and efficient imaging techniques for early detection and effective management. Cone-beam computed tomography (CBCT) is widely regarded as the gold standard for evaluating osseous changes in the TMJ, offering detailed visualization of bony structures. However, ultrasonography (US) has emerged as a promising alternative, offering a non-invasive and radiation-free option for assessing TMJ disorders. This study aims to evaluate the diagnostic accuracy of US in identifying degenerative changes in the TMJ, with CBCT serving as the definitive diagnostic reference. By analyzing the sensitivity, specificity, and predictive values of US in detecting key degenerative markers-such as subchondral erosion, osteophytes, and joint space narrowing-this investigation seeks to assess its utility as a screening tool and its potential integration into clinical workflows.

METHODS

Forty adult patients presenting temporomandibular joint disorders were included in our cross-sectional study. Each patient underwent a clinical examination and was subjected to cone-beam computed tomography (CBCT) and ultrasonography (US). A statistical analysis was performed to compare the imaging results from CBCT and US.

RESULTS

The results are summarized in three tables. The first table presents a comparative analysis of radiological outcomes in patients with temporomandibular joint disorders using different imaging techniques. CBCT demonstrated higher sensitivity in detecting osteophytes in the right mandibular head (27.50% vs. 7.50%, p = 0.027) and higher detection rates for erosions, though without a significant advantage over US. The second table analyzes the consistency of diagnostic results between CBCT and US. A moderate agreement was observed for detecting normal bone structures, with AC1 values of 0.58 for the right and 0.68 for the left mandibular head (p < 0.001). The third table evaluates the diagnostic accuracy of US compared to CBCT. US demonstrated a positive predictive value (PPV) of 90% for detecting normal conditions, indicating its high reliability as a screening tool for normal findings. US demonstrates higher effectiveness in ruling out certain issues due to its high specificity and negative predictive value. However, its lower sensitivity in detecting abnormalities may lead to both false-positive and false-negative results.

CONCLUSIONS

US holds significant promise as a screening modality for detecting normal anatomical features of the temporomandibular joint, its limitations in identifying more complex degenerative changes necessitate a cautious and integrated approach to TMJ diagnostics.

Optimizing Radiation Dose and Image Quality in Stroke CT Protocols: Proposed Diagnostic Reference Levels for Multiphase CT Angiography and Perfusion Imaging

OBJECTIVE

In suspected acute ischemic stroke, it is now reasonable to expand the conventional "stroke protocol" (non-contrast computed tomography (NCCT), arterial CT angiography (CTA), and optionally CT perfusion (CTP)) to early and late venous head scans yielding a multiphase CTA (MP-CTA) to increase diagnostic confidence. Diagnostic reference levels (DRLs) have been defined for neither MP-CTA nor CTP. We therefore present dosimetry data, while also considering image quality, for a large, unselected patient cohort.

METHODS

A retrospective single-center study of 1790 patients undergoing the extended stroke protocol with three scanners (2× dual-source, DSCT; 1× single-source, SSCT) between 07/21 and 12/23 was conducted. For each sequence, we analyzed the radiation dose (volumetric CT dose index (CTDIvol); dose length product; effective dose); objective image quality using manually placed regions of interest (contrast-to-noise ratio (CNR)); and subjective image quality (4-point scale: 1 = non-diagnostic, 4 = excellent). The DRL was defined as the 75% percentile of the CTDIvol distribution. The Kruskal-Wallis test was used initially to test for overall equality of median values in each data group. Single post-test comparisons were performed with Dunn's test, with an overall statistical significance level of 0.05.

RESULTS

Dosimetry values were significantly higher for SSCT (p < 0.001, each). Local DRLs ranged between 37.3 and 49.1 mGy for NCCT, 3.6-5.5 mGy for arterial CTA, 1.2-2.5 mGy each for early/late venous CTA, and 141.1-220.5 mGy for CTP. Protocol adjustment (DSCT-1: CTP) yielded a 28.2% dose reduction. The highest/lowest CNRs (arterial/early venous CTA, respectively) were recorded for SSCT/DSCT-2 (p < 0.001). Subjective image quality was rated excellent except for slightly increased MP-CTA noise at DSCT-2 (median = 3).

CONCLUSIONS

Our data imply that additive MP-CTA scans only yield a minor increase in radiation exposure, particularly when using DSCT. CTP should be limited to selected patients.

CGF with Bio-Oss collagen as grafting materials for simultaneous implant placement after osteotome sinus floor elevation: a prospective study

BACKGROUND

Osteotome sinus floor elevation (OSFE) procedure with simultaneous implant placement is known to be an efficient procedure in the atrophic maxilla, where bone regeneration is required the most. The purpose of this study was to radiologically evaluate the efficacy of using Bio-Oss Collagen with Concentrated Growth Factor (CGF) as grafting materials for OSFE with simultaneous implant placement in the atrophic maxilla after one year of functional loading.

METHODS

A total of 126 implants were placed for 123 patients. Our inclusion criteria were patients with Residual Bone Height (RBH) ≤ 5 whom underwent OSFE procedure and simultaneous implant placement with different grafting materials: Group A with no grafting materials, Group B with Bio-Oss bone graft, and Group C with Bio-Oss Collagen with CGF. The Implants Survival Rate (ISR) was the primary outcome variable. Secondary outcome variables included radiographic measurements assessed at four follow-up time points, the Implant Stability Quotient (ISQ), and bone density (B). Indicators of bone formation were compared at different time points. Appropriate statistical analyses were conducted, with statistical significance set at a P value of 0.05 for all tests.

RESULTS

ISR was 96%. A significant positive relationship was found between RBH and ISR, [r (126) = .359, p = .000]. Endo sinus bone gain indictors increased in both grafted groups as compared to the non-grafted group. Total Bone Resorption (TBR1) and (TBR2) significantly decreased in both grafted groups compared to the non-grafted group (P = .004, P = .000). Graft size (D) was a positive predictor for ISR at three time points: D0 (odds ratio [OR] 8.06; 95% CI 1.59 to 38.24; P = .010); D1 (OR 96.58; 95% CI 1.69 to 5.52; P = .027); D2 (OR 4.97; 95% CI 1.29 to 19.19; P = .020). Visual Analog Scale (VAS) pain score significantly increased in Group B compared to Groups A and C (P = .000).

CONCLUSION

The combination of Bio-Oss Collagen with CGF as grafting material is a reliable protocol after OSFE with simultaneous implant placement in the atrophic maxilla. This approach is accompanied by high patient satisfaction.

Patellar Non-Traumatic Pathologies: A Pictorial Review of Radiologic Findings

Patellar pathologies are a common cause of knee dysfunction, with Patellofemoral Pain Syndrome (PFPS) alone responsible for 25% of knee-related visits to sports medicine clinics. Non-traumatic conditions, while often overlooked, can also lead to significant discomfort and functional limitations, highlighting the importance of accurate and timely diagnosis for effective management and prevention of complications. This pictorial review examines the radiologic characteristics of various non-traumatic patellar disorders, focusing on imaging modalities such as radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Key diagnostic markers, including patellar tilt, tibial tuberosity-trochlear groove distance (TT-TG), and congruence angle (CA), are discussed for their significance in non-traumatic pathology identification. Furthermore, this review highlights specific radiologic features for a range of non-traumatic patellar conditions, including patellar tendinopathy, chondromalacia patellae, and trochlear dysplasia, emphasizing how distinct radiologic findings facilitate precise diagnosis and clinical assessment. Ultimately, it provides a practical guide for clinicians in diagnosing non-traumatic patellar pathologies through a comprehensive review of key radiologic features while also discussing advancements in imaging technologies and management strategies to support accurate diagnosis and effective clinical decision-making.

Association between depression and vascular aging: a comprehensive analysis of predictive value and mortality risks

BACKGROUND

Depression is a significant global health concern, projected to become the leading disease burden. Vascular burden has been implicated in the pathogenesis of depression. Conversely, whether depression independently influences the process of vascular aging is unknown. This study aims to investigate the mutual relationship between vascular age and depression.

METHODS

Utilizing data from the National Health and Nutrition Examination Survey (NHANES), the study included 27,764 participants after exclusions. Depression was assessed using the Patient Health Questionnaire (PHQ-9). Vascular aging was assessed by estimated pulse wave velocity (ePWV) and the heart age/vascular age (HVA) based on Framingham Risk Score (FRS). The study employed weighted logistic regression and Cox proportional hazards models to analyze the association between vascular age and depression as well as its mortality risk. Mendelian randomization was utilized to explore the causal associations.

RESULTS

Individuals with depression exhibited a higher risk of an advanced vascular age over their chronological age. Mendelian randomization analysis indicated a causal relationship between depression and arterial stiffness. A significant association was found between vascular age and depression incidence with odds ratios ranging from 1.10 to 1.38. As vascular age increased, the risk of mortality in individuals with depression increased by 22 % and 46 %, respectively.

LIMITATIONS

The study design limits the exploration of the dynamic relationship between changes in vascular age and depression due to the single timepoint measurement.

CONCLUSION

This study highlights the bidirectional relationship between depression and vascular age. Vascular age is a significant biomarker for the risk and prognosis of depression, while depression may contribute to vascular aging, which underscores the importance of integrated strategies for managing both vascular health and depression.

Gout and Hyperuricemia: A Narrative Review of Their Comorbidities and Clinical Implications

Gout is the most common form of inflammatory arthritis, caused by the deposition of monosodium urate crystals in the joints due to elevated serum uric acid levels. Its prevalence and associated healthcare burden have been rising in recent decades, a trend expected to continue. It is crucial to recognize that gout and hyperuricemia are not merely causes of painful joint flares, but systemic metabolic disorders linked to a broad spectrum of comorbidities such as cardiovascular diseases, chronic kidney disease, diabetes, insulin resistance, steatotic liver disease, osteoarthritis, and respiratory and eye diseases. Numerous risk factors for gout and hyperuricemia have been identified, with recent research uncovering further associations with other conditions. To optimize patient outcomes, gout and hyperuricemia must be addressed through a holistic approach that accounts for these risk factors while providing comprehensive management of related comorbidities affecting various organ systems. This review summarizes the current knowledge on the risk factors, comorbidities, and clinical implications of gout and hyperuricemia. Future research should focus on improving patient outcomes by tailoring treatments individually and addressing the underlying metabolic comorbidities of gout with multimodal treatment.

Microstructurally informed subject-specific parcellation of the corpus callosum using axonal water fraction

The corpus callosum (CC) is the most important interhemispheric white matter (WM) structure composed of several anatomically and functionally distinct WM tracts. Resolving these tracts is a challenge since the callosum appears relatively homogenous in conventional structural imaging. Commonly used callosal parcellation methods such as Hofer and Frahm scheme rely on rigid geometric guidelines to separate the substructures that are limited to consider individual variation. Here we present a novel subject-specific and microstructurally-informed method for callosal parcellation based on axonal water fraction (ƒ) known as a diffusion metric reflective of axon caliber and density. We studied 30 healthy subjects from the Human Connectome Project dataset with multi-shell diffusion MRI. The biophysical parameter ƒ was derived from compartment-specific WM modeling. Inflection points were identified where there were concavity changes in ƒ across the CC to delineate callosal subregions. We observed relatively higher ƒ in anterior and posterior areas known to consist of a greater number of small diameter fibers and lower ƒ in posterior body areas of the CC known to consist of a greater number of large diameter fibers. Based on the degree of change in ƒ along the callosum, seven callosal subregions were consistently delineated for each individual. Therefore, this method provides microstructurally informed callosal parcellation in a subject-specific way, allowing for more accurate analysis in the corpus callosum.

The top 100 most-cited articles on artificial intelligence in breast radiology: a bibliometric analysis

INTRODUCTION

Artificial intelligence (AI) in radiology is a rapidly evolving field. In breast imaging, AI has already been applied in a real-world setting and multiple studies have been conducted in the area. The aim of this analysis is to identify the most influential publications on the topic of artificial intelligence in breast imaging.

METHODS

A retrospective bibliometric analysis was conducted on artificial intelligence in breast radiology using the Web of Science database. The search strategy involved searching for the keywords 'breast radiology' or 'breast imaging' and the various keywords associated with AI such as 'deep learning', 'machine learning,' and 'neural networks'.

RESULTS

From the top 100 list, the number of citations per article ranged from 30 to 346 (average 85). The highest cited article titled 'Artificial Neural Networks In Mammography-Application To Decision-Making In The Diagnosis Of Breast-Cancer' was published in Radiology in 1993. Eighty-three of the articles were published in the last 10 years. The journal with the greatest number of articles was Radiology (n = 22). The most common country of origin was the United States (n = 51). Commonly occurring topics published were the use of deep learning models for breast cancer detection in mammography or ultrasound, radiomics in breast cancer, and the use of AI for breast cancer risk prediction.

CONCLUSION

This study provides a comprehensive analysis of the top 100 most-cited papers on the subject of artificial intelligence in breast radiology and discusses the current most influential papers in the field.

CLINICAL RELEVANCE STATEMENT

This article provides a concise summary of the top 100 most-cited articles in the field of artificial intelligence in breast radiology. It discusses the most impactful articles and explores the recent trends and topics of research in the field.

KEY POINTS

Multiple studies have been conducted on AI in breast radiology. The most-cited article was published in the journal Radiology in 1993. This study highlights influential articles and topics on AI in breast radiology.

Application of contrast-enhanced ultrasonography for gallbladder squamous cell carcinoma: a case report

Preoperative diagnosis of Gallbladder squamous cell carcinoma (GBSCC) is difficult, and the contrast-enhanced ultrasound (CEUS) pattern has never been reported before. We present a case of GBSCC where CEUS revealed special findings that facilitated early diagnosis. CEUS demonstrated irregular peripheral ring-like enhancement during the arterial phase, with hypoenhancement in the late phases, and an irregular non-enhancing area persistently present in the center of the lesion.

Magnetic Resonance Imaging Liver Segmentation Protocol Enables More Consistent and Robust Annotations, Paving the Way for Advanced Computer-Assisted Analysis

BACKGROUND/OBJECTIVES

Recent advancements in artificial intelligence (AI) have spurred interest in developing computer-assisted analysis for imaging examinations. However, the lack of high-quality datasets remains a significant bottleneck. Labeling instructions are critical for improving dataset quality but are often lacking. This study aimed to establish a liver MRI segmentation protocol and assess its impact on annotation quality and inter-reader agreement.

METHODS

This retrospective study included 20 patients with chronic liver disease. Manual liver segmentations were performed by a radiologist in training and a radiology technician on T2-weighted imaging (wi) and T1wi at the portal venous phase. Based on the inter-reader discrepancies identified after the first segmentation round, a segmentation protocol was established, guiding the second round of segmentation, resulting in a total of 160 segmentations. The Dice Similarity Coefficient (DSC) assessed inter-reader agreement pre- and post-protocol, with a Wilcoxon signed-rank test for per-volume analysis and an Aligned-Rank Transform (ART) for repeated measures analyses of variance (ANOVA) for per-slice analysis. Slice selection at extreme cranial or caudal liver positions was evaluated using the McNemar test.

RESULTS

The per-volume DSC significantly increased after protocol implementation for both T2wi (p < 0.001) and T1wi (p = 0.03). Per-slice DSC also improved significantly for both T2wi and T1wi (p < 0.001). The protocol reduced the number of liver segmentations with a non-annotated slice on T1wi (p = 0.04), but the change was not significant on T2wi (p = 0.16).

CONCLUSIONS

Establishing a liver MRI segmentation protocol improves annotation robustness and reproducibility, paving the way for advanced computer-assisted analysis. Moreover, segmentation protocols could be extended to other organs and lesions and incorporated into guidelines, thereby expanding the potential applications of AI in daily clinical practice.

Microstructural Alterations of Cerebellar Peduncles in Relapsing Remitting Multiple Sclerosis: a Systematic Review and Meta-Analysis of Diffusion Tensor Imaging Studies

Damage to cerebellar peduncles is common in patients with relapsing-remitting multiple sclerosis (RRMS). This can lead to a diverse range of motor and cognitive disabilities. Here, we aimed to evaluate the quantitative alterations of cerebellar peduncles using diffusion tensor imaging (DTI). After a comprehensive search in Web of Science, PubMed, Embase, and Scopus and a rigorous screening, eligible studies underwent data extraction and risk of bias assessment. Standardized Mean Difference (SMD) with a 95% CI was used as effect size. We compared DTI metrics in the cerebellar peduncle regions (SCP, MCP, ICP) between RRMS patients and healthy controls (HC). Sensitivity analysis employed the leave-one-out method. Contour-enhanced funnel plots and Pustejovsky test were used to evaluate the publication bias. Additionally, subgroup analysis was performed using available variables. In eleven included studies encompassing 623 RRMS patients and 416 HC, RRMS patients exhibited significantly decreased fractional anisotropy (FA) values in the SCP (SMD - 0.26) and MCP (SMD - 1.03), increased mean diffusivity (MD) values in the SCP (SMD 1.46), MCP (SMD 0.48) and ICP (SMD 0.70), elevated radial diffusivity (RD) values in the MCP (SMD 0.85) and ICP (SMD 1.20) compared to HC. The subgroup analysis revealed that individuals with elevated EDSS scores exhibited reduced FA and increased MD in the SCP region. No considerable publication bias was detected. No outliers were detected in the sensitivity analysis. DTI proves promising for identifying microstructural abnormalities in cerebellar peduncles of RRMS patients, with decreased FA and increased RD, and MD values observed.

Cancer Risk in Thyroid Nodules: An Analysis of Over 1000 Consecutive FNA Biopsies Performed in a Single Canadian Institution

Objective: To determine the cancer risk in thyroid nodules using ACR TI-RADS. Methods: A retrospective analysis of all thyroid biopsies was performed over a 3-year period (2021 to 2023). Variables including gender, age, history of thyroid cancer or neck irradiation, nodule size and location, TR level, and sonographic features such as punctate echogenic foci (PEF), a very hypoechoic appearance, taller-than-wide shape, and suspected extrathyroidal extension were analyzed. Results: A total of 1140 nodules were assessed in 993 patients, including 740 females (74.5%) and 253 males (25.5%). The mean patient age was 57.1 ± 15.4 years. Variables significantly associated with nodule malignancy included (1) younger age, (2) a prior history of thyroid cancer or neck irradiation, (3) a higher TR level, (4) a taller-than-wide shape in nodules <1 cm, (5) PEF, (6) a very hypoechoic appearance, and (5) suspected extrathyroidal extension (p < 0.05). Gender, nodule location and size were not associated with a higher cancer risk (p > 0.05). Malignancy was found in 40.7% of TR5, 4.8% of TR4, 0.3% of TR3, and 0% of TR1 and 2 nodules. The odds ratios (ORs) for cancer were as follows: TR4 or 5, OR = 19; PEF, OR = 11; a very hypoechoic appearance, OR = 13.3; and suspected extrathyroidal extension, OR = 27.2 (p < 0.01). Conclusions: Higher TR levels, PEF, a very hypoechoic appearance, and suspected extrathyroidal extension are important features for predicting cancer risk. These findings affirm the effectiveness of ACR TI-RADS in nodule risk stratification.

New Trends of Personalized Medicine in the Management of Abdominal Aortic Aneurysm: A Review

Abdominal aortic aneurysm (AAA) is a significant vascular condition characterized by the dilation of the abdominal aorta, presenting a substantial risk of rupture and associated high mortality rates. Current management strategies primarily rely on aneurysm diameter and growth rates to predict rupture risk and determine the timing of surgical intervention. However, this approach has limitations, as ruptures can occur in smaller AAAs below surgical thresholds, and many large AAAs remain stable without intervention. This review highlights the need for more precise and individualized assessment tools that integrate biomechanical parameters such as wall stress, wall strength, and hemodynamic factors. Advancements in imaging modalities like ultrasound elastography, computed tomography (CT) angiography, and magnetic resonance imaging (MRI), combined with artificial intelligence, offer enhanced capabilities to assess biomechanical indices and predict rupture risk more accurately. Incorporating these technologies can lead to personalized medicine approaches, improving decision-making regarding the timing of interventions. Additionally, emerging treatments focusing on targeted delivery of therapeutics to weakened areas of the aortic wall, such as nanoparticle-based drug delivery, stem cell therapy, and gene editing techniques like CRISPR-Cas9, show promise in strengthening the aortic wall and halting aneurysm progression. By validating advanced screening modalities and developing targeted treatments, the future management of AAA aims to reduce unnecessary surgeries, prevent ruptures, and significantly improve patient outcomes.

Hepatic artery pseudoaneurysm-the Mayo Clinic experience and literature review

Introduction

Hepatic artery pseudoaneurysm (HAP) is a rare and potentially life-threatening condition associated with high mortality. This study aims to review the etiology, clinical manifestations, management, and outcomes of patients diagnosed and treated for HAP at the Mayo Clinic.

Methodology

This study was a retrospective chart review of medical records for patients diagnosed and treated for hepatic artery pseudoaneurysm (HAP) at the Mayo Clinic (Florida, Minnesota, and Arizona) between September 1, 1998, and June 30, 2022. A total of 27 patients with HAP were identified, and their demographics, presenting symptoms, location of HAP, etiology, associated liver pathology, type of intervention, and outcomes were analyzed.

Results

The majority of patients with hepatic artery pseudoaneurysm (HAP) were male (63%), with a median age of 57 years (range: 25-87 years). HAP was predominantly intrahepatic (85.2%) and most commonly located on the right hepatic artery (RHA) (70.4%). In 89.9% of cases, the condition was attributable to hepatobiliary procedures or trauma, while only 10.1% occurred spontaneously. Presenting symptoms at the time of HAP diagnosis varied, including gastrointestinal (GI) bleeding (29.6%), abdominal pain (14.81%), non-GI bleeding (11.1%), traumatic bodily injury (11.1%), and other symptoms (14.81%). Asymptomatic or incidental findings of HAP were observed in 18% of cases. Malignancy was identified in 52% of patients, and 26% were liver transplant recipients. Statistical analysis revealed that factors such as prior knowledge of HAP (p = 0.381), HAP rupture (p = 0.382), anticoagulation therapy (p = 0.856), hemorrhagic shock (p = 0.25), liver cirrhosis (p = 0.143), gastrointestinal bleeding (p = 0.879), hepatobiliary abscess (p = 0.079), liver transplantation (p = 0.738), spontaneous HAP (p = 0.381), and malignancy (p = 0.163) were not significantly associated with increased mortality. In contrast, the need for transfusions (p = 0.021), tumor invasion (p = 0.023), portal vein thrombosis (PVT) (p = 0.02), and liver necrosis (p = 0.02) were significantly associated with higher mortality. The overall infection rate was 3%, while the mortality rate was 18.5%.

Discussion

Hepatic artery pseudoaneurysm (HAP) is a rare but serious condition often associated with hepatobiliary procedures, trauma, or liver transplants, though it can also occur spontaneously. While HAP is commonly detected incidentally, its diagnosis is frequently linked to complications such as rupture and gastrointestinal bleeding. However, our study suggests that these complications do not necessarily increase mortality. Key factors associated with higher mortality include the need for blood transfusions, tumor invasion, portal vein thrombosis, and liver necrosis at the time of diagnosis. The overall infection rate was low, but the mortality rate was 18.5%, highlighting the importance of early detection and management.

Interleukin-6 and thyroid-stimulating hormone index predict plaque stability in carotid artery stenosis: analyses by lasso-logistic regression

Objective

To develop and validate a new prediction model based on the Lass-logistic regression with inflammatory serologic markers for the assessment of carotid plaque stability, providing clinicians with a reliable tool for risk stratification and decision-making in the management of carotid artery disease.

Methods

In this study, we retrospectively collected the data of the patients who underwent carotid endarterectomy (CEA) from 2019 to 2023 in Nanjing Drum Tower Hospital. Demographic characteristics, vascular risk factors, and the results of preoperative serum biochemistry were measured and collected. The risk factors for vulnerable carotid plaque were analyzed. A Lasso-logistic regression prediction model was developed and compared with traditional logistic regression models. The Akaike information criterion (AIC) and Bayesian information criterion (BIC) were used to evaluate the performance of three models.

Results

A total of 131 patients were collected in this study, including 66 (50.4%) in the vulnerable plaque group and 65 (49.6%) in the stable plaque group. The final Lasso-logistic regression model included 4 features:IL-6, TSH, TSHI, and TT4RI; AIC = 161.6376, BIC = 176.0136, both lower than the all-variable logistic regression model (AIC = 181.0881, BIC = 261.5936), and the BIC was smaller than the stepwise logistic regression model (AIC = 154.024, BIC = 179.9007). Finally, the prediction model was constructed based on the variables screened by the Lasso regression, and the model had favorable discrimination and calibration.

Conclusions

The noninvasive prediction model based on IL-6 and TSHI is a quantitative tool for predicting vulnerable carotid plaques. It has high diagnostic efficacy and is worth popularizing and applying.

Juvenile Xanthogranuloma Involving the Left Femur: A Case Report and Literature Review

Background

Juvenile xanthogranuloma is a rare condition, and femoral involvement is even rarer. We report a case of juvenile xanthogranuloma affecting the femur. To the best of our knowledge, this is the first reported case of femoral juvenile xanthogranuloma in China.

Case Presentation

A 19-year-old boy began experiencing swelling in various parts of his body at the age of 1 year, followed by pain in his left hip. Preoperative pathology and imaging indicated juvenile xanthogranuloma of the left femur, leading to surgical intervention. Postoperatively, the patient experienced significant relief from left hip discomfort.

Conclusion

Surgery can be an effective treatment for juvenile xanthogranuloma involving the femur.

Clinical Features of Long COVID Patients Coinfected With Mycoplasma pneumoniae

Background: Since the SARS-CoV-2 pandemic, many patients have suffered prolonged complications, called "long COVID." Mycoplasma pneumoniae is a common respiratory pathogen. Reports of simultaneous long COVID and M. pneumoniae infections are rare in the literature. Methods: We analyzed the clinical data of patients with long COVID-19 who visited the Respiratory Clinic of The Affiliated Hospital of Hangzhou Normal University between January 1 and January 31, 2023, together with their laboratory and radiographic findings, with Pearson's χ 2 test. Results: Fifty-two patients diagnosed with both long COVID and M. pneumoniae infection and 77 with long COVID only were compared. The ages, clinical symptoms, and comorbidities of the two groups did not differ significantly (p > 0.05). However, sex and imaging findings differed between the groups. Conclusions: Our study showed that long COVID-M. pneumoniae coinfection was more commonly seen in females and patients with typical chest computed tomography (CT) images.

Role of Imaging in Multiple Myeloma: A Potential Opportunity for Quantitative Imaging and Radiomics?

Multiple myeloma (MM) is the second most prevalent hematologic malignancy, particularly affecting the elderly. The disease often begins with a premalignant phase known as monoclonal gammopathy of undetermined significance (MGUS), solitary plasmacytoma (SP) and smoldering multiple myeloma (SMM). Multiple imaging modalities are employed throughout the disease continuum to assess bone lesions, prevent complications, detect intra- and extramedullary disease, and evaluate the risk of neurological complications. The implementation of advanced imaging analysis techniques, including artificial intelligence (AI) and radiomics, holds great promise for enhancing our understanding of MM. The integration of advanced image analysis techniques which extract features from magnetic resonance imaging (MRI), computed tomography (CT), or positron emission tomography (PET) images has the potential to enhance the diagnostic accuracy for MM. This innovative approach may lead to the identification of imaging biomarkers that can predict disease prognosis and treatment outcomes. Further research and standardized evaluations are needed to define the role of radiomics in everyday clinical practice for patients with MM.

Diagnostic modalities in the mediastinum and the role of bronchoscopy in mediastinal assessment: a narrative review

Background and Objective

Diagnosis of pathology in the mediastinum has proven quite challenging, given the wide variability of both benign and malignant diseases that affect a diverse array of structures. This complexity has led to the development of many different non-invasive and invasive diagnostic modalities. Historically, diagnosis of the mediastinum has relied on different imaging modalities such as chest X-ray, computed tomography (CT), magnetic resonance imaging, and positron emission topography. Once a suspicious lesion was identified with one of these techniques, the gold standard for diagnosis was mediastinoscopy for diagnosis and staging of disease. More recently, many minimally invasive techniques such as CT-guided biopsy, endobronchial ultrasound with transbronchial needle aspiration, and endoscopic ultrasound with fine needle aspiration have revolutionized the diagnosis of the mediastinum. This review provides a comprehensive analysis of all the modalities available for diagnosing mediastinal disease with an emphasis on bronchoscopic techniques.

Methods

Literature search was performed via the PubMed database. We included all types of articles and study designs, including original research, meta-analyses, reviews, and abstracts.

Key Content and Findings

Minimally invasive techniques such as endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) and endoscopic ultrasound-fine needle aspiration (EUS-FNA) have demonstrated high diagnostic yield and low complication rate and have made a significant difference in the time to diagnosis and lives of patients. There continues to be innovation in the field of bronchoscopy with the development of new technologies such as confocal laser endomicroscopy, optical coherence tomography, and artificial intelligence.

Conclusions

Bronchoscopy is and will continue to be an integral modality in minimally invasive diagnosis of the mediastinum.

Development and validation of a lung biological equivalent dose-based multiregional radiomic model for predicting symptomatic radiation pneumonitis after SBRT in lung cancer patients

Background

This study aimed to develop and validate a multiregional radiomic-based composite model to predict symptomatic radiation pneumonitis (SRP) in non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiation therapy (SBRT).

Materials and methods

189 patients from two institutions were allocated into training, internal validation and external testing cohorts. The associations between the SRP and clinic-dosimetric factors were analyzed using univariate and multivariate regression. Radiomics features were extracted from seven discrete and three composite regions of interest (ROIs), including anatomical, physical dosimetry, and biologically equivalent dose (BED) dimensions. Correlation filters and Lasso regularization were applied for feature selection and five machine learning algorithms were utilized to construct radiomic models. Multiregional radiomic models integrating features from various regions were developed and undergone performance test in comparison with single-region models. Ultimately, three models-a radiomic model, a dosimetric model, and a combined model-were developed and evaluated using receiver operating characteristic (ROC) curve, model calibration, and decision curve analysis.

Results

VBED70 (α/β = 3) of the nontarget lung volume was identified as an independent dosimetric risk factor. The multiregional radiomic models eclipsed their single-regional counterparts, notably with the incorporation of BED-based dimensions, achieving an area under the curve (AUC) of 0.816 [95% CI: 0.694-0.938]. The best predictive model for SRP was the combined model, which integrated the multiregional radiomic features with dosimetric parameters [AUC=0.828, 95% CI: 0.701-0.956]. The calibration and decision curves indicated good predictive accuracy and clinical benefit, respectively.

Conclusions

The combined model improves SRP prediction across various SBRT fractionation schemes, which warrants further validation and optimization using larger-scale retrospective data and in prospective trials.

Spontaneous Resolution of an Aggressive Direct Carotid Cavernous Fistula Following Partial Transvenous Embolization Treatment: A Case Report and Review of Literatures

Traumatic direct type carotid cavernous fistula (CCF) is an acquired arteriovenous shunt between the carotid artery and the cavernous sinus post severe craniofacial trauma or iatrogenic injury. We reported a 46-year-old woman who had developed a traumatic direct type CCF after severe head trauma with a skull base fracture and brain contusion hemorrhage. The clinical manifestations of the patient included pulsatile exophthalmos, proptosis, bruits, chemosis, and a decline in consciousness. Magnetic resonance imaging (MRI) revealed engorgement of the right superior ophthalmic vein (SOV), perifocal cerebral edema in the right frontal-temporal cortex, right basal ganglia, and brain stem. Digital subtraction angiography (DSA) disclosed a direct type high-flow CCF with an aggressive cortical venous reflux drainage pattern, which was attributed to Barrow type A and Thomas classification type 5. After partial treatment by transvenous coil embolization for the CCF, the residual high-flow fistula with aggressive venous drainage had an unusual rapid spontaneous resolution in a brief period. Therefore, it is strongly recommended to meticulously monitor the clinical conditions of patients and perform brain MRI and DSA at short intervals to determine the treatment strategy for residual CCF after partial endovascular treatment.

Oligodendrocytes in Huntington's Disease: A Review of Oligodendrocyte Pathology and Current Cell Reprogramming Approaches for Oligodendrocyte Modelling of Huntington's Disease

Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder traditionally characterized by the selective loss of medium spiny neurons in the basal ganglia. However, it has become apparent that white matter injury and oligodendrocyte dysfunction precede the degeneration of medium spiny neurons, garnering interest as a key pathogenic mechanism of HD. Oligodendrocytes are glial cells found within the central nervous system involved in the production of myelin and the myelination of axons. Myelin is a lipid-rich sheath that wraps around axons, facilitating signal conduction and neuronal viability. The degeneration of myelin hinders effective communication and leaves neurons vulnerable to external damage and subsequent degeneration. Abnormalities in oligodendrocyte maturation have been established in the HD human brain, however, investigations into the underlying dysfunction of human oligodendrocytes in HD are limited. This review will detail the involvement of oligodendrocytes and white matter damage in HD. Recent developments in modeling human-specific oligodendrocyte pathology in HD will be discussed, with a particular focus on emerging somatic cell reprogramming approaches.

Case series: Using laryngeal mask airway to enhance the radiological evaluation and staging of cancers involving the larynx: A novel technique

The diagnosis and staging of head and neck tumors requires proper clinical, endoscopic, and radiological evaluation. Currently, imaging techniques such as Magnetic Resonance Imagining (MRI) and Computed Tomography (CT) are used for head and neck tumors but are limited in showing involvement of different hypopharyngeal sub-compartments. Several maneuvers have been developed to improve visualization of the head and neck area; however, they demonstrated minimal benefit. In this case series, patients with tumors involving the hypopharynx are studied. A laryngeal mask airway was used to stent the hypopharynx to assess the extent of the disease by creating real space between mucosal surfaces. This case series aims to describe the impact of using laryngeal mask airway on the evaluation of cancers involving the hypopharynx.

Ectopic Dental Canal: A Case Report Highlighting a Unique Bifid Mandibular Canal Variant

Bifid mandibular canals are common anatomical findings with variations based on direction and location of branching, which carry significant clinical implications for endodontic and surgical dental procedures. This case report describes a previously unreported ectopic dental canal that branches off the superior border of the mandibular canal, enters the apex of a mandibular second molar, traverses through the root, anastomoses with the root canal system, and subsequently exits through the lingual aspect of the root. The anastomosis of this ectopic dental canal with the mesial lingual canal led to significant bleeding during rotary instrumentation. This unique anatomical variation demonstrates the importance of a thorough cone-beam computed tomography analysis to identify critical structures prior to undertaking dental procedures involving the root apices of mandibular posterior teeth and adjacent areas.

Deconstructive repair of a direct carotid-cavernous fistula via a posterior circulation retrograde approach

We report a case of a 24-year-old patient who presented after a head trauma with a traumatic occlusion of his left internal carotid artery. He underwent diagnostic cerebral angiogram and was found to have a direct left carotid-cavernous fistula (CCF) with retrograde filling from the posterior circulation across the posterior communicating artery. Because of the severe injury to the left internal carotid artery (ICA), reconstructive repair of the ICA was not possible. The patient underwent deconstructive repair of the CCF by coil embolization using a posterior retrograde approach. Coils were successfully placed in the cavernous sinus and back into the left ICA with complete cure of the CCF and restoration of cerebral perfusion distal to the treated CCF. We review the types of CCFs, their clinical presentation, and their endovascular treatments. Retrograde access of a direct CCF is rarely reported in the literature, and we believe this approach offers a viable alternative in appropriately selected patients.

Spherical-deconvolution informed filtering of tractograms changes laterality of structural connectome

Diffusion MRI-driven tractography, a non-invasive technique that reveals how the brain is connected, is widely used in brain lateralization studies. To improve the accuracy of tractography in showing the underlying anatomy of the brain, various tractography filtering methods were applied to reduce false positives. Based on different algorithms, tractography filtering methods are able to identify the fibers most consistent with the original diffusion data while removing fibers that do not align with the original signals, ensuring the tractograms are as biologically accurate as possible. However, the impact of tractography filtering on the lateralization of the brain connectome remains unclear. This study aims to investigate the relationship between fiber filtering and laterality changes in brain structural connectivity. Three typical tracking algorithms were used to construct the raw tractography, and two popular fiber filtering methods(SIFT and SIFT2) were employed to filter the tractography across a range of parameters. Laterality indices were computed for six popular biological features, including four microstructural measures (AD, FA, RD, and T1/T2 ratio) and two structural features (fiber length and connectivity) for each brain region. The results revealed that tractography filtering may cause significant laterality changes in more than 10% of connections, up to 25% for probabilistic tracking, and deterministic tracking exhibited minimal laterality changes compared to probabilistic tracking, experiencing only about 6%. Except for tracking algorithms, different fiber filtering methods, along with the various biological features themselves, displayed more variable patterns of laterality change. In conclusion, this study provides valuable insights into the intricate relationship between fiber filtering and laterality changes in brain structural connectivity. These findings can be used to develop improved tractography filtering methods, ultimately leading to more robust and reliable measurements of brain asymmetry in lateralization studies.

Liquid biopsy in gallbladder carcinoma: Current evidence and future prospective

Although there have been significant advances in the early detection and treatment of gallbladder cancer (GBC), it is still considered a leading cause of morbidity and mortality. Molecular profiling of tumors is generally performed using samples obtained during surgery or biopsy. However, tissue genotyping has its limitations as it only provides a single snapshot and is susceptible to spatial selection bias due to the tumor heterogeneity. Over the past decade, there has been a remarkable transition from invasive diagnostic methods to non-invasive alternatives, including liquid biopsy, for cancer diagnosis and monitoring. Liquid biopsies have ushered in a new era in clinical oncology, enabling convenient tumor sampling, continuous monitoring through repeated analysis, development of personalized treatment regimens, and assessment of therapy resistance. While peripheral blood is the primary medium for these biopsies, other biological fluids, including urine, saliva, and bile, also serve as valuable sources of information. Currently, the focus of blood-based biopsy analyses is on four main sources of biomarkers for cancer detection and stratification: circulating tumor DNA (ctDNA) or circulating free DNA (cfDNA), circulating tumor cells (CTCs), and extracellular vesicle (EVs). There are over 300 clinical trials either ongoing or actively recruiting participants to investigate the diagnostic and prognostic applications of ctDNA/cfDNA in the context of cancer. This review outlines the current standard of care for individuals with GBC, anticipates future treatment developments, and evaluates the potential applications of liquid biopsies in various clinical contexts. The review addresses ctDNA/cfDNA, CTC, and circulating microRNA and highlights their prospective roles in management of GBC.

Neck triangle nerve enlargement in hereditary transthyretin amyloidosis correlates with changes in the autonomic, cardiac, and gastrointestinal systems

BACKGROUND

Hereditary transthyretin amyloidosis (ATTRv) is a hereditary disease that affects multiple bodily systems. Although sonography generally reveals enlargement of nerves in the limbs, the brachial plexus, and vagus nerve, the clinical significance of these findings remains unclear.

METHODS

We performed sonographic measurements of the median nerve, cervical spinal nerves at the C5-C7 level, and the vagus nerve in patients with ATTRv and healthy controls. Clinical profiles and cardiac and gastrointestinal examination results were also collected for linear regression analysis.

RESULTS

We recruited 47 patients with ATTRv (males/females: 34/13, age: 65.6 ± 5.3 years). The sampled segments were all significantly larger than those of the controls. In the clinical profiles, the sum of the Z scores of the neck triangle nerves (cervical spinal nerves and vagus nerve) and of all nerves (cervical spinal nerves, vagus nerve, and median nerve at the wrist) significantly correlated with the familial amyloid polyneuropathy stage, onset of autonomic nervous system (ANS) symptoms, and autonomic symptom scores. On cardiac examinations, several ultrasonography and magnetic resonance imaging parameters (primarily those that reflect heart volume) were found to be significantly correlated with the sum of the Z scores of the cervical spinal nerves but not with the Z score of the vagus nerve. In gastrointestinal evaluation, the cross-sectional area of the vagus nerve was correlated with gastric emptying time parameters on scintigraphy.

CONCLUSIONS

Neck triangle nerve enlargement on sonography correlated with parameters related to ANS dysfunction, indicating that nerve enlargement observed on ultrasonography may serve as a potential surrogate biomarker of ATTRv.

Two complex coronary artery abnormalities discovered after an acute coronary syndrome : A case report

BACKGROUND

Complex coronary artery abnormalities (CAA) are rare findings with no established guideline for their management in asymptomatic patients.

CASE SUMMARY

We report the case of a 49-year-old male patient, with no medical history, who was incidentally diagnosed for two congenital complex CAA during for the management of an acute coronary syndrome without ST elevation. The coronary angiogram showed an acute atheromatous occlusion of the right coronary artery (RCA) that was treated by a drug-eluting stent. Transcatheter angiograms as well as the coronary computed tomography (CT) also revealed an ectopic RCA arising from the left cuspid with an inter-arterial course, and a second left anterior descending artery emerging from the RCA with a retro-pulmonary course. The present acute coronary syndrome was not in relation to his congenital disease but with an atheromatous disease. On 48 months of follow-up, the transthoracic echocardiography is normal and the patient remains asymptomatic despite the risk of sudden cardiac death and myocardial infarction.

DISCUSSION

This case shows that CAA can be clinically silent for a long period of time without any correction. It highlights that ischemia in patients with CAA is not always due to the congenital disease. As patients seemed to remain at SCD risk despite surgical correction, not correcting the CAA might remain an alternative in asymptomatic adult patients.

Vocal Cord Palsy in Hypoxic Brain Injury: A Qualitative Systematic Review

This study aimed to consolidate evidence linking vocal cord palsy (VCP) to hypoxic injury, and its pathophysiology, and explore related topographical representations along laryngeal innervation. PubMed, Embase, and Scopus were the databases used. This review adheres to PRISMA guidelines. We included case series or case reports published before December 6, 2023. These studies must document VCP, diagnosed via direct or indirect laryngoscopic evaluation, resulting from hypoxic injury with imaging documentation specifying the level of injury. Screening, review, quality assessment, and extraction were done using Covidence. Our search strategy yielded 380 articles, of which 11 papers met the inclusion criteria for final review. A total of 12 patients were included across the selected studies, evenly split between genders. The causes of hypoxic injury were stroke in 11 cases and perinatal asphyxia in one. The hypoxic injury affected the medulla, pons, basal ganglia, thalamus, internal capsule, cortex, and cerebellum. The distribution of hypoxic injuries was: left side (6), bilateral (2), right side (2), and not mentioned (2). Vocal cord involvement was unilateral in eight cases and bilateral in four cases. In five cases, the involvement was ipsilateral to the hypoxic injury, bilateral when the injury was bilateral, and contralateral in two cases. Our study provides insights into how hypoxic brain injury can cause VCP and correlates the level of lesions along the innervation pathway with the clinical presentation. VCP can be induced by hypoxic injuries to the neurons extending from the laryngeal motor cortex to the laryngeal motor neurons in the medulla.

Diagnostic value of uric acid to high-density lipoprotein cholesterol ratio in abdominal aortic aneurysms

BACKGROUND

Abdominal aortic aneurysm (AAA) is highly lethal upon onset of acute aortic diseases (AAD) or rupture. Dyslipidaemia and hyperuricaemia are important risk factors for the development of AAA and AAD as well as aortic disease-related death. The aim of this study was to explore whether uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) can be used as an independent predictor of the presence of AAA or AAD.

METHODS

Three hundred subjects, including 100 AAA patients (AAA group), 100 AAD patients (AAD group) and 100 controls (CON group), were recruited in this study. UHR and other serum samples were obtained upon the patients' admission before any medical treatment. The optimal cut-off points of UHR were determined using receiver operating characteristic (ROC) curve analysis.

RESULTS

The UHR in AAA group was significantly higher than that in CON group, but there was no significant difference between AAD group and CON group. The optimal cut-off point of UHR for AAA was 7.78 (sensitivity 84.7%, specificity 62.4%, and AUC 0.811; p < 0.001), and UHR (OR: 1.122, 95%CI: 1.064-1.184; p < 0.001) was found to be an independent factor for predicting AAA after adjusting for traditional AAA risk factor.

CONCLUSION

UHR can be widely used in clinical practice as an auxiliary tool for screening AAA. The optimal cut-off point for UHR to AAA was determined for the first time in Chinese subjects.

Distortion-free water-fat separated diffusion-weighted imaging using spatiotemporal joint reconstruction

PURPOSE

Diffusion-weighted imaging (DWI) suffers from geometric distortion and chemical shift artifacts due to the commonly used Echo Planar Imaging (EPI) trajectory. Even with fat suppression in DWI, severe B0 and B1 variations can result in residual fat, which becomes both a source of image artifacts and a confounding factor in diffusion-weighted contrast in distinguishing benign and malignant tissues. This work presents a method for acquiring distortion-free diffusion-weighted images using spatiotemporal acquisition and joint reconstruction. Water-fat separation is performed by chemical-shift encoding.

METHODS

Spatiotemporal acquisition is employed to obtain distortion-free images at a series of echo times. Chemical-shift encoding is used for water-fat separation. Reconstruction and separation are performed jointly in the spat-spectral domain. To address the shot-to-shot motion-induced phase in DWI, an Fast Spin Echo (FSE)-based phase navigator is incorporated into the sequence to obtain distortion-free phase information. The proposed method was validated in phantoms and in vivo for the brain, head and neck, and breast.

RESULTS

The proposed method enables the acquisition of distortion-free diffusion-weighted images in the presence of B0 field inhomogenieties commonly observed in the body. Water and fat components are separated with no obvious spectral leakage artifacts. The estimated Apparent Diffusion Coefficient (ADC) is comparable to that of multishot DW-EPI.

CONCLUSION

Distortion-free, water-fat separated diffusion-weighted images in body can be obtained through the utilization of spatiotemporal acquisition and joint reconstruction methods.

Motor Unit Magnetic Resonance Imaging (MUMRI) In Skeletal Muscle

Magnetic resonance imaging (MRI) is routinely used in the musculoskeletal system to measure skeletal muscle structure and pathology in health and disease. Recently, it has been shown that MRI also has promise for detecting the functional changes, which occur in muscles, commonly associated with a range of neuromuscular disorders. This review focuses on novel adaptations of MRI, which can detect the activity of the functional sub-units of skeletal muscle, the motor units, referred to as "motor unit MRI (MUMRI)." MUMRI utilizes pulsed gradient spin echo, pulsed gradient stimulated echo and phase contrast MRI sequences and has, so far, been used to investigate spontaneous motor unit activity (fasciculation) and used in combination with electrical nerve stimulation to study motor unit morphology and muscle twitch dynamics. Through detection of disease driven changes in motor unit activity, MUMRI shows promise as a tool to aid in both earlier diagnosis of neuromuscular disorders and to help in furthering our understanding of the underlying mechanisms, which proceed gross structural and anatomical changes within diseased muscle. Here, we summarize evidence for the use of MUMRI in neuromuscular disorders and discuss what future research is required to translate MUMRI toward clinical practice. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.