Imaging Considerations in Differentiating Plantar Plate Pathology and Webspace Neuroma

Myriad pathologies affect the lesser toes. In this article, the focus is on the challenging radiological differential diagnosis of plantar plate (PP) degeneration and tear versus webspace neuroma. It is now understood that PP tear and even degeneration without tear is most accompanied by reactive pericapsular soft tissue thickening (pseudoneuroma), which contributes to neuritic symptoms that are often indistinguishable from webspace neuroma. In this article, the authors will review the differing clinical presentations and radiographic, sonographic, and MRI findings of these entities and the different acquired toe deformities that occur in PP dysfunction with pseudoneuroma, versus webspace neuroma.

Portal vein stenting blocked the inflow tract and completely resolved bile duct varices, formed by cavernous transformation of the portal vein

There is no established treatment for bleeding bile duct varices (BDVs). We report the first case of portal vein (PV) stenting completely eradicating bleeding BDVs. A 70-year-old male with malignant lymphoma developed BDVs due to PV obstruction, which had caused compression and stricture of the distal bile duct. Endoscopic retrograde cholangiography was performed to evaluate the stricture and bleeding from the ruptured BDV was observed. Endoscopic hemostasis was difficult, requiring reopening of the extra-hepatic PV and reducing the blood flow to the BDVs for hemostasis. Therefore, PV stenting was performed. During the procedure, portal angiography confirmed an inflow tract to the BDVs. Therefore, covered stents were placed in the PV and adjusted to block the inflow tract to the BDVs at the distal end. After stenting, the BDVs were successfully blocked and all PV blood flowed through the stent placed in the extra-hepatic PV. Two weeks after stenting, the BDVs had disappeared completely and the bleeding has not recurred for months. We experienced a case in which PV stenting not only reopened an obstructed PV but also successfully occluded the inflow tract. This case demonstrates the potential of PV stenting for the treatment of hemorrhagic BDVs.

Artificial intelligence in skeletal metastasis imaging

In the field of metastatic skeletal oncology imaging, the role of artificial intelligence (AI) is becoming more prominent. Bone metastasis typically indicates the terminal stage of various malignant neoplasms. Once identified, it necessitates a comprehensive revision of the initial treatment regime, and palliative care is often the only resort. Given the gravity of the condition, the diagnosis of bone metastasis should be approached with utmost caution. AI techniques are being evaluated for their efficacy in a range of tasks within medical imaging, including object detection, disease classification, region segmentation, and prognosis prediction in medical imaging. These methods offer a standardized solution to the frequently subjective challenge of image interpretation.This subjectivity is most desirable in bone metastasis imaging. This review describes the basic imaging modalities of bone metastasis imaging, along with the recent developments and current applications of AI in the respective imaging studies. These concrete examples emphasize the importance of using computer-aided systems in the clinical setting. The review culminates with an examination of the current limitations and prospects of AI in the realm of bone metastasis imaging. To establish the credibility of AI in this domain, further research efforts are required to enhance the reproducibility and attain robust level of empirical support.

Coexistence of kidney and lung hydatid cyst in a child: A case report

Hydatid cyst (HC) is a zoonotic disease that often affects regions where animal husbandry is common and preventive measures are not taken. This disease mostly affects the liver and the lungs. Involvement of other organs, such as the kidney, musculoskeletal system, and intracranial structures, is rare. In this case report we will be discussing a patient who was diagnosed with bacterial pulmonary empyema without proper response to treatment. In further management, a ruptured hydatid cyst was diagnosed along with a renal hydatid cyst.

Relationship between pancreatic morphological changes and diabetes in autoimmune pancreatitis: Multimodal medical imaging assessment has important potential

Autoimmune pancreatitis (AIP) is a special type of chronic pancreatitis with clinical symptoms of obstructive jaundice and abdominal discomfort; this condition is caused by autoimmunity and marked by pancreatic fibrosis and dysfunction. Previous studies have revealed a close relationship between early pancreatic atrophy and the incidence rate of diabetes in type 1 AIP patients receiving steroid treatment. Shimada et al performed a long-term follow-up study and reported that the pancreatic volume (PV) of these patients initially exponentially decreased but then slowly decreased, which was considered to be an important factor related to diabetes; moreover, serum IgG4 levels were positively correlated with PV during follow-up. In this letter, regarding the original study presented by Shimada et al, we present our insights and discuss how multimodal medical imaging and artificial intelligence can be used to better assess the relationship between pancreatic morphological changes and diabetes in patients with AIP.

Optimizing clinical decision-making for ruptured intracranial aneurysms: Current applications and future directions of computed tomography angiography

Ruptured intracranial aneurysms (RIAs) are a leading cause of subarachnoid haemorrhage (SAH) and are associated with a poor prognosis and high mortality rate. Computed tomography angiography (CTA) is the preferred imaging modality for the diagnosis of RIAs, as it is considered to be a fast, economical, and less invasive method. In this letter, regarding an original study presented by Elmokadem et al, we present our insights and discuss how CTA can better assist in clinical decision-making for patients with RIAs complicated by SAH.

AI-Based Noise-Reduction Filter for Whole-Body Planar Bone Scintigraphy Reliably Improves Low-Count Images

Background/Objectives: Artificial intelligence (AI) is a promising tool for the enhancement of physician workflow and serves to further improve the efficiency of their diagnostic evaluations. This study aimed to assess the performance of an AI-based bone scan noise-reduction filter on noisy, low-count images in a routine clinical environment. Methods: The performance of the AI bone-scan filter (BS-AI filter) in question was retrospectively evaluated on 47 different patients' 99mTc-MDP bone scintigraphy image pairs (anterior- and posterior-view images), which were obtained in such a manner as to represent the diverse characteristics of the general patient population. The BS-AI filter was tested on artificially degraded noisy images-75, 50, and 25% of total counts-which were generated by binominal sampling. The AI-filtered and unfiltered images were concurrently appraised for image quality and contrast by three nuclear medicine physicians. It was also determined whether there was any difference between the lesions seen on the unfiltered and filtered images. For quantitative analysis, an automatic lesion detector (BS-AI annotator) was utilized as a segmentation algorithm. The total number of lesions and their locations as detected by the BS-AI annotator in the BS-AI-filtered low-count images was compared to the total-count filtered images. The total number of pixels labeled as lesions in the filtered low-count images in relation to the number of pixels in the total-count filtered images was also compared to ensure the filtering process did not change lesion sizes significantly. The comparison of pixel numbers was performed using the reduced-count filtered images that contained only those lesions that were detected in the total-count images. Results: Based on visual assessment, observers agreed that image contrast and quality were better in the BS-AI-filtered images, increasing their diagnostic confidence. Similarities in lesion numbers and sites detected by the BS-AI annotator compared to filtered total-count images were 89%, 83%, and 75% for images degraded to counts of 75%, 50%, and 25%, respectively. No significant difference was found in the number of annotated pixels between filtered images with different counts (p > 0.05). Conclusions: Our findings indicate that the BS-AI noise-reduction filter enhances image quality and contrast without loss of vital information. The implementation of this filter in routine diagnostic procedures reliably improves diagnostic confidence in low-count images and elicits a reduction in the administered dose or acquisition time by a minimum of 50% relative to the original dose or acquisition time.

Carbon ion radiation therapy in prostate cancer: The importance of dosage

In this article, we comment on the article by Ono et al. We focus specifically on the carbon ion radiotherapy studies and the method to calculate the dosing schedule. While photon hypofractionated radiotherapy in prostate cancer has demonstrated improvement in tumor control with reduced gastrointestinal toxicity compared to conventional radiotherapy, carbon ion radiotherapy (CIRT) offers additional physical and biological advantages. Recent findings, including those from Ono et al, have established new dose constraints of CIRT for prostate cancer treatment and risk factors for rectal bleeding. Due to limited data on CIRT dosing, this study underscores the need for more research to refine dose calculation methods and better understand their effects on clinical outcomes.

Clinical impact of novel cardiovascular magnetic resonance technology on patients with congenital heart disease: a scientific statement of the Association for European Pediatric and Congenital Cardiology and the European Association of Cardiovascular Imaging of the European Society of Cardiology

Cardiovascular magnetic resonance (CMR) imaging is recommended in patients with congenital heart disease (CHD) in clinical practice guidelines as the imaging standard for a large variety of diseases. As CMR is evolving, novel techniques are becoming available. Some of them are already used clinically, whereas others still need further evaluation. In this statement, the authors give an overview of relevant new CMR techniques for the assessment of CHD. Studies with reference values for these new techniques are listed in the Supplementary data online, supplement.

Optimizing Scan Range in Computed Tomography of Kidneys, Ureters, and Bladder: A Retrospective Study on Reducing Overscanning

Background and Objectives: Computed tomography of the kidneys, ureters, and bladder (CT KUB) is essential for evaluating urinary stones but also exposes patients to significant radiation. The scanning field should be minimized to only the necessary area to limit this radiation exposure. This study aims to assess the extent of CT KUB overscanning in renal colic procedures and identify the appropriate vertebral level for starting CT KUB scans. Materials and Methods: A retrospective analysis of 299 adult patients who underwent CT KUB examinations for kidney stone assessment was performed. To assess overscanning, the number of excess slices above the pole of the highest kidney and under the pubic symphysis was measured on the axial image of each patient. To allow for potential human error, a maximum acceptable level of overscanning was set at 10%. Results: This study found that only 31% of the scans met the target of less than 10% of overscanning superior to the highest kidney and inferior to the pubic symphysis. In comparison, overscanning was present in 69% of the scans, mainly at a superior level, resulting in higher radiation exposure for patients. Conclusions: A significant number of the scans exhibited unnecessary overscanning beyond the highest kidney, prompting us to propose using the upper border of the T10 vertebral body as a potential reference point to establish the upper margin for a CT KUB scan. This study suggests using T10 and the pubic symphysis as reliable landmarks to accurately determine the scan length. Starting CT KUB scans from the T10 vertebral body to the pubic symphysis allows for imaging of the entire urinary tract, minimizing unnecessary overscanning and reducing patient irradiation.

An Evaluation of a Point-of-Care GEM Premier ChemSTAT Analyzer in an Emergency Department: Prevention of Contrast-Induced Nephropathy and Optimization of Patient Flow

Background: Having a laboratory renal profile for medical imaging examinations requiring contrast media (CM) administration is strongly advised. Creatinine helps identify patients at risk of contrast-induced nephropathy (CIN). The GEM® Premier™ ChemSTAT (Werfen) is a point-of-care (POC) analyzer with 12 emergency parameters, including a creatinine assay. This study aims to compare ChemSTAT with the central analytical solution of the University Hospital of Clermont-Ferrand and to evaluate the interest in using POC creatinine in the emergency department (ED) to optimize the flow of patients, especially when CM administration is necessary. Methods: More than 200 whole blood (WB) samples from the ED were evaluated on the ChemSTAT analyzer. As comparative methods, the plasma aliquots from the same samples were assayed on an Atellica® CH (Siemens Healthineers). The clinical concordance was assessed according to the decision cut-offs of the French Society of Radiology for the risk of CIN. The availability times of biological results between ChemSTAT and the central laboratory were studied. Results: WB results from the ChemSTAT analyzer correlated well with those from the Atellica® CH, except for tCO2 (the known bias between the Siemens and Cobas Roche methods for predicting ChemSTAT values). The results of the creatinine assay allow for identical medical decisions in comparison to the renal-risk cut-offs. The availability of the biological results was reduced by 50 min on average with ChemSTAT vs the central laboratory. Computed tomography (CT) was performed for 44.7% of patients, including the injection of the CM in 68% of cases. For these patients, the availability of creatinine results relative to imaging time is faster with the ChemSTAT by an average of 45.2 min. Conclusions: Great analytical and clinical correlations for creatinine assays allow for the safe identification of patients at risk of CIN, and improve patient flow in ED, especially for those requiring computed tomography with CM.

Non-Contrast MRI Sequences for Ischemic Stroke: A Concise Overview for Clinical Radiologists

Ischemic stroke is the second leading cause of mortality and morbidity worldwide. Due to the urgency of implementing immediate therapy, acute stroke necessitates prompt diagnosis. The current gold standards for vascular imaging in stroke include computed tomography angiography (CTA), digital subtraction angiography (DSA) and magnetic resonance angiography (MRA). However, the contrast agents used in these methods can be costly and pose risks for patients with renal impairment or allergies. The aim of this paper is to provide a comprehensive overview of current MRI techniques and sequences for evaluating ischemic stroke, emphasizing the importance of non-contrast options and their clinical implications for radiologists in the diagnosis and management of ischemic stroke. Standard MRI sequences-such as T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), DWI-FLAIR mismatch, and apparent diffusion coefficient (ADC)-are essential for determining infarct location, volume, and age. Additionally, incorporating susceptibility-weighted imaging (SWI) sequence aids in identifying signs of hemorrhagic transformation within the infarcted region. Advanced techniques like arterial spin labeling (ASL) can serve as a non-contrast alternative for mapping cerebral blood flow (CBF) and allowing for comparison between infarcted and healthy brain areas. Adding ASL to the routine sequence allows ASL-DWI mismatch analysis that is useful for quantifying salvageable tissue volume and facilitate timely recanalization, while time-of-flight (TOF) MRA and magnetic resonance venography (MRV) help assess venous thrombosis, stenosis, or arterial occlusions. Finally, MR spectroscopy can provide insights into critical brain metabolites, including N-acetylaspartate (NAA), and lactate (Lac) to determine patient prognosis. Current MRI technology provides a myriad of sequence options for the comprehensive evaluation of ischemic stroke without the need for contrast material. A thorough understanding of the advantages and limitations of each sequence is crucial for its optimal implementation in diagnosis and treatment.

How Arterial Embolization Is Transforming Treatment of Oncologic and Degenerative Musculoskeletal Disease

BACKGROUND

Arterial embolization is a minimally invasive treatment that occludes blood vessels supplying pathological tissue. Developed to control bleeding without surgery, it has evolved over decades and is now applied in musculoskeletal oncology as a preoperative treatment, palliative care, or standalone therapy for select tumors. Recently, its use has expanded globally in treating chronic pain syndromes and osteoarthritis.

MATERIALS AND METHODS

We reviewed the literature on arterial embolization in various musculoskeletal conditions. The focus was on established oncologic indications for primary and metastatic bone or soft tissue tumors, and emerging evidence on degenerative diseases like osteoarthritis, inflammatory musculoskeletal pathology, and intractable pain. Emphasis was placed on leading studies regarding efficacy, complications, and recurrence rates.

DISCUSSION

Arterial embolization has progressed from bleeding control to a versatile therapeutic option in musculoskeletal medicine. It offers symptom relief, reduces tumor size, and improves quality of life. Applications include oncologic interventions and management of degenerative and inflammatory conditions. Despite its benefits, variations in complications and recurrence rates highlight the need for standardized protocols and further research.

CONCLUSIONS

Arterial embolization is a safe and effective minimally invasive tool in the multidisciplinary management of a wide range of musculoskeletal pathologies. Ongoing research is crucial to understand long-term efficacy, optimize protocols, and broaden its applications.

CT radiation dose reduction with tin filter for localisation/characterisation level image quality in PET-CT: a phantom study

BACKGROUND

The tin filter has allowed radiation dose reduction in some standalone diagnostic computed tomography (CT) applications. Yet, 'low-dose' CT scans are commonly used in positron emission tomography (PET)-CT for lesion localisation/characterisation (L/C), with higher noise tolerated. Thus, dose reductions permissible with the tin filter at this image quality level may differ. The aim was to determine the level of CT dose reduction permitted with the tin filter in PET-CT, for comparable image quality to the clinical reference standard (CRS) L/C CT images acquired with standard filtration.

MATERIALS AND METHODS

A whole-body CT phantom was scanned with standard filtration in CRS protocols, using 120 kV with 20mAs-ref for bone L/C (used in 18F-Sodium Fluoride (NaF) PET-CT) and 40mAs-ref for soft tissue L/C (used in 18F-Fluorodeoxyglucose (FDG) PET-CT), followed by tin filter scans at 100 kV (Sn100kV) and 140 kV (Sn140kV) with a range of mAs settings. For each scan, effective dose (ED) in an equivalent-sized patient was calculated, and image quality determined in 5 different tissues through quantitative (contrast-to-noise ratio) and qualitative (visual) analyses. The relative dose reductions which could be achieved with the tin filter for comparable image quality to CRS images were calculated.

RESULTS

Quantitative analysis demonstrated dose savings of 50-76% in bone, 27-51% in lung and 8-61% in soft tissue with use of the tin filter at Sn100kV. Qualitative analysis demonstrated dose reductions using Sn100kV in general agreement with the dose reductions indicated by quantitative analysis. Overall, CT dose reductions of around 85% were indicated for NaF bone PET-CT, allowing whole-body CT at just 0.2mSv ED, and a 30-40% CT dose reduction for FDG PET-CT using Sn100kV (1.7-2.0mSv), providing comparable image quality to current CRS images with standard filtration. Sn140kV demonstrated limited value in CT dose reduction.

CONCLUSIONS

Large CT dose reductions can be made using the tin filter at Sn100kV, when imaging bone, lung and soft tissue at L/C level CT image quality in PET-CT. As well as reducing the risk of inducing a cancer in later life, such dose reductions may also impact PET-CT practice, such as justifying cross-sectional over planar imaging or justifying PET-CT in younger patients.

Hepatocellular Carcinoma Surveillance Strategies: Major Guidelines and Screening Advances

BACKGROUND/OBJECTIVES

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths globally, with prognosis and treatment outcomes that are significantly influenced by the stage at diagnosis. Early detection through regular surveillance is crucial for improving patient outcomes, especially in high-risk groups such as those with cirrhosis or chronic hepatitis B. Geographic variations in HCC risk factors, including viral hepatitis and non-alcoholic fatty liver disease (NAFLD), have led to the development of different international surveillance guidelines. This review aims to compare and evaluate the surveillance strategies proposed by the Asian Pacific Association for the Study of the Liver (APASL), the American Association for the Study of Liver Diseases (AASLD), and the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer (EASL-EORTC).

METHODS

The review examined and compared major international guidelines on HCC surveillance, focusing on patient selection, imaging modalities, and the integration of biomarkers. We also explored recent advancements in screening techniques, including artificial intelligence and emerging biomarkers, to identify future directions for improving surveillance strategies.

RESULTS

Our analysis identified key differences in the guidelines, particularly in imaging modality preferences and the use of biomarkers for early detection. While all guidelines place emphasis on high-risk populations, the inclusion criteria and surveillance intervals vary. Additionally, novel technologies such as artificial intelligence show potential to enhance the accuracy and efficiency of HCC detection.

CONCLUSIONS

This review highlights the need to harmonize the international guidelines, particularly in regard to patients with non-cirrhotic NAFLD who remain under-represented in current surveillance protocols. Future research should focus on integrating emerging technologies and biomarkers to improve early detection and overall patient outcomes.

[18F]FDG PET/CT performs better than CT in determining the bone biopsy site : randomized controlled clinical trial

BACKGROUND

Bone biopsy is the gold standard for diagnosing bone metastases. However, there is no clinical consensus regarding the optimal imaging test for determining the puncture site.

METHODS

We compared the performance of [18F]FDG PET/CT with CT in detecting bone metastases to achieve the highest biopsy efficiency. This registered prospective study enrolled 273 patients with bone lesions who were treated between January 2020 and March 2021. Patients were randomly assigned to undergo [18F]FDG PET/CT or CT to determine the puncture site before bone biopsy. The accuracy, sensitivity, specificity, second biopsy rate, diagnostic time and cost-effectiveness of the two imaging tests were compared.

RESULTS

The accuracy and sensitivity of [18F]FDG PET/CT group in detecting bone metastases were significantly higher than CT group(97.08% vs. 90.44%, 98.76% vs. 92.22%, P < 0.05). The second biopsy rate was significantly lower in the [18F]FDG PET/CT group (2.19% vs. 5.15%; P < 0.05). The diagnostic time of [18F]FDG PET/CT was 18.33 ± 2.08 days, which was significantly shorter than 21.28 ± 1.25 days in CT group ( P < 0.05). The cost of [18F] FDG PETCT is 11428.35 yuan, and the cost of CT is 13287.52 yuan; the incremental cost is 1859.17 yuan. SUVmax > 6.3 combined with ALP > 103 U/L showed a tendency for tumor metastases with an AUC of 0.901 (95%CI 0.839 to 0.946, P < 0.001).

CONCLUSION

[18F]FDG PET/CT has better performance and cost-effectiveness than CT in determining the bone biopsy site for suspect bone metastases.

TRIAL REGISTRATION

The prospective study was registered on 2018-04-10, and the registration number is ChiCTR1800015540.

White matter differences between younger and older adults revealed by fixel-based analysis

The process of healthy aging involves complex alterations in neural structures, with white matter (WM) changes significantly impacting cognitive and motor functions. Conventional methods such as diffusion tensor imaging provide valuable insights, but their limitations in capturing complex WM geometry advocate for more advanced approaches. In this study involving 120 healthy volunteers, we investigated whole-brain WM differences between young and old individuals using a novel technique called fixel-based analysis (FBA). This approach revealed that older adults exhibited reduced FBA-derived metrics in several WM tracts, with frontal areas particularly affected. Surprisingly, age-related differences in FBA-derived measures showed no significant correlation with risk factors such as alcohol consumption, exercise frequency, or pulse pressure but predicted cognitive performance. These findings emphasize FBA's potential in characterizing complex WM changes and the link between cognitive abilities and WM alterations in healthy aging. Overall, this study advances our understanding of age-related neurodegeneration, highlighting the importance of comprehensive assessments that integrate advanced neuroimaging techniques, cognitive evaluation, and demographic factors to gain insights into healthy aging.

The use of PK Papyrus covered coronary stent for carotid reconstruction: an initial institutional experience

BACKGROUND

The use of covered stent grafts for the treatment of carotid rupture is increasingly being used given their ability to preserve the parent artery while simultaneously occluding the fistula or rupture point.

METHODS

This case series describes the technical feasibility of using, and the performance of, the PK Papyrus covered coronary stent (Biotronik, Inc., Lake Oswego, Oregon, USA) in six patients with carotid rupture, including carotid cavernous fistulas, between July 2021 and October 2023 in a single-center institution in the USA.

RESULTS

The median decade of life was 5 (IQR 3) with a 1:1 male-to-female ratio. The majority were black patients (n=5/6, 83.3%). The most common disease pathology was carotid cavernous fistula (n=4/6, 66.7%), followed by traumatic carotid rupture (n=2/6, 33.3%). All the stent embolization procedures were successfully treated with the PK Papyrus covered coronary stent. None of the patients had any recurrence or re-treatment. The number of stents required ranged from 1 to 3. A balloon guide catheter was used in 66.7% of cases (n=4/6). In-hospital mortality was 0.0% (n=0/6). No in-stent thrombosis was observed, but there was one case of cangrelor-associated hemorrhagic stroke conversion. Transfemoral access was used in all cases with one access site complication. Median follow-up time was 1.8 months (IQR 3.5).

CONCLUSIONS

To our knowledge, this is the largest case series in the USA demonstrating the feasibility and safety of using the PK Papyrus covered coronary stent for the treatment of carotid rupture, including carotid cavernous fistulas.

A new clinical classification of congenital biliary dilatation - HUAXI CBD classification

BACKGROUND

Current biliary dilatation (BD) classifications are complex and based on cases including secondary BD, leading to unclear distinctions. Notably, congenital and secondary BD differ in etiology, symptoms, and prognosis.

OBJECTIVE

To propose a more concise and more suitable classification of congenital biliary dilatation (CBD), and exploring the feasibility and effectiveness of this classification in diagnosis and treatment.

METHODS

Based on the preoperative imaging data of patients with CBD admitted to the Department of Pediatric Surgery of West China Hospital of Sichuan University, from January 2015 to December 2018, a new classification of CBD was accomplished according to the site of bile duct dilatation lesions, which was named HUAXI CBD classification. The CBD was classified into 4 types: type I (distal extra-hepatic bile duct dilatation), type II (distal extra-hepatic combined with right and left primary hepatic bile duct dilatation), type III (extra-hepatic combined with secondary and above hepatic bile duct dilatation), and type IV (intra-hepatic bile duct dilatation). Meanwhile, the feasibility and reliability of the HUAXI CBD classification were analyzed by analyzing the clinical treatment strategies, perioperative complications and long-term follow-up results of different subtypes.

RESULTS

A total of 300 patients with CBD were included in this study. According to the HUAXI CBD classification method, 240 cases were type I, 48 cases were type II, 10 cases were type III, and 2 cases were type IV. After treatment, patients with type I had a normal hepatobiliary function after surgery and a good prognosis; patients with type II had good recovery of liver function in 37 cases (77.1%), but 11 cases (22.9%) had postoperative complications during follow-up; patients with type III and IV had high incidence of cholangitis (6/10, 2/2, respectively) and choledocholithiasis (5/10, 2/2, respectively) after surgery, especially those with diffuse intrahepatic dilatation having a poor prognosis, eventually developing cirrhosis and necessitating liver transplantation.

CONCLUSIONS

The HUAXI CBD classification is consistent with treatment principles, concise and easy to remember, and more suitable for CBD clinical application.

Incidence, epidemiology, radiology, and classification of metastatic spine tumors: WFNS Spine Committee recommendations

Spinal metastasis (SMs) are the most encountered tumors of the spine. Their occurrence is expected roughly around one to two years after primary tumor diagnosis. Since the advent of Magnetic Resonance Imaging (MRI), this technology has been considered the gold standard for SMs diagnosis and characterization due to its precise ability to comprehend the rate of soft tissue compression/invasion (dural sac/nervous tissue), which is one of the main drivers of management strategies. Computed Tomography (CT) remains unbeatable when a detailed bony anatomy and instability assessment is searched. Nuclear medicine technologies may have a role in diagnosis when standard MR or CT study findings are inconclusive or when the extent of the systemic metastatic disease is studied. The main objective of this study is to offer an update on the epidemiology and radiology of spinal metastasis (SMs), endorsed by the WFNS Spine Committee. A systematic review of the literature of the last ten years gave 1531 results with "spine/spinal metastatic tumors/metastasis AND radiology OR imaging OR classification" as search strings in all fields, of which 56 papers were fully analyzed. The results were discussed and voted on in two consensus meetings of the WFNS (World Federation of Neurosurgical Societies) Spine Committee, reaching a positive or negative consensus using the Delphi method. The committee stated nine recommendations on two main topics: (1) Incidence and epidemiology of SMs; (2) Radiology and classifications of SMs.

Neurobiological Changes Induced by Mindfulness and Meditation: A Systematic Review

Background and Objectives: Meditation and mindfulness, rooted in ancient traditions, enhance mental well-being by cultivating awareness and emotional control. It has been shown to induce neuroplasticity, increase cortical thickness, reduce amygdala reactivity, and improve brain connectivity and neurotransmitter levels, leading to improved emotional regulation, cognitive function, and stress resilience. This systematic review will synthesize research on neurobiological changes associated with mindfulness and meditation practices. Materials and Methods: Studies were identified from an online search of PubMed, Web of Science, Cochrane Library, and Embase databases without any search time range. This review has been registered on Open OSF (n) GV2JY. Results: Mindfulness-Based Stress Reduction (MBSR) enhances brain regions related to emotional processing and sensory perception, improves psychological outcomes like anxiety and depression, and exhibits unique mechanisms of pain reduction compared to placebo. Conclusions: This review highlights that mindfulness, particularly through MBSR, improves emotional regulation and brain structure, reduces anxiety, and enhances stress resilience. Future research should focus on diverse populations and naturalistic settings to better understand and optimize these benefits.

Orbital inflammatory disease as a presenting feature of suspected Lyme neuroborreliosis: case report

Orbital inflammatory disease (OID) is an inflammatory condition of the orbital and periorbital region. This case reports suspected Lyme neuroborreliosis underlying an initial presentation of OID in a 37-year-old male. Myositis was confirmed by computed tomography (CT) imaging. Cranial neuritis of the third, fifth, and seventh cranial nerves was evidenced by magnetic resonance imaging (MRI). Serology was positive for Borrelia burgdorferi IgM, but did not seroconvert to positive IgG. Thus, the rare diagnosis of orbital myositis as a presenting feature of suspected Lyme neuroborreliosis was established.

Parkinson's disease and posture: evaluation with biometrical holistic of human body device: a pilot study

Background

Patients with Parkinson's disease (PD) commonly develop severe spinal deformity. The etiology of Parkinson's spinal deformity is not completely understood and in most cases is likely due to multiple factors. These include dystonia and focal myopathy. Clinical, neurophysiological, and radiological data must be considered to monitor the pathology and the effects of rehabilitation. The aim of this pilot study is to evaluate spine alignment with a surface topography analysis of Parkinson's patients with Biometrical Holistic of Human Body (BHOHB®) and to compare results with their x-rays spine standard as already done for adolescent scoliosis.

Methods

32 adult patients affected by Parkinson disease, have been evaluated with BHOHB ®. The correspondence of the Cobb angles were evaluated using the BHOHB device and with standard spinal x-rays.

Results

A total of 32 patients were enrolled. The mean age was 67.45 years. In this pilot study the measurement of the correlations between the radiological and BHOHB® Cobb angles of the patients were excellent.

Conclusion

This preliminary result supports the use of BHOHB® as a device useful to monitor and measure posture in Parkinson's. This needs to be evaluated on a larger sample and over time. Keywords: Parkinson's disease, scoliosis, postural imbalance, neurophysiology.

Eye movement characteristics of emotional face recognizing task in patients with mild to moderate depression

Objective

Depression is a complex affective disorder characterized by high prevalence and severe impact, commonly presenting with cognitive impairment. The objective diagnosis of depression lacks precise standards. This study investigates eye movement characteristics during emotional face recognition task (EFRT) in depressive patients to provide empirical support for objective diagnosis.

Methods

We recruited 43 patients with depression (Depressive patients, DP) from a psychiatric hospital and 44 healthy participants (Healthy Control, HC) online. All participants completed an EFRT comprising 120 trials. Each trial presented a gray screen for 800 ms followed by a stimulus image for judgment. Emotions were categorized as positive, neutral, or negative. Eye movement trajectories were recorded throughout the task. Latency of First Fixation (LFF), Latency of First Fixation for Eye AOI, and Latency of First Fixation for Mouth AOI were used as representative indicators of early attention, Proportion of Eye AOI, and Proportion of Mouth AOI as measures of intermediate attention, Accuracy (ACC) and Reaction Time (RT) as behavioral indicators of late-stage attention. In this study, these metrics were employed to explore the differences between patients with depression and healthy individuals.

Results

Compared to healthy participants, individuals with depression exhibit longer first fixation latencies on the eyes and mouth during the early attention stage of emotional face recognition, indicating an avoidance tendency toward key facial recognition cues. In the mid-to-late attention stages, depressive individuals show an increased fixation ratio on the eyes and a decreased fixation ratio on the mouth, along with lower accuracy and longer response times. These findings suggest that, relative to healthy individuals, individuals with depression have deficits in facial recognition.

Conclusion

This study identified distinct attention patterns and cognitive deficits in emotional face recognition among individuals with depression compared to healthy individuals, providing an attention-based approach for exploring potential clinical diagnostic markers for depression.

Case Report: Successful Treatment of Solitary Fibrous Tumor with Selective Internal Radiation Therapy (SIRT)

Background: This case report details the innovative use of selective internal radiation therapy (SIRT) with Yttrium-90 resin microspheres to treat a 73-year-old woman with a solitary fibrous tumor (SFT), a rare and challenging tumor type. SFTs often present significant treatment difficulties, especially in cases of recurrence or metastasis, as systemic therapies typically show limited effectiveness. This report explores SIRT as an alternative therapeutic approach for SFTs with liver metastasis. Methods: The patient initially presented with a pelvic mass, which was surgically resected. However, metastatic disease later developed in the liver. After experiencing severe side effects from targeted therapy with sunitinib, the patient was selected for treatment with SIRT as an alternative. Results: Following the SIRT intervention, the patient demonstrated a substantial reduction in tumor size and significant relief from symptoms. This outcome suggests SIRT's effectiveness as a targeted treatment for metastatic SFT. Conclusions: To our knowledge, and based on an extensive literature review, this is the first reported instance of treating SFT with SIRT. This case provides new insights into SIRT's potential as a therapeutic strategy, particularly for patients for whom conventional treatments are either ineffective or intolerable. The success observed here underscores SIRT's potential as a less invasive, locally targeted treatment option, offering hope for similar cases.

Parkinson's Disease Mild Cognitive Impairment with MRI evidence of Cholinergic Nucleus 4 Degeneration: A New Subtype?

Subtyping Parkinson's disease with mild cognitive impairment (PD-MCI) could improve clinical trial design and personalized treatments. Cholinergic nucleus 4 (Ch4) volume has been linked to cognitive impairment severity and future decline in PD. This study investigates whether PD-MCI patients with MRI evidence of Ch4 degeneration have distinct clinical profiles and cognitive trajectories. Baseline MRI scans of 148 PD-MCI participants from the Parkinson's Progression Markers Initiative (PPMI) were analyzed. Patients with low Ch4 grey matter density (GMD) had worse motor, autonomic, and olfactory symptoms, and were more likely to belong to the diffuse malignant PD subtype (51.6% vs. 23.4%; P < 0.01). They also had faster progression to cognitive milestones (P = 0.0046). These findings identify PD-MCI with low Ch4 as a distinct subtype with more severe symptoms and faster cognitive decline, highlighting the importance of considering this group in PD-MCI clinical trials, particularly for cholinergic therapies.

Radiomics-Based Diagnosis in Dentomaxillofacial Radiology: A Systematic Review

Radiomics is a quantitative tool for digital image analysis. This systematic review aims to investigate the scientific articles to evaluate the potential implications of Radiomics analysis in Dentomaxillofacial Radiology (DMFR). Studies regarding Radiomics applications in DMFR and human samples, in vivo study, a case reports/series if ≧5 samples were included, while case reports/series if < 5 samples, articles other than in English, abstracts without full text, and studies published before 2015 were excluded. Fifty-one articles were selected from 3789 literatures. The QUADAS-2 tool was used for risk of bias assessment. The accuracy of predicting dentomaxillofacial pathologies was considered as the primary outcome, and the modeling type of Radiomics was considered as the secondary outcome. A meta-analysis could not be performed due to the lack of information and standardization among the reported accuracies. The reported accuracies were found between 0.66 and 99.65%. Logistic regression (n = 6) was found to be the most common Radiomics modeling type, followed by Support Vector Machine and Decision Tree (n = 5). Second-order statistics (n = 38) was the most common type of Radiomics application, followed by first-order (n = 26), higher-order (n = 20), and shape-based (n = 15) statistics. Further work is needed to increase standardization in the Radiomics workflow. Quantitative image analysis is an alternative tool for conventional visual radiographic evaluation. Radiomics systems depend on elements such as imaging modality, feature type, data mining, or statistical method. Radiomics applications do not justify digital transformation on their own, but the potential of its integration into the digital workflow is considerable.

Effects of Kinesio tape on individuals with carpal tunnel syndrome: a randomized controlled study

Objective

Carpal tunnel syndrome (CTS) is a common neuromuscular disorder with an incidence rate of 4.9%. Research on the impact of Kinesio taping (KT) on electroneurography in individuals with CTS is limited, highlighting a significant gap in the literature. This study aimed to evaluate the effects of KT on palm numbness, pain intensity, hand grip strength, and median nerve electroneuromyography in individuals with mild to moderate CTS.

Method

This was a randomized, controlled, parallel design study. Twenty-seven participants diagnosed with CTS through hospital outpatient clinics were randomly assigned to either the control or KT group. The outcome measurements included hand grip strength, the Boston Carpal Tunnel Questionnaire (BCTQ), and electroneurography, assessed at baseline and after 6 weeks of intervention. The statistical method used was non-parametric analysis, comparing differences with the median and interquartile range (IQR).

Results

Both the KT and control groups significantly improved the numbness grades, hand grip strength, and the BCTQ. The kinesio-taping group demonstrated an improvement in grip strength with a median increase of 2.21 kg (IQR: 0.65-3.79 kg), compared to the control group, which showed a median increase of only 0.70 kg (IQR: 0.22-1.45 kg). Statistical analysis revealed a significant difference between the two groups (p = 0.039), with an effect size of r = 0.33.

Conclusion

This study suggested that KT can be a supplementary treatment to relieve pain intensity, enhance hand grip strength, and improve sensory conduction velocity, motor latency, and motor amplitude.

Clinical Trial Registration

https://doi.org/10.1186/ISRCTN82192319, ISRCTNregistry (No. ISRCTN82192319).

Characterisation of Paediatric Neuroblastic Tumours by Quantitative Structural and Diffusion-Weighted MRI

Purpose: To determine the diagnostic accuracy of quantitative diffusion-weighted (DW) MRI apparent diffusion coefficient (ADC) and tumour volumes to differentiate between malignant (neuroblastoma (NB)) and benign types of neuroblastic tumours (ganglioneuroma (GN) and ganglioneuroblastoma (GNB)) using different region-of-interest (ROI) sizes. Materials and Methods: This single-centre retrospective study included malignant and benign paediatric neuroblastic tumours that had undergone DW MRI at diagnosis. The outcome was diagnostic accuracy of the tumour volume from structural and ADC DW MRI, in comparison to histopathology (reference standard). Results: Data from 40 patients (NB, n = 24; GNB, n = 6; GN, n = 10), 18 (45%) females and 22 (55%) males, with a median age at diagnosis of 21 months (NB), 64 months (GNB), and 133 months (GN), respectively, ranging from 0 to 193 months, were evaluated. The area under the receiver operating characteristic (AUROC) curve for ADC for discriminating between neuroblastic tumours' histopathology for a small ROI was 0.86 (95% CI: 0.75-0.98), and for a large ROI, 0.83 (95% CI: 0.71-0.96). An ADC cut-off value of 1.06 × 10-3 mm2/s was able to distinguish malignant from benign tumours with 83% (68-98%) sensitivity and 75% (95% CI: 54-98%) specificity. Tumour volume was not indicative of malignant vs. benign tumour diagnosis. Conclusions: In this study, both small and large ROIs used to derive ADC DW MRI metrics demonstrated high accuracy to differentiate malignant from benign neuroblastic tumours, with the ADC AUROC for the averaged multiple small ROIs being slightly greater than that of large ROIs, but with overlapping 95% CIs. This should be taken into consideration for standardisation of ROI-related data analysis by international initiatives.

Diagnostic performance of multishot echo-planar imaging (RESOLVE) and non-echo-planar imaging (HASTE) diffusion-weighted imaging in cholesteatoma with an emphasis on signal intensity ratio measurement

PURPOSE

To evaluate the diagnostic efficacy of multishot echo-planar imaging (EPI) [RESOLVE (RS)] and non-EPI (HASTE) diffusion-weighted imaging (DWI) in detecting cholesteatoma (CHO), and to explore the role of signal intensity (SI) ratio measurements in addressing diagnostic challenges.

METHODS

We analyzed RS-EPI and non-EPI DWI images from 154 patients who had undergone microscopic middle ear surgery, with pathological confirmation of their diagnoses. Two radiologists, referred to as Reader A and Reader B, independently reviewed the images without prior knowledge of the outcomes. Their evaluation focused on lesion location, T1-weighted (T1W) signal characteristics, and contrast enhancement in temporal bone magnetic resonance imaging. Key parameters included lesion hyperintensity, size, SI, SI ratio, and susceptibility artifact scores across both imaging modalities.

RESULTS

Of the patients, 62.3% (96/154) were diagnosed with CHO, whereas 37.7% (58/154) were found to have non-CHO conditions. In RS-EPI DWI, Reader A achieved 89.6% sensitivity, 79.3% specificity, 87.8% positive predictive value (PPV), and 82.1% negative predictive value (NPV). Non-EPI DWI presented similar results with sensitivities of 89.6%, specificities of 86.2%, PPVs of 91.5%, and NPVs of 83.3%. Reader B’s results for RS-EPI DWI were 82.3% sensitivity, 84.5% specificity, 89.8% PPV, and 74.2% NPV, whereas, for non-EPI DWI, they were 86.5% sensitivity, 89.7% specificity, 93.3% PPV, and 80% NPV. The interobserver agreement was excellent (RS-EPI, κ: 0.84; non-EPI, κ: 0.91). The SI ratio measurements were consistently higher in non-EPI DWI (Reader A: 2.51, Reader B: 2.46) for the CHO group compared with RS-EPI. The SI ratio cut-off (>1.98) effectively differentiated hyperintense lesions between CHO and non-CHO groups, demonstrating 82.9% sensitivity and 100% specificity, with an area under the curve of 0.901 (95% confidence interval: 0.815–0.956; P < 0.001). Susceptibility artifact scores averaged 1.18 ± 0.7 (Reader A) and 1.04 ± 0.41 (Reader B) in RS-EPI, with non-EPI DWI recording a mean score of 0.

CONCLUSION

Both RS-EPI and non-EPI DWI exhibited high diagnostic accuracy for CHO. While RS-EPI DWI cannot replace non-EPI DWI, their combined use improves sensitivity. SI ratio measurement in non-EPI DWI was particularly beneficial in complex diagnostic scenarios.

CLINICAL SIGNIFICANCE

This study refines CHO diagnostic protocols by showcasing the diagnostic capabilities of both RS-EPI and non-EPI DWI and highlighting the utility of SI measurements as a diagnostic tool. These findings may reduce false positives and aid in more accurate treatment planning, offering substantial insights for clinicians in managing CHO.

Evaluation of Dose Calculation Algorithms Accuracy for ISOgray Treatment Planning System in Motorized Wedged Treatment Fields

Background

Different dose calculation methods vary in accuracy and speed. While most methods sacrifice precision for efficiency Monte Carlo (MC) simulation offers high accuracy but slower calculation. ISOgray treatment planning system (TPS) uses Clarkson, collapsed cone convolution (CCC), and fast Fourier transform (FFT) algorithms for dose distribution. This study's primary goal is to evaluate the dose calculation accuracy for ISOgray TPS algorithms in the presence of a wedge.

Methods

This study evaluates the dose calculation algorithms using the ISOgray TPS in the context of radiation therapy. The authors compare ISOgray TPS algorithms on an Elekta Compact LINAC through MC simulations. The study compares MC simulations for open and wedge fields with ISOgray algorithms by using gamma index analysis for validation.

Results

The percentage depth dose results for all open and wedge fields showed a more than 98% pass rate for points. However, there were differences in the dose profile gamma index results. Open fields passed the gamma index analysis in the in-plane direction, but not all points passed in the cross-plane direction. Wedge fields passed in the cross-plane direction, but not all in the in-plane direction, except for the Clarkson algorithms.

Conclusion

In all investigated algorithms, error increases in the penumbra areas, outside the field, and at cross-plane of open fields and in-plane direction of wedged fields. By increasing the wedge angle, the discrepancy between the TPS algorithms and MC simulations becomes more pronounced. This discrepancy is attributed to the increased presence of scattered photons and the variation in the delivered dose within the wedge field, consequently impacts the beam quality. While the CCC and FFT algorithms had better accuracy, the Clarkson algorithm, particularly at larger effective wedge angles, exhibited greater effectiveness than the two mentioned algorithms.

High-quality multimodal MRI with simultaneous EEG using conductive ink and polymer-thick film nets

Objective. Combining magnetic resonance imaging (MRI) and electroencephalography (EEG) provides a powerful tool for investigating brain function at varying spatial and temporal scales. Simultaneous acquisition of both modalities can provide unique information that a single modality alone cannot reveal. However, current simultaneous EEG-fMRI studies are limited to a small set of MRI sequences due to the image quality and safety limitations of commercially available MR-conditional EEG nets. We tested whether the Inknet2, a high-resistance polymer thick film based EEG net that uses conductive ink, could enable the acquisition of a variety of MR image modalities with minimal artifacts by reducing the radiofrequency-shielding caused by traditional MR-conditional nets.Approach. We first performed simulations to model the effect of the EEG nets on the magnetic field and image quality. We then performed phantom scans to test image quality with a conventional copper EEG net, with the new Inknet2, and without any EEG net. Finally, we scanned five human subjects at 3 Tesla (3 T) and three human subjects at 7 Tesla (7 T) with and without the Inknet2 to assess structural and functional MRI image quality.Main results. Across these simulations, phantom scans, and human studies, the Inknet2 induced fewer artifacts than the conventional net and produced image quality similar to scans with no net present.Significance. Our results demonstrate that high-quality structural and functional multimodal imaging across a variety of MRI pulse sequences at both 3 T and 7 T is achievable with an EEG net made with conductive ink and polymer thick film technology.

Artificial intelligence applied to coronary artery calcium scans (AI-CAC) significantly improves cardiovascular events prediction

Coronary artery calcium (CAC) scans contain valuable information beyond the Agatston Score which is currently reported for predicting coronary heart disease (CHD) only. We examined whether new artificial intelligence (AI) applied to CAC scans can predict non-CHD events, including heart failure, atrial fibrillation, and stroke. We applied AI-enabled automated cardiac chambers volumetry and calcified plaque characterization to CAC scans (AI-CAC) of 5830 asymptomatic individuals (52.2% women, age 61.7 ± 10.2 years) in the multi-ethnic study of atherosclerosis during 15 years of follow-up, 1773 CVD events accrued. The AUC at 1-, 5-, 10-, and 15-year follow-up for AI-CAC vs. Agatston score was (0.784 vs. 0.701), (0.771 vs. 0.709), (0.789 vs. 0.712) and (0.816 vs. 0.729) (p < 0.0001 for all), respectively. AI-CAC plaque characteristics, including number, location, density, plus number of vessels, significantly improved CHD prediction in the CAC 1-100 cohort vs. Agatston Score. AI-CAC significantly improved the Agatston score for predicting all CVD events.

Harnessing Artificial Intelligence for the Detection and Management of Colorectal Cancer Treatment

Currently, eight million people in the United States suffer from cancer and it is a major global health concern. Early detection and interventions are urgently needed for all cancers, including colorectal cancer. Colorectal cancer is the third most common type of cancer worldwide. Based on the diagnostic efforts to general awareness and lifestyle choices, it is understandable why colorectal cancer is so prevalent today. There is a notable lack of awareness concerning the impact of this cancer and its connection to lifestyle elements, as well as people sometimes mistaking symptoms for a different gastrointestinal condition. Artificial intelligence (AI) may assist in the early detection of all cancers, including colorectal cancer. The usage of AI has exponentially grown in healthcare through extensive research, and since clinical implementation, it has succeeded in improving patient lifestyles, modernizing diagnostic processes, and innovating current treatment strategies. Numerous challenges arise for patients with colorectal cancer and oncologists alike during treatment. For initial screening phases, conventional methods often result in misdiagnosis. Moreover, after detection, determining the course of which colorectal cancer can sometimes contribute to treatment delays. This article touches on recent advancements in AI and its clinical application while shedding light on why this disease is so common today.

Hospital costs of COVID-19, post-COVID-19 condition and other viral pneumonias: a cost comparison analysis

OBJECTIVES

To compare hospital admission costs for coronavirus disease 2019 (COVID-19) cases to hospital admission costs for other viral pneumonia cases in Australia, and to describe hospital admission costs for post-COVID-19 condition.

DESIGN, SETTING, PARTICIPANTS

A cost comparison analysis of hospital admissions due to COVID-19 or other viral pneumonias between 1 January 2020 and 30 June 2021 at Victorian public health acute and subacute services.

MAIN OUTCOME MEASURES

Demographic characteristics, clinical outcomes (including diagnoses, impairment, subacute admission, intensive care unit admissions, ventilation, and length of stay) and cost data (including diagnostic-related groups, and total, direct and indirect costs).

RESULTS

During the study period, 3197 patients were admitted to hospital due to COVID-19 and 15 761 were admitted for other viral pneumonias. Admissions for COVID-19 cost 29% more than admissions for other viral pneumonias. Admissions for COVID-19 requiring intensive care unit admission incurred significantly higher mean costs (A$120 504 or US$90 595) compared with those not requiring intensive care unit admission (A$19 634 or US$14 761). The adjusted cost of admissions related to post-COVID-19 condition was A$11 090 or US$8 337, and these admissions were significantly more likely to be elective. Direct costs accounted for most of the costs for all groups, and admissions for post-COVID-19 condition used less allied health services than other groups.

CONCLUSIONS

Given its recent emergence, cases of acute COVID-19 and post-COVID-19 condition have had a significant additional financial impact on Australian hospitals. Further studies are required to understand long term costs and identify trends over time in the context of increased vaccination rates and subsequent variants of severe acute respiratory syndrome coronavirus 2.

Delayed Pontomesencephalic and Cervical Cord Venous Drainage Followed by Contralateral Carotid-Cavernous Fistula after Craniofacial Fractures: A Case Report

A 24-year-old male was admitted with progressive cervical hypesthesia, tetraparesis, dyspnea, and a history of craniofacial fracture. Spinal magnetic resonance imaging (MRI) showed brainstem edema extending to the thoracic spine with multiple prominent perimedullary vascular structures. Cerebral digital-substraction angiography revealed Barrow type A carotid-cavernous fistula. Total occlusion with preservation of internal carotid artery flow was achieved using 1 detachable balloon and 6 coils. Postoperatively, immediate respiratory recovery, gradual extremities strength improvement, and right abducens nerve palsy were found. One month follow-up cervical MRI showed good recovery of spinal cord edema and perimedullary veins.

Classification of Multi-Parametric Body MRI Series Using Deep Learning

Multi-parametric magnetic resonance imaging (mpMRI) exams have various series types acquired with different imaging protocols. The DICOM headers of these series often have incorrect information due to the sheer diversity of protocols and occasional technologist errors. To address this, we present a deep learning-based classification model to classify 8 different body mpMRI series types so that radiologists read the exams efficiently. Using mpMRI data from various institutions, multiple deep learning-based classifiers of ResNet, EfficientNet, and DenseNet are trained to classify 8 different MRI series, and their performance is compared. Then, the best-performing classifier is identified, and its classification capability under the setting of different training data quantities is studied. Also, the model is evaluated on the out-of-training-distribution datasets. Moreover, the model is trained using mpMRI exams obtained from different scanners in two training strategies, and its performance is tested. Experimental results show that the DenseNet-121 model achieves the highest F1-score and accuracy of 0.966 and 0.972 over the other classification models with p-value 0.05. The model shows greater than 0.95 accuracy when trained with over 729 studies of the training data, whose performance improves as the training data quantities grow larger. On the external data with the DLDS and CPTAC-UCEC datasets, the model yields 0.872 and 0.810 accuracy for each. These results indicate that in both the internal and external datasets, the DenseNet-121 model attains high accuracy for the task of classifying 8 body MRI series types.

Noninvasive Tests in Assessment of Patients with Alcohol-Associated Liver Disease

Alcohol-associated liver disease (ALD) remains a significant public health concern, accounting for at least half of cirrhosis cases in Europe. Historically, liver biopsy has been considered the gold standard method for both diagnosing and staging ALD. However, in the past 3 decades, there has been a growing interest in developing noninvasive biomarkers for identifying high-risk patients prone to develop liver-related complications, including elastography methods or blood-based biomarkers. This review aims to summarize currently available noninvasive testing methods that are clinically available for assessing patients with ALD, including notably steatosis and fibrosis.

Endoscopic ultrasound-guided tissue acquisition for focal liver lesions can be safely performed in patients with ascites

Background and study aims In patients with ascites, percutaneous liver biopsy is generally contraindicated. Because endoscopic ultrasound-guided tissue acquisition (EUS-TA) allows tissue sample obtention from the digestive tract lumen, a biopsy without the intervention of ascites may prevent adverse events (AEs). This study aimed to evaluate the safety of EUS-TA for focal liver lesions in the presence of ascites. Patients and methods A retrospective study was conducted using medical records of cases in which EUS-TA was performed on focal liver lesions between 2016 and 2022. Study participants were classified into two groups: those with ascites and those without it, and the outcomes were compared. The primary outcome was AEs. Results We included 109 cases of EUS-TA for focal liver lesions. Ascites was present in 20.1% of cases (22/109) and absent in 79.8% of cases (87/109). There were no significant differences between the two groups in clinical backgrounds and EUS-TA procedure, although fine-needle biopsy needles were significantly more frequently used in patients without ascites. In the ascites group, puncture without intervening ascites was successful in 90.9% of cases (20/22). The incidence of AEs was 4.5% (1/22) in the ascites group and 1.1% (1/87) in the non-ascites group, showing no significant difference. The two AEs were mild self-limiting abdominal pain. Conclusions In focal liver lesions with ascites, EUS-TA allows biopsy without the intervention of ascites in most cases. The incidence of AEs did not differ significantly between patients with and without ascites.

Correlation between common iliac vein geometry and the risk of deep vein thrombosis in patients with May-Thurner syndrome

BACKGROUND

May-Thurner syndrome (MTS) is a continuous pathological change of the left common iliac vein intraluminal wall due to compression between the right common iliac artery and a lumbar vertebra, with clinical signs of compromised venous drainage of the left leg, which eventually leads to development of left-sided deep vein thrombosis (DVT).

PURPOSE

To analyze the correlation between iliac vessel geometry and probability of DVT in patients with MTS.

MATERIAL AND METHODS

This study consists of two age-matched female groups: DVT (n = 21) and control (n = 28). Iliac vein geometry, including left common iliac vein (LCIV) diameter, percentage of stenosis, angle between LCIV and right common iliac vein (RCIV), tilt angle of each CIV with horizontal line, and crossing angle between right common iliac artery (RCIA) and LCIV, were measured on computed tomography venography (CTV) images. The probability of DVT development was assessed using logistic regression.

RESULTS

Comparing the DVT and control groups, the mean LCIV diameter was 2.4 mm and 3.7 mm (P = 0.001), and mean LCIV stenosis was 77.7% and 68.3% (P = 0.001), respectively. After age-adjustment, the odds of left DVT in patients with MTS correlated with LCIV diameter (odds ratio [OR]=0.25, P < 0.001, 95% confidence interval [CI]=0.11-0.54), LCIV stenosis (%) (OR=1.12, P = 0.003, 95% CI=1.04-1.21), LCIV tilt angle (OR=0.95, P < 0.038, 95% CI=0.91-0.99), and angle between two CIVs (OR=1.04, P < 0.039, 95% CI=1.00-1.09).

CONCLUSION

LCIV diameter and percentage of stenosis, LCIV tilt angle, and CIV angle were independent risk factors for the development of DVT in patients with MTS.

Implementation of 300-mL Rule for Management of Traumatic Hemothorax

BACKGROUND

Traumatic hemothorax (HTX) is often managed with tube thoracostomy (TT); however, TT carries a high complication rate. In 2017, a guideline was implemented at our Level I trauma center to observe traumatic HTX 300 mL or less in patients who are hemodynamically stable. We hypothesized that this guideline would decrease TT placement without increasing observation failure rates.

STUDY DESIGN

This was a single-center retrospective review of all adult patients admitted with an HTX on CT before (2015 to 2016) and after (2018 to 2019) the guideline implementation. Exclusion criteria were TT placement before CT scan, absence of CT scan, death within 5 days of admission, and a concurrent pneumothorax more than 20 mm. HTX volume was calculated using CT scan images and Mergo's formula: V = d2 × L (where V is the volume, d is the depth, and L is the length). The primary outcome was observation failure, defined as the need for TT, video-assisted thoracoscopic surgery, thoracotomy after repeat imaging or worsening of symptoms, and pulmonary morbidity.

RESULTS

A total of 357 patients met inclusion criteria, of whom 210 were admitted after guideline implementation. No significant differences in baseline demographics, comorbidities, or injury characteristics across both cohorts were observed. The postimplementation cohort had a significant increase in observation rate (75% vs 59%) and a decrease in TT placement (42% vs 57%). The postimplementation group had a statistically significant shorter hospital (6 vs 8 days) and ICU (2 vs 3 days) length of stay. No significant differences in observation failure, pulmonary complications, 30-day readmission, or 30-day mortality were observed across both cohorts.

CONCLUSIONS

The implementation of the 300-mL guideline led to a decrease in TT placement without increasing observation failure or complication rates.

Magnetic Resonance Imaging Assessment of Morphological Changes and Molecular Behavior to Evaluate Treatment Response of Brain Metastatic Lesions After Stereotactic Radiosurgery

BACKGROUND

Brain metastases (BMs) are the most common type of intracranial tumors, frequently arising from primary cancers such as lung, breast, melanoma, and renal cell carcinoma. Magnetic resonance imaging (MRI) plays a crucial role in assessing both the morphological and molecular characteristics of BMs, particularly in evaluating treatment response following radiosurgery. However, the interpretation of these imaging changes remains complex, often influencing clinical decision-making.

OBJECTIVE

This study aims to evaluate the morphological changes and molecular behavior of BMs postradiosurgery using MRI to assess treatment response.

MATERIALS AND METHODS

A retrospective review was conducted at a high specialty medical center, including 41 patients with BMs treated with stereotactic radiosurgery (SRS) from 2018 to 2022. Patients had a baseline MRI (pre-SRS) prior to treatment and follow-ups at 2-3 months (MRI-2) and 5-6 months (MRI-3). The response assessment in neuro-oncology brain metastases (RANO-BM) criteria were used, and T1/T2 matching was analyzed for each follow-up. Logistic regression was performed relating the T1/T2 matching and susceptibility areas (susceptibility-weighted imaging (SWI)) for MRI-2 and MRI-3. Cross tables were created regarding treatment response and demographic characteristics according to Pearson's Chi-squared test.

RESULTS

The mean age was 56.7 years; 53.7% (n = 22) were female. Primary tumors included lung (29.3%, n = 12), breast (19.5%, n = 8), colon (12.2%, n = 5), and melanoma and kidney tumors (7.3%, n = 3). Post-SRS changes included transitions from solid to cystic lesions, reduced perilesional edema, size reduction, and increased areas of magnetic susceptibility. A mixed pattern (areas of T1/T2 match + mismatch) was noted at lesion margins during follow-ups (MRI-2: 70.7% (n = 29), MRI-3: 68.3% (n = 28)). Most patients exhibited a partial response at MRI-2 (43.9%, n = 18), while at MRI-3, disease progression occurred (43.9%, n = 18) due to an increase in lesion number. Logistic regression linking T1/T2 matching and SWI demonstrated a significantly central-peripheral SWI distribution for T1/T2 match during both follow-ups (MRI-2: p = 0.005, R2: 0.52; MRI-3: p = 0.002, R2: 0.56). SWI distribution was higher when a mixed T1/T2 matching was present. Significant associations were found with systemic treatment and response type at MRI-2 (p =0.001), predominantly showing a partial response for those receiving chemotherapy + targeted therapy.

CONCLUSIONS

SWI and T1/T2 mismatch are valuable tools reflecting changes in the tumor microenvironment postradiosurgery, aiding in treatment response monitoring. The appearance of susceptibility areas may precede changes in the enhancement of the lesion margin. Short-term follow-ups (2-3 months) are crucial due to prevalent progression, marked primarily by the appearance of new lesions in approximately 50% of patients.

Groove pancreatitis: From enigma to future directions-A comprehensive review

Groove pancreatitis (GP) is a rare and clinically distinct form of chronic pancreatitis affecting the pancreaticoduodenal groove comprising the head of the pancreas, duodenum, and the common bile duct. It is more prevalent in individuals in their 4-5th decade of life and disproportionately affects men compared with women. Excessive alcohol consumption, tobacco smoking, pancreatic ductal stones, pancreatic divisum, annular pancreas, ectopic pancreas, duodenal wall thickening, and peptic ulcers are significant risk factors implicated in the development of GP. The usual presenting symptoms include severe abdominal pain, nausea, vomiting, diarrhea, weight loss, and jaundice. Establishing a diagnosis of GP is often challenging due to significant clinical and radiological overlap with numerous benign and malignant conditions affecting the same anatomical location. This can lead to a delay in initiation of treatment leading to increasing morbidity, mortality, and complication rates. Promising research in artificial intelligence (AI) has garnered immense interest in recent years. Due to its widespread application in diagnostic imaging with a high degree of sensitivity and specificity, AI has the potential of becoming a vital tool in differentiating GP from pancreatic malignancies, thereby preventing a missed or delayed diagnosis. In this article, we provide a comprehensive review of GP, covering the etiology, pathogenesis, clinical presentation, radiological and endoscopic evaluation, management strategies, and future directions. This article also aims to increase awareness about this lesser known and often-misdiagnosed clinical entity amongst clinicians to ultimately improve patient outcomes.

3D Genial Tubercle Anatomic Considerations in Genioglossus Advancement Surgery

OBJECTIVE

To qualitatively describe variation in morphology of the genial tubercle and quantify the spatial relationship between the tubercle and genioglossus muscle.

STUDY DESIGN

Case series.

SETTING

Cadaver dissection.

METHODS

Segmental sections of the mandible, with muscular attachments intact, were harvested from 18 fresh cadaver heads. Three-dimensional laser scans, with a resolution of 0.025 mm, were taken of each specimen with muscle attached and repeated after muscle removal. The genioglossus muscular attachment was measured relation to bony landmarks.

RESULTS

The morphology of the genial tubercle varied, with anywhere from 1 large spine to 4 individual spines. However, all specimens had a distinguishable superior portion of the tubercle, where the genioglossus attached, and an inferior portion, where the geniohyoid attached. The height of the superior tubercle (ST) was 6.1 mm (95% confidence inerval [CI]: 5.7-6.5). The height of the genioglossus muscle above the peak amplitude of the ST was 4.3 mm (3.8-4.9), but only 2.5 mm (2.0-3.0) below. On average, 64.4% (58.6-70.2) of the height of the genioglossus muscle attachment was above the peak. Overall, 19.5% (14.1-25.0) of the muscle surface area extended beyond the boundaries of the tubercle.

CONCLUSION

The genioglossus muscle attachment originates from the superior genial tubercle, which has a variable topography and amplitude. However, the muscle is not centered on the spines-more of the muscular fibers attach above the spine as compared to below. This new data may explain the genioglossus advancement "miss rate"-failure to advance muscle on initial osteotomy-of 39-78% reported in the literature.

Study protocol for the iMarkHD study in individuals with Huntington's disease

Background: Huntington's disease (HD) is still often defined by the onset of motor symptoms, inversely associated with the size of the CAG repeat expansion in the huntingtin gene. Although the cause of HD is known, much remains unknown about mechanisms underlying clinical symptom development, disease progression, and specific clinical subtypes/endophenotypes. Objective: In the iMarkHD study, we aim to investigate four discrete molecular positron emission tomography (PET) tracers and magnetic resonance imaging (MRI) markers as biomarkers for disease and symptom progression. Methods: Following MRI optimization in five healthy volunteers (cohort 1), we aim to recruit 108 participants of whom 72 are people with HD (PwHD) and 36 healthy volunteers (cohort 2). Pending interim analysis, these numbers could increase to 96 PwHD and 48 healthy controls. Participants will complete a total of 10 study visits, consisting of a screening visit followed by a clinical and MRI visit and PET visits at baseline, year 1, and year 2. PET targets include the cannabinoid 1, histamine 3, and serotonin 2A receptors, and phosphodiesterase 10A, whereas MRI will be multimodal, including, but not limited to, the assessment of cerebral blood flow, functional connectivity, and brain iron. Results: Recruitment is currently active and started in September 2022. Conclusions: By combining PET and multi-modal MRI assessments we expect to provide a comprehensive examination of the molecular, functional, and structural framework of HD progression. As such, the iMarkHD study will provide a solid base for the identification of treatment targets and novel outcome measures for future clinical trials.

Correlation of thyroid function and sensitivity to thyroid hormone with spinal bone mineral content, bone mineral density, and osteoporotic vertebral fracture: A cross-sectional study based on NHANES

Previous studies have demonstrated that thyroid hormone plays an important role in normal bone development, bone metabolism, and establishment of peak bone mass. However, the correlation of thyroid status with bone mineral content (BMC), bone mineral density (BMD), and osteoporotic vertebral fracture (OVF) is rarely discussed. The current study probes into the potential association between thyroid status and spinal BMC, BMD, and OVF from a novel perspective of thyroid function (TF) and sensitivity to thyroid hormone based on the National Health and Nutrition Examination Survey database. A total of 1844 participants were included in this study. The association of thyroid status with outcome variables, like spinal BMC, BMD, and OVF, was analyzed using thyroid function indices and sensitivity to thyroid hormone indices as influence factors. The correlation of them were assessed using univariate and multivariable weighted linear regression, weighted logistic regression models, restricted cubic spline model, and subgroup analyses. The results of this study showed that the association of free triiodothyronine (FT3)/free thyroxine (FT4) with BMC remained negatively associated after adjustment for all covariates. Higher thyroid peroxidase antibody (TPOAb) was significantly associated with an increased risk of developing OVF in both unadjusted and adjusted models. In addition, the results of the restricted cubic spline model were consistent with the weighted multivariate regression analysis after adjustment. The results of this cross-sectional study showed that higher FT3/FT4 and TPOAb were associated with decreased spinal BMC and the increased risk of OVF, indicating a complex link between thyroid status and bone health. Therefore, patients with hyperthyroidism, hypothyroidism, autoimmune thyroid disease, or abnormal peripheral thyroid sensitivity, especially who with elevated TPOAb or FT3/FT4, should focus on the prevention of vertebral osteopenia, osteoporosis, and OVF.

Functional connectivity of the amygdala in relation to high stress and low mindfulness

BACKGROUND

High psychological stress has been associated with several brain functional changes, including functional connectivity (FC) alterations in regions such as the prefrontal cortex and the amygdala. This study explored FC alterations associated with high perceived stress, and also investigated whether these neuroimaging features were correlated with low levels of mindfulness.

METHODS

This study included 29 adults (12 males and 17 females; mean age: 27.6 ± 3.2) who complained of moderate or higher perceived stress and 31 adults (17 males and 14 females; mean age: 29.2 ± 7.2) who complained of low-level stress on the questionnaire scale. Seed-based resting-state FC analysis was conducted to compare between high and low stress groups. The dorsolateral prefrontal cortex (DLPFC), the ventromedial prefrontal cortex (VMPFC) and the amygdala were selected as seeds.

RESULTS

High stress group showed weaker left amygdala-based FC in the left cerebellum crus II and the left orbitofrontal cortex compared with low stress group. High stress group had weaker FC between the left DLPFC and the left inferior parietal lobule. On the contrary, high stress group had stronger FC between the left VMPFC and the left caudate compared with low stress group. Weaker FC between the amygdala and the cerebellum crus II was correlated with lower level of awareness facet of mindfulness.

CONCLUSIONS

Those with high perceived stress showed low levels of mindfulness and several FC alterations centered on the prefrontal cortex and amygdala. Our findings also suggest that weak amygdala-based FC alterations associated with high psychological stress are related to low-level awareness facet of mindfulness.

Adjunctive rescue therapy in acute large vessel occlusion secondary to underlying intracranial atherosclerotic disease

BACKGROUND

The optimal treatment for patients with acute large vessel occlusion (LVO) secondary to intracranial atherosclerotic disease (ICAD) is unclear. Adjunctive rescue therapy with balloon angioplasty or stenting may be necessary to ensure vessel patency. We aimed to compare the safety and clinical outcomes of adjunctive rescue therapy vs lone thrombectomy for ICAD-related-LVO.

METHODS

A retrospective propensity score matching analysis was performed in acute stroke patients who had endovascular thrombectomy between 2008 and 2021. We included patients with acute ICAD-related-LVO. The location of ICAD and exposure to thrombolysis were used to generate propensity score matching to estimate the likelihood of treatment by adjunctive rescue therapy. The primary clinical outcome (90-day modified rankin scale 0-2) and safety outcomes (symptomatic intracerebral hemorrhage) were assessed between the two groups.

RESULTS

One-hundred and forty-four patients were included. The median (IQR) age was 68(59-76) and 52(36 %) were females. The baseline NIHSS was 12.5(8-19). Sixty-seven (47 %) patients had ICAD in M1 or M2 segments. Forty-six patients (67 %) had lone thrombectomy and twenty-one (28 %) had adjunctive rescue therapy. Propensity score matching did not demonstrate significant differences in 90-day modified Rankin Score 0-2 between lone thrombectomy (38.8 %) and adjunctive rescue therapy (39.3 %) (p = 0.3). Lone thrombectomy, compared to adjunctive rescue therapy, did not result in significantly more symptomatic intracerebral hemorrhages (2.8 % vs 8.3 %, p = 0.6), nor progressive occlusion (17 % vs 19 %, p = 0.8).

CONCLUSION

We did not find significant differences in clinical outcomes and safety between lone thrombectomy and adjunctive rescue therapy. Randomized controlled studies are required to resolve the equipoise in treatment of ICAD-related-LVO.

Diagnostic performance of 18F‑FDG PET/CT vs. 18F‑NaF PET/CT in breast cancer with bone metastases: An indirect comparative meta‑analysis

Breast cancer remains the leading cause of cancer-related death in women, with 5-year survival rates of as high as 90% for patients with early-stage breast cancer without metastasis, falling to 10% once bone metastases (BM) occur. Currently, there is no cure for breast cancer with BM. However, appropriate treatment can extend survival and improve patients' quality of life. Therefore, it is important to accurately evaluate the presence of BM in patients with breast cancer. The present meta-analysis evaluated the diagnostic performance of 18F-FDG and 18F-NaF as PET/CT tracers for breast cancer-associated BM. The present study aimed to compare the diagnostic performance of fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomographs (PET/CT) and 18F-sodium fluoride (18F-NaF) PET/CT in patients with breast cancer and BM. The PubMed and Embase databases were searched for English literature on the diagnostic performance of 18F-FDG PET/CT and 18F-NaF PET/CT for breast cancer BM, and two authors independently extracted data. All included studies presented data that could be used to construct a 2×2 contingency table. The methodological quality of the selected studies was assessed using QUADAS-2, and forest plots were generated based on the sensitivity and specificity of 18F-FDG PET/CT and 18F-NaF PET/CT in the diagnosis of BM associated with breast cancer. A total of 14 articles were identified, including eight on the analysis of 18F-FDG PET/CT, five on 18F-NaF PET/CT and one on both. The studies on 18F-FDG PET/CT and 18F-NaF PET/CT included 530 and 270 patients, respectively. The pooled sensitivities were 0.88 [95% confidence interval (95% CI), 0.76-0.94] for 18F-FDG PET/CT and 0.98 (95% CI, 0.92-1.00) for 18F-NaF PET/CT, and the pooled specificities were 0.99 (95% CI, 0.97-1.00) and 0.91 (95% CI: 0.76-0.97), respectively. The area under the summary receiver operating characteristic curve for both 18F-FDG PET/CT and 18F-NaF PET/CT was 0.99 (95% CI, 0.98-1.00). Lesion-based analysis using 18F-FDG PET/CT was performed for 909 lesions, with a sensitivity of 0.84 (95% CI, 0.67-1.00) and specificity of 1.00 (95% CI, 0.98-1.00). Compared with 18F-FDG PET/CT, 18F-NaF PET/CT showed higher sensitivity (98 vs. 88%) but lower specificity (91 vs. 99%), although the difference between methods was not statistically significant. In conclusion, the results of the present study indicated that 18F-NaF PET/CT and 18F-FDG PET/CT are both accurate methods for the detection of BM in patients with breast cancer, and have comparable diagnostic accuracy.