Multi-model quantitative MRI of uterine cancers in precision medicine's era-a narrative review

PURPOSE

This review aims to summarize the current applications of quantitative MRI biomarkers in the staging, treatment response evaluation, and prognostication of endometrial (EC) and cervical cancer (CC). By focusing on functional imaging techniques, we explore how these biomarkers enhance personalized cancer management beyond traditional morphological assessments.

METHODS

A structured search of the PubMed database from January to May 2024 was conducted to identify relevant studies on quantitative MRI in uterine cancers. We included studies examining MRI biomarkers like Dynamic Contrast-Enhanced MRI (DCE-MRI), Diffusion-Weighted Imaging (DWI), and Magnetic Resonance Spectroscopy (MRS), emphasizing their roles in assessing tumor physiology, microstructure, and metabolic changes.

RESULTS

DCE-MRI provides valuable quantitative biomarkers such as Ktrans and Ve, which reflect microvascular characteristics and tumor aggressiveness, outperforming T2-weighted imaging in detecting critical factors like myometrial and cervical invasion. DWI, including advanced models like Intravoxel Incoherent Motion (IVIM), distinguishes between normal and cancerous tissue and correlates with tumor grade and treatment response. MRS identifies metabolic alterations, such as elevated choline and lipid signals, which serve as prognostic markers in uterine cancers.

CONCLUSION

Quantitative MRI offers a noninvasive method to assess key biomarkers that inform prognosis and guide treatment decisions in uterine cancers. By providing insights into tumor biology, these imaging techniques represent a significant step forward in the precision medicine era, allowing for a more tailored therapeutic approach based on the unique pathological and molecular characteristics of each tumor.

CRITICAL RELEVANCE STATEMENT

Biomarkers obtained from MRI can provide useful quantitative information about the nature of uterine cancers and their prognosis, both at diagnosis and response assessment, allowing better therapeutic strategies to be prepared.

KEY POINTS

Quantitative MRI improves diagnosis and management of uterine cancers through advanced imaging biomarkers. Quantitative MRI biomarkers enhance staging, prognosis, and treatment response assessment in uterine cancers. Quantitative MRI biomarkers support personalized treatment strategies and improve patient management in uterine cancers.

Solitary fibrous tumors from A to Z: a pictorial review with radiologic-pathologic correlation

Solitary fibrous tumors (SFTs) represent a rare subset of mesenchymal neoplasms, affecting 1-2 per million people, with no gender preference. They demonstrate indolent behavior, frequent asymptomatic presentation, and widespread anatomical involvement. At imaging, SFTs typically appear as well-defined, predominantly hypervascular masses with varying degrees of cystic change and necrosis, though calcification is rare. Avid heterogeneous enhancement is typical following intravenous contrast administration, with multiple blood vessels observed at the periphery. Although findings on CT and MRI alone are generally nonspecific, a frequent feature of SFTs at MRI is the presence of rounded or linear low signal intensity foci on T1- and T2-weighted images, corresponding to the fibrous and collagenous content. Nevertheless, because the imaging features of SFTs overlap with those of many benign and malignant tumors, histologic confirmation is required for the final diagnosis. A comprehensive understanding of SFTs' multifaceted clinical, pathological, and radiological presentations across various organs is crucial for accurate diagnosis and effective management. CRITICAL RELEVANCE STATEMENT: A comprehensive understanding of the classic radiological and pathological features of solitary fibrous tumors across various organs is crucial for accurate diagnosis and effective management. KEY POINTS: Solitary fibrous tumors (SFTs) are rare hypervascular fibrous tumors with indolent behavior. Imaging features of SFTs overlap with many other tumors, necessitating histologic confirmation. Understanding SFTs' radiological presentations is crucial for accurate diagnosis and effective management.

Toward diffusion MRI in the diagnosis and treatment of pancreatic cancer

Pancreatic cancer is a highly aggressive malignancy with rising incidence and mortality rates, often diagnosed at advanced stages. Conventional imaging methods, such as computed tomography (CT) and magnetic resonance imaging (MRI), struggle to assess tumor characteristics and vascular involvement, which are crucial for treatment planning. This paper explores the potential of diffusion magnetic resonance imaging (dMRI) in enhancing pancreatic cancer diagnosis and treatment. Diffusion-based techniques, such as diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI), combined with emerging AI‑powered analysis, provide insights into tissue microstructure, allowing for earlier detection and improved evaluation of tumor cellularity. These methods may help assess prognosis and monitor therapy response by tracking diffusion and perfusion metrics. However, challenges remain, such as standardized protocols and robust data analysis pipelines. Ongoing research, including deep learning applications, aims to improve reliability, and dMRI shows promise in providing functional insights and improving patient outcomes. Further clinical validation is necessary to maximize its benefits.

Expanding the role of endoscopic resection in esophageal gastrointestinal stromal tumors: Insights and challenges

While rare, esophageal gastrointestinal stromal tumors (GISTs) have higher malignant potential and are typically diagnosed at larger sizes compared to gastric GISTs. However, well-defined guidelines for their optimal management remain lacking. Most esophageal GISTs are surgically managed with enucleation, while esophagectomy is reserved for larger tumors. Recent advances in endoscopic techniques, such as endoscopic submucosal dissection and submucosal tunneling endoscopic resection (ER), have allowed for endoscopic removal of submucosal esophageal lesions, including GISTs. Xu et al reported on the clinical and oncological outcomes of 32 patients with esophageal GISTs treated with ER. The study demonstrated high en bloc resection rates and favorable 5-year overall survival and disease-free survival. However, it primarily focused on small, incidentally detected GISTs, with 75% of cases classified as very low or low risk according to the National Institutes of Health criteria. The authors favored the submucosal tunneling ER technique despite its procedural challenges in the upper esophagus. In this editorial, we briefly discuss the advantages and limitations of endoscopic techniques compared to surgical approaches. We also emphasize the need to establish specific management criteria for submucosal esophageal lesions to guide clinical practice.

Right-to-left shunt detection in patent foramen ovale: The value of synchronized contrast transcranial Doppler and contrast transthoracic echocardiography

Patent foramen ovale (PFO) is a common congenital heart disorder associated with stroke, decompression sickness and migraine. Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiography has important clinical significance and can improve the accuracy of detecting right-left shunts (RLSs) in patients with PFO. In this letter, regarding an original study presented by Yao et al, we present our insights and discuss how to better help clinicians evaluate changes in PFO-related RLS.

Analysis of the efficacy of splenic artery superselective embolization in cirrhosis with hepatocellular carcinoma

BACKGROUND

To explore the safety and effectiveness of partial splenic embolization (PSE) in patients with hypersplenism and hepatocellular carcinoma (HCC) and to compare the efficacy of superselective and non-superselective embolization of splenic artery branches.

PROCEDURE

We retrospectively analyzed 64 patients with HCC who underwent PSE between August 2020 and December 2022. The patients were categorized into two groups based on different treatment plans: Group A (n=33) underwent superselective embolization and Group B (n=31) underwent non-superselective embolization of the splenic artery branches. The safety and effectiveness of the two methods were evaluated along with changes in peripheral blood cells [mainly white blood cells (WBC) and red blood cells (RBC)] and platelet (PLT) counts at different time points after PSE. Postoperative adverse events were also compared between the two groups.

RESULTS

The technical success rate was 100% for both procedures. The PLT and WBC counts of the two groups significantly increased one week after PSE (P<0.05), and there was no statistically significant difference in the RBC count changes. At follow-up (4, 16, and 24 weeks), the PLT and WBC counts remained consistent at levels which were significantly different from those before PSE (P<0.05). However, the RBC counts were not significantly different (P>0.05). An independent sample t-test was used to compare the differences in blood counts between the two groups at the same time point. There were no statistically significant differences in PLT, WBC, and RBC counts between Group A and Group B at any time point after PSE (P>0.05). The incidence of fever and pain in Group B was significantly higher than that in Group A (P<0.05).

CONCLUSION

Partial splenic artery embolization is a safe and effective treatment option for hypersplenism. Both splenic artery branch superselective and non-superselective embolization strategies demonstrated comparable outcomes. However, superselective embolization exhibited a lower incidence of postprocedural complications than non-superselective embolization.

Harnessing artificial intelligence to address immune response heterogeneity in low-dose radiation therapy

Low-dose radiation therapy has emerged as a promising modality for cancer treatment because of its ability to stimulate antitumor immune responses while minimizing damage to healthy tissues. However, the significant heterogeneity in immune responses among patients complicates its clinical application, hindering outcome prediction and treatment personalization. Artificial intelligence (AI) offers a transformative solution by integrating multidimensional data such as immunomics, radiomics, and clinical features to decode complex immune patterns and predict individual therapeutic outcomes. This editorial explored the potential of AI to address immune response heterogeneity in low-dose radiation therapy and proposed an AI-driven framework for precision immunotherapy. While promising, challenges, including data standardization, model interpretability, and clinical validation, must be overcome to ensure successful integration into oncological practice.

Association of post-operative transperineal ultrasound parameters with de novo stress urinary incontinence following transvaginal mesh surgery

Pelvic organ prolapse (POP) often coexists with stress urinary incontinence (SUI), posing challenges in surgical management. De novo SUI post-surgery remains unpredictable, prompting this study to explore ultrasound's role in assessing de novo SUI after transvaginal mesh (TVM) surgery. A retrospective analysis of 92 women undergoing TVM surgery revealed a 36.9% incidence of de novo SUI. Specific ultrasound parameters, such as proximal urethral rotational angle and levator urethral gap during straining, were found associated with de novo SUI after TVM surgery. Despite certain limitations in this study, ultrasound emerges as a valuable tool for assessing pelvic floor integrity and guiding clinical decisions in urogynecology.

Computed Tomography Angiography Utilization in Lower Extremity Trauma: Insights From a Canadian Level I Trauma Centre

Introduction: Computed tomography angiography (CTA) plays an important role in assessing patients with suspected lower extremity traumatic vascular injury. However, CTA overutilization has been reported in some centres, and improper use has been linked to increased healthcare costs and prolonged Emergency Department wait times. This study evaluated CTA utilization in a Canadian Level I trauma centre, determined the rate of positive CTA studies requiring intervention, and identified factors that may reduce unnecessary examinations. Methods and Materials: This retrospective study included trauma patients who underwent lower extremity CTA between January 2020 and September 2024. Data regarding patient demographics, mechanism of injury, physical exam and computed tomography findings, ankle-brachial index value, and interventions were collected and evaluated. Statistical analysis included descriptive statistics and chi-square or Fisher's exact tests for categorical associations. Results: Six hundred twelve patients (82% male, median age 32 years) were included. Forty-six percent had a normal physical exam, and CTA was positive in 27% of cases. Eight percent of patients required an intervention, all of whom had at least one hard sign of vascular injury. A statistically significant association was identified between hard signs of a vascular injury and positive CTA findings (P < .001) and major vascular injuries (P < .01). No patients with a normal physical exam and a positive CTA required intervention. Conclusion: Nearly half of the CTA studies were performed on patients with a normal physical exam, none requiring intervention. Our findings suggest that implementing institution-specific appropriate criteria may reduce unnecessary CTA studies.

Intra-aortic infusion of nicotine can induce a novel mouse model of abdominal aortic aneurysm

OBJECTIVE

Smoking is one of the most important independent risk factors for abdominal aortic aneurysm (AAA). However, harmful tobacco substances, such as nicotine, are not directly used to induce experimental AAAs in animals to mimic smokers with an AAA status similar to that of humans. To facilitate the study of the relationship between smoking and AAA, this study presents a novel model of nicotine-induced AAA.

METHODS

In the present study, Mendelian randomization (MR) analyses were used to validate that smoking and its main harmful substance, nicotine, are independent risk factors for AAA. We then evaluated the intraluminal infusion of four doses of nicotine into mouse abdominal aortas to establish a novel AAA model.

RESULTS

MR analysis revealed that smoking, daily cigarette consumption, and smoking cessation history were positively associated with AAA pathogenesis, and the associations between the nicotine metabolism rate and AAA approached statistical significance. On day 14 after nicotine infusion in the mice, the mean diameter of the abdominal aorta increased from approximately 0.50 mm (baseline) to 0.94 to 1.0 mm in the four groups. Almost all of the mice developed abdominal aortic aneurysms, but aortic dilation did not show a clear dose‒dependent relationship. Compared with the sham and PBS infusion groups, the nicotine infusion group (5 mg/mL dose was selected for subsequent analysis) presented more severe aortic dilation, aortic elastin degradation, medial smooth muscle cell loss and aortic leukocyte accumulation. A more severe inflammatory status also increased aortic matrix metalloproteinase (MMP)2 and MMP9 expression and promoted mural neovessel sprouting. Notably, the lesions in the nicotine infusion group were generally not as severe as those in the PPE infusion group, which served as a positive control. To test whether the effect of nicotine on AAA pathogenesis is dependent on its corresponding receptors, we blocked its main receptor, the α7 subunit nicotinic acetylcholine receptor, with the antagonist methyllycaconitine (MLA). The results showed that the aneurysmal lesions were significantly improved by MLA treatment.

CONCLUSION

In this study, we established a novel and highly efficient experimental AAA model via direct intraluminal nicotine infusion. We also demonstrated that nicotine-induced AAA formation is partially dependent on the activation of its receptors, thus providing a research tool for studying the management of smoking-induced AAAs.

Clinicoradiological Evaluation of Cholesteatoma: Integrating Clinical, CT, and MRI Diagnostics

OBJECTIVES

The common chronic disorder, otitis media (COM), can lead to cholesteatoma, a destructive lesion of the middle ear that could potentially have major consequences. Correct diagnosis at an early stage is crucial for effective management. In this study, histopathology is used as the gold standard to compare how well a clinicoradiological method that uses clinical observations, high-resolution computed tomography (HRCT), and echo-planar imaging diffusion-weighted magnetic resonance imaging (EPI-DWI) can diagnose cholesteatoma.

METHODS

A prospective diagnostic accuracy study was conducted on 230 patients aged 15 to 50 years with COM and clinically-suspected cholesteatoma. All patients underwent clinical evaluation (history, otoscopy, and audiometry) followed by HRCT and EPI-DWI imaging. Imaging findings were interpreted independently by radiologists blinded to clinical and histopathological results. Surgical exploration and histopathological confirmation were performed in all cases.

RESULTS

Of the 230 patients, histopathology confirmed cholesteatoma in 110 cases (47.8%). Diffusion-weighted magnetic resonance imaging (DW-MRI) demonstrated superior sensitivity (92.7%) and specificity (89.4%) compared with HRCT (sensitivity: 75.5%; specificity: 70.2%). The clinicoradiological approach combining clinical assessment with EPI-DWI and HRCT improved diagnostic accuracy, achieving a sensitivity of 95.5%, specificity of 90.7%, positive predictive value of 93.2%, and negative predictive value of 94.3%. Receiver operating characteristic analysis revealed an area under the curve of 0.96 for DW-MRI and 0.88 for the clinicoradiological approach. Cohen's kappa showed an excellent agreement between the clinicoradiological assessment and histopathology (κ = .85).

CONCLUSIONS

The integration of clinical findings with EPI-DWI and HRCT significantly enhances the diagnostic accuracy for cholesteatoma, making the clinicoradiological approach a valuable tool in the evaluation of patients with COM. EPI-DWI remains the preferred imaging modality for cholesteatoma diagnosis, while HRCT provides complementary information on middle ear anatomy and bone erosion.

Human liver CEST imaging at 7 T: Impact of B 1 + shimming

PURPOSE

To explore the feasibility of CEST imaging in the human liver at 7 T withB 1 + $$ {B}_1^{+} $$ shimming.

METHODS

CEST MRI was performed on a 7 T whole-body scanner with a parallel transmission (pTx) system in five healthy volunteers. Static pTx (B 1 + $$ {B}_1^{+} $$ shimming) was applied to locally maximize theB 1 + $$ {B}_1^{+} $$ magnitude per input power within a given region of interest (ROI) of approximately 30 mm diameter (ROIshim). Relaxation-compensated inverse magnetization transfer ratio (MTRRex) values were quantified for amide protons, guanidino protons, and relayed nuclear Overhauser effect signals based on five-pool Lorentzian fit analysis. MTRRex values were corrected for B1 inhomogeneities using an absolute, accurate MR fingerprinting-basedB 1 + $$ {B}_1^{+} $$ mapping technique.

RESULTS

Within the ROIshim, reliable MTRRex values could be calculated for an average of 85% of voxels. The mean MTRRex values and corresponding coefficient of variations across the group are: 0.113 ± 0.009, 8.8% for amide; 0.167 ± 0.010, 6.3% for nuclear Overhauser effect; and 0.079 ± 0.010, 12.9% for guanidino. MTRRex values exhibit low variation between subjects, as reflected by low coefficient of variations.

CONCLUSION

In this study, we have demonstrated for the first time the feasibility of acquiring and quantifying relaxation-compensated CEST contrasts in the human liver at ultrahigh field. The application of static pTx effectively eliminatesB 1 + $$ {B}_1^{+} $$ dropouts and allows for accurate CEST contrast quantification within the selected ROI. In addition, the proposedB 1 + $$ {B}_1^{+} $$ mapping technique shows efficacy for enhanced MTRRex B1 corrections in the abdomen.

A cautionary tale of anatomical variations of the extrahepatic biliary system and their implications for surgical procedures: a systematic literature review

BACKGROUND

The hepatobiliary system has the most associated anatomical variations in the body and they are a direct reflection of the complexity of its embryological development. The anatomical pattern commonly described as 'normal' occurs only in 57-72% of the population. The objective of the study is to review the English Language published literature on the prevalence of the anatomical extra-hepatic biliary system variations and their potential implications for surgical and endoscopic procedures. This will assist both practicing and trainee surgeons in preventing biliary tract injuries while operating in this area.

METHODOLOGY

A comprehensive literature search was conducted using the PICO framework across SCOPUS, PubMed, MEDLINE, and Cochrane databases. Study characteristics and relevant data were collated. The prevalence of the most clinically important anatomical variations is presented.

RESULTS

Seventy studies, encompassing 17,207 subjects, were included: 27 studies (9,738 subjects) on cystic duct variations, 17 studies (2,633 subjects) on gallbladder variations, and 26 studies (4,836 subjects) on cystic artery variations. Notable findings include low insertion (11.2%), medial insertion (9.8%), and parallel course (7.4%) of the cystic duct, Hartmann's pouch in 12.2% of gallbladders, and the cystic artery originating from the right hepatic artery in 83.6% or other sources in 16.4%. Moynihan's hump of the right hepatic artery was found in 1.8%.

CONCLUSION

These variations are frequent and surgically relevant. Understanding them is critical to avoiding complications. Employing the critical view of safety in laparoscopic cholecystectomy ensures proper visualization of anatomical structures, reducing the risk of injury.

Surgical Correction of Severe Scoliosis Leads to Changes in Central Airway Resistance Evaluated with CT-Based 3D Reconstruction and Impulse Oscillometry

BACKGROUND

Previous studies have not compared airway resistance and morphological parameters before and after the treatment of severe scoliosis. In the present study, 3-dimensional (3D) computed tomographic (CT) reconstruction and impulse oscillometry (IOS) were used to evaluate the changes in airway dilation and airway resistance caused by posterior spinal fusion for the treatment of severe kyphoscoliosis.

METHODS

Thirty-four patients with severe scoliosis (Cobb angle, >100°) underwent posterior spinal fusion. Preoperative and postoperative evaluations included CT scans, radiographic assessment, and IOS. Changes in bronchial dilation were evaluated with use of 3D CT reconstruction, and changes in airway resistance were evaluated with use of IOS. Differences were assessed with use of 2-tailed paired Student t tests, and correlations were evaluated with use of the Spearman rank test.

RESULTS

Nearly all spinal radiographic measurements improved after posterior spinal fusion. The mean Cobb angle was 133.21° ± 22.15° preoperatively and 50.92° ± 13.37° postoperatively (p < 0.001). The mean thoracic kyphosis angle was 121.42° ± 32.42° preoperatively and 50.67° ± 5.21° postoperatively (p < 0.001). The IOS measurements improved, with the reactance at 20 Hz (R20) decreasing from 0.4029 ± 0.0747 to 0.3100 ± 0.0837 kPa/(L/s) (p = 0.0004). Following posterior spinal fusion, the trachea, left main bronchus, and right main bronchus expanded. Moreover, the diameter and lumen area of the trachea were moderately correlated with R20 (r = -0.5071, p = 0.0114; r = -0.5537, p = 0.0050) and the diameter and lumen area of the right main bronchus were correlated with R20 (r = -0.5583, p = 0.0056; r = -0.6389, p = 0.0008). R20 and the lumen area of the trachea were correlated with the thoracic kyphosis angle (r = 0.6394, p = 0.0004; r = -0.6160, p = 0.0023).

CONCLUSIONS

Posterior spinal fusion can safely and effectively improve the curve and relieve airway obstruction in patients with severe scoliosis. Impulse oscillometry analysis suggested that R20 substantially increased after posterior spinal fusion, primarily because of altered central airway enlargement as measured with CT reconstruction.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Maxillary sinus pathologies in dental implant candidates: CBCT-based prevalence and odontogenic risk factors

BACKGROUND

This retrospective study aimed to assess the prevalence of maxillary sinus pathologies and their associations with odontogenic factors in dental implant candidates using cone beam computed tomography (CBCT). By identifying the most common sinus pathologies and their potential relationship with odontogenic conditions, this study provides insights into factors influencing preoperative planning for sinus augmentation and implant placement.

METHODS

1,000 CBCT scans (500 males, 500 females), representing 2,000 maxillary sinuses, were analyzed. Sinus pathologies were classified based on demographic variations and odontogenic factors, including periapical lesions without root canal treatment (RCT), periapical lesions with RCT, root canal-treated teeth without lesions, and edentulism. The distinction between unilateral and bilateral occurrences was also assessed. The associations between these factors and sinus pathologies were statistically evaluated.

RESULTS

Sinus pathologies were identified in 39.5% of sinuses, affecting 54.8% of patients. The most common finding was mucosal thickening (61%), followed by cysts/polyps (27.6%) and opacifications (11.4%). Males had a higher prevalence of cysts/polyps (p =.020), while mucosal thickening showed no significant gender difference. Odontogenic factors were present in 65.2% of pathological sinuses, particularly in mucosal thickening cases. Periapical lesions-whether untreated or treated with RCT-were significantly associated with sinus pathology (p <.0001 and p =.013), while root canal-treated teeth without lesions showed no association (p =.411). The rate of complete sinus opacification, which may impact sinus augmentation procedures, was 5%. Patients aged 41-60 exhibited a higher incidence of bilateral sinus pathology (p <.0001). Mucosal thickening was more frequently bilateral, whereas sinus cysts were predominantly unilateral (p =.003).

CONCLUSIONS

This study highlights the high prevalence of sinus pathologies in dental implant candidates and their significant association with odontogenic factors. These findings underscore the importance of thorough preoperative radiographic evaluation to optimize implant planning and reduce complications. Identifying these relationships may enhance clinical decision-making before sinus augmentation procedures. Further research incorporating clinical examinations and patient records is warranted to strengthen these findings.

Investigation of the biomechanical effects of severe anterior disc displacement on the temporomandibular joint and occlusion

The temporomandibular joint (TMJ) and occlusion, as critical load-bearing components of the stomatognathic system, exhibit complex interdependence. While occlusal abnormalities contribute to internal joint disorders, their reciprocal effects remain poorly understood. This study investigates how severe anterior disc displacement (ADD) alters the stress distribution within the TMJ and the occlusion, aiming to elucidate the TMJ-occlusion relationship and inform clinical diagnosis and treatment strategies. Refined finite element models of the masticatory system of the normal, bilaterally severe ADD, and unilaterally severe ADD groups were developed. Stress distributions were analyzed under maximum voluntary intercuspal clenching (MIC) and maximum voluntary unilateral molar clenching (MUC) with corresponding muscle force intensities. Results showed that under high-intensity clenching, the contact stress on the second molars in the severe ADD groups (48.4-50.3 MPa) exceeded that in the normal group (37.7-38.4 MPa). The condylar contact stress of the severe ADD group was more than 40 times greater than that of the normal group. The ranking of peak stresses on the condyles with unilateral severe ADD under different high-intensity tasks was as follows: MUCI (336.97 MPa) > MUCC (206.54 MPa) > MIC (169.19 MPa). In conclusion, severe ADD under high-intensity clenching induces anterior slippage of discs, resulting in abnormal stress concentrations on the condyles and second molars, particularly during ipsilateral clenching. To mitigate potential biomechanical risks, patients are encouraged to adopt balanced mastication habits.

Alterations of White Matter Functional Networks in Pediatric Drug-Resistant Temporal Lobe Epilepsy: A Graph Theory Analysis Study

Neurological disorder can cause functional network changes in white matter (WM). However, changes in the WM functional network in children with drug-resistant temporal lobe epilepsy (DRTLE) require further clarification. Therefore, we combine graph theory with resting-state functional magnetic resonance imaging (rs-fMRI) and T1-weighted imaging (T1WI) to investigate the topological features of the WM network in children with DRTLE, discover potential biomarkers, and understand the underlying neurological mechanisms. We included 91 children (43 with DRTLE and 48 healthy controls), acquiring structural and functional MRI data to construct WM functional networks. Graph theory was applied to evaluate topological differences and their correlation with onset age, disease duration and cognitive measures. A Support Vector Machine model classified individuals with DRTLE based on WM connectivity, with accuracy validated through leave-one-out cross-validation. The global topological properties of the WM network in children with DRTLE were altered, manifesting as an imbalance between global integration and segregation Local nodal efficiency changes in the association fibers exhibited reduced information transfer and centrality at several nodes. Conversely, commissural and projection fibers displayed increased network properties. Cognitive metrics correlated with nodal disturbances. The classification model achieved 73.6% accuracy and an area under the curve (AUC) of 0.744. This indicates that the WM functional network in DRTLE presents with anomalies in the topological attributes, which are associated with cognitive impairments. The WM functional connectivity may serve as valuable indicators for clinical classification of the condition. The insights provided have augmented our understanding of the complex neurological mechanisms involved in epilepsy.

Rapid, moderate, or slow bleeding? CT analysis of abdominopelvic active vascular contrast extravasation classes and mortality outcomes

OBJECTIVES

Building on prior findings that active vascular contrast extravasation (AVCE) size is an independent predictor of in-hospital mortality in abdominopelvic hemorrhages, this study aimed to categorize AVCEs using latent profile analysis (LPA) and examine differences in patient characteristics, treatments, and outcomes.

METHODS

We retrospectively included consecutive adults with CT-detected AVCE between January 2019 and May 2022. LPA was applied to classify AVCEs based on size-related features, optimizing the number of classes predictive of 24-h and in-hospital mortality. These classes were compared using univariable analysis with post-hoc pairwise comparisons to identify significant differences. Cutoff values for categorization were derived from size parameters and changes across arterial (AP) and portovenous (PVP) phases.

RESULTS

LPA classified 223 patients with single-organ, traumatic, and nontraumatic AVCEs (mean age 59.8 ± 20.1 years, 123 men) into three groups-slow (n = 136), moderate (n = 75), and rapid (n = 12). Slow AVCEs showed smaller size parameters and minimal changes between AP and delayed phases. Rapid AVCEs frequently exhibited coexisting pseudoaneurysms, smaller areas on AP, lower mean attenuation differences in AP-PVP pairs, and were associated with lower systolic and diastolic blood pressures, requiring the highest quantity of packed red cells. Perimeter percentage changes between AP and PVP performed comparably to LPA classes and provided practical classification cutoffs.

CONCLUSION

LPA-based classification of AVCEs into slow, moderate, and rapid types revealed distinct size patterns and associated clinical outcomes, offering a robust framework for risk stratification and guiding management of abdominopelvic hemorrhages.

KEY POINTS

Question It is unclear if the size of active vascular contrast extravasation (AVCE) is predictive of mortality in patients with abdominopelvic hemorrhage. Findings AVCEs could be classified by latent profile analysis into three groups: slow, moderate, and rapid, based on size at multiphasic CT with distinct mortality risks. Clinical relevance Practical cutoff values of perimeter percentage changes of AVCE between arterial- and portovenous-phase CT were identified for AVCE classification, potentially guiding clinical prioritization and management of patients with abdominopelvic hemorrhage.

Trading off Iodine and Radiation Dose in Coronary Computed Tomography

Coronary CT angiography (CCTA) has seen steady progress since its inception, becoming a key player in the non-invasive assessment of coronary artery disease (CAD). Advancements in CT technology, including iterative and deep-learning-based reconstruction, wide-area detectors, and dual-source systems, have helped mitigate early limitations, such as high radiation doses, motion artifacts, high iodine load, and non-diagnostic image quality. However, the adjustments between ionizing radiation and iodinated contrast material (CM) volumes remain a critical concern, especially due to the increasing use of CCTA in various indications. This review explores the balance between radiation and CM volumes, emphasizing patient-specific protocol optimization to improve diagnostic accuracy while minimizing risks. Radiation dose reduction strategies, such as low tube voltage protocols, prospective ECG-gating, and modern reconstruction algorithms, have significantly decreased radiation exposure, with some studies achieving sub-millisievert doses. Similarly, CM volume optimization, including adjustments in strategies for calculating CM volume, iodine concentration, and flow protocols, plays a role in managing risks such as contrast-associated acute kidney injury, particularly in patients with renal impairment. Emerging technologies, such as photon-counting CT and deep-learning reconstruction, promise further improvements in dose efficiency and image quality. This review summarizes current evidence, highlights the benefits and limitations of dose control approaches, and provides practical recommendations for practitioners. By tailoring protocols to patient characteristics, such as age, renal function, and body habitus, clinicians can achieve an optimal trade-off between diagnostic accuracy and patient safety, ensuring optimal operation of CT systems in clinical practice.

First clinical multicenter experience of the new NeVa NET 5.5 thrombectomy device

BACKGROUND

Mechanical thrombectomy for the treatment of acute ischemic stroke has undergone relevant technical improvements over recent years. However, distal emboli and incomplete reperfusion after mechanical thrombectomy are still shortcomings in the care of patients with endovascular acute ischemic stroke. The NeVa NET 5.5 thrombectomy device (Vesalio, Nashville, Tennessee, USA) is the first stent retriever featuring an integrated clot micro-filtration system, aiming to enhance first pass efficacy and reduce distal embolization. This study evaluates the safety and efficacy of the NeVa NET 5.5 thrombectomy device.

METHODS

Patients with acute anterior circulation occlusions and vessel diameters >2 mm treated with the NeVa NET 5.5 stent retriever as a first-line approach were retrospectively included in this study. Data were collected from three European comprehensive stroke centers between October 2022 and April 2024. Patient data, occlusion details, clinical outcomes, and procedure-related parameters were analyzed.

RESULTS

A total of 51 patients were included. The most common occlusion locations were the internal carotid artery terminus and intradural internal carotid artery (70.6%). The mean±SD clot length was 25.1±13.3 mm (range 4-50 mm). First pass reperfusion (eTICI 2b-3) was achieved in 78.5%, with a final reperfusion rate of eTICI 2b-3 in 98.1%. Distal embolization in new territories occurred in 3.9%. No device-related adverse events were reported, and procedure-related adverse events occurred in 7.6% of the overall included cases.

CONCLUSION

The NeVa NET 5.5 stent retriever has a high first pass reperfusion rate in large vessel occlusions of the anterior circulation, with a good safety profile and low rate of distal embolization.

miR-221-3p, arterial blood gas, and lung ultrasound: a multimodal approach for predicting neonatal respiratory distress syndrome outcomes

BACKGROUND

Neonatal respiratory distress syndrome (NRDS) is one of the critical illnesses causing early death in infants due to alveolar surface-active substance deficiency, and the prognosis may show varying degrees of sequelae. Some miRNAs are valuable in the prognosis of NRDS infants. The objective of this research was to assess the predictive value of combining the three factors on the prognosis of NRDS infants by analyzing miR-221-3p levels, arterial blood gas analysis parameters and lung ultrasound (LUS) scores in NRDS infants with good and poor prognosis.

METHODS

Serum miR-221-3p levels were measured by qRT-PCR. Effect of miR-221-3p expression in prognosis of NRDS infants using Kaplan-Meier curve and COX analyses. Arterial blood gas parameters were analyzed, as well as LUS score was recorded for NRDS infants. Role of miR-221-3p combined with arterial blood gas parameters and LUS score in prognosis of NRDS infants was assessed by ROC curves. Pearson correlation was applied to assess the association of miR-221-3p with arterial blood gas analysis parameters and LUS score.

RESULTS

Serum miR-221-3p was notably greater in NRDS infants than in healthy newborns. High miR-221-3p level was related to poor prognosis for NRDS infants. pH and PaO2 were lower and PaCO2 was higher in arterial blood gas analysis parameters in poor prognosis. Furthermore, LUS score was greater on poor prognosis as opposed to good prognosis. miR-221-3p combined with arterial blood gas parameters and LUS score has a high accuracy in predicting prognosis in NRDS infants. Moreover, miR-221-3p was associated negatively with pH and PaO2 and positively with PaCO2 and LUS score.

CONCLUSIONS

Elevated miR-221-3p may be related to poor survival outcomes in NRDS infants. miR-221-3p in combination with arterial blood gas parameters and LUS score has a high accuracy in determining the survival outcome of NRDS infants and may be a useful tool for clinical NRDS prognosis.

Incidental pediatric intraparenchymal meningioma: illustrative case

BACKGROUND

Meningiomas are the most common benign tumors among CNS neoplasms. In the pediatric population, however, they account for only 0.4%-4.6% of all intracranial neoplasms; they are rare inside the brain parenchyma and are frequently confused with other entities, such as glioneuronal tumors and cavernomas, among others.

OBSERVATIONS

The authors describe the case of a 4-year-old male who presented to the emergency department for evaluation of periorbital cellulitis and was incidentally diagnosed with a brain tumor. MRI demonstrated an expansive heterogeneous lesion, 2.2 × 1.9 × 1.8 cm, in the left lingual gyrus. Spectroscopy and perfusion imaging suggested a low-grade glioneuronal tumor. After thorough discussion, the family and medical team elected to pursue surgical treatment. The patient had an uneventful postoperative recovery, and subsequent pathological and immunohistochemical analysis confirmed the diagnosis of a fibrous meningioma (WHO grade 1).

LESSONS

Intraparenchymal meningiomas are a rare and misdiagnosed tumor, especially in the pediatric age group, and therefore are not usually considered in the differential diagnosis of intra-axial neoplasms in children. When suspected, surgery may be encouraged due to the tendency of these tumors to exhibit more aggressive behavior compared with adult meningiomas. https://thejns.org/doi/10.3171/CASE24611.

Role of Quantitative CEUS in the Diagnosis of Peripheral Pulmonary Lesions: A Systematic Review

Background/Objectives: This systematic review describes a largely descriptive synthesis of studies investigating the diagnostic performance of quantitative contrast-enhanced ultrasound (CEUS) in differentiating benign from malignant peripheral pulmonary lesions. Methods: Formal quantitative pooling of effect sizes was not feasible due to variability in outcome measurements and reporting. Results: Combining CEUS parameters with real-time on-site evaluation (ROSE) substantially improved percutaneous biopsy success rates. In one comparative study, biopsy yield reached 97.62% with CEUS, versus 84% using conventional ultrasound, while complications remained minimal. Other investigations focused on the discriminatory value of specific time-based indices (e.g., AT ≥ 10 s, lesion-lung AT difference ≥ 2.5 s) or complex multi-parameter models. A notable large study demonstrated that a six-parameter logistic regression model achieved near-excellent discrimination, with C-statistics exceeding 0.97 for both development and validation cohorts, outperforming single-threshold approaches. Nevertheless, certain findings emphasize that no single indicator-particularly arrival time alone-reliably distinguishes benign from malignant lesions, given the diverse vascular patterns and histological subtypes involved. TDOA-based analyses proved more promising, as malignant lesions generally exhibit a delayed but robust bronchial arterial supply and rapid washout. Heterogeneity in ultrasound systems, operator experience, and patient populations further underscores the need for standardized protocols. Conclusions: Overall, these data suggest that CEUS, particularly when combined with additional sonographic or cytological tools, significantly enhances diagnostic precision for peripheral pulmonary lesions.

The effect to dose and diagnostic quality of limiting source-to-image distance on anterior-posterior semi-erect adult chest X-rays

INTRODUCTION

Mobile chest X-rays (CXR) examinations are requested for clinically unstable inpatients who cannot be transported to the radiology department. These examinations often have limitations, such as reduced source-to-image distance (SID) in anterior-posterior (AP) position due to limited space in ward environments. This study aimed to investigate the effect of entrance skin dose (ESD) and the diagnostic image quality of reduced SID from the standard 180cm to 150cm and 100cm on semi-erect AP CXRs.

METHOD

A human tissue equivalent Alderson Rando phantom was positioned in a hospital bed at an AP semi-erect 45-degree angle. Three exposures were taken for each SID; the dose was recorded with an Ion Chamber attached to the anterior chest wall to record the ESD and the dose area product (DAP). The mean dose from the three SID positions was compared using a t-test. Image quality was assessed using Image Quality Score (IQS) and RadLex criteria for diagnostic quality using Analysis of Variance (ANOVA).

RESULTS

A linear response of decreasing the SID resulted in a 40.1 % increase in ESD (53.7 μGy; p = < 0.001) from 180 cm to 150 cm SID and a 121.5 % increase (329.9 μGy; p = < 0.001) from 180 cm to 100 cm SID. There was also a decrease in image quality from 180 cm to 100 cm SID (IQS p = 0.03), with 100 cm scoring poor against lower lung field visual reproduction and limited diagnostic quality on RadLex.

CONCLUSION

The findings demonstrate that in controlled X-ray settings, the ESD is increased when the SID is reduced from 180cm to 150cm SID (40.1 %) and to 100cm SID (121.5 %), which furthermore decreases image quality (p = 0.03) and the diagnostic value of the image. It is recommended that radiographers maintain the standard 180 cm SID during adult inpatient semi-erect AP CXR examinations to maintain as low as reasonably practicable (ALARP) diagnostic X-ray examinations.

The predictive value of non-enhanced CT radiomics in differentiating early and advanced T-staging of colon cancer

This study aimed to assess the diagnostic value of non-enhanced CT radiomics in preoperatively differentiating early-stage (T1-T2) from locally advanced (T3-T4) colon cancer, addressing the limitations of conventional empirical staging. A retrospective analysis was conducted on 170 patients with surgically confirmed primary colon cancer who underwent non-enhanced CT scans within 1 week before surgery. Three-dimensional segmentation of colonic tumors was performed on the non-enhanced images, followed by automated extraction of radiomic features. Feature selection was executed using the minimum redundancy maximum relevance (mRMR) algorithm, and key features associated with cancer stage were identified using the least absolute shrinkage and selection operator logistic regression. The performance of the radiomics model was compared with conventional T-staging by radiologists. The cohort comprised 170 patients with an average age of 61.69 ± 13.22 years, 43.3% of whom were female, and 75 (44.1%) presented with early-stage disease. Eight radiomic features from non-enhanced imaging were ultimately included. The radiomics model achieved an area under the curve (AUC) of 0.85 (95% confidence interval: 0.78-0.92) in the training set and 0.84 (95% confidence interval: 0.74-0.95) in the test set, with corresponding accuracies of 0.70 and 0.78, sensitivities of 0.87 and 0.87, and specificities of 0.69 and 0.71, respectively. Additionally, in the training set, the radiomics model (AUC = 0.85) significantly outperformed empirical T-staging by radiologists (AUC = 0.71, P < .009). A similar trend was observed in the test set, where the radiomics model (AUC = 0.85) surpassed empirical T-staging (AUC = 0.76), although this difference was not statistically significant (P = .27). Non-enhanced CT radiomics demonstrated superior performance over conventional radiologists' T-staging in distinguishing early from advanced colon cancer stages.

Role of Pectoralis Muscle Analysis in Breast Magnetic Resonance Imaging for Body Composition Evaluation Before and After Neoadjuvant Chemotherapy for Breast Cancer

Background: sarcopenia is a physical condition characterized by the loss of muscle mass and strength; it is associated with worse outcomes in oncological diseases and is recognized as an independent predictor of poor survival. The aim of our work is to evaluate the correlation between the pectoralis muscles area (PMA) calculated in breast MRI examinations and the body composition parameters assessed in CT examinations, in order to identify a threshold useful for diagnosing sarcopenia in breast cancer patients who are candidates for neoadjuvant chemotherapy (NACT), so as to be able to provide the correct nutritional counselling. Methods: we included 116 patients with non-metastatic breast cancer, who were studied with MRI before and after NACT, in the 2018-2023 period. All patients were categorized according to age, weight, height, and BMI. Using MRI scans, both before and after treatment, we measured the PMA at the level of the sternal angle of Louis and evaluated the changes caused by NACT, and we performed the same procedure for CT body composition parameters. Results: the ROC we calculated describes the ability of the PMA to discriminate sarcopenic patients from non-sarcopenic ones, identifying an optimal cut-off of 20.55, which achieves a specificity of 92%. The variations in PMA after NACT showed a strong, statistically significant association with the variations in all CT body composition parameters. Conclusions: these results introduce the possibility of also assessing body composition in breast MRI. The novelty in this study is to have estimated, on the basis of these correlations, a cut-off value that reflects the skeletal muscle index threshold for the definition of sarcopenia that is usually used.

The clinical value of dual-phase CT angiography (CTA) of the pulmonary artery and bronchial artery in diagnosing bronchial artery-pulmonary artery fistula

To evaluate the diagnostic efficacy of dual-phase computed tomography angiography (CTA) in identifying bronchial artery-pulmonary artery fistulas (BPAF). A retrospective cohort study was conducted on 62 patients diagnosed with BPAF via dual-phase CTA at our institution between February 2022 and January 2025. Comprehensive analyses were performed to characterize vascular involvement patterns, ectopic vessel distribution, aberrant feeding vessels, and associated imaging features. Among the cohort, 26 patients (41.9%) presented with hemoptysis as the predominant symptom. Comorbid pulmonary conditions included bronchiectasis (54.8%, n = 34), atelectasis (16.1%, n = 10), chronic obstructive pulmonary disease (12.9%, n = 8), pulmonary embolism (6.4%, n = 4), pulmonary tuberculosis (3.2%, n = 2), fibrosing mediastinitis (3.2%, n = 2), and pneumoconiosis (3.2%, n = 2). Imaging revealed 82 BPAF lesions across 62 patients, with 12 cases (19.4%) demonstrating multi-vessel involvement. Anomalous vascular findings included non-bronchial systemic collaterals (n = 8, 12.9%) and ectopic bronchial artery origins (n = 6, 9.7%). Hallmark CTA features comprised tortuous bronchial artery dilation (100%), Phase-discordant opacification of pulmonary artery, delayed pulmonary artery opacification, and jet-like hypodense shadows within pulmonary arteries during the pulmonary phase. Dual-phase CT angiography (CTA) of the pulmonary artery and bronchial artery can better display the bronchial artery-pulmonary artery fistula and provide detailed and comprehensive treatment basis for clinical practice.

TSPO deficiency exacerbates acute brain damage after intracerebral hemorrhage in male mice

Intracerebral hemorrhage (ICH) is a stroke subtype with no effective treatment despite high morbidity and mortality rates. The delineation of the mechanisms of brain damage after ICH is critical to identifying novel molecular targets for therapeutic intervention. Apart from the augmented expression of 18 kDa translocator protein (TSPO) in microglia/macrophages post-ICH and its potential to track neuroinflammation, the precise function of TSPO after brain damage remains largely enigmatic. In the present study, we employed transgenic animal models, such as global and myeloid-specific conditional knockouts, to elucidate the functional role of TSPO in ICH-induced acute brain damage. Neurological deficits, neurodegeneration, and neuroinflammation were assessed at 3-days post-ICH in male and female mice. Male TSPO global knockout and conditional knockout exhibited enhanced neurobehavioral deficits with a concomitant increase in neurodegeneration and neuroinflammation compared to their respective controls. Interestingly, their female counterparts did not exhibit augmented brain damage compared to the respective controls. Mechanistically, studies employing RNA-Seq and subsequent functional validation demonstrate that TSPO could regulate brain cholesterol efflux, which could partly be responsible for enhanced brain damage in TSPO KO male mice after ICH, warranting further investigation.

Sodium-glucose cotransporter-2 inhibitor therapy improves renal and hepatic function in patients with cirrhosis secondary to metabolic dysfunction associated steatotic liver disease and type 2 diabetes

Purpose

Metabolic dysfunction-associated steatotic liver disease (MASLD) increases the risk of chronic kidney disease (CKD), compounding morbidity in patients with cirrhosis. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are disease-modifying agents in type 2 diabetes mellitus (T2DM) and CKD, but studies on their use in cirrhosis are limited. We aimed to assess the effect of SGLT2i therapy on renal and hepatic function in patients with Child-Turcotte-Pugh (CTP) B cirrhosis and T2DM.

Methods

We conducted a 48-month longitudinal, retrospective cohort study of 54 patients with CTP B cirrhosis secondary to MASLD and T2DM who were initiated on SGLT2i (n=27) or insulin (n=27). Laboratory data were collected every 3 months. Liver stiffness (LS) was measured every 6 months via transient elastography (TE) and acoustic radiation force impulse with shear wave velocity (ARFI-SWV). The primary outcome was change in glomerular filtration rate (GFR) and chronic kidney disease (CKD) stage. Secondary outcomes included LS changes measured via TE and ARFI. Additional end points included MELD-Na, MELD 3.0, CTP scores, hepatic decompensations, proteinuria, body mass index (BMI), hemoglobin A1c (Hb-A1c), blood glucose (BG).

Results

At baseline, the two groups were comparable in GFR (SGLT2i: 55.6 ± 1.9 vs. insulin: 58.1 ± 2.1 mL/min/1.73 m², p = 0.37), CKD stage, ARFI-SWV (2.9 ± 0.1 vs. 2.8 ± 0.1 m/s, p = 0.26), MELD-Na, and MELD 3.0. The SGLT2i group was older (p < 0.01) and had higher AST (p=0.01), ALT (p<0.01), and CTP scores (p=0.02), but lower LS by TE (p = 0.03). Over 48 months, GFR increased in the SGLT2i group (+13.5 ± 1.3) and declined in the insulin group (-4.2 ± 1.4; p < 0.01). A greater proportion of SGLT2i patients transitioned from CKD stage 3a to 2 (p = 0.04). Liver stiffness by TE decreased in the SGLT2i group (-4.0 ± 1.1 kPa), while it increased in the insulin group (+3.0 ± 2.5 kPa; p < 0.01). ARFI-SWV also declined in the SGLT2i group but increased in the insulin group (2.5 ± 0.1 vs. 3.2 ± 0.1 m/s; p < 0.01). The SGLT2i group also demonstrated significant improvement in MELD-Na, MELD 3.0 and CTP scores, with greater resolution of hepatic decompensations, proteinuria, as well as better BMI and HbA1c outcomes (all p < 0.01).

Conclusions

Patients with CTP B cirrhosis and T2DM receiving SGLT2i therapy experienced a significant improvement in renal, hepatic function, and glycemic control over 48 months compared to patients treated with insulin.

Sickle cell mice exhibit elevated plasma bilirubin and altered intracranial cerebral blood velocities that are exacerbated by hypoxia-reoxygenation

Sickle cell disease (SCD) is a genetic disorder characterized by sickle red blood cells (RBCs). Sickle RBCs cause cerebral vasculopathies including vaso-occlusive events, leading to ischemia-reperfusion injury and hypoxic tissue environment. To date, the physiological blood flow velocities in cerebral vessels of preclinical SCD models has not been evaluated under hypoxic-reoxygenation. In our study, we used transcranial ultrasound techniques to measure abnormal blood flow velocities in the internal carotid (ICA) and middle cerebral arteries (MCA) of transgenic sickle cell mice (SS) challenged with hypoxia-reoxygenation. Our study showed that SS mice that underwent hypoxic stress exhibited lower relative mean velocities in the MCA compared to wildtype mice (AA) (0.67 ± 0.18 vs. 0.95 ± 0.15; p < 0.05). Comparison of the Lindegaard ratio between normoxia and hypoxia in SS mice suggested that the MCA underwent vasodilation (0.67 ± 0.18 vs. 0.95 ± 0.15; p < 0.05). Bilirubin, a potential biomarker for cerebral vasculopathies in SCD, was higher in SS than AA mice (0.56  ±   0.28 vs. 0.05  ±   0.07 mg/dL; p < 0.05). Correlation analyses revealed a significant association between bilirubin levels and blood velocities of MCA (r = -0.9377, p = 0.0002) and ICA (r = 0.8203, p = 0.0068), especially in hypoxic conditions of SS mice. We propose that the reactivity of cerebral vessels in SS mice is correlated with the elevated plasma bilirubin level.

Challenges in Implementing Artificial Intelligence in Breast Cancer Screening Programs: Systematic Review and Framework for Safe Adoption

BACKGROUND

Artificial intelligence (AI) studies show promise in enhancing accuracy and efficiency in mammographic screening programs worldwide. However, its integration into clinical workflows faces several challenges, including unintended errors, the need for professional training, and ethical concerns. Notably, specific frameworks for AI imaging in breast cancer screening are still lacking.

OBJECTIVE

This study aims to identify the challenges associated with implementing AI in breast screening programs and to apply the Consolidated Framework for Implementation Research (CFIR) to discuss a practical governance framework for AI in this context.

METHODS

Three electronic databases (PubMed, Embase, and MEDLINE) were searched using combinations of the keywords "artificial intelligence," "regulation," "governance," "breast cancer," and "screening." Original studies evaluating AI in breast cancer detection or discussing challenges related to AI implementation in this setting were eligible for review. Findings were narratively synthesized and subsequently mapped directly onto the constructs within the CFIR.

RESULTS

A total of 1240 results were retrieved, with 20 original studies ultimately included in this systematic review. The majority (n=19) focused on AI-enhanced mammography, while 1 addressed AI-enhanced ultrasound for women with dense breasts. Most studies originated from the United States (n=5) and the United Kingdom (n=4), with publication years ranging from 2019 to 2023. The quality of papers was rated as moderate to high. The key challenges identified were reproducibility, evidentiary standards, technological concerns, trust issues, as well as ethical, legal, societal concerns, and postadoption uncertainty. By aligning these findings with the CFIR constructs, action plans targeting the main challenges were incorporated into the framework, facilitating a structured approach to addressing these issues.

CONCLUSIONS

This systematic review identifies key challenges in implementing AI in breast cancer screening, emphasizing the need for consistency, robust evidentiary standards, technological advancements, user trust, ethical frameworks, legal safeguards, and societal benefits. These findings can serve as a blueprint for policy makers, clinicians, and AI developers to collaboratively advance AI adoption in breast cancer screening.

TRIAL REGISTRATION

PROSPERO CRD42024553889; https://tinyurl.com/mu4nwcxt.

[Clinical Ultrasound Part II - Sonopsychology or Psychological Interactions using Ultrasound]

In contrast to cross-sectional imaging using computed tomography, magnetic resonance imaging or positron emission tomography, ultrasound examinations enable direct real-time interaction between examiner and patient and their companions. In this review, we highlight general patient-relevant aspects, whereby endpoints such as emotional factors of general and physical stress caused by the examination are discussed. On the other hand, we take a closer look at specific psychosocial interactions during ultrasound examinations in primary care, gastroenterology, oncology, palliative care, pediatrics, obstetrics and gynecology. Furthermore, we consider ultrasound not only as an intervention in the sense of a needle-guiding procedure, but also as an opportunity to change relationships and initiate lifestyle modifications. The psychological impact of incidental findings and the importance of adequate communication of findings and prognosis is discussed from the patient's perspective.

Temporal evolution of MRI findings and survival outcomes in patients with brain metastases after stereotactic radiosurgery

OBJECTIVE

This study aims to investigate the temporal evolution of magnetic resonance imaging (MRI) findings in brain metastases following stereotactic radiosurgery (SRS) and their correlation with treatment response and survival outcomes. By analyzing volumetric changes in tumor size, perilesional edema, and necrotic components, we seek to identify imaging biomarkers that predict prognosis and treatment efficacy.

METHODS

A retrospective analysis was conducted on 97 patients (200 metastatic lesions) who underwent SRS for brain metastases between 2010 and 2022. Multiparametric MRI (MPMRI) scans were analyzed at four distinct follow-up periods: 1 to 3 months, 3 to 8 months, 8 to 16 months, and 16 to 24 months post-SRS. Volumetric measurements of tumor size, perilesional edema, and necrosis were obtained using semi-automated segmentation. Apparent diffusion coefficient (ADC) values and relative cerebral blood volume (rCBV) ratios were also assessed. Statistical analyses, including Kaplan-Meier survival curves and ROC analysis, were performed to determine prognostic imaging biomarkers.

RESULTS

The most significant reduction in tumor and perilesional edema volume occurred within the first 1 to 3 months post-SRS and continued until the 8th month. A transient increase in lesion size (pseudoprogression) was observed in 31.5% of cases, predominantly between 3 and 8 months post-SRS. Pretreatment tumor volume was found to be significantly associated with treatment response. ROC analysis identified 1.22 cm³ as the optimal cutoff value for differentiating between Group A (good response) and Group B (poor response) lesions (AUC = 0.754, sensitivity = 87.0%, specificity = 57.1%). Survival analysis revealed that higher pretreatment tumor volume, larger necrotic volume, and extensive perilesional edema were associated with shorter survival times (p < 0.05). No significant association was found between survival and ADC or rCBV.

CONCLUSION

Following SRS, early reductions in tumor and edema volume were observed, while 31.5% of cases showed transient enlargement. Smaller tumors responded better to SRS, whereas larger volume, extensive edema, and necrosis were linked to shorter survival. Given the high rate of pseudoprogression, not every post-treatment size increase indicates true progression. A wait-and-see approach may help avoid unnecessary interventions in selected cases.

CLINICAL TRIAL NUMBER

Not applicable.

Cerebral hemodynamics evaluation of FLAIR vascular hyperintensity in TIA patients with large artery severe stenosis or occlusion

Purpose

To assess the practicality and utility of employing dual post-label delay (PLD) arterial spin labeling (ASL) in transient ischemic attack (TIA) individuals exhibiting Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH).

Materials and methods

We conducted a retrospective review of clinical data from TIA patients presenting with unilateral severe atherosclerotic stenosis or obstruction of either the intracranial internal carotid artery or the middle cerebral artery. Participants were categorized into two groups based on the presence or absence of FVH: FVH positive and FVH negative. All individuals underwent pseudo-continuous ASL perfusion imaging, utilizing distinct PLD durations (1,525 and 2,525 ms) alongside qualitative visual assessments of ASL perfusion irregularities. Standardized TIA evaluations, which included medical history reviews, neuropsychological assessments, and ABCD2 scoring, were performed on all subjects. We explored the correlations between FVHs, clinical manifestations, vascular risk factors, and perfusion metrics.

Results

A total of 50 patients were included in this investigation, with FVH detected in 16 subjects (32.0%). The ABCD2 score was notably elevated within the FVH positive cohort compared to the FVH negative group. At a PLD of 1,525 ms, cerebral blood flow (CBF) values for the affected and healthy hemispheres in the FVH positive group were recorded at 19.55 ± 6.67 and 40.32 ± 6.83, respectively; corresponding values in the FVH negative group were 23.74 ± 5.03 and 46.43 ± 7.91. For a PLD of 2,525 ms, the CBF values for the affected and healthy sides in the FVH positive group were 34.11 ± 5.87 and 50.27 ± 8.57, while the FVH negative group recorded values of 42.79 ± 7.03 and 52.07 ± 7.29, respectively. The differential CBF (ΔCBF) for the affected side in the FVH positive and negative groups was 14.57 ± 4.34 and 19.05 ± 6.10, respectively. A significant negative correlation was established between ΔCBF and ABCD2 scores (Kendall's tau-b = -0.578, p < 0.001).

Conclusion

The findings of this study indicate a strong association between the presence of FVH signs and a marked reduction in cerebral blood flow, as well as diminished blood flow reserve. This underscores the potential role of FVH as a biomarker for hemodynamic impairment in TIA patients.

CBCT Evaluation of Maxillary Incisive Canal Characteristics Among Population in Regard to Possibility of Implant Cortical Anchorage-A Multicenter Study

Background/Objectives: Implant placement in cases of severe bone atrophy or compromised alveolar bone requires careful planning, especially in the anterior maxilla. The nasopalatine canal (NPC) and its cortical walls offer potential anchorage sites. This study evaluates the NPC's anatomical characteristics using cone beam computed tomography (CBCT) to assess its suitability for implant anchorage. Methods: A retrospective analysis of 150 CBCT scans from three dental clinics in Poland was conducted. NPC measurements-including length, width, number of canals, and distances to adjacent anatomical structures-were taken in the sagittal, coronal, and axial planes. Statistical tests included Pearson correlation and Student's t-test to explore relationships between NPC dimensions and gender. Results: The mean NPC length was 10.27 mm and mean width 3.55 mm. Significant gender differences were observed in the canal length, width, and distances to the labial and palatal plates (p < 0.05). Strong positive correlations were found between the canal width at the palate base and other parameters, such as the midpoint width (r = 0.58) and diameter (r = 0.44). The distance from the palatal opening to the labial plate showed the strongest correlation (r = 0.67), indicating enhanced cortical anchorage potential with increased canal dimensions. Discussion: NPC morphology varied (cylindrical, funnel-like, hourglass), aligning with prior studies. Larger diameters were linked to single-canal configurations. Implant placement strategies-such as direct canal insertion or lateralization-can be effective, especially with polished, single-piece implants that reduce soft tissue ingrowth and improve primary stability. Conclusions: Understanding NPC anatomy is crucial for implant planning in atrophic maxillae. With the proper technique, NPC use for cortical anchorage is a viable treatment option.

Insights into radiomics: a comprehensive review for beginners

Radiomics and artificial intelligence (AI) are rapidly evolving, significantly transforming the field of medical imaging. Despite their growing adoption, these technologies remain challenging to approach due to their technical complexity. This review serves as a practical guide for early-career radiologists and researchers seeking to integrate radiomics into their studies. It provides practical insights for clinical and research applications, addressing common challenges, limitations, and future directions in the field. This work offers a structured overview of the essential steps in the radiomics workflow, focusing on concrete aspects of each step, including indicative and practical examples. It covers the main steps such as dataset definition, image acquisition and preprocessing, segmentation, feature extraction and selection, and AI model training and validation. Different methods to be considered are discussed, accompanied by summary diagrams. This review equips readers with the knowledge necessary to approach radiomics and AI in medical imaging from a hands-on research perspective.

The role of echocardiography in the diagnosis of heart failure with preserved ejection fraction

Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common form of HF in older adults. While manifest as distinct clinical phenotypes, almost all patients with HFpEF will present with exercise intolerance or exertional dyspnea. Distinguishing HFpEF from other clinical conditions remains challenging, as the accurate diagnosis of HFpEF involves integrating a diverse array of cardiovascular (CV) structural and physiologic inputs. Owing to its intrinsic ability to characterize the structure and function of the myocardium, cardiac valves, pericardium, and vasculature, echocardiography (TTE) has emerged as an essential modality for diagnosing HFpEF. In contrast to HF with reduced EF, however, no single TTE variable defines HFpEF. Abnormal diastolic function is typically associated with HFpEF, but "diastolic dysfunction" per se is not synonymous with "HFpEF": the pathophysiology of HFpEF is more complex than diastolic dysfunction alone. HFpEF may involve abnormalities at multiple loci within the CV system, including (1) dysfunction of the left ventricle, left atrium, or right ventricle; (2) pulmonary hypertension or pulmonary vascular disease; (3) pericardial restraint; (4) abnormal systemic vascular impedance; (5) coronary or peripheral microcirculatory dysfunction; and (6) defects of tissue oxygen uptake within the periphery. Thus, the accurate diagnosis of HFpEF - and its specific clinical phenotypes - requires diagnostic algorithms that comprise multiple clinical variables, many of which may be derived from TTE data. Refining such algorithms to better discriminate among specific HFpEF phenotypes is the subject of continued investigation.

Beta-band power modulation in the human amygdala during a Direct Reach arm reaching task

The human amygdala is primarily known for its involvement in processing emotional and fearful responses, but newer evidence has identified a role for this structure in motor processing. Our lab previously utilized an arm-reaching task and observed significant beta-band (13-30 Hz) modulation in the hippocampus. Given these results, we sought to characterize the role of beta-band modulation in the amygdala during movement execution in participants with stereoelectroencephalography (SEEG) depth electrodes in the amygdala for seizure localization. We show that 9 of 13 participants (69.2 %) showed decreased beta-band power in the amygdala during the Response (movement execution) phase of an arm-reaching task when compared to Fixation (baseline). Secondary analyses show that there are no statistically significant differences in beta-band modulation between ipsilateral and contralateral implanted electrodes, but there is a small difference between male and female participants. The decrease in beta-band power in the amygdala during the Response phase of a Direct Reach task is consistent with our previous findings in the hippocampus. Our study is the first to report beta-band modulation in the amygdala during motor processing and sets the stage for further studies into the involvement of the amygdala in motor control.

A systematic review and meta-analysis of the utility of quantitative, imaging-based approaches to predict radiation-induced toxicity in lung cancer patients

BACKGROUND AND PURPOSE

To conduct a systematic review and meta-analysis of the performance of radiomics, dosiomics and machine learning in generating toxicity prediction in thoracic radiotherapy.

MATERIALS AND METHODS

An electronic database search was conducted and dual-screened by independent authors to identify eligible studies for systematic review and meta-analysis. Data was extracted and study quality was assessed using TRIPOD for machine learning studies, RQS for Radiomics and RoB for dosiomics.

RESULTS

10,703 studies were identified, and 5,252 entered screening. 104 studies including 23,373 patients were eligible for systematic review. Primary toxicity predicted was radiation pneumonitis (81), followed by esophagitis (12) and lymphopenia (4). Fourty-two studies studying radiation pneumonitis were eligible for meta-analysis, with pooled area-under-curve (AUC) of 0.82 (95% CI 0.79-0.85). Studies with machine learning had the best performance, with classical and deep learning models having similar performance. There is a trend towards an improvement of the performance of models with the year of publication. There is variability in study quality among the three study categories and dosiomic studies scored the highest among these. Publication bias was not observed.

CONCLUSION

The majority of existing literature using radiomics, dosiomics and machine learning has focused on radiation pneumonitis prediction. Future research should focus on toxicity prediction of other organs at risk and the adoption of these models into clinical practice.

Evaluation of focused ultrasound modulation of the blood-brain barrier in gray and white matter

RATIONALE

Focused ultrasound (FUS) in combination with intravenous microbubbles is being studied clinically for modulation of the blood-brain barrier. Contrast-enhanced MRI can be used to visualize the enhanced permeability resulting from the treatment. However, contrast enhancement in the white matter (WM) are inconsistently observed compared to the gray matter (GM). Intrinsic tissue differences are believed to result in reduced treatment efficacy and insufficient drug delivery to the WM. In this study we evaluate the deposition of MRI contrast and clinically relevant antineoplastics in GM and WM tissues following single and repeated FUS and microbubble treatments.

METHODS

The brains of Fischer-344 rats (n = 24) and Yorkshire pigs (n = 6) underwent FUS (rats: 580 kHz; pigs: 220 kHz) treatments targeting the internal capsule and thalamus, repeated at 30-min intervals. Definity microbubbles (rats: 20 μL/kg bolus; pigs: 4 μL/kg/5-min infusion) were administered intravenously for each sonication with MRI contrast to measure gadolinium-mediated signal change. Feedback-controlled algorithms were used to monitor treatments and modulate the pressure based on emitted microbubble signals to ensure safe and effective exposures. The delivery of methotrexate (MTX; 454.4 Da) and bevacizumab (BVZ; 149 kDa) was evaluated via immunofluorescence microscopy in rats, and respectively quantified via liquid chromatography mass spectrometry and enzyme-linked immunosorbent assay in pigs.

RESULTS

Repeated FUS exposures successfully increased the vascular permeability of both gray and white matter tissues to MRI contrast and drugs of both small and large molecular sizes. In rats, single treatments showed statistically significant higher enhancements in the GM (23.5 ± 4.3 %; WM: 4.68 ± 3.75 %), however following a second sonication there were no between-tissue differences (GM: 38.0 ± 6.4 %; WM: 34.0 ± 8.7 %). In pigs, the smaller focus size relative to the brain enabled separate targeting of GM vs WM and the treatment controller used higher average power level in the WM to achieve the same cavitation dose. This resulted in no difference in gray and white matter permeability levels (to both contrast and pharmacological agents) after a single sonication. Repeated treatments sustained MRI enhancements for a longer time and enhanced drug deposition (MTX increased 6.5 and 8.3 folds after single and repeated treatment; BVZ increased 6.8 and 20.4 folds respectively).

CONCLUSIONS

Feedback-controlled algorithms and the possibility to individually target gray and white matter highlighted the impact of tissue composition on treatment outcomes. Repeated FUS-mediated modulation of the brain microvasculature achieved higher levels of permeabilization to contrast and pharmacological agents in both gray and white matter.

Comparison of Tumor Cell Responses to Different Radiotherapy Techniques: Three-Dimensional Conformal Radiotherapy (3D-CRT), Volumetric Modulated Arc Therapy (VMAT), and Helical Tomotherapy (HT)

Currently, advanced RT techniques such as VMAT and HT are being developed to optimize tumor coverage while minimizing radiation exposure to the surrounding organs that are at risk. Despite their growing clinical use, comparative studies evaluating the dosimetric and radiobiological effects of these modalities remain limited. In this study, A549, HeLa, and HepG2 cells were exposed to a single 2 Gy dose, using three RT techniques (3D-CRT, dual arc VMAT, and HT). Treatment plans were generated using a water phantom to ensure consistent target coverage and comparable dosimetric parameters across the techniques. Multiple radiobiological endpoints were assessed to evaluate the cellular responses. Although all three techniques yielded similar dosimetric parameters without statistically significant differences, the biological responses varied among the cell lines. Notably, VMAT and HT demonstrated superior tumor cell suppression compared to 3D-CRT. This was likely due to their enhanced dose conformity and modulation precision, which potentially led to improved tumor cell killing. These findings highlight the importance of integrating radiobiological assessments with physical dose metrics to inform the clinical application of advanced RT technologies. However, this study had several limitations. The use of a single radiation dose limited its clinical relevance, and the immediate post-irradiation assessments may not have captured delayed biological responses. Additionally, the small number of replicates may have reduced the study's statistical power. Future studies incorporating dose fractionation schemes, time course analyses, and larger sample sizes are warranted to better simulate clinical conditions and further elucidate the radiobiological effects of advanced RT techniques.

Perspective on Renal Involvement in Antiphospholipid Syndrome: Implications for Diagnosis, Pathogenesis, and Treatment

Antiphospholipid syndrome (APS) can affect the kidneys, leading to renal artery and vein thrombosis, allograft loss following transplantation, and microvascular damage referred to as aPL-nephropathy (aPL-N). APL-N is a complex and frequently underdiagnosed condition characterized by an incomplete understanding of its etiopathogenesis and associated with unfavorable renal outcomes. The 2023 ACR/EULAR classification criteria for APS included aPL-N within the microvascular domain. The gold standard for aPL-N is the biopsy, revealing lesions associated with acute thrombotic microangiopathy and chronic vascular changes. Nevertheless, reluctance for biopsies due to anticoagulation and thrombocytopenia underscores the need for noninvasive diagnostics. Common clinical features include hypertension, microscopic hematuria, proteinuria, and renal insufficiency. Antiphospholipid antibodies seem crucial to kidney damage through thrombotic and inflammatory processes. Studies and experimental models of thrombotic microangiopathy lesions suggest the involvement of the complement cascade, tissue factor, and mammalian target of the rapamycin complex activation pathway. Currently, the management of aPL-N is based mainly on expert opinion, with limited evidence supporting the use of anticoagulants, leading to controversy in their application. Treatment may include heparin, intravenous immunoglobulin, plasma exchange, and targeted therapies tailored to aPL-N mechanisms. Future multicenter studies are essential to clarify their roles. The goal of this review is to inform clinicians and create a research agenda to address the unmet needs in diagnosing and managing APL-N.

Implementing appropriateness criteria for use of imaging technology (Project ACUITY) in magnetic resonance imaging of the lumbar spine: a Singapore experience

INTRODUCTION

Uncomplicated acute low back pain is usually self-limiting and does not warrant imaging. However, despite current recommendations, many patients continue to receive spinal imaging, increasing healthcare costs. The Ministry of Health, Singapore, convened a multidisciplinary workgroup to develop a consensus guideline on magnetic resonance imaging (MRI) of the lumbar spine (Agency for Care Effectiveness [ACE] guideline) for low back pain that was incorporated into electronic radiology order forms. We analysed the MRI orders following implementation of the guideline.

METHODS

A list of 'appropriate' and 'inappropriate' indications was developed based on existing literature. These indications were inserted into the MRI of the lumbar spine request form within the electronic system. It was mandatory for clinicians to specify on a drop-down list of indications. For 'inappropriate' indications, clinicians are required to fill out a free-text 'pop up' elaborating on their clinical reasoning for the MRI request.

RESULTS

Baseline pre-intervention data were collected over 3 months. A total of 492 MRI scans were performed with 64 (13.0%) inappropriate orders. Post-intervention, we retrospectively analysed two sets of data over 3 months each in 2021 and 2022. In 2021, there were 86 (9.1%) inappropriate orders out of 940 scans performed. In 2022, there were 38 (7.3%) inappropriate studies out of 521 scans performed. There was a statistically significant overall decrease in inappropriate scans from 13.0% pre-intervention to 7.3% post-intervention ( P = 0.01). Among all the 124 inappropriate studies post-intervention, only one patient eventually required surgery.

CONCLUSION

Our study demonstrates the positive impact of implementing a local guideline through electronic medical records in reducing inappropriate MRI of the lumbar spine for low back pain. Further studies on the impact of other behavioural nudges are recommended.

Emerging use of pulmonary artery and cardiac pressure sensing technology in the management of worsening heart failure events

Unplanned admissions for worsening heart failure (WHF) are the largest resource cost in heart failure (HF) management. Despite advances in pharmacological agents and interventional therapy, HF remains a global epidemic. One crucial-and costly-gap in HF management is the inability to obtain objective information to identify and quantify congestion and personalize treatment plans to effectively manage WHF events without resorting to expensive, invasive methods. Although the causes of WHF are varied and complex, the universal effect of HF decompensation is the significant decline in quality of life due to symptoms of hypervolemic congestion and the resultant reduction in cardiac output, which can be quantified via increased pulmonary venous congestion due to high intracardiac filling pressures. Accessible and reliable markers of congestion could more precisely quantify the severity of WHF events and stabilize patients earlier by interrupting and reversing this process with timely introduction or modification of evidence-based treatments. Pulmonary artery and cardiac pressure sensing tools have gained evidential credence and increased clinical uptake in recent years for the prevention and treatment of WHF, as studies of implantable hemodynamic devices have iteratively and reliably demonstrated substantial reductions in WHF events. Recent advances in sensing technologies have ranged from single-parameter invasive pulmonary artery monitors to completely non-invasive multi-parameter devices incorporating multi-sensor concept technologies aided by machine learning or artificial intelligence, although many remain investigational. This review aims to evaluate the potential for novel pulmonary artery and cardiac pressure sensing technology to reshape the management of WHF from within the hospitalized and ambulatory care environments.

Inherited transthyretin cardiac amyloidosis presenting with diastolic heart failure and gastrointestinal symptoms: a case report and literature review

The prevalence of Inherited transthyretin cardiac amyloidosis (hATTR-CA) is rising with an aging population and more mutation carriers. Its symptoms often resemble other heart diseases, leading to delayed diagnosis and affecting prognosis. With the advancement of noninvasive diagnostic methods, early detection and targeted treatment of hATTR-CA are becoming possible. However, better clinical awareness and diagnostic capabilities are still needed. This article reports a typical case of a 70-year-old man diagnosed with hATTR-CA. The patient presented with cardiac symptoms, including chronic chest tightness, breathlessness, and hypotension, as well as extracardiac symptoms such as chronic diarrhea. He also experienced two episodes of syncope, with symptoms progressively worsening. The diagnosis of hATTR-CA was confirmed following a comprehensive diagnostic work-up, including ECG, ambulatory blood pressure monitoring, echocardiography, cardiac magnetic resonance (CMR), bone scintigraphy, and genetic testing, in accordance with current guidelines. The patient has been treated with tafamidis, a transthyretin (TTR) tetramer stabilizer, for 3 months. While there was no significant improvement in ECG and echocardiography, the patient reported a marked reduction in chest tightness, breathlessness, hypotension, and gastrointestinal symptoms compared to before treatment. This case, along with a literature review, explores the clinical features, diagnostic methods, and treatment strategies of the disease, highlighting the importance of early diagnosis for prognosis, particularly the role of imaging in diagnosis.

The Effect of White Matter Hyperintensity Burden on Antidepressant Treatment Remission: A Meta-Analysis

OBJECTIVE

Depression is a common problem among older adults and is further exacerbated by poor antidepressant treatment response and remission. The vascular depression hypothesis suggests that cerebrovascular disease and executive dysfunction are main contributors to treatment nonresponse in older adults. While a previous meta-analysis has demonstrated the effects of executive dysfunction on treatment response, similar techniques have not been used to address the relationship between cerebrovascular disease and treatment response or remission. The purpose of this meta-analysis was to rigorously evaluate well-controlled antidepressant treatment trials to determine the relationship between cerebrovascular disease and antidepressant treatment remission.

METHODS

A MEDLINE search was conducted to identify regimented antidepressant treatment trials contrasting white matter hyperintensity (WMH) burden between remitters and nonremitters. Regimented treatment trials for depressed outpatients aged 50 and older that had a pretreatment measure of WMH burden and remitter/nonremitter comparison were included. Log odds ratio (LOR) was calculated for each trial's treatment effect. A Bayesian meta-analysis was used to estimate an aggregate effect size.

RESULTS

Seven studies met inclusion criteria. There was a significant, negative effect of WMH burden on antidepressant remission status (LOR = -0.62, 95% CI: -1.14, -0.14; z = -2.48, p = 0.013).

CONCLUSION

Depressed older adults with high cerebrovascular burden are 35% less likely to remit compared to depressed older adults with low or no levels of cerebrovascular disease. Results suggest that it may be important to consider vascular depression as a distinct treatment target of alternate interventions.

Potential of artificial intelligence for radiation dose reduction in computed tomography -A scoping review

INTRODUCTION

Artificial intelligence (AI) is now transforming medical imaging, with extensive ramifications for nearly every aspect of diagnostic imaging, including computed tomography (CT). This current work aims to review, evaluate, and summarise the role of AI in radiation dose optimisation across three fundamental domains in CT: patient positioning, scan range determination, and image reconstruction.

METHODS

A comprehensive scoping review of the literature was performed. Electronic databases including Scopus, Ovid, EBSCOhost and PubMed were searched between January 2018 and December 2024. Relevant articles were identified from their titles had their abstracts evaluated, and those deemed relevant had their full text reviewed. Extracted data from selected studies included the application of AI, radiation dose, anatomical part, and any relevant evaluation metrics based on the CT parameter in which AI is applied.

RESULTS

90 articles met the selection criteria. Included studies evaluated the performance of AI for dose optimisation through patient positioning, scan range determination, and reconstruction across various CT scans, including the abdomen, chest, head, neck, and pelvis, as well as CT angiography. A concise overview of the present state of AI in these three domains, emphasising benefits, limitations, and impact on the transformation of dose reduction in CT scanning, is provided.

CONCLUSIONS

AI methods can help minimise positioning offsets and over-scanning caused by manual errors and helped to overcome the limitation associated with low-dose CT settings through deep learning image reconstruction algorithms. Further clinical integration of AI will continue to allow for improvements in optimising CT scan protocols and radiation dose.

IMPLICATIONS FOR PRACTICE

This review underscores the significance of AI in optimizing radiation doses in CT imaging, focusing on three key areas: patient positioning, scan range determination, and image reconstruction.

Infratentorial white matter integrity as a potential biomarker for post-stroke aphasia

Traditionally, neuroimaging studies of post-stroke aphasia focus on supratentorial brain regions related to language function and recovery. However, stroke-induced lesions often distort these areas, posing a challenge for neuroimaging analyses aimed at identifying reliable biomarkers. This study seeks to explore alternative biomarkers in regions less affected by direct stroke damage, such as white matter regions below the tentorium, to overcome these methodological limitations. Diffusion tensor imaging was accomplished on 55 participants with chronic post-stroke aphasia. Focusing on regions below the tentorium, correlations were analysed between Western Aphasia Battery-Revised scores and average fractional anisotropy values. The volume of intersection between each participant's lesion and their left arcuate fasciculus was also analysed for correlations with Western Aphasia Battery-Revised scores as well. Linear regression analyses were then conducted using regions showing significant correlations as univariate predictors. After applying multiple comparisons corrections, we found that average fractional anisotropy in the middle cerebellar peduncle was positively correlated with aphasia quotient (P = 0.004), spontaneous speech (P = 0.005), auditory verbal comprehension (P = 0.004), naming and word finding (P = 0.005) and repetition (P = 0.013). Average fractional anisotropy in the left inferior cerebellar peduncle positively correlated with spontaneous speech (P = 0.018) and auditory verbal comprehension (P = 0.018). Average fractional anisotropy in the left corticospinal tract positively correlated with aphasia quotient (P = 0.019) and spontaneous speech (P = 0.005). The volume of intersection between the left arcuate fasciculus and participant lesion was negatively correlated with aphasia quotient (P = 0.014) and repetition (P = 0.002). Through linear regression analyses, average fractional anisotropy of the middle cerebellar peduncle significantly predicted aphasia quotient and all subscores. Average fractional anisotropy of the left inferior cerebellar peduncle significantly predicted all scores except repetition. Average fractional anisotropy of the left corticospinal tract significantly predicted all scores except for auditory verbal comprehension. The volume of intersection between the left arcuate fasciculus and lesions significantly predicted all scores except for auditory verbal comprehension. These findings underscore the potential of infratentorial white matter regions as biomarkers of aphasia severity, encompassing overall and specific subdomain impairment. By shifting the focus to below the tentorium, it becomes possible to find more robust targets for further research and therapeutic interventions. This approach is not only able to sidestep analytical complications posed by cortical lesions, it also opens new doors for understanding complex cerebellar mechanisms that underlie language function and recovery post-stroke.

Involvement of the Cerebellar Peduncles in FMR1 Premutation Carriers: A Pictorial Review of Their Anatomy, Imaging, and Pathology

The cerebellar peduncles (CPs) contain essential pathways connecting the cerebellum and other regions of the central nervous system, yet their role is often overlooked in daily medical practice. Individuals with the FMR1 premutation are at risk of developing fragile X-associated tremor/ataxia syndrome (FXTAS), a late-onset neurodegenerative disorder. The major clinical and radiological signs of FXTAS are cerebellar gait ataxia, intention tremor, and T2-weighted MRI hyperintensity of the middle cerebellar peduncle (MCP sign). Over the years, metabolic and structural abnormalities have also been described in the CPs of FMR1 premutation carriers, with some being associated with CGG repeat length and FMR1 mRNA levels. Evidence seems to associate the clinical disfunction observed in FXTAS with MCP abnormalities. However, other tracts within the different CPs may also contribute to the symptoms observed in FXTAS. By integrating imaging and pathological data, this review looks to enhance the understanding of the functional anatomy of the CPs and their involvement in different pathological entities, with special interest in premutation carriers and FXTAS. This review, therefore, aims to provide accessible knowledge on the subject of the CPs and their functional anatomy through detailed diagrams, offering a clearer understanding of their role in FMR1 premutation.