Clinical practice guidelines for the diagnosis and management of Charcot-Marie-Tooth disease

INTRODUCTION

Charcot-Marie-Tooth disease (CMT) is classified according to neurophysiological and histological findings, the inheritance pattern, and the underlying genetic defect. The objective of these guidelines is to offer recommendations for the diagnosis, prognosis, follow-up, and treatment of this disease in Spain.

MATERIAL AND METHODS

These consensus guidelines were developed through collaboration by a multidisciplinary panel encompassing a broad group of experts on the subject, including neurologists, paediatric neurologists, geneticists, physiatrists, and orthopaedic surgeons.

RECOMMENDATIONS

The diagnosis of CMT is clinical, with patients usually presenting a common or classical phenotype. Clinical assessment should be followed by an appropriate neurophysiological study; specific recommendations are established for the parameters that should be included. Genetic diagnosis should be approached sequentially; once PMP22 duplication has been ruled out, if appropriate, a next-generation sequencing study should be considered, taking into account the limitations of the available techniques. To date, no pharmacological disease-modifying treatment is available, but symptomatic management, guided by a multidiciplinary team, is important, as is proper rehabilitation and orthopaedic management. The latter should be initiated early to identify and improve the patient's functional deficits, and should include individualised exercise guidelines, orthotic adaptation, and assessment of conservative surgeries such as tendon transfer. The follow-up of patients with CMT is exclusively clinical, and ancillary testing is not necessary in routine clinical practice.

Evaluation of the mandibular canal and the third mandibular molar relationship by CBCT with a deep learning approach

OBJECTIVE

The mandibular canal (MC) houses the inferior alveolar nerve. Extraction of the mandibular third molar (MM3) is a common dental surgery, often complicated by nerve damage. CBCT is the most effective imaging method to assess the relationship between MM3 and MC. With advancements in artificial intelligence, deep learning has shown promising results in dentistry. The aim of this study is to evaluate the MC-MM3 relationship using CBCT and a deep learning technique, as well as to automatically segment the mandibular impacted third molar, mandibular canal, mental and mandibular foramen.

METHODS

This retrospective study analyzed CBCT data from 300 patients. Segmentation was used for labeling, dividing the data into training (n = 270) and test (n = 30) sets. The nnU-NetV2 architecture was employed to develop an optimal deep learning model. The model's success was validated using the test set, with metrics including accuracy, sensitivity, precision, Dice score, Jaccard index, and AUC.

RESULTS

For the MM3 annotated on CBCT, the accuracy was 0.99, sensitivity 0.90, precision 0.85, Dice score 0.85, Jaccard index 0.78, AUC value 0.95. In MC evaluation, accuracy was 0.99, sensitivity 0.75, precision 0.78, Dice score 0.76, Jaccard index 0.62, AUC value 0.88. For the evaluation of mental foramen; accuracy 0.99, sensitivity 0.64, precision 0.66, Dice score 0.64, Jaccard index 0.57, AUC value 0.82. In the evaluation of mandibular foramen, accuracy was found to be 0.99, sensitivity 0.79, precision 0.68, Dice score 0.71, and AUC value 0.90. Evaluating the MM3-MC relationship, the model showed an 80% correlation with observer assessments.

CONCLUSION

The nnU-NetV2 deep learning architecture reliably identifies the MC-MM3 relationship in CBCT images, aiding in diagnosis, surgical planning, and complication prediction.

Current and potential methods to assess kidney structure and morphology in term and preterm neonates

After birth, the kidney structure in neonates adapt to the functional demands of extrauterine life. Nephrogenesis is complete in the third trimester, but glomeruli, tubuli, and vasculature mature with the rapidly increasing renal blood flow and glomerular filtration. In preterm infants, nephrogenesis remains incomplete and maturation is slower and may be aberrant. This structural and functional deficit has life-long consequences: preterm born individuals are at higher risk for chronic kidney disease and arterial hypertension later in life. This review assembles the literature on existing and potential methods to visualize neonatal kidney structure and morphology and explore their potential to longitudinally document the developmental deviation after preterm birth. X-rays with and without contrast, fluoroscopy and computed tomography (CT) involve relevant ionizing radiation exposure and, apart from CT, do not provide sufficient structural details. Ultrasound has evolved into a safe and noninvasive high-resolution imaging method which is excellent for longitudinal observations. Doppler ultrasound modes can characterize and quantify blood flow to and through the kidneys. Microvascular flow imaging has opened new possibilities of visualizing previously unseen vascular structures. Recent advances in magnetic resonance imaging display renal structure and function in unprecedented detail, but are offset by the logistical challenges of the imaging procedure and limited experience with the new techniques in neonates. Kidney biopsies visualize structure histologically, but are too invasive and remain anecdotal in newborns. All the explored methods have predominantly been examined in term newborns and require further research on longitudinal structural observation in the kidneys of preterm infants.

2D echocardiography video to 3D heart shape reconstruction for clinical application

Transthoracic Echocardiography (TTE) is a crucial tool for assessing cardiac morphology and function quickly and non-invasively without ionising radiation. However, the examination is subject to intra- and inter-user variability and recordings are often limited to 2D imaging and assessments of end-diastolic and end-systolic volumes. We have developed a novel, fully automated machine learning-based framework to generate a personalised 4D (3D plus time) model of the left ventricular (LV) blood pool with high temporal resolution. A 4D shape is reconstructed from specific 2D echocardiographic views employing deep neural networks, pretrained on a synthetic dataset, and fine-tuned in a self-supervised manner using a novel optimisation method for cross-sectional imaging data. No 3D ground truth is needed for model training. The generated digital twins enhance the interpretation of TTE data by providing a versatile tool for automated analysis of LV volume changes, localisation of infarct areas, and identification of new and clinically relevant biomarkers. Experiments are performed on a multicentre dataset that includes TTE exams of 144 patients with normal TTE and 314 patients with acute myocardial infarction (AMI). The novel biomarkers show a high predictive value for survival (area under the curve (AUC) of 0.82 for 1-year all-cause mortality), demonstrating that personalised 3D shape modelling has the potential to improve diagnostic accuracy and risk assessment.

Challenges in detecting various peri-implant bone defects on modified intraoral oblique radiographic projections: evaluation of an artificial mandibular model

OBJECTIVE

The objective of this study was to evaluate the effectiveness of oblique radiographic projection using the intraoral paralleling technique in detecting various peri-implant bone defects.

METHODS

Artificial mandibular models with appropriate radiopacity were created. An alveolar bone model without bone defects and models with 12 types of peri-implant bone defects (buccal, circumferential, and mixed types with different widths and depths) were created. A total of 273 images were obtained with orthoradial projections and 10-, 20-, and 30-degree oblique projections using a modified receptor holder. Two observers independently evaluated the images to detect bone defects. The grayscale values (GVs) of the peri-implant region and the adjacent area were measured and compared. The relationship between the GV and the observers' results was examined. The area under the curve (AUC) and inter-observer agreement were calculated.

RESULTS

Circumferential and mixed bone defects were detected on the orthoradial projections, while buccal defects were not detected. However, the detection of buccal defects was markedly improved using the oblique projections. In particular, the highest detection rates were obtained using the 20-degree oblique projection. There were no significant correlations between the GV and the bone defect detection rate. The AUCs for the two observers were 0.712 and 0.669. The inter-observer agreement was 0.502.

CONCLUSIONS

Compared with orthoradial projections, the use of oblique projection images greatly improved the ability of observers to detect peri-implant bone defects on the buccal side. The results provide new evidence for the selection of radiographic images in the follow-up of implant treatment.

Multiple b value diffusion-weighted MRI of liver: A novel respiratory frequency-modulated continuous-wave radar-trigger technique and comparison with free-breathing technique

OBJECTIVE

The aim of this study was to evaluate a novel respiratory frequency-modulated continuous-wave radar-trigger (FT) technique for multiple -b-value diffusion-weighted imaging (DWI) of liver and compare it with conventional free breathing (FB) DWI technique.

MATERIAL AND METHODS

39 patients with focal liver lesions underwent both frequency-modulated continuous-wave radar-trigger (FT) and conventional free-breathing (FB) multi-b-value diffusion-weighted imaging (DWI,b = 0,50,400,800 s/mm2). Two abdominal radiologists independently assessed the quality of liver DWI images obtained using both techniques, measured and compared liver signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) at different b-values, as well as apparent diffusion coefficient (ADC) values calculated from all b-values.

RESULTS

In terms of image quality, the FT technique is superior to the conventional FB technique, with overall image quality scores (Reader 1, 3.56 ± 0.50 and Reader 2, 3.59 ± 0.55)vs (Reader 1, 2.90 ± 0.75 and Reader 2, 2.97 ± 0.71), respectively. The liver SNR (at b-values of 50,400,and 800 s/mm2) obtained by FT was (138.5 ± 43.48, 96.67 ± 31.95, 71.54 ± 22.03), respectively, which was significantly higher than that obtained by conventional FB (110.90 ± 39.28, 80.86 ± 29.13, 60.43 ± 18.61, P < 0.05). The lesion CNR with FT was significantly higher than that with conventional FB (258.99 ± 151.38 vs 174.60 ± 99.90; 164.56 ± 87.25 vs 111.12 ± 42.43; 118.83 ± 68.76 vs 76.01 ± 35.48, P < 0.001). There was no significant difference in ADC values of liver and lesions between the two techniques: ADCliver-L and ADCliver-R: (FT 1479.3 ± 270.0 vs FB 1529.3 ± 275.5 and FT 1219.6 ± 127.4 vs FB 1248.7 ± 168.2, P > 0.05); ADC lesion:FT(969.0 ± 261.3) vs FB (1017.5 ± 240.4, P > 0.05).

CONCLUSION

For multi-b-value liver diffusion-weighted imaging, FT technique has higher image quality and better lesion visibility than conventional FB technique and there is no significant difference in ADC values of liver and lesions between the two techniques.

Interrater Agreement of Physicians Identifying Lung Sliding Artifact on B-Mode And M-Mode Point of Care Ultrasound (POCUS)

Background

Chest point of care ultrasound (POCUS) is a first-line diagnostic test to identify lung sliding, an important artifact to diagnose or rule out pneumothorax. Despite enthusiastic adoption of this modality, the interrater reliability for physicians to identify lung sliding is unknown. Additionally, the relative diagnostic performance of physicians interpreting B-mode and M-mode ultrasound is unclear. We sought to determine the interrater reliability of physicians to detect lung sliding on B-mode and M-mode POCUS.

Methods

We performed a cross-sectional interrater agreement study surveying acute care physicians on their interpretation of 20 B-mode and M-mode POCUS clips. Two experienced clinicians determined the reference standard diagnosis. Respondents reported their interpretation of each POCUS B-mode clip or M-mode image. The primary outcome was the interrater agreement, determined by an intra-class correlation coefficient (ICC).

Results

From September to November 2023, there were 20 survey respondents. Fourteen (70%) respondents were resident physicians. Respondents were confident or very confident in their skill performing chest POCUS in 14 (70%) cases, with 19 (90%) performing chest POCUS every week or more frequently. The ICC on B-mode was 0.44 and for M-mode was 0.43, indicating moderate agreement. There were no significant differences in interrater reliability between subgroups of confidence or experience.

Conclusion

There is only moderate interrater reliability between clinicians to diagnose lung sliding. Clinicians have superior accuracy on B-mode compared to M-mode clips.

Can deep learning classify cerebral ultrasound images for the detection of brain injury in very preterm infants?

OBJECTIVES

Cerebral ultrasound (CUS) is the main imaging screening tool in preterm infants. The aim of this work is to develop deep learning (DL) models that classify normal vs abnormal CUS to serve as a computer-aided detection tool providing timely interpretation of the scans.

METHODS

A population-based cohort of very preterm infants (220-306 weeks) born between 2004 and 2016 in Nova Scotia, Canada. A set of nine sequential CUS images per infant was retrieved at three specific coronal landmarks at three pre-identified times (first, sixth weeks, and term age). A radiologist manually labeled each image as normal or abnormal. The dataset was split into training/development/test subsets (80:10:10). Different convolutional neural networks were tested, with filtering of the most uncertain prediction. The model's performance was assessed using precision/recall and the receiver operating area under the curve.

RESULTS

Sequential CUS retrieved for 538/665 babies (81% of the cohort). Four thousand one hundred eighty images were used to develop and test the model. The model performance was only discrete at the beginning but, through different machine learning strategies was boosted to good levels averaging 0.86 ROC AUC (95% CI: 0.82, 0.90) and 0.87 PR AUC (95% CI: 0.84, 0.90) (model uncertainty estimation filters using normalized entropy threshold = 0.5).

CONCLUSION

This study offers proof of the feasibility of applying DL to CUS. This basic diagnostic model showed good discriminative ability to classify normal versus abnormal CUS. This serves as a CAD and a framework for constructing a prognostic model.

CLINICAL RELEVANCE STATEMENT

This DL model can serve as a computer-aided detection tool to classify CUS of very preterm babies as either normal or abnormal. This model will also be used as a framework to develop a prognostic model.

KEY POINTS

Binary computer-aided detection models of CUS are applicable for classifying ultrasound images in very preterm babies. This model acts as a step towards developing a model for predicting neurodevelopmental outcomes in very preterm babies. This model serves as a tool for interpretation of CUS in this patient population with a heightened risk of brain injury.

Clinical TNM Lung Cancer Staging: A Diagnostic Algorithm with a Pictorial Review

Lung cancer is a prevalent malignant disease with the highest mortality rate among oncological conditions. The assessment of its clinical TNM staging primarily relies on contrast-enhanced computed tomography (CT) of the thorax and proximal abdomen, sometimes with the addition of positron emission tomography/CT scans, mainly for better evaluation of mediastinal lymph node involvement and detection of distant metastases. The purpose of TNM staging is to establish a universal nomenclature for the anatomical extent of lung cancer, facilitating interdisciplinary communication for treatment decisions and research advancements. Recent studies utilizing a large international database and multidisciplinary insights indicate a need to update the TNM classification to enhance the anatomical categorization of lung cancer, ultimately optimizing treatment strategies. The eighth edition of the TNM classification, issued by the International Association for the Study of Lung Cancer (IASLC), transitioned to the ninth edition on 1 January 2025. Key changes include a more detailed classification of the N and M descriptor categories, whereas the T descriptor remains unchanged. Notably, the N2 category will be split into N2a and N2b based on the single-station or multi-station involvement of ipsilateral mediastinal and/or subcarinal lymph nodes, respectively. The M1c category will differentiate between single (M1c1) and multiple (M1c2) organ system involvement for extrathoracic metastases. This review article emphasizes the role of radiologists in implementing the updated TNM classification through CT imaging for correct clinical lung cancer staging and optimal patient management.

Intraoperative Ultrasound Guidance in Laparoscopic Adrenalectomy: A Retrospective Analysis of Perioperative Outcomes

Background: This study aimed to evaluate the advantages of integrating intraoperative ultrasound (IOUS) into laparoscopic adrenal surgery by assessing its impact on perioperative outcomes and identifying potential complications. Methods: This retrospective study analyzed 128 patients with adrenal gland tumors who underwent a laparoscopic adrenalectomy by comparing those who received intraoperative ultrasound guidance with those who did not. The procedures were performed using either the transperitoneal or the lateral retroperitoneal approach. Results: The IOUS-guided group had significantly lower blood loss (p < 0.001) and a shorter hospitalization duration (p = 0.005) compared with the non-IOUS group. No intraoperative complications were observed in the IOUS group, whereas three complications occurred in the non-IOUS group, including peritoneal breaches and minor liver damage. The retroperitoneal approach demonstrated superior perioperative outcomes, with a shorter operative time (p < 0.001), reduced blood loss (p < 0.001), earlier resumption of oral intake and lower postoperative analgesia requirements (p < 0.001). Conclusions: Intraoperative ultrasound enhanced the surgical precision in laparoscopic adrenalectomy, which reduced the blood loss, shortened the hospital stays and minimized the intraoperative complications.

Complications and Outcomes of Chemically Treated Allograft in Preadolescent and Adolescent Patients Undergoing Medial Patellofemoral Ligament Reconstruction

Background

Chemically treated allografts (CTAs) have been developed with the goal of providing a graft that is fully sterilized while maintaining the structural integrity and biochemical properties of the graft without irradiation. Few studies have analyzed the complications and postoperative outcomes of CTA in medial patellofemoral ligament (MPFL) reconstruction.

Hypothesis

The rate of complications and the outcomes of pediatric patients undergoing MPFL reconstruction would be similar between CTAs and low-dose irradiated allografts (IAs).

Study Design

Cohort study; Level of evidence, 3.

Methods

The medical charts of a consecutive cohort of pediatric patients (aged 12-18 years) who underwent MPFL reconstruction at a single center from June 2011 to September 2022 with either 1- or 2-year follow-up were retrospectively reviewed. Patient characteristics, operative data, and postoperative data were collected in those without diagnosed collagen disorder or multiligament reconstruction. Without deliberate allocation, CTAs were overwhelmingly gracilis tendon allografts, whereas the majority of IAs were semitendinosus. Complications were recorded and included infection, redislocation, and reoperation. Patient-reported outcomes were collected including the Single Assessment Numeric Evaluation score, Kujala score, overall rating of treatment satisfaction, and pain score.

Results

A total of 235 (114 CTA, 121 IA) patients had 1-year follow-up with no significant differences in complication rate noted between the cohorts (CTA: 6/114 [5.3%]; IA: 5/121 [4.1%]; P = .786). Of the entire group, 122 (60 CTA, 62 IA) patients had 2-year follow-up, with no significant differences in patient-reported outcomes between the CTA and IA cohorts at mean follow-ups of 35.9 and 38.3 months, respectively (P = .271). At a minimum 2-year follow-up, failure rates (defined as redislocation) were 5% (3/60) for the CTA group and 17.7% (11/62) for the IA group (P = .059). Reoperation rates (defined as redislocation requiring repeat operative intervention) were 5% (3/60) and 9.7% (6/62) for the CTA and IA cohorts, respectively (P = .433).

Conclusion

CTA and IA for reconstruction of the MPFL in the pediatric patient demonstrate similarly low rates of complication, patellar redislocation, and need for revision surgery. Moreover, the outcomes appear to indicate that utilization of gracilis tendon CTA carries the same risk as low-dose semitendinosus IAs when managing children with MPFL reconstruction.

Dose-Volume Constraints for Thoracic, Abdominal, and Pelvic Carbon Ion Radiotherapy: A Literature Review

BACKGROUND

Applying dose-volume constraints is extremely important in ensuring the safe use of radiotherapy. However, constraints for carbon ion radiotherapy (CIRT) have not been established yet. This review aims to summarize dose-volume constraints for thoracic, abdominal, and pelvic CIRT that have been identified through previous research based on the Japanese models for relative biological effectiveness (RBE).

RESULTS

Constraints are reported for the lungs, liver, stomach, gastrointestinal tract, rectum, sigmoid, bladder, nerves, rib, femoral head, sacrum, and skin. The constraints are classified into hard and soft to aid in determining whether priority should be given to the target coverage or organ-at-risk (OAR) sparing during treatment planning.

CONCLUSIONS

Further research is necessary to verify the applicability of the reported constraints and to identify constraints for the OARs that have not been investigated yet.

Myths and Facts About Allograft Use in Anterior Cruciate Ligament Reconstruction: A Detailed Review of the Literature

» Patient-Specific Graft Selection: Graft selection for anterior cruciate ligament reconstruction (ACLR) requires a nuanced approach that considers various patient-specific factors, such as age, activity level, comorbidities, and surgical goals. Generally, allografts are preferred for older patients with less active lifestyles, whereas autografts are more suitable for younger, active patients because of autografts' lower retear rates.» Impact of Sterilization Techniques: Sterilization and processing techniques significantly affect the biomechanical properties and outcomes of allografts. While high-dose irradiation reduces allograft strength and compromises healing, low-dose irradiation or nonirradiated grafts offer superior biomechanical and clinical outcomes. However, standardized sterilization protocols are yet to be established.» Comparative Outcomes of Allografts and Autografts: Evaluating the literature on allografts vs. autografts in ACLR remains challenging because of the significant variability in patient characteristics, outcome measures, graft strength testing, and sterilization techniques across studies.

Reproducibility of liver ADC measurements using first moment optimized diffusion imaging

PURPOSE

Cardiac-induced liver motion can bias liver ADC measurements and compromise reproducibility. The purpose of this work was to enable motion-robust DWI on multiple MR scanners and assess reproducibility of the resulting liver ADC measurements.

METHODS

First moment-optimized diffusion imaging (MODI) was implemented on three MR scanners with various gradient performances and field strengths. MODI-DWI and conventional Stejskal-Tanner monopolar (MONO) DWI were acquired in eight (N = 8) healthy volunteers on each scanner, and DWI repetitions were combined using three different averaging methods. For each combination of scanner, acquisition, and averaging method, ADC measurements from each liver segment were collected. Systematic differences in ADC values between scanners and methods were assessed with linear mixed effects modeling, and reproducibility was quantified via reproducibility coefficients.

RESULTS

MODI reduced left-right liver lobe ADC bias from 0.43 × 10-3 mm2/s (MONO) to 0.19 × 10-3 mm2/s (MODI) when simple (unweighted) repetition averaging was used. The bias was reduced from 0.23 × 10-3 mm2/s to 0.06 × 10-3 mm2/s using weighted averaging, and 0.14 × 10-3 mm2/s to 0.01 × 10-3 mm2/s using squared weighted averaging. There was no significant difference in ADC measurements between field strengths or scanner gradient performance. MODI improved reproducibility coefficients compared to MONO: 0.84 × 10-3 mm2/s vs. 0.63 × 10-3 mm2/s (MODI vs. MONO) for simple averaging, 0.66 × 10-3 mm2/s vs. 0.50 × 10-3 mm2/s for weighted averaging, and 0.61 × 10-3 mm2/s vs. 0.47 × 10-3 mm2/s for squared weighted averaging.

CONCLUSION

The feasibility of motion-robust liver DWI using MODI was demonstrated on multiple MR scanners. MODI improved interlobar agreement and reproducibility of ADC measurements in a healthy cohort.

Ultrasonographic characteristics of masseter muscle myalgia: a comparative study

OBJECTIVE

To compare the ultrasonographic characteristics of masseter muscles in temporomandibular disorder (TMD) subjects with a diagnosis of myalgia of the masticatory muscles to a control population.

METHOD

In total, 45 TMD subjects with masseter muscle myalgia according to the Diagnostic Criteria for Temporomandibular Disorders were compared with 45 control subjects. The masseter muscles of each subject were examined by ultrasonography (US) to assess the quantitative characteristic of local cross-sectional dimension (LCSD) and the qualitative parameters of intramuscular ultrasonographic appearance, anechoic areas, and isoechogenic areas.

RESULTS

Differences in mean LCSD between TMD and control subjects were not statistically significant (P = .565). Similarly, mean LCSD in the unilateral TMD subjects was not significantly different than in the bilateral TMD subjects (P = .808). The type I ultrasonographic appearance, in which fine bands are clearly visible in the muscle, was the most prevalent pattern, detected in 57.2% of muscles. Anechoic areas were present in 16.1% of muscles, and isoechogenic areas were found in 15.6% of muscles, but differences between TMD subjects and control subjects for qualitative ultrasonographic characteristics were not statistically significant (P ≥ .156).

CONCLUSION

None of the ultrasonographic characteristics were significantly different between TMD subjects and controls. Considering the limitations of the study, future research is required to assess the utility and reliability of US as a diagnostic tool for masticatory muscle myalgia.

The role of dual-energy computed tomography (DECT) in emergency radiology: a visual guide to advanced diagnostics

Dual-energy computed tomography (DECT) has become an essential tool in emergency radiology, significantly enhancing diagnostic capabilities for a variety of acute conditions. By utilising two distinct X-ray energy spectra, DECT differentiates materials based on their attenuation properties, providing detailed insights into tissue composition and pathology. In emergency settings, DECT is used in thoracic imaging for the detection of pulmonary embolism, in abdominal imaging to enhance the diagnosis and characterisation of conditions such as pancreatitis, appendicitis, gastrointestinal bleeding, and bowel ischaemia and in the genitourinary system for identifying kidney stones, pyelonephritis, and urinary bleeding. In neuroimaging, DECT enables image optimisation through virtual monochromatic images and the reduction of metal artifacts. It helps in the differential diagnosis of haemorrhage versus tumour-related haemorrhage, haemorrhage versus contrast extravasation, and in the dating of vertebral collapse. DECT offers several advantages, including enhanced visualisation, the potential to reduce radiation exposure and contrast medium, and improved diagnostic accuracy across a wide range of conditions. However, its routine clinical adoption is still evolving due to challenges such as limited availability, cost, and the need for specialised training. This pictorial essay aims to encourage the broader integration of DECT into emergency imaging protocols by showcasing its clinical applications and benefits.

A novel serum protein biomarker for the late-stage diagnosis of nasopharyngeal carcinoma

BACKGROUND

Nasopharyngeal carcinoma (NPC) is a malignant tumor prevalent in Southern China, strongly associated with Epstein-Barr virus (EBV) infection. Accurate diagnosis is critical in determining treatment strategies for NPC. In clinical practice, imaging techniques are the most predominant diagnostic methods, which are costly and may fail to detect small metastatic lesions. Moreover, while EBV antibody and DNA tests contribute to the assessment of tumor progression, they carry the risk of false negatives.

METHODS

To develop novel serum protein biomarkers for late-stage NPC diagnosis, our study included 189 samples, including healthy controls (HCs) and early- or late-stage NPC patients. A high-throughput serum proteomics approach was employed to delineate protein profiles, followed by enzyme-linked immunosorbent assay (ELISA) validation of candidate biomarkers.

RESULTS

Our study identified fibronectin 1 (FN1) as a promising serum biomarker for late-stage NPC. The serum levels of FN1 significantly decreased with tumor progression, achieving AUCs of 0.71 and 0.72 in differentiating late-stage NPC patients from HCs and early-stage NPC patients, respectively. Importantly, FN1 demonstrated diagnostic utility in challenging cases, accurately identifying all VCA-IgA-negative and 88.2% EBV DNA-negative patients with late-stage NPC. Combining FN1 with VCA-IgA or EBV DNA test significantly increased diagnostic sensitivity for advanced NPC.

CONCLUSIONS

Our discovery of FN1 as a biomarker for the late-stage diagnosis of NPC will assist in clinical treatment decisions and improve the prognosis of patients.

A Comprehensive and Repeatable Contrast-Enhanced Ultrasound Quantification Approach for Clinical Evaluations of Tumor Blood Flow

OBJECTIVE

The aim of this study is to define a comprehensive and repeatable contrast-enhanced ultrasound (CEUS) imaging protocol and analysis method to quantitatively assess lesional blood flow. Easily repeatable CEUS evaluations are essential for longitudinal treatment monitoring. The quantification method described here aims to provide a structure for future clinical studies.

MATERIALS AND METHODS

This retrospective analysis study included liver CEUS studies in 80 patients, 40 of which contained lesions (primarily hepatocellular carcinoma, n = 28). Each patient was given at least 2 injections of a microbubble contrast agent, and 60-second continuous loops were acquired for each injection to enable evaluation of repeatability. For each bolus injection, 1.2 mL of contrast was delivered, whereas continuous, stationary scanning was performed. Automated respiratory gating and motion compensation algorithms dealt with breathing motion. Similar in size regions of interest were drawn around the lesion and liver parenchyma, and time-intensity curves (TICs) with linearized image data were generated. Four bolus transit parameters, rise time ( RT ), mean transit time ( MTT ), peak intensity ( PI ), and area under the curve ( AUC ), were extracted either directly from the actual TIC data or from a lognormal distribution curve fitted to the TIC. Interinjection repeatability for each parameter was evaluated with coefficient of variation. A 95% confidence interval was calculated for all fitted lognormal distribution curve coefficient of determination ( R2 ) values, which serves as a data quality metric. One-sample t tests were performed between values obtained from injection pairs and between the fitted lognormal distribution curve and direct extraction from the TIC calculation methods to establish there were no significant differences between injections and measurement precision, respectively.

RESULTS

Average interinjection coefficient of variation with both the fitted curve and direct calculation of RT and MTT was less than 21%, whereas PI and AUC were less than 40% for lesion and parenchyma regions of interest. The 95% confidence interval for the R2 value of all fitted lognormal curves was [0.95, 0.96]. The 1-sample t test for interinjection value difference showed no significant differences, indicating there was no relationship between the order of the repeated bolus injections and the resulting parameters. The 1-sample t test between the values from the fitted lognormal distribution curve and the direct extraction from the TIC calculation found no statistically significant differences (α = 0.05) for all perfusion-related parameters except lesion and parenchyma PI and lesion MTT .

CONCLUSIONS

The scanning protocol and analysis method outlined and validated in this study provide easily repeatable quantitative evaluations of lesional blood flow with bolus transit parameters in CEUS data that were not available before. With vital features such as probe stabilization ideally performed with an articulated arm and an automated respiratory gating algorithm, we were able to achieve interinjection repeatability of blood flow parameters that are comparable or surpass levels currently established for clinical 2D CEUS scans. Similar values and interinjection repeatability were achieved between calculations from a fitted curve or directly from the data. This demonstrated not only the strength of the protocol to generate TICs with minimal noise, but also suggests that curve fitting might be avoided for a more standardized approach. Utilizing the imaging protocol and analysis method defined in this study, we aim for this methodology to potentially assist clinicians to assess true perfusion changes for treatment monitoring with CEUS in longitudinal studies.

Role of artificial intelligence in magnetic resonance imaging-based detection of temporomandibular joint disorder: a systematic review

This systematic review aimed to evaluate the application of artificial intelligence (AI) in the identification of temporomandibular joint (TMJ) disc position in normal or temporomandibular joint disorder (TMD) individuals using magnetic resonance imaging (MRI). Database search was done in Pub med, Google scholar, Semantic scholar and Cochrane for studies on AI application to detect TMJ disc position in MRI till September 2023 adhering PRISMA guidelines. Data extraction included number of patients, number of TMJ/MRI, AI algorithm and performance metrics. Risk of bias was done with modified PROBAST tool. Seven studies were included (deep learning = 6, machine learning = 1). Sensitivity values (n = 7) ranged from 0.735 to 1, while specificity values (n = 4) ranged from 0.68 to 0.961. AI achieves accuracy levels exceeding 83%. MobileNetV2 and ResNet have revealed better performance metrics. Machine learning demonstrated the lowest accuracy 74.2%. Risk of bias was low (n = 6) and high (n = 1). Deep learning models showed reliable performance metrics for AI based detection of temporomandibular joint disc position in MRI. Future research is warranted with better standardisation of design and consistent reporting.

ORACLE: An analytical approach for T1, T2, proton density, and off-resonance mapping with phase-cycled balanced steady-state free precession

PURPOSE

To develop and validate a novel analytical approach simplifyingT 1 $$ {T}_1 $$ ,T 2 $$ {T}_2 $$ , proton density (PD), and off-resonanceΔ f $$ \Delta f $$ quantifications from phase-cycled balanced steady-state free precession (bSSFP) data. Additionally, to introduce a method to correct aliasing effects in undersampled bSSFP profiles.

THEORY AND METHODS

Off-resonant-encoded analytical parameter quantification using complex linearized equations (ORACLE) provides analytical solutions for bSSFP profiles. which instantaneously quantifyT 1 $$ {T}_1 $$ ,T 2 $$ {T}_2 $$ , proton density (PD), andΔ f $$ \Delta f $$ . An aliasing correction formalism was derived to allow undersampling of bSSFP profiles. ORACLE was used to quantifyT 1 $$ {T}_1 $$ ,T 2 $$ {T}_2 $$ , PD,T 1 $$ {T}_1 $$ /T 2 $$ {T}_2 $$ , andΔ f $$ \Delta f $$ based on fully sampled (N = 20 $$ N=20 $$ ) bSSFP profiles from numerical simulations and 3T MRI experiments in phantom and 10 healthy subjects' brains. Obtained values were compared with reference scans in the same scan session. Aliasing correction was validated in subsampled (N = 4 $$ N=4 $$ ) bSSFP profiles in numerical simulations and human brains.

RESULTS

ORACLE quantifications agreed well with input values from simulations and phantom reference values (R2 = 0.99). In human brains,T 1 $$ {T}_1 $$ andT 2 $$ {T}_2 $$ quantifications when compared with reference methods showed coefficients of variation below 2.9% and 3.9%, biases of 182 and 16.6 ms, and mean white-matter values of 642 and 51 ms using ORACLE. TheΔ f $$ \Delta f $$ quantification differed less than 3 Hz between both methods. PD andT 1 $$ {T}_1 $$ maps had comparable histograms. TheΛ $$ \varLambda $$ maps effectively identified cerebrospinal fluid. Aliasing correction removed aliasing-related quantification errors in undersampled bSSFP profiles, significantly reducing scan time.

CONCLUSION

ORACLE enables simplified and rapid quantification ofT 1 $$ {T}_1 $$ ,T 2 $$ {T}_2 $$ , PD, andΔ f $$ \Delta f $$ from phase-cycled bSSFP profiles, reducing acquisition time and eliminating biomarker maps' coregistration issues.

Exploring anatomical uniqueness: A rare case report of the buccomesial groove variation in maxillary lateral incisor and its management

This case report introduces the rare anatomical variation in a maxillary lateral incisor, known as the buccomesial groove (BMG). The BMG is rare and leads to endodontic-periodontal lesions. Due to its subtle presence, funnel-shaped form, and varying depth in the root, it facilitates microbial film adhesion, leading to pathology. A 25-year-old Asian male patient presented with pain in his maxillary left lateral incisor. After comprehensive clinical and radiographic assessments, the diagnosis of pulpal necrosis with symptomatic apical periodontitis associated with BMG in the maxillary left lateral incisor was confirmed. A cone-beam computed tomography preoperatively showed the groove extending from two-thirds of the buccal to the mesial side of the left lateral incisor. This case presents a new anatomical anomaly, highlighting the necessity for precise diagnosis and treatment.

[Rectal Cancer: Optimal Preoperative Diagnostics]

Preoperative diagnostics for rectal cancer aim to determine the extent of local and systemic spread. Local staging includes rectoscopy with accurate height localisation, histological confirmation, MRI of the pelvis and, particularly in the case of localised tumours, endosonography. In addition to tumour height and possible infiltration of adjacent organs, MRI findings should include minimum tumour distance from the mesorectal fascia and MR morphological criteria for extramural vascular invasion. In the case of lower rectal cancer, the relationship to the various components of the sphincter muscle is important in planning the surgical strategy; in the case of upper rectal cancer, the MRI findings should include possible infiltration of the peritoneal fold. As outlined in the German guidelines, the basic diagnostic tests required to detect or exclude distant metastases are a chest X-ray and an abdominal ultrasound. If unclear findings are observed, these should be supplemented by a chest and abdominal CT. In addition to the carcinoembryonic antigen (CEA) test, which is primarily used for follow-up, a complete colonoscopy should be performed to rule out a second malignancy in the colon. If this is not possible due to an obstructive tumour, the colonoscopy should be performed three months postoperatively. Additionally, a preoperative CT or MR colonoscopy can reliably detect larger polyps and carcinomas.

Comparison of Echo Planar and Turbo Spin Echo Diffusion-Weighted Imaging in Intraoperative MRI

BACKGROUND

Diffusion-weighted imaging (DWI) is routinely used in brain tumor surgery guided by intraoperative MRI (IoMRI). However, conventional echo planar imaging DWI (EPI-DWI) is susceptible to distortion and artifacts that affect image quality. Turbo spin echo DWI (TSE-DWI) is an alternative technique with minimal spatial distortions that has the potential to be the radiologically preferred sequence.

PURPOSE

To compare via single- and multisequence assessment EPI-DWI and TSE-DWI in the IoMRI setting to determine whether there is a radiological preference for either sequence.

STUDY TYPE

Retrospective.

POPULATION

Thirty-four patients (22 female) aged 2-61 years (24 under 18 years) undergoing IoMRI during surgical resection of intracranial tumors.

FIELD STRENGTH/SEQUENCE

3-T, EPI-DWI, and TSE-DWI.

ASSESSMENT

Patients were scanned with EPI- and TSE-DWI as part of the standard IoMRI scanning protocol. A single-sequence assessment of spatial distortion and image artifact was performed by three neuroradiologists blinded to the sequence type. Images were scored regarding distortion and artifacts, around and remote to the resection cavity. A multisequence radiological assessment was performed by three neuroradiologists in full radiological context including all other IoMRI sequences from each case. The DWI images were directly compared with scorings of the radiologists on which they preferred with respect to anatomy, abnormality, artifact, and overall preference.

STATISTICAL TESTS

Wilcoxon signed-rank tests for single-sequence assessment, weighted kappa for single and multisequence assessment. A P-value <0.001 was considered statistically significant.

RESULTS

For the blinded single-sequence assessment, the TSE-DWI sequence was scored equal to or superior to the EPI-DWI sequence for distortion and artifacts, around and remote to the resection cavity for every case. In the multisequence assessment, all radiologists independently expressed a preference for TSE-DWI over EPI-DWI sequences on viewing brain anatomy, abnormalities, and artifacts.

DATA CONCLUSION

The TSE-DWI sequences may be favored over EPI-DWI for IoMRI in patients with intracranial tumors.

LEVEL OF EVIDENCE

2 TECHNICAL EFFICACY: Stage 5.

Comparison between 3D-Enhanced Conventional Pelvic Ultrasound and Magnetic Resonance Imaging in the Evaluation of Obstructive Müllerian Anomalies and Its Concordance with Surgical Diagnosis

STUDY OBJECTIVE

This study aimed to assess the practical application of conventional 2D pelvic ultrasound in conjunction with 3D ultrasound for evaluating obstructive Müllerian abnormalities.

DESIGN

Retrospective study in a tertiary referral hospital METHODS: Computerized stored data were used to collect surgically confirmed obstructive Müllerian anomaly cases between December 2022 and October 2023 with evaluation of presurgical imaging. Acute presentation with abdominal pain and clinical suspicion of an obstructive Müllerian abnormality were required for inclusion. All study participants underwent pelvic ultrasound before the definitive surgery, with or without a repeat MRI if one was performed before admission. Those situations where both MRI and ultrasound were not conducted were excluded, such as transverse vaginal septum, imperforate hymen, iatrogenic cervical injury, or Müllerian malformation alone without obstructive outflow anomalies such as didelphys, bicornuate, or septate uterus.

MAIN OUTCOME MEASURES

Concordance between the surgically confirmed diagnosis and the pelvic ultrasound was reported in 27 of 29 women (93.1%). In contrast, only 24 of 29 cases were correctly diagnosed with MRI in this study (82.8%). This pilot study presents a comparison of 2 techniques, with a specific focus on obstructive Müllerian anomalies. The use of pelvic ultrasound not only assisted in our surgical practice but also significantly improved patient-doctor counseling.

CONCLUSION

In managing obstructive Müllerian abnormalities, 3D-enhanced conventional pelvic ultrasound was found to be effective in diagnosis and was comparable to MRI.

Exploring utilities of [ 64 Cu]Cu-DOTA-trastuzumab immunoPET in breast cancer: a systematic review and meta-analysis

[ 64 Cu]Cu-DOTA-trastuzumab represents a novel immunopositron emission tomography (immunoPET) agent with emerging diagnostic applications in human epidermal growth factor receptor-2 (HER2)-expressing breast cancer (BC). This systematic review and meta-analysis evaluates the current diagnostic utilities of [ 64 Cu]Cu-DOTA-trastuzumab PET/computed tomography (CT) and explores tumor uptake metrics in HER2-positive BC lesions. A systematic literature search of PubMed , Scopus , and Ovid databases was conducted using relevant keywords to identify eligible studies. Of the 123 articles reviewed, six met the inclusion criteria. Qualitative data analysis was applied to all included studies. Several promising utilities were identified, including [ 64 Cu]Cu-DOTA-trastuzumab's capacity to detect HER2-positive primary BC lesions, lymph nodes, and distant metastases. Additionally, [ 64 Cu]Cu-DOTA-trastuzumab PET/CT demonstrated potential in predicting therapy response in HER2-positive lesions. The overall lesion detectability was 91% [95% confidence interval (CI), 81-98%] for HER2-positive BC. HER2-positive BC lesions exhibited significantly higher maximum standardized uptake values compared to HER2-negative lesions, with a weighted mean difference of 2.14 (95% CI, 0.18-4.09; P  = 0.03). These findings underscore the need for further large-scale and prospective investigations of this promising radiotracer in the near future.

Review of mammography screening guidelines of the 5 largest global economies

Breast cancer is the number one cancer among women globally. Breast imaging-based screening is important for the early detection of breast cancer and decreases mortality rates significantly. Breast cancer screening guidelines vary worldwide, and it is important to know about the variations in screening guidelines in different countries. Japan, China, and Germany are three countries with national screening programs only while, the United States and India have nationally recommended guidelines but not national screening programs. In this review, we aim to outline the screening guidelines in the 5 countries with the highest Gross Domestic Product and offer insights into relevant screening practices across different nations.

Impact of myosteatosis on prognosis in multiple myeloma patients: A subgroup analysis of 182 cases and development of a nomogram

Background

This study aims to explore the prognostic value of myosteatosis in multiple myeloma (MM) and to analyze the factors influencing myosteatosis.

Methods

A retrospective analysis was conducted on 182 patients treated for MM at our institution from 2009 to 2020 who underwent MRI examinations. The fatty infiltration rate (FIR) of the erector spinae and multifidus muscles at the L3 level was measured to assess the degree of myosteatosis. Patients were grouped based on fracture presence and median FIR, and group differences were compared, with P < 0.05 considered statistically significant. Survival and fractures were used as prognostic indicators, and regression analysis was performed to determine the impact of FIR on these outcomes in MM patients. The factors influencing FIR were analyzed, and the relationship between myosteatosis and MM prognosis was further analyzed within its sensitive subgroups. Finally, a nomogram based on FIR was established and validated.

Results

Significant differences were observed between the fracture and non-fracture groups in lactate dehydrogenase, serum phosphorus, visual analogue scale, oswestry disability index and FIR (P < 0.05). When patients were grouped based on the median FIR (28.89 %), there were significant differences in age, sex, body mass index (BMI), red blood cell (RBC) count, hemoglobin, hematocrit, albumin, visual analogue scale, oswestry disability index, and fracture incidence (P < 0.05). Univariate COX regression analysis indicated that myosteatosis had no significant impact on survival prognosis in MM patients (HR = 0.999, P = 0.852), with a log-rank test P value of 0.11 when grouped by the cut-off FIR value of 33.67 %. Multivariate logistic regression indicated that FIR is an independent predictor of fractures (OR = 1.054, P = 0.000). Multivariate linear regression revealed that age, sex, RBC count, and BMI are independent factors influencing FIR (P < 0.05). When not grouped, FIR's prediction of fractures showed no significant interaction with age, sex, RBC count, or BMI (P for interaction > 0.05). In subgroups with BMI ≥ 25 kg/m2 or RBC count > 3.68 × 10^12/L, FIR lost its predictive significance for fractures. The FIR nomogram model had a C-index of 0.777, and the calibration curve, decision curve analysis, and clinical impact curve all validated its effectiveness.

Conclusions

Myosteatosis characterized by FIR is not a reliable predictor of survival in MM patients but is effective in predicting fractures and is closely related to back pain and functional impairment. FIR is significantly associated with age, sex, RBC count, and BMI.

"Chocolate Chip Sign" on Susceptibility-Weighted Imaging: A Novel Neuroimaging Biomarker for HTRA1-Related Cerebral Small Vessel Disease

Background and Objectives

HTRA1-related cerebral small vessel disease (HRSVD) is a rare hereditary form of cerebral small vessel disease (CSVD) caused by HTRA1 pathogenic variants. Diagnosing HRSVD without genetic testing is challenging because of the lack of distinctive imaging features and clinical symptoms, and even family history can be unclear in some cases with HRSVD. This study investigates whether susceptibility-weighted imaging (SWI) can identify useful diagnostic findings for HRSVD.

Methods

This retrospective study included 8 patients with HRSVD, 12 with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), and 14 with sporadic CSVD (sCSVD). Two neurologists blinded to clinical data counted the number of hypointense dots around the midbrain on SWI. Receiver operating characteristic curve analysis evaluated the optimal threshold of the number that can distinguish HRSVD and CADASIL or sCSVD. In addition, histopathologic analysis including measurement of leptomeningeal vessel diameter and type III collagen deposition was performed on autopsied brains from 3 cases each of HRSVD, CADASIL, and sCSVD and control participants.

Results

Patients with HRSVD exhibited a significantly higher number of hypointense dots around the midbrain on SWI compared with CADASIL and sCSVD groups. A threshold of 5 or more dots, termed the "Chocolate Chip Sign," well distinguished HRSVD from CADASIL and sCSVD (area under the curve: 0.817, 95% confidence interval: 0.624-1.00). Three-dimensional SWI reconstruction and 7T MRI confirmed these dots as dilated extraparenchymal vessels. Histopathologic analysis revealed pronounced dilation of leptomeningeal veins with type III collagen accumulation specifically, in HRSVD brains.

Discussion

The Chocolate Chip Sign on SWI represents a novel and promising neuroimaging biomarker for HRSVD. This finding holds significant potential for facilitating early diagnosis, prompting timely genetic testing, and appropriate family screening for this rare genetic disorder.

Clinical Profiles and Treatment Outcomes of 51 Cases of Carotid Cavernous Fistula: A Retrospective Observational Study

PURPOSE

This study investigated demographics, clinical profiles, imaging results, and treatment outcomes in patients with carotid cavernous fistula (CCF).

METHODS

This retrospective analysis examined medical records of the patients with CCF from January 2016 to January 2022. The study included 51 cases: 34 traumatic and 17 spontaneous CCFs.

RESULTS

A total of 51 patients with CCFs was analyzed. Traumatic CCF (34 patients, 66.7%) was more common than spontaneous CCF (17 patients, 33.3%). Traumatic CCF predominantly affected male patients, while spontaneous CCF was more frequent in female patients (p = 0.005). Clinical signs including proptosis and lagophthalmos were more common in traumatic CCF, with significant differences in eye movement restriction (p = 0.006) and bruit (p = 0.008). According to the Barrow classification, all spontaneous CCF cases were categorized as types B, C, or D, whereas traumatic CCF was predominantly classified as type A (p < 0.001). Endovascular treatment was more effective than conservative treatment in reducing clinical signs of traumatic CCF (p < 0.05), while no significant differences were observed in outcomes for spontaneous CCF between the two approaches.

CONCLUSIONS

Spontaneous CCF is less common than traumatic CCF in this study cohort. Traumatic and spontaneous CCF may have different clinical characteristics. Eye movement restriction and bruit are more frequently observed in traumatic CCF. After treatment for traumatic CCF, the incidence of proptosis, conjunctival abnormalities, and bruit is significantly lower in patients who undergo endovascular treatment compared to those who receive conservative management.

High PSMA Avidity, Yet Still Benign: The Importance of CT Morphology for Diagnosing Fibrous Dysplasia on PSMA-Targeted PET/CT

ABSTRACT

A 64-year-old man with newly diagnosed prostate cancer underwent 18 F-Piflufolastat PET/CT. Radiotracer avidity localized to the primary prostate malignancy and to a left rib (SUV max , 9.0). The high 18 F-Piflufolastat avidity may have been mistaken for a metastasis if not for the corresponding CT images demonstrating a well-circumscribed sclerotic rim at the site of the PET focus. This CT finding is uncommon for osseous malignancy, but common in benign fibrous dysplasia. Biopsy confirmed benign fibrous dysplasia. This case emphasizes that benign CT morphology may supersede even high avidity on PSMA-targeted PET imaging. Physicians interpreting PET/CT must recognize CT findings that supersede PET findings.

Revolutionizing prostate cancer therapy: Artificial intelligence - Based nanocarriers for precision diagnosis and treatment

Prostate cancer is one of the major health challenges in the world and needs novel therapeutic approaches to overcome the limitations of conventional treatment. This review delineates the transformative potential of artificial intelligence (AL) in enhancing nanocarrier-based drug delivery systems for prostate cancer therapy. With its ability to optimize nanocarrier design and predict drug delivery kinetics, AI has revolutionized personalized treatment planning in oncology. We discuss how AI can be integrated with nanotechnology to address challenges related to tumor heterogeneity, drug resistance, and systemic toxicity. Emphasis is placed on strong AI-driven advancements in the design of nanocarriers, structural optimization, targeting of ligands, and pharmacokinetics. We also give an overview of how AI can better predict toxicity, reduce costs, and enable personalized medicine. While challenges persist in the way of data accessibility, regulatory hurdles, and interactions with the immune system, future directions based on explainable AI (XAI) models, integration of multimodal data, and green nanocarrier designs promise to move the field forward. Convergence between AI and nanotechnology has been one key step toward safer, more effective, and patient-tailored cancer therapy.

Differentiation of inflammatory pseudotumors and malignant pulmonary nodules using the time-to-peak in first-pass dual-input volume computed tomography-perfusion

Background

Inflammatory pseudotumors (IPTs) are often misdiagnosed as malignant solitary pulmonary nodules (SPNs) because their imaging features overlap with those of malignant SPNs, leading to overtreatment. The purpose of this article was to investigate the value of first-pass enhanced time-to-peak (TTP) in distinguishing IPTs from malignant SPNs using dual-input volume computed tomography perfusion (DI-CTP).

Methods

This retrospective study included consecutive patients from No. 82 Group Hospital of Chinese People's Liberation Army with IPTs or malignant SPNs by surgery or biopsy from June 2016 to October 2021. Pulmonary artery flow (PF), bronchial artery flow (BF), perfusion index (PI), time-density curve, total perfusion (TLP), and first-pass TTP for all SPNs were determined by DI-CTP. The receiver operating characteristic (ROC) curve was used to analyse the values of TTP and other perfusion parameters in the differential diagnosis of IPTs and malignant SPNs.

Results

Ninety-eight patients were enrolled, including 25 with IPTs and 73 with malignant SPNs. The intraclass correlation coefficient (ICC) for inter-observer and intra-observer reliability of all parameters was perfect (all ICCs >0.90, P<0.01). Compared with IPTs, the malignant SPNs showed significantly higher PF, TLP, and TTP (all P<0.01), without significant differences in BF and PI (all P>0.05). The area under the curve of TTP was 0.987, which was higher than those of the other perfusion parameters (0.987 vs. 0.752 vs. 0.609 vs. 0.728 vs. 0.628). With a cut-off TTP of 18.10 s to distinguish IPNs from malignant SPNs, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 92.0%, 97.3%, 97.3%, 96.0%, and 96.9%, respectively. The sensitivity, specificity, and accuracy of CT plain scan combined with DI-CTP in diagnosing pulmonary nodules were 100%, 96.83%, and 98.97%, respectively.

Conclusions

Compared with other perfusion parameters, TTP may be a more valuable parameter to differentiate IPTs from malignant SPNs.

Estimation of shear viscoelasticity via time-domain elastic full waveform inversion in ultrasound shear wave elastography

The elastography inversion process typically assumes local homogeneity or ignores viscosity, which can lead to inaccuracies. This study presents a methodology for estimating viscous and elastic properties of a heterogenous media based on time-domain elastic full waveform inversion using the limited data available in conventional ultrasound shear wave elastography (SWE). The proposed method is based on the elastodynamic equation and minimizes a squared residual misfit function. To improve the optimization process, a total viscoelastic search space is considered and a quasi-Newton optimization is employed, where gradients are approximated using the adjoint state method. Additionally, Tikhonov regularization is incorporated to handle noisy and sparse displacement data. The proposed method was evaluated across various scenarios simulating real-world experimental conditions, accounting for noise levels and temporal sampling sparsity of displacement field. Using noisy displacement data from a single slice of three-dimensional volume, imitating the ultrasound SWE, resulted in 2.91% error for elasticity estimation and 23.97% error for viscosity estimation across the field of view. This framework enables the estimation of viscous and elastic properties of heterogeneous media and has shown promising results. Additionally, the optimization was improved, and noisy and sparse displacement data were effectively addressed.

Coronary Artery Calcium Score and Incident Lung Cancer in a Population-based Cohort: The Screening Perspective

Purpose To estimate the extent in which coronary artery calcium (CAC) score and incident lung cancer diagnosis are associated and determine if use of CAC score to predict lung cancer could improve lung cancer screening (LCS). Materials and Methods This retrospective analysis analyzed data from an ongoing, prospective, population-based cohort study (Heinz Nixdorf Recall study) in which participants aged 45-75 years underwent electron-beam CT of the heart. The association between CAC score and incident lung cancer was assessed using Cox proportional hazard regression models adjusted for potential confounders. The area under the receiver operating characteristic curve (AUC) was used to assess predictive performance of CAC score for lung cancer in all participants, eligible participants, and ineligible participants for LCS. Results The study included 4605 participants (mean age, 59.7 [SD, 7.8] years; 2328 female). During a median follow-up time of 15.2 years, incident lung cancer was diagnosed in 111 participants. CAC score as a continuous variable (log CAC+1) was associated with incident lung cancer (hazard ratio [HR] in the fully adjusted model: 1.21 [95% CI: 1.10, 1.32]). A CAC score of 400 or higher versus 0 was associated with a more than fourfold higher risk of lung cancer (adjusted HR: 4.31 [95% CI: 2.19, 8.51]). CAC score alone showed poor performance for predicting lung cancer in the total study sample (AUC, 0.63) and subgroups of participants eligible (AUC, 0.56) and ineligible (AUC, 0.61) for LCS. Conclusion CAC score was associated with incident lung cancer but did not demonstrate potential to improve the efficiency of LCS. Keywords: Epidemiology, Screening, Arteriosclerosis, Cardiac, Thorax, CT, Lung Cancer Supplemental material is available for this article. © RSNA, 2025.

Aetiology and Feasibility of Endoscopic Interventions for Massive Upper Gastrointestinal Bleeding in Makurdi, North-Central Nigeria

Introduction

Massive upper gastrointestinal bleeding (UGIB) is a life-threatening emergency with high mortality. Emergency upper gastrointestinal (GI) endoscopy, endotherapy, interventional radiology, and surgery are necessary to control the bleeding source and restore normal physiology. However, these interventions are suboptimal in most centres in Nigeria, contributing to the dismal mortality observed in this condition.

Objectives & Methodology

We aimed to determine the aetiology, feasibility of endoscopic intervention, and outcome of management of massive UGIB in Madonna Hospital, Makurdi, over a 30-month-period by retrospectively reviewing the medical and procedural records of patients presenting with hypotension from an endoscopically diagnosed upper GI bleeding source.

Result

A total of 39 patients were identified, with a mean age of 49.3 ± 17.7 years. Among them, 27 were males (69.2%) and 12 were females (30.8%). Bleeding peptic ulcers were the cause of massive UGIB in 21 cases (53.8%), followed by variceal bleeding, observed in 10 (25.6%) cases. Most of these cases were amenable to endoscopic treatment using adrenaline injection, endoclips, endoscopic variceal band ligation, and diathermy fulguration. Thirty-three (84.6%) patients survived, while the in-hospital mortality following initial endoscopic intervention was 6 out of 39 patients (15.4%), which is comparable to figures from more advanced climes.

Conclusion & Recommendation

Endoscopic management of massive UGIB is feasible in a low-resource setting. However, timely access to emergency endoscopy is vital to reduce mortality. Strategies to reduce risk factors for peptic ulcers and oesophageal varices are necessary to reduce the incidence of massive UGIB in Makurdi, Nigeria.

Improving VMAT dose calculation accuracy and planning quality via a GPU-accelerated Fourier transform dose calculation algorithm

BACKGROUND

Inverse planning typically utilizes fast, less accurate dose calculation algorithms during the iterative optimization process, thus leading to dose calculation errors (DCEs) and suboptimal plans that often require dose normalization and/or plan re-optimization.

PURPOSE

A graphic processing unit (GPU) accelerated Fourier transform dose calculation (FTDC) was recently commissioned at our institution during the Eclipse treatment planning system (Varian Medical Systems) v18.0 upgrade. We hypothesize that FTDC could reduce DCEs and planning failure rates (PFRs) compared to its predecessor, multi-resolution dose calculation (MRDC), while improving efficiency through utilization of GPUs.

METHODS

Fifty lung SBRT plans were optimized with MRDC and FTDC dose calculation algorithms. Acuros XB (AXB) was then used for final dose calculations. DCEs for target and organ-at-risk (OAR) were calculated as the percent difference between AXB and dose calculated at the final optimization step. Plan quality was assessed using an in-house planning scorecard where PFRs were calculated as the percentage of plans that had a plan score less than 90% with optimal plans scored at 100%.

RESULTS

FTDC showed excellent agreement with AXB in terms of planning target volume (PTV) coverage, as PTV D95% DCEFTDC averaged 0.8% ± 0.9%, compared to DCEMRDC's -2.5% ± 3.2%. DCEs for thoracic OARs were reduced with less variation when optimizing with FTDC as compared to MRDC. FTDC had a PFR of 10% (5 out of 50) versus MRDC's 32% (16 out of 50). The subsequent re-optimization rate resulted from a plan normalization of 3% or greater was 4% for FTDC compared to MRDC's 38%. FTDC with GPU acceleration reduced optimization time by 75% on average compared to MRDC without GPU acceleration.

CONCLUSIONS

FTDC shows more accurate dose calculation accuracy compared to MRDC. Its use during the optimization process improved planning quality and efficiency assisted with GPUs.

Advancements and applications of 3D printing in pediatric orthopedics: A comprehensive review

Preoperative planning is crucial for successful surgical outcomes. 3D printing technology has revolutionized surgical planning by enabling the creation and manufacturing of patient-specific models and instruments. This review explores the applications of 3D printing in pediatric orthopedics, focusing on image acquisition, segmentation, 3D model creation, and printing techniques within specific applications, including pediatric limb deformities, pediatric orthopedic oncology, and pediatric spinal deformities. 3D printing simultaneously enhances surgical precision while reducing operative time, reduces complications, and improves patient outcomes in various pediatric orthopedic conditions. 3D printing is a transformative technology in pediatric orthopedics, offering significant advantages in preoperative planning, surgical execution, and postoperative care.

A deep learning pipeline for systematic and accurate vertebral fracture reporting in computed tomography

AIM

Spine fractures are a frequent and relevant diagnosis, but systematic documentation is time-consuming and sometimes overlooked. A deep learning pipeline for opportunistic fracture detection in computed tomography (CT) spine images of varying field-of-views is introduced.

MATERIALS AND METHODS

This retrospective study builds on 452 CTs of the lumbar/thoracolumbar spine. Patients were included based on the evidence of ≥1 vertebral body fracture and excluded in case of history of spinal surgery or pathologic fractures. The collective was split into training/validation (405) and test (47) sets. An open-source spine dataset was used to train a preliminary segmentation model, which was applied on the training set. The resulting segmentation was post-processed to remove posterior vertebral structures and if needed, manually refined by a radiologist. Using the refined version as new training data, a final segmentation nnU-net was trained. Sagittal slices from each vertebra were labelled individually with regard to fracture evidence. Slices without fracture were used as negative class. Twenty seven thousand nineteen slices (20,396 negative, 6,623 positive) trained a classification algorithm using resnet18. Two senior readers independently assessed fractures in the test set to obtain a consensual ground truth. The segmentation-classification pipeline was applied to the test set and compared with the ground truth.

RESULTS

The segmentation model correctly segmented 330/339 (97%) vertebrae. Considering every segmented vertebra, the classifier detected fractures with 88% sensitivity, 95% specificity, and 93% accuracy.

CONCLUSION

A deep learning pipeline was built and shown to accurately detect fractures on CT images. The final models as well as our code material are available at https://github.com/usb-radiology/VertebraeFx.

Carotid Revascularization Is Associated With Improved Mood in Patients With Advanced Carotid Disease

OBJECTIVE

To investigate the impact of carotid interventions on the mental well-being of patients with carotid stenosis.

BACKGROUND

Ongoing research highlights the effect of carotid interventions on neurocognitive function in patients with advanced carotid atherosclerosis. However, data regarding the impact of carotid revascularization on mood are scarce.

METHODS

A total of 157 patients undergoing carotid revascularization were prospectively recruited. The primary outcome was depressive mood, evaluated preoperatively and at 1-, 6-, and 12-month postintervention using the long form of the geriatric depression scale (GDS-30) questionnaire. Other tests were also used to assess cognition at the respective timepoints. Statistical analyses were performed to assess the postoperative outcomes compared with baseline.

RESULTS

Baseline depression (GDS>9) was observed in 49 (31%) subjects, whereas 108 (69%) patients were not depressed (GDS≤9). The average preoperative GDS score was 15.42 ± 4.40 (14.2-16.7) and 4.28 ±2.9 (3.7-4.8) in the depressed and nondepressed groups, respectively. We observed a significant improvement in GDS scores within the depressed group at 1 month ( P =0.002), 6 months ( P =0.027), and 1 year ( P <0.001) postintervention compared with pre-op, whereas the nondepressed group had similar post-op GDS scores at all timepoints compared with baseline. Significant improvement in measures of executive function was seen in nondepressed patients at all 3 timepoints, whereas depressed patients showed an improvement at 1-year follow-up.

CONCLUSIONS

Our study highlights improvement in mood among patients with advanced carotid disease who screened positive for depression at baseline. Further studies with larger sample sizes are warranted to investigate the association between depression, carotid disease, and carotid intervention.

Relevance of lesion size in navigator-triggered and free-breathing diffusion-weighted liver MRI

OBJECTIVES

The purpose of this study was to investigate the relevance of focal liver lesions (FLL) size for lesion detection comparing navigator triggering (TRIG) to free breathing (FB) liver Diffusion-weighted magnetic resonance imaging (DWI).

MATERIALS AND METHOD

Patients with known or suspected FLL were prospectively (registry number 276_19 B) included from October to December 2019 in this study, out of which 32 had liver lesions. Echo planar spin-echo DWI data both with TRIG and FB were with approximately constant acquisition times acquired at 1.5 T. Lesions were segmented in the b = 800 s/mm² images in both the TRIG and FB images. The lesion size, location (liver segment), liver lesion visibility, as well as contrast-to-noise ratio (CNR) were recorded. The CNR was assessed with the Wilcoxon-Mann-Whitney test and the number of visible lesions with the Fisher test.

RESULTS

Data from 43 patients (22 female) were analyzed. The mean patient age was 58 ± 14 years. A total of 885 FLL (Ntotal) were segmented. Among these, 811 lesions (Nboth) were detected with TRIG and FB, 65 lesions exclusively with TRIG (NTRIG_Only), and nine exclusively in FB (NFB_Only). The largest additional lesion in TRIG/FB had a diameter of 10.4 mm/7.6 mm. The number of additional lesions detected with TRIG decreased with size. Among all lesions ≤ 4.7 mm, the relative number of additional lesions was 15.6%. Additional lesions were found in all liver segments with TRIG. In the left liver lobe, the relative proportion was 9.2%, and in the right liver lobe 5.4%. CNR and visibility were significantly higher in TRIG than in FB (p < 0.001). In relation to size, the difference is significant in terms of visibility and CNR for lesion diameters ≤ 8 mm.

CONCLUSION

Respiration triggering can improve the detection of small liver lesions with diameters up to approx. 1 cm in the whole liver.

KEY POINTS

Question Can respiration triggering (TRIG) improve the detection of small FLL compared to FB diffusion-weighted imaging? Findings Among 885 segmented FLL, TRIG was superior to FB for lesions smaller than 8 mm and had improved CNR and visibility. Clinical relevance Diffusion-weighted magnetic resonance imaging is used for the detection of focal liver lesions and image quality is influenced by breathing motion. Navigator triggering becomes more important for smaller lesions, and seems recommendable for the detection of small focal liver lesions.

The role and potential of digital breast tomosynthesis in neoadjuvant systemic therapy evaluation for optimising breast cancer management: a pictorial essay

Neoadjuvant therapy (NT) has become the gold standard for treating locally advanced breast cancer (BC). The assessment of pathological response (pR) post-NT plays a crucial role in predicting long-term survival, with contrast-enhanced MRI currently recognised as the preferred imaging modality for its evaluation. Traditional imaging techniques, such as digital mammography (DM) and ultrasonography (US), encounter difficulties in post-NT assessments due to breast density, lesion changes, fibrosis, and molecular patterns. Digital breast tomosynthesis (DBT) offers solutions to prevalent challenges in DM, such as tissue overlap, and facilitates a comprehensive assessment of lesion morphology, dimensions, and margins. Studies suggest that DBT correlates more accurately with pathology than DM and US, showcasing its potential advantages. This pictorial essay demonstrates the potential of DBT as a complementary tool to DM for assessing pR after NT, including instances of true- and false-positive assessments correlated with histopathological findings. In conclusion, DBT emerges as a valuable adjunct to DM, effectively addressing its limitations in post-NT assessment. The technology's potential to diminish tissue overlap, improve discrimination, and provide multi-dimensional perspectives demonstrates promising results, indicating its utility in scenarios where MRI is contraindicated or inaccessible.

Automated vertebral compression fracture detection and quantification on opportunistic CT scans: a performance evaluation

AIM

Since the majority of vertebral compression fractures (VCFs) are asymptomatic, they often go undetected on opportunistic CT scans. To reduce rates of undiagnosed osteoporosis, we developed a deep learning (DL)-based algorithm using 2D/3D U-Nets convolutional neural networks to opportunistically screen for VCF on CT scans. This study aimed to evaluate the performance of the algorithm using external real-world data.

MATERIALS AND METHODS

CT scans acquired for various indications other than a suspicion of VCF from January 2019 to August 2020 were retrospectively and consecutively collected. The algorithm was designed to label each vertebra, detect VCF, measure vertebral height loss (VHL) and calculate mean Hounsfield Units (mean HU) for vertebral bone attenuation. For the ground truth, two board-certified radiologists defined if VCF was present and performed the measurements. The algorithm analyzed the scans and the results were compared to the experts' assessments.

RESULTS

A total of 100 patients (mean age: 76.6 years ± 10.1[SD], 72% women) were evaluated. The overall labeling agreement was 94.9% (95%CI: 93.7%-95.9%). Regarding VHL, the 95% limits of agreement (LoA) between the algorithm and the radiologists was [-9.3, 8.6]; 94.1% of the differences lay within the radiologists' LoA and the intraclass correlation coefficient was 0.854 (95%CI: 0.822-0.881). For the mean HU, Pearson's correlation was 0.89 (95%CI: 0.84-0.92; p-value <0.0001). Finally, the algorithm's VCF screening sensitivity and specificity were 92.3% (95%CI: 81.5%-97.9%) and 91.7% (95%CI: 80.0%-97.7%), respectively.

CONCLUSIONS

This automated tool for screening and quantification of opportunistic VCF demonstrated high reliability and performance that may facilitate radiologists' task and improve opportunistic osteoporosis assessments.

Ureter development and associated congenital anomalies

Malformations of the ureter are among the most common birth defects in humans. Although some of these anomalies are asymptomatic, others are clinically relevant, causing perinatal lethality or progressing to kidney failure in childhood. The genetic causes and developmental aetiology of ureteral anomalies are difficult to study in humans; however, embryological and genetic analyses in the mouse have provided insights into the complex developmental programmes that govern ureter formation from simple tissue primordia, and the pathological consequences that result from disruption of these programmes. Abnormalities in the formation of the nephric duct and ureteric bud lead to changes in the number of ureters (and kidneys), whereas the formation of ectopic ureteric buds, failure of the nephric duct to target the cloaca or failure of the distal ureter to mature underlie vesicoureteral reflux, ureter ectopia, ureterocoele and subsequent hydroureter. Alterations in ureter specification, early growth or cyto-differentiation programmes have now also been associated with various forms of perinatal hydroureter and hydronephrosis as a consequence of functional obstruction. The characterization of cellular processes and molecular drivers of ureterogenesis in the mouse may not only aid understanding of the aetiology of human ureteral anomalies, improve prognostication and benefit the development of therapeutic strategies, but may also prove important for efforts to generate a bioartificial organ.

Roles of artificial intelligence and high frame-rate contrast-enhanced ultrasound in the differential diagnosis of Breast Imaging Reporting and Data System 4 breast nodules

Background

Breast cancer prevalence and mortality are rising, emphasizing the need for early, accurate diagnosis. Contrast-enhanced ultrasound (CEUS) and artificial intelligence (AI) show promise in distinguishing benign from malignant breast nodules. We compared the diagnostic values of AI, high frame-rate CEUS (HiFR-CEUS), and their combination in Breast Imaging Reporting and Data System (BI-RADS) 4 nodules, using pathology as the gold standard.

Methods

Patients with BI-RADS 4 breast nodules who were hospitalized at the Department of Thyroid and Breast Surgery, Taizhou People's Hospital from December 2021 to June 2022 were enrolled in the study.80 female patients (80 lesions) underwent preoperative AI and/or HiFR-CEUS. We assessed diagnostic outcomes of AI, HiFR-CEUS, and their combination, calculating sensitivity (SE), specificity (SP), accuracy (ACC), positive/negative predictive values (PPV/NPV). Reliability was compared using Kappa statistics, and AI-HiFR-CEUS correlation was analyzed with Pearson's test. Receiver operating characteristic curves were plotted to compare diagnostic accuracy of AI, HiFR-CEUS, and their combined approach in differentiating BI-RADS 4 lesions.

Results

Of the 80 lesions, 18 were pathologically confirmed to be benign, while the remaining 62 were malignant. The SE, SP, ACC, PPV, and NPV were 75.81%, 94.44%, 80.00%, 97.92%, and 53.13% in the AI group, 74.20%, 94.44%, 78.75%, 97.91%, and 51.51% in the HiFR-CEUS group, and 98.39%, 88.89%, 96.25%, 96.83%, and 94.12% in the combination group, respectively. Thus, the SE, ACC, and NPV of the combination group were significantly higher than those of the AI and HiFR-CEUS groups, and the SP of the combination group was lower (all P<0.05); however, no significant difference was found between the groups in terms of the PPV (P>0.05). No statistically significant difference was observed in the diagnostic performance of the AI and HiFR-CEUS groups (all P>0.05). The AI and HiFR-CEUS groups had moderate agreement with the "gold standard" (Kappa =0.551, Kappa =0.530, respectively), while the combination group had high agreement (Kappa =0.890). AI was positively correlated with HiFR-CEUS (r=0.249, P<0.05). The area under the curves (AUCs) of AI, HiFR-CEUS, and both in combination were 0.851±0.039, 0.815±0.047, and 0.936±0.039, respectively. Thus, the AUC of the combination group was significantly higher than those of the AI and HiFR-CEUS groups (Z1=2.207, Z2=2.477, respectively, both P<0.05). The AI group had a higher AUC than the HiFR-CEUS group, but the difference was not statistically significant (Z3=0.554, P>0.05).

Conclusions

Compared with AI alone or HiFR-CEUS alone, the combined use of these two methods had higher diagnostic performance in distinguishing between benign and malignant BI-RADS 4 breast nodules. Thus, our combination method could further improve the diagnostic accuracy and guide clinical decision making.

Diagnostic test of conventional ultrasonography combined with contrast-enhanced ultrasound in the subcategorization of suspicious Breast Imaging-Reporting and Data System (BI-RADS) 4 breast lesions

Background

Although conventional ultrasonography (CUS) and contrast-enhanced ultrasound (CEUS) play a critical role in cancer detection, diagnosis, and image-guided biopsies, there is no standardized diagnostic approach for the clinical evaluation of suspected Breast Imaging-Reporting and Data System (BI-RADS) category 4 breast lesions. This diagnostic test evaluates the complementary roles of CUS and CEUS in addressing limitations of conventional imaging, such as microvascular visualization. This study aimed to evaluate the diagnostic value of combining CUS with CEUS in subcategorizing suspicious breast lesions classified as BI-RADS for ultrasound (US-BI-RADS) category 4.

Methods

The data of 131 patients with BI-RADS category 4 breast lesions, examined between February 2017 and March 2023, were retrospectively analyzed. All lesions underwent pathological examination following surgery and served as the gold standard for diagnosis. Key features such as lesion margins, echogenicity, size, microcalcification, blood flow distribution via color Doppler flow imaging (CDFI), and CEUS characteristics were assessed. CEUS scores were calculated using a five-point scoring system. Stepwise logistic regression was applied to evaluate the odds ratios (ORs) of the lesion characteristics on US and CEUS. The combination of the US-BI-RADS and CEUS scores (termed the CEUS-BI-RADS) was compared to the US-BI-RADS alone, and a receiver operating characteristic (ROC) curve analysis was conducted to determine the diagnostic performance of these methods.

Results

Of the 131 lesions, 62 (47.3%) were benign, and 69 (52.7%) were malignant. The multivariate logistic regression identified the primary indicators of malignancy as calcification [OR =1.58, 95% confidence interval (CI): 0.25-2.91, P=0.02], suspicious or abnormal axillary lymph nodes (OR =2.51, 95% CI: 0.59-4.44, P=0.01), obscure margins after enhancement (OR =2.67, 95% CI: 0.35 to 4.99, P=0.02), and increased lesion size (OR =4.89, 95% CI: 1.45-8.33, P=0.005). The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of the US-BI-RADS were 73.9%, 74.2%, 74.0%, 71.9%, and 76.1%, respectively, while those of the CEUS-BI-RADS were 92.8%, 79.0%, 86.3%, 90.7%, and 83.1%, respectively. The areas under the ROC curves for the US-BI-RADS and CEUS-BI-RADS were 0.741 and 0.859, respectively.

Conclusions

The CEUS-BI-RADS significantly enhances diagnostic efficacy for BI-RADS category 4 breast lesions, outperforming the US-BI-RADS and could reduce unnecessary biopsies.

Early Experience Using Tantalum-Loaded Nanocomposite Hydrogel Conformable Embolic for Upper Gastrointestinal Bleeding-Open-Sandwich Technique

Background/Objectives: To evaluate the efficacy and safety of using tantalum-loaded Obsidio conformable embolic (Ta-OCE) in gastroduodenal artery (GDA) embolization for upper gastrointestinal bleeding (UGIB), employing a novel "open-sandwich" technique. Methods: An institutional review board (IRB)-approved retrospective analysis was conducted on patients who underwent GDA embolization for UGIB using Ta-OCE between May 2023 and June 2024, using an "open-sandwich" technique. Briefly, the retrograde sources of flow, namely the right gastroepiploic artery (RGEA), was commonly embolized with a single, usually detachable, coil at its proximal aspect. Beginning within the proximal RGEA adjacent to the coil and distal to the site of extravasation and/or an endoscopically placed clip, Ta-OCE was then instilled in a continuous fashion to the origin of GDA. Technical success was defined as complete occlusion of the target vessel without immediate procedural complications. Clinical success was assessed as the absence of rebleeding within 4 weeks post-embolization. Adverse events were evaluated using Common Toxicity Criteria for Adverse Events (v.5). Results: Overall, a total of 10 patients, with a mean age of 67.3 years, underwent Ta-OCE embolization for UGIB. A technical success rate of 100% was achieved with no instances of immediate procedural complications. Clinical success was achieved in eight patients (80%). Re-intervention was required in two patients in whom the proximal GDA and distal GDA/proximal RGEA were not embolized adequately, respectively. A significant change in mean hemoglobin levels was observed 24 h pre- and post-embolization, with a mean increase of 1.47 g/dL. Conclusions: Despite the small sample size, lack of control group, and retrospective design, the "open-sandwich" technique combining Ta-OCE with a single coil appears to be an effective and safe method of GDA embolization in the setting of UGIB. Larger multicenter studies are needed to further evaluate the feasibility of this technique.

The role of parenting stress and perceived social support in affecting family function among families of patients with cleft lip and/or palate: a path analysis based on the family adjustment and adaptation response model

OBJECTIVES

Family function is important for the normal operation of the family and the development of children. However, existing studies have limited explorations on family function among families of patients with cleft lip and/or palate (CL/P). This study aims to validate a hypothesized model of family function based on the family adjustment and adaptation response model, and identify key variables affecting family function among families of patients with cleft lip and/or palate (CL/P) in China.

MATERIALS AND METHODS

The cross-sectional study enrolled 248 families with CL/P patients from two centers in China. The demographic, clinical, family function, resilience, hope, perceived social support, optimism, parenting stress, and coping data were collected. Path analysis was used to investigate the key variables of the family function.

RESULTS

Family functions among families of CL/P patients were higher than the Chinese norm in conflict, moral-religious-emphasis, and control. Furthermore, they were lower in expressiveness, independence, achievement orientation, intellectual, cultural orientation, active recreational orientation, and organization. The fitness of the modified path model was evaluated using various measures, including CMIN/DF = 1.954, GFI = 0.914, RFI = 0.801; IFI = 0.919;TLI = 0.909; CFI = 0.917; RMSEA = 0.065. The path analysis showed that perceived social support and parenting stress have a direct positive effect (β = 0.186) and negative effect (β = -0.384), respectively. Hope, optimism, perceived social support, coping, and resilience indirectly affect family function. The effects from highest to lowest are hope (β = 0.260), optimism (β = 0.203), perceived social support (β = 0.085), coping (β = 0.055), and resilience (β = 0.009). The overall effects of different variables on the family function are as follows: parenting stress (β = -0.384), perceived social support (β = 0.271), hope (β = 0.260), optimism (β = 0.203), coping (β = 0.055), and resilience (β = 0.009).

CONCLUSIONS

The family functions of families with CL/P patients are worthy of attention in China. This study showed that parenting stress and perceived social support are key factors that directly affect family function. Coping, hope, resilience, and optimism could indirectly affect family function through parenting stress and perceived social support. Therefore, strategies targeting these two key factors should be implemented to facilitate family function among families with CL/P patients.

Prevalence and morphometric analysis of retromolar canals and foramina: a cone-beam computed tomography study

BACKGROUND

The retromolar region of the mandible is an anatomically complex area that harbors important neurovascular structures, including the retromolar canal (RMC) and retromolar foramen (RMF). Understanding the prevalence and characteristics of these anatomical variations is crucial for safe and effective dental and maxillofacial procedures. This study aimed to comprehensively investigate RMCs and RMFs using cone-beam computed tomography (CBCT) imaging.

METHODS

This study analyzed CBCT scans of 160 subjects (80 males, 80 females) aged 18 years and above. The presence and morphology of RMCs were assessed, and their spatial relationships with adjacent structures were measured. Statistical analysis using the ANOVA and chi-square tests to evaluate the associations between RMC characteristics and demographic factors yielded no significant results.

RESULTS

RMCs were present in 37 out of 160 subjects (23.1%). The most prevalent type of RMC was the curved Type B (62.2%), followed by Type A (29.7%) and Type C (8.1%). RMFs were predominantly located in a buccal position relative to the mandibular third molar (86.5%). The study also provided comprehensive morphometric data on the retromolar canals (RMCs) and foramina (RMFs) observed in the study population. Key measurements included the distance from the buccal and lingual cortices to the RMCs, the distance from the mandibular foramen to the RMC origin, and the distances from the RMF to the mandibular canal and adjacent molars. These detailed spatial relationships were analyzed across different age groups and between genders. The data revealed trends, such as decreasing buccal distances and increasing lingual distances with advancing age. This morphometric information is valuable for clinicians when planning procedures in the retromolar region, as it can guide preoperative assessment and help mitigate the risk of neurovascular complications associated with the variable anatomy of RMCs and RMFs.

CONCLUSION

This comprehensive CBCT study provides valuable insights into the prevalence, morphology, and spatial relationships of RMCs and RMFs. The variable anatomical features of these structures can have significant clinical implications for various dental and maxillofacial procedures. The data presented in this study can serve as a reference for clinicians to enhance preoperative assessment and improve the safety and efficacy of interventions in the retromolar region.