Assessing the accuracy of artificial intelligence in mandibular canal segmentation compared to semi-automatic segmentation on cone-beam computed tomography images

Purpose

This study aims to assess the accuracy of artificial intelligence (AI) in mandibular canal (MC) segmentation on cone-beam computed tomography (CBCT) compared to semi-automatic segmentation. The impact of third molar status (absent, erupted, impacted) on AI performance was also evaluated.

Material and methods

A total of 150 CBCT scans (300 MCs) were retrospectively analysed. Semi-automatic MC segmentation was performed by experts using Romexis software, serving as the reference standard. AI-based segmentation was conducted using Diagnocat, an AI-driven cloud-based platform. Three-dimensional segmentation accuracy was assessed by comparing AI and semi-automatic segmentations through surface-to-surface distance metrics in Cloud Compare software. Statistical analyses included the intraclass correlation coefficient (ICC) for inter- and intra-rater reliability, Kruskal-Wallis tests for group comparisons, and Mann-Whitney U tests for post-hoc analyses.

Results

The median deviation between AI and semi-automatic MC segmentation was 0.29 mm (SD: 0.25-0.37 mm), with 88% of cases within the clinically acceptable limit (≤ 0.50 mm). Inter-rater reliability for semi-automatic segmentation was 84.5%, while intra-rater reliability reached 95.5%. AI segmentation demonstrated the highest accuracy in scans without third molars (median deviation: 0.27 mm), followed by erupted third molars (0.28 mm) and impacted third molars (0.32 mm).

Conclusions

AI demonstrated high accuracy in MC segmentation, closely matching expert-guided semi-automatic segmentation. However, segmentation errors were more frequent in cases with impacted third molars, probably due to anatomical complexity. Further optimisation of AI models using diverse training datasets and multi-centre validation is recommended to enhance reliability in complex cases.

Role of noncontrast enhanced abdominal ultrasound in the diagnostic assessment of pediatric inflammatory bowel disease

OBJECTIVES

Assessment of small bowel involvement when diagnosing inflammatory bowel disease (IBD) delineates clinical subtype and disease extension. The gold standard for small bowel assessment is magnetic resonance enterography (MRE), but MRE is not always feasible for children. Standard, non-contrast enhanced abdominal ultrasound is an acceptable alternative. The study aimed to evaluate the utility of ultrasound in the diagnostic work-up of pediatric IBD to identify small bowel involvement.

METHODS

A retrospective study was conducted among children (< 18 years) who had abdominal ultrasound during assessment for IBD (2019-2023) at Christchurch Hospital, New Zealand. Descriptive analysis compares small bowel ultrasound to MRE, endoscopy and histology.

RESULTS

The cohort comprised 47 children, mean age 9.9 years (± 4.1), 23 (49%) males and 42 (89%) with Crohn's disease. All had endoscopy and histology data available for comparison, and 26 had MRE. Fourteen (30%) had no small bowel disease on ultrasound, MRE, endoscopy, or histology. Ultrasound confirmed small bowel disease diagnosed by other modalities for 12 (26%). Ultrasound identified small bowel disease for 7 (15%) that had not been seen during the diagnostic process by MRE, endoscopy or histology, possibly due to the limitations of endoscopy and time-delays between diagnosis and MRE. Small bowel disease was not picked up on ultrasound for 14 (30%) children, disease locations being duodenum (n = 6), TI (n = 5), proximal ileum (n = 3), and jejunum (n = 2).

CONCLUSIONS

Abdominal ultrasound is a valuable resource for assessing disease extent in suspected pediatric IBD. This study highlights the clinical benefit and feasibility of a multi-modal diagnostic approach.

Computed Tomography With Implant Movement Analysis in the Work-Up of Painful Total Hip Prostheses

BACKGROUND

Diagnosing aseptic loosening following total hip arthroplasty is challenging. Computed tomography (CT)-guided implant movement analysis (CT-IMA) overlays two CT scans of a stressed total hip prosthesis to evaluate for micromotion. The purpose of this study was to evaluate this technology in identifying clinically stable and unstable total hip prostheses.

METHODS

Plain radiographs and CT-IMA scans of 80 patients with painful total hip prostheses were evaluated. Standard radiographs demonstrating 1- to 2-mm circumferential radiolucent lines within the modified Gruen, or Delee and Charnley zones, or subsidence were considered loose. A CT-IMA scan demonstrating implant motion > 0.5 mm was generally considered loose. Patients were categorized by implant stability based on plain radiographs and CT-IMA scans. Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) scores were calculated for each group from the initial to the final follow-up. Statistical analysis was performed with two-tailed paired t-tests.

RESULTS

There were 66 patients who were categorized into the radiographically Stable-IMA Stable group (Group 1), six into the radiographically Loose-IMA Stable group (Group 2), and eight into the radiographically Loose-IMA Loose group (Group 3). Within Group 1, HOOS, JR scores improved from 49.5 ± 18.4 to 64.2 ± 18.9 (P = 0.004). The 14 patients who underwent revision surgery had well-fixed components. Within Group 2, HOOS, JR scores improved from 57.7 ± 19.7 to 69.1 ± 21.5 (P = 0.01). The two patients who underwent revision surgery had well-fixed components. Within Group 3, HOOS, JR scores improved from 45.5 ± 18.1 to 71.8 ± 15.4 (P = 0.04). The seven patients who underwent revision surgery had loose components and one patient was lost to follow-up.

CONCLUSIONS

A CT-IMA better identified patients who had stable total hip prostheses than standard radiographs, demonstrating its value in the workup of a painful total hip prosthesis.

The Impact of Morning Meditation and Sleep Quality on Affective and Health Outcomes in Healthcare Workers

BACKGROUND

Health is a critical factor influencing key workplace outcomes, including job attitudes, behaviors, and performance. This study investigated the role of daily micro-breaks, specifically morning meditation practices, and positive affective experiences (i.e., positive affect) at work in predicting health-related outcomes, namely vitality and mental health. Using a non-experimental design, this study tested a moderated mediation model in which sleep quality moderates the relationship between morning meditation and positive affect, which, in turn, predicts end-of-the-day health-related outcomes.

METHODOLOGY

Data were collected twice a day from 44 healthcare employees over five consecutive workdays using a daily survey approach.

KEY RESULTS

Multilevel modeling analyses revealed that morning meditation was significantly associated with increased positive affect and improved health indicators at the end of the workday. Moreover, sleep quality moderated the relationship between morning meditation and positive affect, such that the conditional indirect effect of meditation on end-of-day mental health and vitality via positive affect was significant when sleep quality from the preceding night was poor.

CONCLUSIONS

These findings underscore the interactive effect of prior-night sleep quality and morning meditation on affective and health-related outcomes by the end of the day. By identifying sleep quality as a key boundary condition, we contribute to a more nuanced understanding of when meditation is most beneficial. Our findings have significant implications for both research and practice, particularly in high-stress environments such as healthcare, where optimizing employee well-being is crucial for both individual and organizational performance.

Exploring Divergent Electrodiagnostic and Sonographic Findings in Patients With Suspected Carpal Tunnel Syndrome: Role of Median Nerve Cross-Sectional Area

OBJECTIVES

Evaluate electrophysiologic and sonographic findings in patients with suspected carpal tunnel syndrome (CTS) that had divergent electrodiagnostic (EDX) and ultrasound imaging (USI) diagnoses of CTS.

METHODS

Retrospective analysis of 665 limbs from patients who underwent EDX testing and USI. MANOVA, Chi Square, and correlations were used to analyze electrophysiologic and sonographic variables in limbs with divergent findings. CTS diagnosis was determined using EDX- and USI-based classification systems, stratified by median nerve cross-sectional area (CSA) cutoff values producing large conclusive or small questionable shifts in diagnostic probability.

RESULTS

The proportion of limbs with a USI diagnosis of CTS but normal electrophysiologic findings was 17% and 35% when considering CSA cutoff values producing large conclusive and small questionable shifts in diagnostic probability, respectively. These limbs had significantly slower median sensory and motor latencies and larger distal and delta CSA compared to limbs with concordant findings. Conversely, the proportion of limbs with an EDX diagnosis of CTS but normal sonographic findings was 6% and 35% when considering CSA cutoff values producing large conclusive and small questionable shifts in diagnostic probability, respectively. These limbs had faster median motor latency, larger proximal and smaller distal and delta CSA compared to limbs with concordant findings.

CONCLUSIONS

Median nerve CSA proved to be the most reliable and clinically meaningful factor in limbs with divergent EDX and USI diagnoses of CTS regardless of diagnostic accuracy threshold. These results underscore the importance of integrating EDX testing and USI in patients with suspected CTS, particularly in cases with inconclusive or conflicting findings.

Surgical Management of Groove Pancreatitis: Lessons Learnt and Long-Term Experience

BACKGROUND

Groove pancreatitis (GP) is a rare form of focal chronic pancreatitis characterized by inflammation in the anatomic space between the duodenal wall and the head of the pancreas. This study aims to review the surgical experience in diagnosing and managing GP at a tertiary healthcare center in India.

METHODS

A single-center, retrospective, cross-sectional study was conducted at the All India Institute of Medical Sciences, Jodhpur, between January 2017 and December 2023. The study included all patients with clinical, radiologic, and pathologic confirmation of GP. Data on demographics, clinical history, radiologic imaging, surgical intervention, and perioperative outcomes were collected. Pain and quality of life (QOL) were assessed preoperatively and postoperatively at 3, 6, and 12 months using the Izbicki pain score and the SF-36 questionnaire.

RESULTS

During the study period, eleven patients with a clinico-radiologic diagnosis of GP underwent surgery. The median diagnostic delay was 14 months. Common presenting symptoms included abdominal pain (100%), gastric outlet obstruction (81.8%), and obstructive jaundice (18.2%). The majority of patients had a history of tobacco and alcohol abuse. Pancreato-duodenectomy (PD) was performed in ten cases, while one patient underwent a bypass procedure. Post-operative complications included post-operative pancreatic fistula (27.3%), delayed gastric emptying (54.5%), and post-pancreatectomy hemorrhage (9.1%). Three patients developed Clavien-Dindo IIIa complications. The median follow-up duration was 19 (IQR: 12-22) months. At the 12-month follow-up, pain and QOL scores showed significant improvement across all domains when compared to pre-operative measurements (p < 0.001). Three patients had recurrent pancreatitis due to resumption of alcohol and tobacco use.

CONCLUSION

GP is a rare and complex condition with significant challenges in diagnosis and management. Surgical treatment, particularly PD, provides effective symptom relief and improves QOL in most patients.

Efficacy and factors related to prognosis of combination chemotherapy with different radiotherapy methods in patients with unresectable hepatocellular carcinoma

Apart from beam radiation (BR), treatment with radioactive implants (RI) was another important modality of cancer therapy. The main purpose was to explore which radiotherapy combined with chemotherapy was more beneficial and identify factor related to prognosis for patients with unresectable hepatocellular carcinoma (HCC). Patients were collected from the surveillance, epidemiology, and end results (SEER) database and were divided into RI group and BR group. Overall survival (OS) and HCC-specific survival were compared between two groups. Propensity score matched (PSM) was used to reduce baseline differences between the two groups. Univariate and multivariate Cox analysis were used to determine the factors affecting the prognosis, and a nomogram model was constructed based on independent risk factors. A total of 1481 HCC patients from 2000 to 2019 were enrolled, including 502 in RI group and 979 in BR group. After PSM, 376 pairs of matched cases were selected. In the matched cohort, there was no significant difference in the median OS (RI vs. BR, 15 vs. 17 months, P = 0.616) and HCC-specific survival (RI vs. BR, 18 vs. 21 months, P = 0.154) between the two groups. Subgroup analysis of different stages also showed no significant difference. Multivariate Cox analysis also did not indicate a significant prognostic difference between the two groups. Based on the independent risk factors of OS such as AFP, grade, TNM staging, and M1, a nomogram model was constructed and verified. When combined with chemotherapy in the treatment of unresectable HCC, RI demonstrated comparable prognostic outcomes to BR, suggesting its potential as an alternative treatment option. In addition, the constructed nomogram model might be able to intuitively and accurately predict the prognosis of unresectable HCC patients receiving chemotherapy combined with radiotherapy.

Pulmonary echinococcosis mimicking tuberculosis in a child from a dual-endemic region: a case report

Background

Pulmonary echinococcosis represents a significant health challenge, particularly in endemic regions, and is associated with substantial morbidity and mortality. Its nonspecific clinical presentation and radiological diversity often lead to misdiagnosis. Here, we report a case of pulmonary echinococcosis initially misdiagnosed as pulmonary tuberculosis.

Case presentation

We report a case of a 13-year-old girl from a region endemic for both echinococcosis and tuberculosis. She initially presented with recurrent cough, hemoptysis, night sweats, and a pulmonary cystic lesion and was diagnosed with pulmonary tuberculosis. However, her condition progressively deteriorated despite antituberculosis therapy. Ultimately, surgical intervention and histopathological examination confirmed pulmonary echinococcosis, and the patient achieved complete recovery after therapy.

Conclusion

For patients from regions endemic for both tuberculosis and echinococcosis who present with cough, hemoptysis, or pulmonary cystic or cavitary lesions, it is crucial to differentiate pulmonary echinococcosis from pulmonary tuberculosis. The final diagnosis should be supported by other microbiological-serological and/or histopathological tests.

Super-resolution ultrasound imaging of intranodal lymphatic sinuses for predicting sentinel lymph node metastasis in breast cancer: a preliminary study

OBJECTIVES

Accurate preoperative localization and characterization of sentinel lymph nodes (SLNs) is vital in breast cancer management. The application of super-resolution ultrasound (SRUS) imaging to visualize intranodal lymphatic sinuses for the prediction of SLN metastasis has yet to be investigated. The study aimed to assess the value of SRUS imaging of intranodal lymphatic sinuses in predicting SLN metastasis in breast cancer patients.

METHODS

A total of 154 SLNs from 143 patients with breast cancer were prospectively included. All patients underwent conventional US of axillary lymph nodes and SRUS imaging of lymph sinus by percutaneous microbubble injection. Qualitative and quantitative analysis were performed for SRUS imaging, with qualitative analysis focusing on identifying perfusion defects and quantitative analysis including parameters such as lymphatic sinus density, sinus diameter, sinus distance, and lymph flow velocity. The areas under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated for conventional US, SRUS, and combined conventional US and SRUS.

RESULTS

Among the 154 SLNs, 73 were metastatic and 81 were reactive. In predicting metastatic SLNs, the AUC for SRUS (0.824; 95% CI: 0.761-0.888) was significantly higher than that for conventional US (0.661; 95% CI: 0.596-0.726) (p < 0.001). The combination of SRUS and conventional US achieved the highest AUC (0.844; 95% CI: 0.785-0.904), which was significantly higher than conventional US alone (p < 0.001), but not significantly different from SRUS alone (p = 0.2).

CONCLUSION

Imaging lymphatic sinuses by SRUS has the potential to predict metastatic SLNs in patients with breast cancer.

KEY POINTS

Question Super-resolution ultrasound (SRUS) used for visualizing intranodal lymphatic sinuses for the prediction of sentinel lymph nodes (SLNs) metastasis has yet to be investigated. Findings Microlymphatic circulation of SLNs were imaged by SRUS at ten microns scale. SRUS showed better performance for predicting metastatic SLNs than conventional ultrasound. Clinical relevance SRUS is a reliable tool to image lymphatic sinuses and characterize metastatic SLNs in patients with breast cancer. It helps diagnosis of lymph node status and clinical decision-making of breast cancer.

Pneumomediastinum after laughing gas inhalation: not a laughing matter anymore-a case report

INTRODUCTION

Nitrous oxide, popularly known as laughing gas, is a colorless gas with a faint, sweet odor, which has been used for recreational purposes since the nineteenth century. We present the case of an 18-year-old male who presented with spontaneous pneumomediastinum after nitrous oxide inhalation.

CASE PRESENTATION

An 18-year-old Caucasian British male patient presented to the emergency department complaining of sharp, central, pleuritic chest pain that radiated up to the throat and was worse on lying down. On examination, palpable surgical emphysema was noted on the neck and was noted on chest X-ray. A computed tomography of neck and chest was then performed, which revealed extensive pneumomediastinum tracking along the cervical, axillary, presternal, and anterior pericardial regions. A water-soluble contrast study was performed, which showed no evidence of esophageal perforation.

CONCLUSION

Nitrous oxide is a substance that is widely and easily available and used recreationally for its euphoric effects. There are uncommon but significant side effects that can occur with its use; having an awareness of this and covering illicit drug use in history-taking will help guide further management plans.

Therapeutic potential of microRNA-506 in cancer treatment: mechanisms and therapeutic implications

Cancer is a complex and highly lethal disease marked by unchecked cell proliferation, aggressive behavior, and a strong tendency to metastasize. Despite significant advancements in cancer diagnosis and treatment, challenges such as early detection difficulties, drug resistance, and adverse effects of radiotherapy or chemotherapy continue to threaten patient survival. MicroRNAs (miRNAs) have emerged as critical regulators in cancer biology, with miR-506 being extensively studied and recognized for its tumor-suppressive effects across multiple cancer types. This review examines the regulatory mechanisms of miR-506 in common cancers, focusing on its role in the competing endogenous RNA (ceRNA) network and its effects on cancer cell proliferation, apoptosis, and migration. We also discuss the potential of miR-506 as a therapeutic target and its role in overcoming drug resistance in cancer treatment. Overall, these insights underscore the therapeutic potential of miR-506 and its promise in developing novel cancer therapies.

Effects of Ionizing Radiation on the Biophysical Properties of Type I Collagen Fibrils

Ionizing radiation is extensively employed in both diagnostic and therapeutic medical practices. The impact of this radiation on collagen, a primary structural protein in humans, remains underexplored, particularly at varying doses and hydration states. This study explores the impact of ionizing radiation on type I collagen fibrils at three radiation doses (diagnostic, therapeutic, and sterilization) and under two hydration conditions using an engineered acellular collagen membrane to reflect varying biological conditions. Techniques including atomic force microscopy (AFM), fluorescence lifetime imaging microscopy (FLIM), and Attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR) were utilized to assess changes in mechanical properties, biochemical stability, and molecular structure respectively. Our results demonstrate that ionizing radiation alters the mechanical properties of collagen fibrils, notably indentation modulus, which reflects changes in stiffness or elasticity. These modifications depended on the hydration state at the time of radiation exposure; hydrated fibrils typically exhibited increased stiffness, suggesting enhanced cross-linking, whereas dehydrated fibrils showed reduced stiffness, indicative of structural weakening, possibly due to bond breakdown. Morphological changes were minimal, suggesting that radiation primarily affects the internal structure rather than the overall appearance of the fibrils. Biochemically, variations in fluorescence lifetimes highlighted changes in the collagen's biochemical environment, dependent on the dose and hydration state. Despite these biochemical and mechanical changes, FTIR analysis indicated that the primary structure of collagen was largely preserved post-irradiation for all examined dose levels. These findings imply that radiation can modify the mechanical properties of collagen, potentially affecting tissue integrity in clinical settings. This could influence the management of radiation-induced conditions like osteoradionecrosis, fibrosis and cancer metastasis. Overall, our study underscores the need for further research into the effects of radiation on structural proteins to better understand and mitigate radiation-induced tissue damage.

The underlying neurobiological basis of gray matter volume alterations in schizophrenia with auditory verbal hallucinations: A meta-analytic investigation

Schizophrenia patients with auditory verbal hallucinations (AVH) frequently exhibit brain structural alterations, particularly reductions in gray matter volume (GMV).Understanding the neurobiological mechanisms underlying the changes is essential for advancing treatment strategies. To address this, a meta-analysis was conducted to identify GMV changes in schizophrenia patients with AVH and their associations with gene expression and neurotransmitter receptor profiles. The results indicated significant GMV reductions in the left and the right insula, as well as the left anterior cingulate cortex. Ontology analysis of genes associated with GMV alternations revealed enrichment in biological processes related to ion transport and synaptic transmission. Hub genes from the KCN, SCN, GN, and PRK families, along with neurotransmitter receptors such as D2, VAChT, and mGluR5, showed significant correlations with GMV changes. Furthermore, multivariate linear regression analysis demonstrated that GNB2, GNB4, PRKCG, D2, and mGluR5 significantly predicted GMV alternations. These findings suggest that GMV reductions in schizophrenia with AVH are linked to disruptions in neurobiological processes involving specific genes and neurotransmitter systems, highlighting the potential targets for therapeutic intervention.

Pseudoaneurysms Post-biliary Stenting: A Comprehensive Literature Review

PURPOSE

Pseudoaneurysms (PSA) following endoscopic biliary stenting are a rare, potentially life-threatening adverse event. Incidence, diagnostic approach, treatment, and prevention of PSA remain unknown. In this comprehensive literature review, we aimed to evaluate the association of developing PSA following biliary stent placement.

METHODS

We conducted a comprehensive search of databases for studies that reported development of PSA after placement of a biliary stent. Full text review and data extraction were performed according to the PRISMA guidelines.

RESULTS

From 386 initial studies, 32 (n = 36 patients) met inclusion criteria. Thirty-one patients had stents placed in the common bile duct, four in the right or left hepatic ducts, and one in the cystic duct. The most common indication for stent placement was biliary obstruction from pancreatic adenocarcinoma with 69.4% of patients having primary pancreaticobiliary malignancy or metastases. 52.0% had received prior chemotherapy with or without localized radiation. Metal stents were used in 60.5% of cases and plastic stents in 37.2%. Average time to PSA presentation was 114 days, with gastrointestinal bleeding as the most common sign/symptom (75%). PSAs were most often located in the hepatic artery (55.6%), diagnosed by diagnostic angiography (55.6%), and treated with embolization (86.1%). No immediate deaths were reported and 83.3% of patients fully recovered.

CONCLUSION

The majority of PSAs presented with gastrointestinal bleeding and developed in patients who had metal stents placed for pancreaticobiliary malignancy. Prior history of previous chemotherapy/radiation or biliary procedures was common in this population. Angiography and embolization were used to diagnose and manage most cases.

Combining with immunotherapy is an emerging trend for local treatment of colorectal cancer liver metastases: a bibliometric analysis

Background

A growing body of evidence has demonstrated the expanding role of local treatment in managing colorectal cancer liver metastases (CRCLM). To identify current research trends and forecast future directions, we conducted a bibliometric analysis to examine global collaboration patterns and academic influence across countries, institutions, journals, and authors.

Materials and methods

Relevant articles and reviews on CRCLM local therapies were systematically retrieved from the Web of Science Core Collection. The bibliometric package in R software and VOSviewer software were used to analyze countries, institutions, journals, authors, and keywords. The research status and key areas of local treatment of colorectal cancer liver metastases were analyzed by keywords.

Results

The analysis encompassed 2,695 articles published between 2008 and 2023. The United States emerged as the leading contributor, with Memorial Sloan Kettering Cancer Center producing the highest number of publications (n=178). Among journals, Annals of Surgical Oncology ranked first in publication volume, while Journal of Vascular and Interventional Radiology achieved the highest citation count. The local treatment modalities for CRCLM included transarterial therapies (radioembolization and chemoembolization), hepatic artery infusion chemotherapy and immunotherapy, imaging guidance methods, hepatectomy and survival, and ablation and stereotactic body radiotherapy. Recent studies highlighted ablations, microspheres, and immunotherapy as key research areas, with thematic mapping identifying immunotherapy as an emerging niche field.

Conclusion

CRCLM local treatment research focuses on integrating local and systemic therapies. Preclinical studies, RFA with anti - PD - 1 agents, show enhanced anti - tumor immunity and survival. While the synergy of local and immunotherapy is confirmed, large - scale clinical evidence is still needed. Thus, cross - disciplinary cooperation is urgently required to boost translational medical research.

Diagnostic Certainty in Characterizing Liver Lesions in Rectal Cancer: Abbreviated Liver MRI versus CT

BACKGROUND

Early diagnosis of metastases is crucial but routine staging with contrast-enhanced multidetector computed tomography (ceMDCT) is suboptimal. A total of 20% will have indeterminate or too small to characterize (TSTC) liver lesions on CT, requiring formal characterization by magnetic resonance imaging (MRI). This UK cross-sectional study reports our experience undertaking routine abbreviated liver MRI (MRI).

PATIENTS AND METHODS

A total of 99 patients with rectal cancer had ceMDCT, abbreviated liver MRI, and rectal MRI at diagnosis. Liver imaging was scored for liver metastases, benign or indeterminate/TSTC lesions on a per patient basis. Primary rectal cancer was risk scored on MRI.

RESULTS

A total of 42/99 (42%) had liver lesion(s) on ceMDCT versus 55/99 (56%) by MRI, and 46/99 (46%) had high-risk rectal cancer. ceMDCT showed 5 patients with liver metastases, 14 with benign lesions, and 23 with indeterminate/TSTC lesions. MRI showed 6 with liver metastases, 45 with benign lesions, and 4 with indeterminate/TSTC lesions. All liver metastases were in high-risk rectal cancer, OR 17.18 (p = 0.06), with 12.5% conversion rate of TSTC lesions to metastases in high-risk rectal cancer and 0% in low-risk rectal cancer. Diagnostic certainty of the liver findings was achieved in 93% of patients by MRI compared with 45% by ceMDCT (p < 0.0001).

DISCUSSION

Abbreviated liver MRI diagnosed fewer indeterminate/TSTC lesions and provided greater diagnostic certainty than ceMDCT, p < 0.0001. High-risk rectal cancer is associated with a higher conversation rate of TSTC lesions to metastases than low-risk rectal cancers. Risk stratified; routine abbreviated liver MRI sequences should be investigated as part of the patient pathway for high-risk rectal cancer.

Accuracy of Contrast-enhanced Ultrasonography with Perfluorobutane for Diagnosing Subpleural Lung Lesions

RATIONALE AND OBJECTIVES

To investigate the diagnostic value of perfluorobutane-enhanced ultrasound (US) examinations for differentiating benign from malignant subpleural lung lesions.

METHODS

This single-center, retrospective study enrolled consecutive patients with subpleural lung lesions between January 2022 and March 2023. The cause of the lung lesions was confirmed by biopsy and follow-up examinations. The lesions were continuously evaluated using perfluorobutane-enhanced US for 0-180 s, and washout (WT) was observed after 3, 5, and 10 min. Univariate and multivariate analyses were used to identify significant US features, which were evaluated for their diagnostic performance. The diagnostic performance of combining several features for predicting malignant lung lesions was also assessed by multivariate logistic regression analysis.

RESULTS

Seventy cases were included (17 benign lesions [13 men, 4 women; mean age: 57.5 ± 12.2 years] and 53 malignant lesions [41 men, 12 women; mean age: 63.3 ± 11.6 years]). Peak intensity (PI), arrival time (AT), and WT after 10 min significantly differed between malignant and benign lesions. The sensitivity and accuracy were significantly higher for 10-minute WT than for AT (both p < 0.05). The area under the curve of the combined diagnostic evaluation with AT, PI, and 10-minute WT was 0.897 (95% [CI]: 0.806-0.988), which was significantly higher than that of AT or PI alone.

CONCLUSION

Perfluorobutane-enhanced US can differentiate benign from malignant lung lesions, and combining AT, PI, and 10-minute WT for diagnostic purposes performed better than a single feature.

Analysis of the treatment outcome of duodenal varices: A retrospective case series of 15 patients from a single institution

Background & aims

Duodenal varices (DVs) are a rare type of ectopic varices occurring in portal hypertension, for which no standardized treatment strategy has been established. This retrospective study analyzed the outcomes of DV treatments in 15 patients.

Material and methods

All enrolled patients with DVs were treated at a single institution Hospital between 2011 and 2022. The treatment procedure and outcome were analyzed retrospectively.

Results

Six patients presented with hemorrhagic DVs. Endoscopic variceal ligation was used for initial hemostasis in five bleeding cases. Balloon-occluded retrograde transvenous obliteration was the initial treatment in nine cases, achieving curative obliteration in eight cases. Percutaneous transhepatic variceal obliteration was performed as the initial treatment in three cases for which balloon-occluded retrograde transvenous obliteration was difficult to perform for anatomical reasons, and all cases achieved curative obliterations. Splenectomy was performed as the initial treatment in three patients due to complicating gastroesophageal varices. DVs recurred in two cases with splenectomy after approximately 1 year, but balloon-occluded retrograde transvenous obliteration and percutaneous transhepatic variceal obliteration were curatively applied in each case, and no recurrence has been observed since then. Gastroesophageal varices aggravated after the initial DV treatment in eight of the 15 cases during the observation period, and the cumulative aggravating rate was 58.1% at 4 years.

Conclusion

All 15 cases with DVs were preferably controlled by selecting appropriate treatment based on individual hemodynamics of varices. Because of the relatively high rate of aggravation of gastroesophageal varices, careful long-term follow-up may be important for the treatment of DVs.

Grey matter hypertropia in a child with recurrent seizure: A case report

Heterotopia is a common anomaly of cortical development often associated with early-onset and familial epilepsy. Grey matter heterotopias are macroscopically classified into nodular and diffuse types and clinically categorized as subependymal, subcortical, or band heterotopia. They are frequently associated with other neurological conditions, such as corpus callosum agenesis, pachygyria, schizencephaly, polymicrogyria, Chiari II malformation, and basilar cephalocele. The clinical presentation varies depending on the thickness of the arrested neuronal band, ranging from partial complex and atypical absence epilepsy to normal cognitive function, developmental delay, or severe intellectual disability. Magnetic resonance imaging (MRI) is the preferred diagnostic modality, as it reveals the abnormally located heterotopic grey matter within the white matter. Carbamazepine is the most commonly prescribed antiepileptic drug, but its use depends on patient-specific factors such as tolerance, side effects, and efficacy. Here, we report the case of a 7-year-old male with a history of three seizure episodes over the past three years, initially diagnosed as febrile seizures with atypical focal features.

Automated pediatric TMJ articular disk identification and displacement classification in MRI with machine learning

OBJECTIVE

To evaluate the performance of an automated two-step model interpreting pediatric temporomandibular joint (TMJ) magnetic resonance imaging (MRI) using artificial intelligence (AI). Using deep learning techniques, the model first automatically identifies the disk and the TMJ osseous structures, and then an automated algorithm classifies disk displacement.

MATERIALS AND METHODS

MRI images of the TMJ from 235 pediatric patients (470 joints) were reviewed. TMJ structures were segmented, and the disk position was classified as dislocated or not dislocated. The UNet++ model was trained on MRI images from 135 and tested on images from 100 patients. Disk displacement was then classified by an automated algorithm assessing the location of disk centroid and surfaces for bone landmarks.

RESULTS

The mean age was 14.6 ± 0.1 years (Female: 138/235, 58 %), with 104 of 470 disks (22 %) anteriorly dislocated. UNet++ performed well in segmenting the TMJ anatomical structures, with a Dice coefficient of 0.67 for the disk, 0.91 for the condyle, and a Hausdorff distance of 2.8 mm for the articular eminence. The classification algorithm showed disk displacement classification comparable to human experts, with an AUC of 0.89-0.92 for the distance between the disk center and the eminence-condyle line.

CONCLUSION

A two-step automated model can accurately identify TMJ osseous structures and classify disk dislocation in pediatric TMJ MRI. This tool could assist clinicians who are not MRI experts when assessing pediatric TMJ disorders.

CLINICAL SIGNIFICANCE

Automated software that assists in locating the articular disk and surrounding structures and classifies disk displacement would improve the TMJ-MRI interpretation and the assessment of TMJ disorders in children.

Awake Venovenous Extracorporeal Membrane Oxygenation in the Intensive Care Unit: Challenges and Emerging Concepts

Extracorporeal membrane oxygenation (ECMO) is an advanced treatment for severe respiratory failure. Implantation of ECMO before invasive ventilation or extubation during ECMO has been reported and is becoming increasingly popular. Avoidance of sedation and invasive ventilation during ECMO (commonly referred to as "awake ECMO") may have potential advantages, including a lower rate of delirium, shorter mechanical ventilation time, and the possibility of undergoing early rehabilitation and/or physiotherapy. However, awake ECMO is also associated with several risks, such as self-inflicted lung injury and cannula displacement or self-removal. Accordingly, invasive ventilation before ECMO, as well as weaning from ECMO before weaning from mechanical ventilation, remain the most common approaches. In this review, the authors describe indications, contraindications, advantages, disadvantages, and current evidence on the use of ECMO without invasive ventilation in patients with respiratory failure.

Association between radiotherapy and overall survival or cancer-specific survival in patients with solitary plasmacytoma of bone at pre-B cell grade: a real-world study using the SEER database

Limited real-world studies have compared radiation therapy (RT) to non-RT for patients with solitary plasmacytoma of bone (SPB). This study investigated the impact of RT on long-term survival outcomes in patients with SPB at the pre-B cell grade within a real-world context. We conducted a retrospective cohort analysis using data from the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with SPB at the pre-B cell grade between 2010 and 2017. Patients were categorized into two groups based on receipt of RT. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) to investigate the value of RT for overall survival (OS) and cancer-specific survival (CSS). Survival curves were generated using the Kaplan-Meier method. A total of 1,922 individuals with SPB at the pre-B cell grade met the inclusion and exclusion criteria. Among these, 1,417 (74%) received RT, while 505 (26%) underwent non-RT. Multivariate Cox regression analysis revealed higher rates of OS (HR = 0.64, 95% CI = 0.55-0.74, p < 0.0001) and CSS (HR = 0.68, 95% CI = 0.56-0.82, p < 0.0001) in patients who received RT. These results remained consistent across sensitivity and subgroup analyses. Analysis of the SEER database suggests that RT is associated with improved OS and CSS and is the primary treatment for patients with SPB at the pre-B cell grade.

Septic Arthritis: Current Concepts

Septic arthritis is a major cause of morbidity and mortality worldwide, with survivors often facing long-term functional impairments. Prompt diagnosis is crucial to decrease complications such as cartilage loss, osteomyelitis, and reduced mobility. Imaging plays a central role in the diagnosis, as well as offering guidance for diagnostic aspiration. Because septic arthritis may involve any joint in the body, both native and prosthetic, different imaging modalities may be more applicable in various scenarios. We describe the hallmark imaging findings of septic arthritis in radiography, ultrasound, computed tomography, magnetic resonance imaging, and nuclear medicine scintigraphy, as well as the associated complications.

Juvenile Idiopathic Arthritis and Spondylarthritis

Juvenile idiopathic arthritis (JIA) is a heterogeneous disorder affecting children < 16 years of age. The clinical heterogeneity translates to imaging, where no specific joint is affected. This article highlights a general imaging approach to JIA, using specific examples of the knee, hand, and wrist as the typical joints affected. We then focus on unique joints that are commonly affected by JIA: the temporomandibular joint, the joints of the upper cervical spine, and the sacroiliac joint. For these latter anatomical sites, regional anatomy and development, location-specific imaging considerations, and arthritis, treatment decision making, and potential differential considerations are reviewed. We highlight, where applicable, a multimodal approach to imaging using developed or developing standardized scoring systems.

Multiple Hypointense Vessels are Associated with Cognitive Impairment in Patients with Single Subcortical Infarction

We aimed to explore the relationship between multiple hypointense vessels and cognitive function in patients with single subcortical infarction (SSI) and the role of SSI with different etiological mechanisms in the above relationship. Multiple hypointense vessels were measured by the number of deep medullary veins (DMVs), DMVs score, and cortical veins (CVs) score. The Montreal Cognitive Assessment (MoCA), the Shape Trail Test (STT), and the Stroop Color and Word Test (SCWT) were assessed to evaluate cognitive function. SSI was dichotomized as branch atheromatous disease (BAD) and cerebral small vessel disease (CSVD)-related SSI by whole-brain vessel-wall magnetic resonance imaging. We included a total of 103 acute SSI patients. After adjustments were made for related risk factors of cognitive function, the SSI patients with higher DMVs score were more likely to have longer STT-B (P = 0.001) and smaller STT-B-1 min (P = 0.014), and the SSI patients with higher CVs score were more likely to have shorter STT-A (P = 0.049). In subgroup analysis, we found that the negative relationship between DMVs scores and cognitive function and the positive relationship between CVs scores and cognitive function were significantly stronger in BAD patients. We provided valuable insights into the associations between DMVs, CVs, and multi-domain cognitive impairment in SSI patients, which underscored the necessity to further study the dynamic alterations of venules and their specific influence on post-stroke cognitive impairment.

Double-row suture-bridge technique does not yield better clinical and radiological results than single-row technique in patients older than 55 years at 2 years minimum follow-up: A comparative study

Purpose

Arthroscopic rotator cuff repair has evolved, with suture anchor-based techniques like single-row (SR) and Double-row Suture-bridge (DRSB) gaining popularity. Despite improvements, early repair failures remain concerning, necessitating continued assessment of repair methods and devices' lasting impact. This study compares DRSB versus SR repairs at 24 months minimum follow-up, hypothesizing superior clinical outcomes and improved tendon healing with DRSB techniques.

Methods

Fifty patients with rotator cuff tears underwent either SR or DRSB repairs. Clinical evaluation included standardized scoring systems and strength testing. Magnetic Resonance Imaging (MRI) assessed tendon integrity. Partial cuff tears were evaluated according to Snyder's Southern California Orthopaedic Institute rotator cuff classification system, which classifies <2 cm lesions as C2 in its scoring system.

Results

Both groups showed comparable clinical outcomes, strength and MRI findings at 24 months minimum follow-up. No significant correlation was found between repair technique and clinical outcomes or retear rates. Preoperative Patte and Goutallier grades >1 were associated with lower postoperative Constant-Murley scores.

Conclusion

This study suggests that both SR and DRSB techniques offer comparable clinical outcomes and tendon healing rates for rotator cuff tears in patients over 55 at 24 months minimum follow-up. While limitations exist, our findings contribute to understanding optimal surgical approaches, emphasizing individualized treatment based on patient characteristics and surgeon expertise. Further research, including randomized controlled trials with long-term follow-up, is needed to refine treatment algorithms and improve patient outcomes in rotator cuff surgery.

Level of Evidence

Level III.

Anatomy for Prostatic Artery Embolization

Prostatic artery embolization (PAE) is a minimally invasive treatment for patients with moderate to severe lower urinary tract symptoms and/or urinary retention due to benign prostatic hyperplasia (BPH), as well as hematuria secondary to prostatic bleeding. PAE achieves its therapeutic effect by inducing ischemic necrosis and reducing prostatic volume, while also decreasing neuromuscular tone. This dual mechanism addresses both the static and dynamic components of bladder outflow obstruction associated with BPH. PAE is technically challenging and necessitates in-depth knowledge of the complex and variable anatomy of the pelvic vasculature. Successful outcomes depend on precise identification of the prostatic artery and recognition of anastomoses to surrounding structures to minimize the risk of nontarget embolization and associated complications. This article reviews the prostatic arterial anatomy and explores the role of advanced imaging techniques for preprocedural planning and intraprocedural guidance to optimize procedural safety and efficacy.

Primary subcutaneous hydatid cyst in the left flank: A case report and review of the literature

INTRODUCTION AND IMPORTANCE

Hydatidosis, a major parasitic disease in Mediterranean countries, primarily affects the liver and lungs, but in rare cases, it may also affect the subcutaneous tissue. Subtle symptoms often delay diagnosis. This report presents a rare case of left flank hydatid cyst.

CASE PRESENTATION

We report a 40-year-old man who had been suffering from a painless mass in the left flank for three months, which was recently painful, and was diagnosed with a subcutaneous hydatid cyst. Imaging and serology tests were inconclusive. The intact cyst was surgically removed, and histology confirmed hydatid cysts. Postoperative albendazole therapy was given for three months and resulted in complete recovery.

CLINICAL DISCUSSION

Hydatid cysts caused by Echinococcus granulosus primarily affect the liver and lungs, with subcutaneous cases being rare. This is the first reported case of a primary subcutaneous hydatid cyst in the left flank.

CONCLUSION

Hydatid disease should be considered in the differential diagnosis of soft tissue tumors, particularly in endemic areas. Outside of typical liver or lung involvement, diagnosis can be challenging and often delayed.

Detection Rate and Concordance of 4D-MDCT, US, and Tc99m MIBI Imaging in the Detection of Ectopic and Intrathyroidal Parathyroid Adenomas

BACKGROUND

Primary hyperparathyroidism is often caused by parathyroid adenomas (PAs), which can be ectopic (EPAs) or intrathyroidal (ITPAs). Accurate localization is crucial for effective surgical intervention. This study aimed to determine the detection rate of four-dimensional multidetector computed tomography (4D-MDCT), ultrasonography (US), and technetium 99 m sestamibi scintigraphy (MIBI) in detecting EPAs and ITPAs. Additionally, we explored the role of ultrasound-guided fine-needle aspiration (US-FNA) and evaluated correlations between parathyroid hormone (PTH) levels, adenoma size, and detection performance.

METHODS

We retrospectively reviewed the records of 28 patients with 29 EPAs and 27 patients with 27 ITPAs who underwent 4D-MDCT, US (including cine Doppler US and US-FNA), and/or MIBI at our institution. Data were collected on demographics, laboratory values, imaging findings, and intraoperative findings. The detection rate was calculated for each imaging modality and their combination. Logistic regression models were used to assess the relationship between PTH level, adenoma size, and detection performance.

RESULTS

The detection rate of EPAs was 96% for 4D-MDCT, 97% for MIBI, and 46% for US. The detection rate of ITPAs was 96% for US, 65% for 4D-MDCT, and 58% for MIBI. Combined multimodality imaging with results concordant between two or more modalities achieved an overall detection rate of 87%. For ITPAs, smaller PA size was associated with significantly worse MIBI detection performance (p < 0.05). The PTH level was not associated with detection performance.

CONCLUSIONS

Our study highlights the superior detection rate of 4D-MDCT and MIBI for EPAs and US for ITPAs. Combining imaging modalities enhances the diagnostic detection rate.

Lesion Classification by Model-Based Feature Extraction: A Differential Affine Invariant Model of Soft Tissue Elasticity in CT Images

The elasticity of soft tissues has been widely considered a characteristic property for differentiation of healthy and lesions and, therefore, motivated the development of several elasticity imaging modalities, for example, ultrasound elastography, magnetic resonance elastography, and optical coherence elastography to directly measure the tissue elasticity. This paper proposes an alternative approach of modeling the elasticity for prior knowledge-based extraction of tissue elastic characteristic features for machine learning (ML) lesion classification using computed tomography (CT) imaging modality. The model describes a dynamic non-rigid (or elastic) soft tissue deformation in differential manifold to mimic the tissues' elasticity under wave fluctuation in vivo. Based on the model, a local deformation invariant is formulated using the 1st and 2nd order derivatives of the lesion volumetric CT image and used to generate elastic feature map of the lesion volume. From the feature map, tissue elastic features are extracted and fed to ML to perform lesion classification. Two pathologically proven image datasets of colon polyps and lung nodules were used to test the modeling strategy. The outcomes reached the score of area under the curve of receiver operating characteristics of 94.2% for the polyps and 87.4% for the nodules, resulting in an average gain of 5 to 20% over several existing state-of-the-art image feature-based lesion classification methods. The gain demonstrates the importance of extracting tissue characteristic features for lesion classification, instead of extracting image features, which can include various image artifacts and may vary for different protocols in image acquisition and different imaging modalities.

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.

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.

Long-term facial nerve outcome in surgically treated petrous bone cholesteatoma patients

INTRODUCTION

The term petrous bone cholesteatoma (PBC) represents a slow-growing epidermal lesion arising from the petrous part of the temporal bone. It is a rare incidence accounting for only 4-9% of all petrous bone lesions. PBC represents a real surgical challenge due to its complex relationship with critical neurovascular structures.

OBJECTIVE

To demonstrate our experience in using various options of facial nerve (FN) management during surgical treatment of PBC and analyze the long-term facial function outcomes.

STUDY DESIGN

Retrospective medical record review in a quaternary skull-base center.

MATERIALS AND METHODS

Medical records of 298 PBC cases operated between the years 1983 and 2024 were thoroughly evaluated. Sanna's classification scheme was used to classify cases into the appropriate class and the House-Brackmann (HB) grading system of the FN was used to assess the facial function pre- and postoperatively.

RESULTS

A total of 298 PBC cases were surgically treated at our center. Males constitute 68% (n = 203) of total operated PBC patients while the rest 32% (95) were females, making the male-to-female ratio 2.2:1. The age in this series ranged from 9 to 85. According to updated Sanna's PBC classification, 44% were supralabyrinthine, 33% were massive, 9% were infralabyrinthine-apical, 8% were infralabyrinthine, and 5% were apical. On preoperative FN function examination, 45% (n = 133) of patients had various degrees of paresis and complete paralysis whereas 55% (n = 165) had normal FN function. The commonest degree of paresis observed was HB-III (18.5%) followed by HB-IV (5.7%). A total of 40(13.4%) patients, however, had complete facial paralysis at the initial presentation. The facial function was compromised more frequently in supralabyrinthine and massive PBCs. Among the total patients who had an abnormal facial function at presentation, 52% had paresis/paralysis for less than a year whereas 48% had FN paresis/paralysis for greater than one year. The most commonly used surgical approaches at our center were transotic (TO), modified transcochlear type A (MTCA) with rerouting of the FN, and translabyrinthine (TLAB) with external auditory canal (EAC) closure. Intraoperatively an intact fallopian canal was found only in 33% (n = 99) cases whereas the rest 67% (n = 199) had erosion of the fallopian canal either with intact (n = 24) or infiltrated FN (n = 175). The FN was maintained in the bony fallopian canal in 35% (n = 104) cases. An active form of FN management, however, was required in 65% (n = 194) of cases either intraoperatively or as a second-stage procedure. Factors affecting postoperative FN function include age, preoperative FN function (HB), duration of paralysis, class of PBC, surgical approach, and method of active FN management.

CONCLUSION

PBCs represent diagnostically and surgically challenging lesions of temporal bone which are usually frustrating to the treating surgeon. Preoperative anatomic classification of the lesion enables the physician to choose the appropriate surgical approach. Sanna's classification is the most widely accepted system used to classify PBC. This classification is based on the relation of the lesion to the labyrinthine block. Active FN management, including rerouting, end-to-end anastomosis, cable nerve grafting, and masseteric-to-FN anastomosis routinely come into play in the surgical management of PBCs, and the postoperative FN results after such interventions can be satisfactory in most cases.

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.

Characterization of Pulmonary Pathology in the Golden Syrian Hamster Model of COVID-19 Using Micro-Computed Tomography

The Golden Syrian hamster is a well-characterized rodent model for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-associated pneumonia. We sought to characterize the pulmonary disease course during SARS-CoV-2 infection (strain USA-WA1/2020) in the hamster model using micro-computed tomography (micro-CT) and compare radiologic observations with histopathologic findings. We observed a range of radiologic abnormalities, including ground glass opacities (GGOs), consolidations, air bronchograms, and pneumomediastinum. The appearance, distribution, and progression of these abnormalities in hamsters were similar to those observed in the lungs of coronavirus disease 2019 (COVID-19) patients by clinical CT and chest X-rays, and correlated with clinical signs and weight loss during the course of disease. Histopathological analysis of infected hamsters revealed lung pathology characteristic of COVID-19 pneumonia, and we observed a strong association between CT and histopathologic scorings. We also analyzed accumulation of air in the thoracic cavity by both manual and automated threshold-based segmentation and found that automated analysis significantly decreases the time needed for data analysis. Data presented here demonstrate that micro-CT imaging can be a major tool in preclinical investigative studies using animal models by providing early and detailed assessment of disease severity and outcomes.

Large retroperitoneal mass: A case of an undifferentiated pleomorphic sarcoma

Soft tissue sarcomas (STS) are a group of rare malignant tumors arising from mesenchymal stem cells. There are more than 60 different types of neoplasms that fall under the umbrella of STS, including tumors that originate from cartilage, adipose tissue, skeletal muscle, or connective tissue, among many other tissue types. One particular type of high-grade aggressive STS is the undifferentiated pleomorphic sarcoma (UPS), formerly known as the malignant fibrous histiocytoma (MFH). There has historically been much debate about the classification and differentiation of UPS from other types of sarcomas, which has only recently been characterized by novel methods of immunohistochemistry markers and sophisticated cytogenetics. This has left much of the literature regarding UPS largely irrelevant in context of our current classification standards. A recent retrospective analysis of 100 UPS cases revealed an incidence of only 9% for UPS originating in the retroperitoneum. We present a case of UPS originating in the retroperitoneum. In this case, a patient suffering from a large right-sided intra-abdominal mass underwent complete surgical resection. We also demonstrate some of the complexities involved in the diagnosis and treatment of a rare retroperitoneal form of UPS.

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.

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.

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.

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.

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.

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.