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.

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.

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.

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.

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.

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.

[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.

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.

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.

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.

"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.

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.

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.

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.

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.

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.

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.

Hydrogen peroxide-enhanced magnetic resonance imaging: A novel approach for diagnosing anorectal-fistula

In this editorial, a commentary on the article by Chang et al has been provided, the course of treatment of anorectal fistulas, especially complex and recurring ones, require accurate diagnostic procedures for determining ideal surgical procedures. Conventional ways of imaging sometimes fall short, offering insufficient insights in aggravated instances. In this editorial, a novel application of hydrogen peroxide-enhanced magnetic resonance imaging (HP-MRI) that promises significant improvements in the imaging of anorectal fistula. Study is based on a retrospective investigation of 60 patients, contrasts the new HP-MRI with conventional diagnostic techniques such as physical examination, trans-perineal ultrasonography and poor spatial resolution MRI. The findings demonstrate HP-MRI's incredible diagnostic performance, with sensitivity and specificity rates of 96.08% and 90.91%, respectively, and unparalleled interobserver agreement (Kappa values ranging from 0.80 to 0.89). It has been a significant advancement for assessment of anorectal fistulas providing a better roadmap for surgical planning, lowering recurrence rates as well as reduced personal and financial burden on patients by reducing the need for repeated treatment and extended hospital stays. The remaining funds can be utilized for treatment of other medical need. Ultimately HP-MRI provides us a healthier & more efficient society by improvising patients well-being & optimized healthcare infrastructure.

Blunt Renal Trauma: A 6-Year Retrospective Review in a Single Institution

Background and Objectives: Renal trauma is a significant consequence of both blunt and penetrating injuries, with management strategies having continuously evolved over recent years. This management requires careful clinical evaluation to balance the need for operative or non-operative treatment. This is especially critical in the context of the increasing trend of non-operative management for stable renal injuries, largely due to advances in imaging, improved hemodynamic stabilization, and better outcomes with conservative approaches. The main objectives of this study were to evaluate the epidemiology of renal trauma, the mechanism of injury, and the outcomes of management strategies in blunt renal trauma and determine their influence on morbidity and mortality rates. Materials and Methods: A retrospective review was conducted with patients diagnosed with renal trauma in the Emergency Clinical County Hospital in Brasov, Romania from 1.01.2018 to 31.12.2023. Data were collected from medical records. Results: A total of 89 patients with blunt renal trauma were identified. The most frequent renal injuries, according to AAST classification, were grade 2 in 34.83% of the patients and grade 1 in 26.97% of the patients. Most of them, 84.27%, were managed conservatively. The overall mortality rate was 12.36%. Conclusions: This review highlights the importance of personalized management strategies for renal trauma, especially emphasizing conservative treatment for hemodynamically stable patients. Our findings contribute to understanding renal trauma outcomes and should improve future clinical practices and guidelines in renal trauma management. Further studies should explore long-term outcomes and optimize treatment protocols.

Development and evaluation of a machine learning model for osteoporosis risk prediction in Korean women

BACKGROUND

The aim of this study was to develop a machine learning (ML) model for classifying osteoporosis in Korean women based on a large-scale population cohort study. This study also aimed to assess ML model performance compared with traditional osteoporosis screening tools. Furthermore, this study aimed to examine the factors influencing the risk of osteoporosis through variable importance.

METHODS

Data was collected from 4199 women aged 40-69 years in the baseline survey of the Ansan and Ansung cohort of the Korean Genome and Epidemiology Study. Osteoporosis was set as the dependent variable to develop ML classification models. Independent variables included 122 factors related to osteoporosis risk, such as socio-demographic characteristics, anthropometric parameters, lifestyle factors, reproductive factors, nutrient intakes, diet quality indices, medical history, medication history, family history, biochemical parameters, and genetic factors. The six classification models were developed using ML techniques, including decision tree, random forest, multilayer perceptron, support vector machine, light gradient boosting machine, and extreme gradient boosting (XGBoost). The six ML classification models were compared with two traditional osteoporosis screening tools, including the osteoporosis risk assessment instrument (ORAI) and the osteoporosis self-assessment tool (OST). The ML model performances were evaluated and compared using the confusion matrix and area under the curve (AUC) metrics. Variable importance was assessed using the XGBoost technique to investigate osteoporosis risk factors.

RESULTS

The XGBoost model showed the highest performance out of the six ML classification models, with an accuracy of 0.705, precision of 0.664, recall of 0.830, and F1 score of 0.738. Moreover, the XGBoost model showed a higher performance on AUC than ORAI and OST. Variable importance scores were identified for 69 out of the 122 variables associated with osteoporosis risk factors. Age at menopause ranked first in variable importance. Variables of arthritis, physical activities, hypertension, education level, income level; alcohol intake, potassium intake, homeostatic model assessment for insulin resistance; energy intake, vitamin C intake, gout; and dietary inflammatory index ranked in the top 20 out of the 69 variables, using the XGBoost technique.

CONCLUSIONS

This study found that an XGBoost model can be utilized to classify osteoporosis in Korean women. Age at menopause is a significant factor in osteoporosis risk, followed by arthritis, physical activities, hypertension, and education level.

Hydrogen peroxide-enhanced magnetic resonance imaging: A novel approach for diagnosing anorectal-fistula

In this editorial, a commentary on the article by Chang et al has been provided, the course of treatment of anorectal fistulas, especially complex and recurring ones, require accurate diagnostic procedures for determining ideal surgical procedures. Conventional ways of imaging sometimes fall short, offering insufficient insights in aggravated instances. In this editorial, a novel application of hydrogen peroxide-enhanced magnetic resonance imaging (HP-MRI) that promises significant improvements in the imaging of anorectal fistula. Study is based on a retrospective investigation of 60 patients, contrasts the new HP-MRI with conventional diagnostic techniques such as physical examination, trans-perineal ultrasonography and poor spatial resolution MRI. The findings demonstrate HP-MRI's incredible diagnostic performance, with sensitivity and specificity rates of 96.08% and 90.91%, respectively, and unparalleled interobserver agreement (Kappa values ranging from 0.80 to 0.89). It has been a significant advancement for assessment of anorectal fistulas providing a better roadmap for surgical planning, lowering recurrence rates as well as reduced personal and financial burden on patients by reducing the need for repeated treatment and extended hospital stays. The remaining funds can be utilized for treatment of other medical need. Ultimately HP-MRI provides us a healthier & more efficient society by improvising patients well-being & optimized healthcare infrastructure.

Enhancing lymphoma staging: Unveiling the potential and challenges of whole-body magnetic resonance imaging

In this editorial, we comment on the article by Lambert et al, published in the recent issue of the World Journal of Radiology. The focus of the editorial is to explore the advancements in whole-body magnetic resonance imaging (WB-MRI) technology, its current clinical applications, and the challenges that must be addressed to fully realize its potential in oncological imaging. WB-MRI has emerged as a pivotal tool in oncological imaging, offering comprehensive disease assessment without ionizing radiation. Its applications span the detection of bone metastases, evaluation of hematologic malignancies, and staging of a wide range of cancers, including lymphoma, prostate, and breast cancers. Advanced techniques such as diffusion-weighted imaging have enhanced its diagnostic performance by providing superior lesion-to-background contrast and quantitative metrics. Despite its diagnostic strengths, WB-MRI faces challenges in standardization, patient acceptance, and integration into clinical workflows. Variability in acquisition protocols, hardware differences, and patient-related factors, such as anxiety and motion artifacts, have limited widespread adoption. Emerging guidelines like MET-RADS-P and ONCO-RADS aim to address these issues by promoting standardized protocols tailored to specific clinical needs. This editorial explores the advancements in WB-MRI technology, its current clinical applications, and the barriers that must be overcome to maximize its utility. By addressing these challenges and embracing standardization, WB-MRI holds the potential to redefine the landscape of oncological imaging, aligning diagnostic precision with modern treatment goals of reducing long-term patient risk.

Spinal hyperplastic bone marrow with a lumbar vertebral compression fracture mimicking vertebral metastasis

A case of hyperplastic bone marrow that mimicked multiple bone metastases is presented in this report. A man in his 80s presented with lower back pain, and MRI revealed an L1 vertebral compression fracture and multiple signal changes in the whole spine that were low on T1 and high on fat-suppressed T2 images. Bone biopsies and imaging studies, including 18F-fluorodeoxyglucose positron emission tomography-CT, did not indicate primary or metastatic malignancy. On follow-up, MRI signal changes became unremarkable, and the patient showed no signs suggestive of malignancy. The final diagnosis was hyperplastic bone marrow and osteopenia with fragility fracture. Metastatic malignancy is commonly suspected in patients with a compression fracture and multiple vertebral lesions. However, clinicians should be aware that benign spinal hyperplastic bone marrow can have similar imaging findings to vertebral metastasis. Imaging, bone biopsy and careful follow-up are necessary to distinguish hyperplastic bone marrow from metastasis.

Innovative Approaches for the Treatment of Spinal Disorders: A Comprehensive Review

This comprehensive review explores the latest advancements in the management of spinal disorders, including minimally invasive surgical techniques, treatment of complex deformities, disc replacement technologies, and non-surgical approaches. The review highlights the potential of innovations such as robotic-assisted surgeries, regenerative medicine, and artificial intelligence to enhance precision, reduce recovery times, and improve patient outcomes. It also discusses the integration of wearable technologies and personalized medicine in tailoring treatments. Challenges such as high costs, accessibility issues, and limited long-term data are critically analyzed, alongside gaps in research, including a lack of diversity in study populations and insufficient economic evaluations. Future directions emphasize the need for multidisciplinary collaboration to develop durable, accessible, and personalized solutions to address the global burden of spinal disorders.

Pelvic Varicose Veins in Women. Russian Experts Consensus

Pelvic Varicose Veins in Women. Russian Experts Consensus.

Accuracy and precision analyses of single-time-point dosimetry utilising physiologically-based pharmacokinetic modelling and non-linear mixed-effects modelling

PURPOSE

The aim of this study was to investigate the accuracy and precision of single-time-point (STP) dosimetry using a physiologically-based pharmacokinetic (PBPK) model with non-linear mixed-effects modelling (NLMEM).

METHODS

Biokinetic data of [111In]In-DOTA-TATE in tumours, kidneys, liver, spleen, and whole body were collected from eight patients. The imaging was performed using planar scintigraphy at 2, 4, 24, 48, and 72 h after injection. Serum activity concentration was quantified at 5 and 15 min; 0.5, 1, 2, and 4 h; and 1, 2, and 3 d after injection. The PBPK model was fitted to the biokinetic data using NONMEM software version 7.5.1. Goodness-of-fit (GoF) criteria were visual inspection of the biokinetic curves, relative standard errors (RSEs) of the fitted parameters < 50%, and the absolute values of the off-diagonal elements in the correlation matrix < 0.8. All-time-point (ATP) fitting was performed, and the obtained absorbed doses (ADs) were used as reference (rADs). The leave-one-out Jackknife method was applied to calculate STP ADs (sADs). The accuracy of STP dosimetry was evaluated using the relative deviation between sADs and rADs. The time point, which resulted in the smallest root-mean-square error (RMSE), was selected as the optimal time point for STP dosimetry. The precision of the AD was calculated as ratio of AD RSE and AD values.

RESULTS

The ATP fitting was adequate based on the GoF test. STP dosimetry at 48 h after injection provided an acceptable estimation of ADs, yielding the lowest RMSE values for the kidney and tumour, calculated as (7 ± 2)% and (14 ± 4)%, respectively. The ADs in STP dosimetry showed lower precision than in ATP dosimetry. For instance, the ADs precision in ATP and STP dosimetry for kidneys in term median[min, max] were 3[3, 3]% and 6[5, 6]%, respectively. Similar results were found for the tumours where the precision of the ADs in ATP and STP dosimetry were 4[4, 5]% and 9[8, 12] %, respectively.

CONCLUSION

STP dosimetry exhibits acceptable accuracy, although it shows a decrease in precision compared to ATP fitting. Precision information is clinically relevant for developing the optimal strategies for simplified dosimetry protocols.

Case Report: a giant liposarcoma of the spermatic cord

Background

Liposarcoma of the spermatic cord is an extremely rare urological malignancy, with fewer than 300 cases reported in the literature worldwide, and it is often difficult to distinguish from inguinal hernias and epididymal cysts. Typically, it presents as an asymptomatic, slow-growing paratesticular mass.

Case presentation

The case described herein involves a 59-year-old man who presented to our hospital with a painless mass in the left scrotum. Physical examination revealed a fixed, firm mass in the left scrotum. Ultrasonography of the scrotum demonstrated an inhomogeneous echogenic mass measuring approximately 113 x 83 x 62 mm on the left side. Testicular MRI showed a mass in the left scrotum measuring approximately 67 x 56 x 98 mm, exhibiting isointence T1 mixed with high T2 signals. The patient then underwent surgery and pathology confirmed a liposarcoma of the spermatic cord. Currently no signs of tumor recurrence on follow-up.

Conclusions

Liposarcoma of the spermatic cord is an exceedingly rare condition, for which surgical intervention is the preferred treatment option. While there is no definitive evidence supporting the use of adjuvant radiotherapy following surgery, it remains necessary in cases where surgical margins are uncertain.

Transition from acute kidney injury to chronic kidney disease in liver cirrhosis patients: Current perspective

In liver cirrhosis patients, acute kidney injury (AKI) is a common and severe complication associated with significant morbidity and mortality, often leading to chronic kidney disease (CKD). This progression reflects a complex interplay of renal and hepatic pathophysiology, with AKI acting as an initiator through maladaptive repair mechanisms. These mechanisms-such as tubular cell cycle arrest, inflammatory cascades, and fibrotic processes-are exacerbated by the hemodynamic and neurohormonal disturbances characteristic of cirrhosis. Following AKI episodes, persistent kidney dysfunction or acute kidney disease (AKD) often serves as a bridge to CKD. AKD represents a critical phase in renal deterioration, characterized by prolonged kidney injury that does not fully meet CKD criteria but exceeds the temporal scope of AKI. The progression from AKD to CKD is further influenced by recurrent AKI episodes, impaired renal autoregulation, and systemic comorbidities such as diabetes and metabolic dysfunction-associated steatotic liver disease, which compound kidney damage. The clinical management of AKI and CKD in cirrhotic patients requires a multidimensional approach that includes early identification of kidney injury, the application of novel biomarkers, and precision interventions. Recent evidence underscores the inadequacy of traditional biomarkers in predicting the AKI-to-CKD progression, necessitating novel biomarkers for early detection and intervention.

Invasive Brain-Computer Interface for Communication: A Scoping Review

BACKGROUND

The rapid expansion of the brain-computer interface for patients with neurological deficits has garnered significant interest, and for patients, it provides an additional route where conventional rehabilitation has its limits. This has particularly been the case for patients who lose the ability to communicate. Circumventing neural injuries by recording from the intact cortex and subcortex has the potential to allow patients to communicate and restore self-expression. Discoveries over the last 10-15 years have been possible through advancements in technology, neuroscience, and computing. By examining studies involving intracranial brain-computer interfaces that aim to restore communication, we aimed to explore the advances made and explore where the technology is heading.

METHODS

For this scoping review, we systematically searched PubMed and OVID Embase. After processing the articles, the search yielded 41 articles that we included in this review.

RESULTS

The articles predominantly assessed patients who had either suffered from amyotrophic lateral sclerosis, cervical cord injury, or brainstem stroke, resulting in tetraplegia and, in some cases, difficulty speaking. Of the intracranial implants, ten had ALS, six had brainstem stroke, and thirteen had a spinal cord injury. Stereoelectroencephalography was also used, but the results, whilst promising, are still in their infancy. Studies involving patients who were moving cursors on a screen could improve the speed of movement by optimising the interface and utilising better decoding methods. In recent years, intracortical devices have been successfully used for accurate speech-to-text and speech-to-audio decoding in patients who are unable to speak.

CONCLUSIONS

Here, we summarise the progress made by BCIs used for communication. Speech decoding directly from the cortex can provide a novel therapeutic method to restore full, embodied communication to patients suffering from tetraplegia who otherwise cannot communicate.

Comparative analysis of oral disorder burden in China and globally from 1990 to 2021 based on GBD data

Oral disorders are major global health issues, affecting 3.5 billion people and imposing significant economic burdens. This study analyzed the distribution and trends of oral disorder burden globally and in China from 1990 to 2021, aiming to inform resource allocation and prevention strategies. Data from the Global Burden of Disease (GBD) 2021 database were used to evaluate the incidence, prevalence, and years lived with disability (YLDs) of oral disorders. All statistical analyses and data visualizations were conducted using R. In 2021, the burden of oral disorders in China accounted for a significant proportion of the global burden. The incidence, prevalence, and YLDs increased by 15.49%, 52.44%, and 86.86% respectively compared with 1990. The global burden also showed an upward trend during the same period. The relevant indicators in China are at a relatively low level, and disparities were observed among regions with different sociodemographic indices (SDI). Oral disorder burden is on the rise globally, with females, children, adolescents, and the elderly being the key affected groups. Regions with middle SDI bear a heavier burden. This study provides a scientific basis for the formulation of relevant policies and emphasizes the necessity of interventions for specific groups.

Transarterial embolisation in the treatment of persistent haematuria in two dogs with lower urinary tract carcinoma

Two dogs with haematuria and frequent urination were referred to our veterinary hospital. They were diagnosed with lower urinary tract carcinoma based on urine cytology and BRAF mutation testing. Transarterial embolisation was performed because of persistent haematuria. This procedure involved super-selective catheterisation and embolisation of the tumour-feeding arteries using gelatine sponge particles, achieving near stasis. After transarterial embolisation, both patients showed resolution of haematuria within 4 days and a marked reduction in tumour volume after 1 month. However, both patients experienced recurrence of haematuria 4 to 6 weeks after the procedure, leading to a second embolisation being performed for each. Following the second embolisation, the haematuria resolved again. Transarterial embolisation could provide benefits for managing persistent haematuria and provides local tumour control in dogs with lower urinary tract carcinoma.

Optimizing Y-chromosome microdeletion screening in Chinese male infertility patients: a large-scale multi-centre study on incidence

STUDY QUESTION

What is the optimal sperm concentration threshold for screening Y-chromosome microdeletions (YCMs) in male infertility patients?

SUMMARY ANSWER

This study identified three clinically relevant screening thresholds: an receiver operating characteristic (ROC)-optimal cutoff at 0.45 million sperm/ml, a high-sensitivity cutoff at 8 million sperm/ml, and a cost-effective threshold at 1 million sperm/ml.

WHAT IS KNOWN ALREADY

YCMs are the second most common genetic cause of male infertility, however, current screening thresholds remain controversial due to limited supporting evidence.

STUDY DESIGN, SIZE, DURATION

This retrospective multi-centre cohort study included 6806 male patients who underwent fertility assessments and azoospermia factor (AZF) gene testing between September 2013 and January 2024.

PARTICIPANTS/MATERIALS, SETTING, METHODS

ROC analysis was used to determine the AUC to show the effectiveness of sperm concentration for predicting AZF deletions. The sensitivity and specificity of different sperm concentration screening thresholds were measured.

MAIN RESULTS AND THE ROLE OF CHANCE

The incidence of YCMs was found to be 12.71% in non-obstructive azoospermia patients, 13.35% in patients with sperm concentrations between 0 and 1 million/ml, and 3.56% in those between 1 and 5 million/ml. ROC analysis demonstrated that sperm concentration was a good predictor of AZF deletions (AUC: 0.75, 95% CI: 0.74-0.77). The optimal threshold of 0.45 million/ml yielded a sensitivity of 86.84%, specificity of 59.97%, positive predictive value (PPV) of 13.48%, and negative predictive value (NPV) of 98.45%. A threshold of 8 million/ml achieved maximum sensitivity of 100.00% and NPV of 100.00%, but with specificity of 30.32% and PPV of 9.34%. The model showed good calibration with a Brier score of 0.06 and a goodness-of-fit test P-value of 0.726. Cost-effectiveness analysis revealed that a threshold of 1 million/ml provided the lowest incremental cost-effectiveness ratio.

LIMITATIONS, REASONS FOR CAUTION

Firstly, despite being the largest cohort study to date, our data primarily originated from eastern China, particularly the Zhejiang region. A nationwide multi-centre study could further validate our findings across different Chinese populations. Secondly, our cost-effectiveness analysis uses general gross domestics product-based willingness-to-pay thresholds, while disease-specific thresholds might be more appropriate and could be explored through nationwide surveys. Moreover, it is important to note that our cost-effectiveness findings are specifically based on the Chinese healthcare system and may not be directly applicable to other countries due to variations in healthcare systems, insurance coverage, and patient payment responsibilities across different regions globally. Another limitation of our cost-effectiveness analysis is that it may not fully capture the complex downstream implications of YCM detection in non-azoospermic men, where the primary impact relates to reproductive choices. Future studies should consider incorporating intergenerational effects and the potential costs of ART in subsequent generations when evaluating the true cost-effectiveness of YCM screening strategies. Thirdly, while we rigorously excluded cases with obstructive factors, the retrospective nature of our study might have introduced an inherent selection bias that could be addressed in future prospective studies. Fourthly, due to challenges in data collection, precise information on abstinence duration for some patients was unavailable and, therefore, not included in this article. We plan to further explore their potential impact on our conclusions in future prospective studies.

WIDER IMPLICATIONS OF THE FINDINGS

This large-scale study provides comprehensive evidence for optimizing YCM screening strategies in male infertility evaluations.

STUDY FUNDING/COMPETING INTEREST(S)

This project was supported by the Medical and Health Technology Program of Zhejiang Province (2025KY085), the Zhejiang Health Information Association Research Program (2024XHSZ-Z05), the Scientific Research Fund of Zhejiang Provincial Education Department (Y202249537), and the National Natural Science Foundation of China (82471638). There are no known competing interests.

TRIAL REGISTRATION NUMBER

N/A.

MRI fingerprints in testes of infertile men with clinical varicocoele: A narrative review

BACKGROUND

Varicocoele represents the most common cause of male infertility, although most men with varicocoele remain fertile. Currently, no specific or sufficiently reliable criteria exist to identify patients who would benefit from varicocoele treatment to prevent impaired spermatogenesis. Emerging evidence suggests that magnetic resonance imaging (MRI) may provide valuable noninvasive insights into the mechanisms of testicular parenchymal damage in infertile men with clinical varicocoele.

OBJECTIVES

The aim of this narrative review was to discuss the applications of advanced MRI techniques, including diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), dynamic contrast-enhanced MRI (DCE-MRI), and proton magnetic resonance spectroscopy (1H-MRS) in the assessment of testes in infertile men with clinical varicocoele and their role in uncovering the complex mechanisms impairing fertility.

MATERIALS AND METHODS

PubMed database was searched for original articles published during 2010-2024.

RESULTS

Advanced MRI techniques reveal alterations in apparent diffusion coefficient (ADC), fractional anisotropy (FA), intratesticular vasculature, and testicular metabolites in men with varicocoele compared to healthy controls. Decrease in testicular ADC and FA is detected in men with varicocoele, indicating microstructural abnormalities. Testes with varicocoele enhance fast and strongly during the early phases of dynamic imaging, providing a valuable insight into tissue perfusion. Proton MR spectra of infertile testes with varicocoele show a decrease in concentrations of choline, myoinositol, Glx complex, and lipids, signifying metabolic signatures of deranged spermatogenesis.

CONCLUSIONS

Preliminary findings from advanced MRI techniques, including DWI, DTI, DCE-MRI, and 1H-MRS have demonstrated potential as noninvasive biomarkers of impaired spermatogenesis, by evaluating testicular microstructure, perfusion, and biochemical milieu.

Orthodontic appliances and their diagnostic impact to brain MRI

OBJECTIVE

The aim of this study was to display and quantify signal loss artifacts in 1.5T and 3T brain MRI on a volunteer with different orthodontic appliances.

MATERIALS AND METHODS

In this experimental study, three different orthodontic appliances were examined on a 1.5T and a 3T MRI scanner in a healthy adult with normal dental occlusion: stainless-steel brackets paired with a nickel-titanium archwire; brackets, archwire, and stainless-steel molar bands; brackets, archwire, molar bands, and a stainless-steel trans-palatal archwire. Assessment of diverse anatomical structures, including different cerebral structures and blood vessels, was conducted using a six-point Likert scale.

RESULTS

Utilizing conventional stainless-steel brackets and a nickel-titanium archwire, with or without the inclusion of stainless-steel molar bands, all cerebral structures demonstrated satisfactory assessability with high diagnostic quality under both 1.5T and 3T MRI. For example, with an average rating of 85/85 for T2 and 77/85 for susceptibility-weighted imaging (SWI). Upon introduction of the stainless-steel trans-palatal archwire, additional artifacts were observed, predominantly manifesting in SWI (20/85), diffusion-weighted imaging (DWI) sequences (31/85), and phase contrast angiography (PCA) (17/20). Differences in artifact severity were mainly observed in the SWI and DWI sequences.

CONCLUSION

Based on the findings of this study, it is not imperative to entirely remove orthodontic appliances to achieve sufficient diagnostic quality in brain MRI. In instances where SWI or DWI sequences are necessitated, the removal of solely the trans-palatal stainless-steel archwire should be contemplated, given its straightforward execution.

CLINICAL RELEVANCE

These results highlight the potential to reduce injury risk during orthodontic appliance removal, expedite imaging procedures, and consequently accelerate diagnostic processes, particularly crucial in emergencies.

Osteoporosis Evaluation by Radiofrequency Echographic Multispectrometry (REMS) in Primary Healthcare

Background/Objectives: Radiofrequency echographic multispectrometry (REMS) technology has emerged as a promising alternative for osteoporosis diagnosis. This non-ionising, portable and accessible method enables early detection of osteoporosis in primary healthcare settings. The aim of this study was to assess the effectiveness of REMS in evaluating osteoporosis within primary healthcare. Methods: Bone mineral density was assessed in 86 participants trough 172 scans of the lumbar spine and femur, using REMS technology in two Portuguese primary healthcare units in Guarda. Results: In the lumbar spine evaluation, 51.2% of the participants had osteopenia and 31.4% osteoporosis; in the femur evaluation, 43.0% had osteopenia and 34.9% osteoporosis. The data indicated a significant prevalence of bone fragility. The bone mineral density estimated by radiofrequency echographic multispectrometry showed good agreement with the clinical diagnosis, suggesting that this technology is effective in the early detection of osteoporosis. Conclusions: Bone densitometry using REMS method, performed by a radiographer in primary healthcare settings, offers a viable and innovative alternative for the effective detection of osteoporosis and osteopenia.