Massive isolated pneumomediastinum in a ventilated patient with COVID-19 pneumonia managed with the insertion of a novel mediastinal drain

Spontaneous pneumomediastinum is associated with SARS-CoV-2 infection-related respiratory manifestations. Coexistence of pneumomediastinum with severe pneumonia may interfere with providing mechanical ventilation due to the possibility of the development of tension inside the mediastinum. We describe a case of severe COVID-19 pneumonia with spontaneous pneumomediastinum and subcutaneous emphysema who required mechanical ventilation. A novel drain was inserted into the mediastinum to decompress the large pneumomediastinum. A 47-year-old male with severe COVID-19 pneumonia required invasive ventilation due to respiratory failure. With the commencement of invasive ventilation, the patient developed a large pneumomediastinum with extensive subcutaneous emphysema. With the deterioration of COVID-19 pneumonia, it was necessary to increase respiratory parameters but was limited because of the possibility of tension pneumomediastinum. Two different drains were inserted, one to the subcutaneous space and the other to the mediastinum. A fenestrated suction drain with an outer protective sheath was created using a 24 Fr chest drain tube and a temporary peritoneal dialysis catheter increment of positive end-expiratory pressure was limited by the risk of development of tension pneumomediastinum. After the procedure, the patient slowly improved over the next few days. After 7 days of the procedure, the patient succumbed due to a secondary bacterial infection of the lung. This case report highlights that a simple technique using easily available equipment improves the condition and can assist in the escalation of ventilatory support in patients with pneumomediastinum.

Preoperative and Postoperative CT Imaging Assessment of Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) can result from various causes of partial or complete obstruction of the upper airway. CT is amenable to quantitative analysis of the upper airway and surrounding structures. CT is also useful for identifying abnormalities that could be attributed to the patient's symptoms and is relevant for surgical planning. There are various surgical procedures that can be performed for OSA that can also be encountered on CT. The relevant anatomic measurements, imaging features of various pathologies that can affect the upper airway, and postoperative imaging for OSA are reviewed in this article.

Diagnostic performance of contrast-enhanced CT combined with contrast-enhanced MRI for colorectal liver metastases: a case-control study

BACKGROUND

Colorectal liver metastases (CRLM) are a major determinant of prognosis in colorectal cancer (CRC) patients. Their early and accurate detection is essential for appropriate therapeutic planning and improving survival outcomes.

PURPOSE

To evaluate the diagnostic capabilities of contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) in detecting colorectal liver metastases.

MATERIALS AND METHODS

We employed a case-control design to compare patients with histologically confirmed liver metastases against a control group without the condition. A total of 85 patients in each group were selected and retrospectively matched based on relevant factors. All subjects underwent both contrast-enhanced CT and MRI. The diagnostic performance of these imaging modalities was assessed by analysing sensitivity, specificity, positive and negative predictive values, and radiologists' diagnostic confidence. Kappa statistics were used to evaluate inter-observer agreement. All MRI scans were performed using a 3-Tesla (3-T) MRI scanner to ensure high-quality imaging and detailed lesion characterization. And all the scans were reviewed by two radiologists.

RESULTS

The combination of contrast-enhanced CT and MRI demonstrated a statistically significant improvement in sensitivity (90.6% for MRI alone vs. 96.5% for combined modalities) and specificity (95.3% for MRI alone vs. 98.3% for combined modalities). Positive and negative predictive values were similarly enhanced. Radiologists' diagnostic confidence was higher with combined imaging, achieving a 'very high' confidence level in 78.8% of cases compared with 64.7% for MRI alone. The inter-observer agreement reached 'almost perfect' status with the combined approach.

CONCLUSION

The integration of contrast-enhanced CT with MRI significantly enhanced the diagnostic accuracy for colorectal liver metastases, representing a valuable tool for the preoperative evaluation of patients with CRC.

CLINICAL TRIAL NUMBER

Not applicable.

An Imported Case of Gigantic Amoebic Liver Abscess in a 24-Year-Old Woman in Singapore

A liver abscess can be due to several different microbiological aetiologies. While pyogenic liver abscess is most frequently encountered, amoebic liver abscess and hydatid cyst caused by the parasites, Entamoeba histolytica and Echinococcus granulosus, respectively, should be considered whenever there is epidemiological exposure. As parasitic infections are now rarely seen in clinical practice in developed countries with improvement in sanitation, lack of clinical experience in managing amoebic liver abscesses and overlapping clinical and imaging features between amoebic and pyogenic liver abscesses may lead to delay in diagnosis. In particular, although amoebic liver abscesses respond well to treatment if diagnosed early, they can progress and rupture with high mortality if treatment is delayed. Hence, early diagnosis and prompt initiation of antimicrobials are crucial to prevent complications and death. This case report highlights a case of a very large 21 cm ALA in a young lady to illustrate the challenges faced during diagnostic evaluation.

Relationship Between Sigmoid Volvulus Subtypes, Clinical Course, and Imaging Findings

Background: Recent studies indicate that the organo-axial subtype of a sigmoid volvulus is more prevalent than the conventional mesentero-axial subtype. Our study aimed to assess the clinical and radiological findings that differentiate between these two subtypes, as well as to ascertain treatment outcomes and prognostic characteristics. Methods: A retrospective review included 54 patients, during which abdominal plain radiographs and computed tomography images were analyzed by two radiologists, and data on recurrence, mortality, and treatment outcomes were documented. Results: The mesentero-axial subtype comprised 40 cases (74%). No distinct radiographic findings were observed to differentiate between the two groups. In computed tomography, the sole significant parameter for differentiation was the number of transition zones. The diameter of the segment exhibiting a volvulus was greater in instances of the mesentero-axial subtype. The endoscopic detorsion treatment proved ineffective in five patients within the mesentero-axial sigmoid volvulus cohort. Conclusions: Identifying these two types of SV on CT images is essential because of their distinct prognoses and therapeutic results.

CT-based body composition analysis to study the effect of visceral obesity on postoperative complications in ovarian cancer: implications for young patients

PURPOSE

Ovarian cancer is characterized by high morbidity and mortality, with surgery remaining the primary treatment modality. The occurrence of postoperative complications significantly impacts patient prognosis and quality of life. As cancer increasingly affects younger individuals, it is crucial to consider age-related differences. Meanwhile, epidemiology suggests a high prevalence of obesity among females. This study aims to evaluate the effect of visceral obesity (VO), diagnosed using computed tomography (CT)-based body composition analysis, on postoperative complications.

METHODS

A total of 309 patients operated between 2017 and 2022 were included in this study. Patients were stratified into two age groups: ≤65 years (younger group) and > 65 years (older group). The receiver operating characteristic (ROC) curve was employed to determine the threshold value for VO. Univariate and multivariate analyses were conducted to identify risk factors associated with postoperative complications.

RESULTS

According to the cut-off value, the incidence of postoperative complications was significantly higher in younger patients with VO compared to the non-VO group (56% vs. 36%, p < 0.01), whereas no difference was observed in older age groups. VO (OR = 1.980, p = 0.031), total protein < 65 g/L (OR = 3.704, p = 0.045), primary debulking surgery (PDS) (OR = 0.369, p = 0.026), duration of surgery (OR = 1.004, p = 0.006) and intraoperative bleeding volume (OR = 1.003, p < 0.01) were identified as independent predictors of postoperative complications in the younger age group. International Federation of Gynecology and Obstetrics (FIGO) stage for III or IV (OR = 4.00, p = 0.029) remained as the only independent predictor for the older age group.

CONCLUSIONS

In young ovarian cancer patients, VO may serve as a predictor for postoperative complications, and appropriate preventive measures may be beneficial in reducing the incidence of postoperative complications.

Complications of Endoscopic Retrograde Cholangiopancreatography

Up to 1 in 6 patients will experience an unplanned hospitalization after endoscopic retrograde cholangiopancreatography (ERCP), largely for the evaluation and management of adverse events. Therefore, a commitment to the prevention, early recognition, and effective rescue of complications related to ERCP is critical toward improving outcomes. ERCP is most often complicated by acute pancreatitis, bleeding, infection, or perforation, although myriad other adverse events may occur. The prevention of post-ERCP pancreatitis has been the area of greatest interest and progress in the last decade, but the application of evidence-based prophylactic measures remains inconsistent. Innovations in stent, hemostasis, and perforation closure technology now allow effective and efficient endoscopic management of several important nonpancreatitis complications. Overall, our ability to prevent and treat ERCP-related adverse events has improved substantially, amplifying the importance of a high level of suspicion for and a thorough understanding of these events.

Do We Need to Add the Type of Treatment Planning System, Dose Calculation Grid Size, and CT Density Curve to Predictive Models?

Background: Generalizability and domain dependency are critical challenges in developing predictive models for healthcare, particularly in medical diagnostics and radiation oncology. Predictive models designed to assess tumor recurrence rely on comprehensive and high-quality datasets, encompassing treatment planning parameters, imaging protocols, and patient-specific data. However, domain dependency, arising from variations in dose calculation algorithms, computed tomography (CT) density conversion curves, imaging modalities, and institutional protocols, can significantly undermine model reliability and clinical utility. Methods: This study evaluated dose calculation differences in the head and neck cancer treatment plans of 19 patients using two treatment planning systems, Pinnacle 9.10 and RayStation 11, with similar dose calculation algorithms. Variations in the dose grid size and CT density conversion curves were assessed for their impact on domain dependency. Results: Results showed that dose grid size differences had a more significant influence within RayStation than Pinnacle, while CT curve variations introduced potential domain discrepancies. The findings underscore the critical role of precise and standardized treatment planning in enhancing the reliability of predictive modeling for tumor recurrence assessment. Conclusions: Incorporating treatment planning parameters, such as dose distribution and target volumes, as explicit features in model training can mitigate the impact of domain dependency and enhance prediction accuracy. Solutions such as multi-institutional data harmonization and domain adaptation techniques are essential to improve model generalizability and robustness. These strategies support the better integration of predictive modeling into clinical workflows, ultimately optimizing patient outcomes and personalized treatment strategies.

Grading of clear cell renal cell carcinoma using diffusion MRI with a multimodal apparent diffusion model

Objective

To assess the feasibility of utilizing parameters derived from a multimodal apparent diffusion (MAD) model to distinguish between low- and high-grade clear cell renal cell carcinoma (ccRCC).

Method

Diffusion-weighted imaging (DWI) scans with 12 b-values (0 - 3000 s/mm²) were conducted on 54 patients diagnosed with ccRCC (30 low-grade and 24 high-grade). The MAD model parameters, including diffusion coefficients (Dr, Dh, Dui, Df) representing restricted diffusion, hindered diffusion, unimpeded diffusion, and flow, respectively, were computed. Proportions corresponding to these diffusion types (fr, fh, fui, ff) and the heterogeneous nature of hindered diffusion (αh) were also obtained. Parameters were compared between low- and high-grade groups. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of these parameters, compared with the apparent diffusion coefficient (ADC) from a mono-exponential model.

Result

Significant differences between low- and high-grade ccRCC were observed in Dh (low-grade: 1.360 ± 0.11 μm2/ms; high-grade group, 1.254 ± 0.13 μm2/ms; P = 0.0327), fr (low-grade: 0.06 ± 0.005; high-grade: 0.08 ± 0.009; P = 0.0233), and αh (low-grade: 0.872 ± 0.22; high-grade: 0.896 ± 0.39; P = 0.0294). Additionally, the ADC values (low-grade: 0.924 ± 0.08 μm2/ms; high-grade group, 0.854 ± 0.04 μm2/ms; P = 0.0323) showed statistical significance. The combination of Dh, fr, and αh provided the highest diagnostic accuracy of 0.667, with a sensitivity of 0.750, specificity of 0.734, and area under the curve of 0.796, outperforming individual parameters and ADC.

Conclusion

The MAD diffusion model shows promise as a non-invasive imaging tool for distinguishing between low- and high-grade ccRCC, which may aid in preoperative planning and personalized treatment strategies.

Large-Cell Neuroendocrine Carcinoma of the Cervix: Case Report and Literature Review

Background and clinical significance: Large-cell neuroendocrine carcinoma (LCNEC) of the cervix is considered a rare type of cancer: it represents <1% of invasive cervical cancers. The optimal treatment protocol is not fully established because of its rarity and diagnostic challenges. Case Presentation: A 72-year-old Asian female presented to our outpatient clinic with postmenopausal vaginal spotting for 1 month. Vaginal sonography revealed a cervical tumor of 2.7 cm in diameter with hypervascularity. Tumor markers such as CA 125, CA 19-9, carcinoembryonic antigen, and squamous cell carcinoma antigen all showed no abnormality. Due to high suspicion of cervical cancer, a pap smear and endocervical curettage were performed and confirmed the diagnosis of LCNEC. A positron emission tomography-computed tomography scan demonstrated a glucose hypermetabolic lesion in the mid-pelvic region, localized to the uterus, consistent with LCNEC. Surgery with radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymph node dissection was performed. The patient was finally diagnosed with pT1b2N1mi, FIGO IIIC1. Immunohistochemical stain shows that the neoplastic cells were CK (+), p63 (-), p16 (-), CEA (-), vimentin (-), ER (-), WT-1 (-), p53 (-), and CD56 (+), with a high Ki67 index (75%). Concurrent chemotherapy with cisplatin and radiotherapy was performed. Four cycles of etoposide and cisplatin were planned. A 3-month follow-up of this patient revealed stable tumor marker levels. Conclusions: This case highlights the diagnostic challenges and aggressive nature of LCNEC of the cervix, emphasizing the need for a standardized treatment approach to improve patient outcomes.

Early angiography improves postoperative clinical outcomes compared to delayed angiography among patients with vascular pathologies following partial nephrectomy

PURPOSE

This study aims to assess the evaluation, management, clinical outcomes and incidence of postoperative hematuria following partial nephrectomy (PNx) for renal tumors.

METHODS

We retrospectively reviewed the medical charts of 936 adult patients who underwent PNx between 2008 and 2023. Patients presenting with hematuria during the first 6 months of surgery were included. Group 1, comprising patients who were treated with early angiography and selective embolization (n = 8), was compared to Group 2, patients who underwent imaging first (US or CTA), followed by angiography and selective embolization (n = 10, "delayed" angiography).

RESULTS

24 (2.6%) patients presented with hematuria, 18 (75%) required angiography-assisted intervention. Of those 18 patients, 17 (94.4%) were diagnosed with vascular pathologies; renal artery pseudoaneurysm (RAP) and arteriovenous fistula. Ultrasound (US) did not detect RAP in 33% of patients' initial evaluations (67% sensitivity). The median age was 67 years (IQR: 71.5-58.5 years), and the median time to hematuria was 11.5 days (IQR: 20.3- 7 days). The difference in the median interval time from presentation to embolization between Groups 1 and 2 was 20.2 h (CI 95%, p = 0.25). Group 1 had higher hemoglobin levels following therapy (p = 0.04), lower transfusion rates or antibiotic therapy (p = 0.02), shorter hospitalization stays (p = 0.03), and lower re-admission rates (p = 0.043) compared to Group 2.

CONCLUSION

RAP is ubiquitous among patients presenting with hematuria following PNx. With hematuria presentation, the use of US should be limited. For cases where selective embolization is considered, angiography is sufficient to identify vascular pathologies, guiding therapeutic intervention. Management by early angiographic intervention is associated with better clinical outcomes compared to delayed angiography following confirmatory imaging.

Routine histopathological examination of femoral heads and incidental metastatic bone disease in hip arthroplasty

Objective

This study aimed to assess the necessity of routine pathological examination of femoral heads in detecting incidental metastatic bone disease in patients undergoing elective and emergency hip arthroplasty.

Methods

A retrospective review was conducted on medical records, operative notes, and histopathology reports of patients who underwent hip arthroplasty between 2016 and 2024. Patients without pathological evaluation or with known metastases were excluded. The study included patients with hip osteoarthritis undergoing total hip arthroplasty and those with femoral neck fractures undergoing bipolar hemiarthroplasty. Preoperative diagnoses, comorbidities, and operative and histopathological findings were analyzed.

Results

The study included 193 patients with femoral neck fractures (mean age: 76.8 years, age range=60 - 98 years) and 257 with osteoarthritis (mean age: 60.4 years, age range= 23 - 88). After excluding 22 femoral neck fracture and 90 osteoarthritis patients, 36 patients in the fracture group and 18 in the osteoarthritis group had a history of malignancy, with 10 and 2 patients, respectively, having known metastases. Incidental metastatic bone disease was identified in four femoral neck fracture patients, while no neoplastic findings were detected in the osteoarthritis group.

Conclusion

Routine pathological examination of femoral heads is particularly relevant in femoral neck fracture cases, where the risk of detecting metastatic disease is higher. While thorough preoperative assessments and meticulous intraoperative evaluations aid diagnosis, the decision to submit specimens for pathology should be guided by the surgeon's clinical judgment and patient-specific factors.

Level of Evidence

Level III, Diagnostic Study.

Evaluation of the Effects of Photobiomodulation on Bone Density After Placing Dental Implants: A Pilot Study Using Cone Beam CT Analysis

Background: One of the parameters of maximum interest regarding the quality of the intraoral hard tissues is represented by the bone density, with direct clinical implications. The evaluation of this extremely important clinical parameter can be achieved by several imaging methods, of which the most known in dentistry is represented by the cone beam computed tomography (CBCT). Objectives: The purpose of the study is to obtain a quantitative analysis of bone mineral density changes in patients who underwent treatments of photobiomodulation (PBM), as complementary to a surgical approach in oral surgery and implantology. Methods: The study included the retrospective analysis of maxillary cone beam computed tomography of 28 patients without pathology or medication known to affect bone metabolism or its qualitative and quantitative properties. All patients from the study group followed the same laser PBM treatment protocol after placing dental implants; the PBM protocol implied the intraoral use of a gallium aluminum arsenide laser (GaAlAs) of 808 nm, 450 mW, in pulsed mode, administering an energy of 6 J in 3 points corresponding to each inserted dental implant-mesial, distal, and apical-totaling 18 J/implant. Treatment sessions were performed immediately postoperatively and at a subsequent distance of 48 h for 2 weeks (a total of eight sessions). For every patient, bone density was analyzed before and after PBM treatment, in the same areas of interest, within the same anatomical landmarks. A comparison was also made between the results obtained for the anterior maxilla and the posterior maxilla. All the measurements made were analyzed statistically, the results being presented in the dedicated section. Results: Based on the data analysis, the comparison between the lasered and non-lasered groups reveals that patients who underwent PBM showed a statistically significant improvement in bone mineral density, with the mean increasing from 530.91 HU before treatment to 842.55 HU after treatment (t-test: p < 0.001). In contrast, the non-lasered group showed no significant improvement, with a slight decrease in bone mineral density, as the mean dropped from 495.19 HU before treatment to 462.16 HU after treatment (t-test: p = 0.47). Conclusions: The study demonstrated results with statistical significance regarding the mineral bone density improvement of patients who underwent laser PBM treatment. This positive effect of laser therapy has been shown, both at the level of the vestibular cortical bone and at level of the trabecular bone, independent of the patient's sex, for the anterior maxilla and at the lateral areas also.

Imaging and interventions in vascular malformations of the gastrointestinal tract

Vascular malformations of the gastrointestinal (GI) tract are a rare yet significant cause of GI bleeding, that can present at any age and require a high index of suspicion for timely diagnosis. While the majority of lesions may be asymptomatic and detected incidentally on imaging, they may also present with anemia if there is occult blood loss, as acute GI bleeding, or as lead points for intussusception. The presence of multiple vascular malformations may be associated with underlying syndromes, such as Hereditary Hemorrhagic Telangiectasia syndrome and Klippel-Trénaunay syndrome. While luminal endoscopy is the first-line diagnostic test to evaluate overt and occult GI bleeding, imaging plays a very significant role in detecting these vascular malformations and planning the best treatment approach. In this review, we describe the various imaging findings of GI tract vascular malformations and available treatment options, focusing on endovascular interventional treatments where possible.

Changes in the mechanical properties of tibialis anterior and peroneus longus allograft depending on sterilization method and storage time

Aims

The aim of the present research was to analyze the effects of different sterilization methods and storage times on the mechanical properties (load at first break, strain at first break, maximum load, strain at maximum load, and Young's modulus of elasticity) of different allografts compared to native groups.

Methods

Two types of grafts were harvested from human cadavers: 165 tibialis anterior (TA) and 166 peroneus longus (PL) tendons. According to the two types of sterilization methods (γ and electron beam irradiation) or the lack of one, and the six types of storage time (one to six months), 36 groups were created. In addition, we created a 1 to 1 native group, which was not sterilized and stored, tested within four hours of collection.

Results

In the results of tendon type TA compared to TA native group, we observed significant differences at the fifth month of storage for all measured parameters. Load at first break of the frozen values at the fifth month was significantly inferior to the native group (p = 0.034). For strain at first break and strain at maximum load, all sterilization methods were significantly inferior at the fifth month (p = 0.003 to p = 0.009). Maximum load values were significantly superior with E-beam irradiation at the fifth month (p = 0.003), and also significantly higher with γ irradiation at the fifth month (p = 0.009). Young's modulus showed significantly inferior values in the frozen tendons at the fifth month (p = 0.001 to p = 0.003). In tendon type PL, no significant differences were found for any of the tested parameters compared to the native group.

Conclusion

Our results indicate that freezing alters mechanical properties via the decrease seen in the ultimate tensile strength. In addition, at the fifth and sixth months of storage, time could notably affect allografts rather than the sterilization procedures.

White matter changes in paediatric bipolar disorder: A systematic review of diffusion magnetic resonance imaging studiesA systematic review of diffusion magnetic resonance imaging studies

BACKGROUND

Paediatric bipolar disorder (PBD) is characterized by severe mood fluctuations that deviate from typical childhood emotional development. Despite the efforts, the pathophysiology of this disorder is not well understood yet. In this review, we aimed to synthesize existing diffusion magnetic resonance imaging (dMRI) research findings in PBD.

METHODS

A literature search was conducted using PubMed, Embase, Scopus, and Web of Science databases to identify relevant studies published before April 2024.

RESULTS

A total of 23 studies were included in the review. The findings showed variations of fractional anisotropy (FA), axial diffusivity, radial diffusivity, and apparent diffusion coefficient in PBD compared to healthy controls (HCs). Key findings included decreased FA in the anterior cingulate, anterior corona radiata, and corpus callosum, particularly the genu, which correlated with clinical symptoms. Furthermore, longitudinal studies emphasized the significance of the uncinate fasciculus as having atypical developmental trajectories in PBD compared to HCs. In addition, graph analysis revealed widespread changes in structural connectivity, especially affecting the orbitofrontal cortex, frontal gyrus, and basal ganglia. Lastly, machine learning models showed promising results in differentiating PBD from HCs.

LIMITATIONS

Cross-sectional design of the studies, small sample sizes, and different imaging protocols preclude integration of the findings.

CONCLUSION

PBD seems to be associated with widespread structural changes compared to HC. Understanding these changes, which might account for the clinical manifestations of this disorder, increase our knowledge of the neurobiological underpinnings of PBD. This, in turn, may help develop more effective treatments for this disorder.

Diagnosing Heart Failure with Preserved Ejection Fraction in Obese Patients

Obesity is a current pandemic that sets all affected individuals at risk of heart failure (HF), and the majority of them will develop the clinical syndrome of HF with preserved ejection fraction (HFpEF). The diagnosis of HFpEF is challenging as it is based on the detection of subtle functional and structural remodeling of the heart that leads to diastolic dysfunction with increased left ventricular (LV) filling pressures and raised natriuretic peptides (NPs). The accurate diagnosis of HFpEF is even more challenging in patients who are obese, since the echocardiographic imaging quality may be suboptimal, the parameters for the evaluation of cardiac structure are indexed to the body surface area (BSA) and thus may underestimate the severity of the remodeling, and the NPs in patients who are obese have a lower normal threshold. Moreover, patients who are obese are prone to atrial fibrillation (AF) and pulmonary hypertension (PH), making the evaluation of diastolic dysfunction more strenuous. The current review aims to offer insights on the accurate diagnosis of HFpEF in patients who are obese in different clinical scenarios-patients who are obese in different clinical scenarios-such as in sinus rhythm, in atrial fibrillation, and in the case of pulmonary hypertension-by applying multimodality imaging and clinical diagnostic algorithms.

Morphological characterization of atypical pancreatic ductal adenocarcinoma with cystic lesion on DCE-CT: a comprehensive retrospective study

BACKGROUND

Pancreatic ductal adenocarcinoma (PDAC) with cystic features presents significant challenges in achieving an accurate preoperative diagnosis and in implementing appropriate clinical management. The aim of this study was to analyze the dynamic contrast-enhanced computed tomography (DCE-CT) findings of PDACs with cystic lesions and correlate them with histopathological findings.

METHODS

We retrospectively reviewed 40 patients with pathology-proven PDACs exhibiting cystic lesions who underwent preoperative DCE-CT imaging. The CT manifestations were classified into three subtypes based on the morphological characteristics of the cystic lesions: Type 1, small proportion (< 50%) of intratumoral cystic lesions, with or without associated peritumoral cystic lesions; Type 2, large proportion (≥ 50%) of intratumoral cystic lesions, with or without associated peritumoral cystic lesions; Type 3, a solid pancreatic mass with accompanying peritumoral cystic lesions. The DCE-CT findings were analyzed based on location, size, contour, enhancement patterns, and secondary findings, and compared with the corresponding pathological diagnoses.

RESULTS

Among the 40 patients, 23 (57.5%) tumors were located in the pancreatic body or tail. Type 1 was identified in 21 cases, Type 2 in 6 cases, and Type 3 in 13 cases. All masses exhibited a bulging pancreatic contour, with 4 cases showing isoattenuating enhancement on DCE-CT. Secondary signs were present in 87.5% (35/40) of cases. Notably, 15 cases (37.5%) were misdiagnosed or missed. Surgical resection specimens demonstrated common pathological features, including large duct-like cysts and coagulative necrosis.

CONCLUSION

Atypical PDAC with cystic lesions is a relatively uncommon variant that exhibits a range of DCE-CT features, along with distinct pathological characteristics. Familiarity with these imaging features is essential for radiologists in order to minimize the risk of misdiagnosis and guide appropriate clinical management of these challenging cases.

Post-traumatic pseudoaneurysm of the anterior tibial artery: therapeutic challenge

Subacute traumatic arterial pseudoaneurysms involving the infragenicular arteries are rarely discussed in the literature because they tend to be asymptomatic or manifest clinically subtle symptoms even at late stages. We describe the case of a 25-year-old patient with a perforation injury to the lower limb from a shard of glass, who, after two weeks, developed pain and swelling in the limb, which suggested deep vein thrombosis. Venous Doppler ultrasound ruled out thrombosis but revealed heterogeneous echogenicity in the anterior wall of the middle third of the anterior tibial artery with internal flow, suggesting a pseudoaneurysm. We opted for conventional surgical treatment and, after proximal and distal control of the artery, drainage of the local hematoma and primary suturing of the lesion were performed. Pseudoaneurysm of the infrapatellar arteries, although rare, is a challenging clinical entity that requires early diagnosis.

Echocardiography in the cardiac assessment of young athletes: a 2025 guideline from the British Society of Echocardiography (endorsed by Cardiac Risk in the Young)

Sudden cardiac death in a young physically active individual or athlete is a rare but tragic event. Pre-participation screening and follow-up investigations are utilised to reduce the risk and occurrence of these events. Echocardiography plays a key role in the cardiac diagnostic pathway and aims to identify underlying inherited or congenital structural cardiac conditions. In 2013 the British Society of Echocardiography and Cardiac Risk in the Young produced a joint guidance document to support echocardiographers in this setting. The document was subsequently updated in 2018, and it is now timely to provide a further update to the guideline drawing on the advances in our knowledge alongside the developments in ultrasound technology within this nuanced area of sports cardiology.

These Hips Don't Lie: Deep Vein Thrombosis in an Adolescent With an Inferior Vena Cava Anomaly

Congenital anomalies of the inferior vena cava can predispose adolescents to deep vein thrombosis. A 13-year-old male with left hip pain after a sports injury was found to have extensive deep vein thromobis due to an interrupted inferior vena cava. The diagnosis led to catheter-directed thrombolysis and anticoagulation, resolving symptoms.

Reliability of Shear Wave Elastography for Measuring the Elastic Properties of the Quadratus Lumborum Muscle

Background/Objectives: The quadratus lumborum (QL) muscle is a key structure involved in patients with low back pain (LBP). Since the discriminative capability of morphological descriptors is uncertain and considering the high prevalence of myofascial trigger points and the poor reliability of manual palpation in this condition, developing a reliable procedure for assessing the QL's tenderness is needed for facilitating the diagnosis and monitoring changes over time. We aimed to analyze the intra- and inter-examiner reliability of SWE for calculating the QL tenderness in patients with LBP. Methods: Using a convex transducer, longitudinal shear wave elastography (SWE) images of the QL muscle were acquired bilaterally twice in 52 volunteers with moderate LBP and disability by one experienced examiner and one novel examiner to measure shear wave speed and Young's modulus as stiffness metrics. Results: Intra-examiner reliability estimates demonstrated high consistency independently of the examiner's experience (intraclass correlation coefficients (ICCs) > 0.930) for both metrics. However, experienced examiners showed smaller minimal detectable changes. Additionally, inter-examiner reliability was lower, with ICCs ranging from 0.57 to 0.68, and significant differences in mean values between examiners (p < 0.01) were found. Conclusions: This procedure exhibited excellent intra-examiner reliability for assessing QL muscle stiffness in patients suffering LBP, indicating high repeatability of measurements when performed by the same examiner. In addition, experienced examiners demonstrated greater sensitivity in detecting real changes not attributed to measurement errors. However, inter-examiner reliability was moderate, highlighting the need for consistent examiner use to avoid measurement variability and averaging multiple measurements to enhance the accuracy.

Comparative analysis of traditional and integrated approaches to radiology training for residents

BACKGROUND

The study aims to conduct a comparative analysis of traditional and integrated approaches to radiology teaching in order to evaluate the effectiveness of novel educational methods.

METHODS

The study was conducted in Shenzhen, China, between January and December 2023. It involved 100 radiology residents who were randomly assigned to either a traditional training (TT) group or an integrated training (IT) group. The average age of participants was 28 years.

RESULTS

The TT group received conventional lectures and practical training, while the IT group used simulation software, interactive platforms, and artificial intelligence (AI) tools. The analysis revealed that the mean score of the IT group in the theoretical knowledge test was 170.3 ± 15.1, which is significantly higher than that of the TT group (155.7 ± 20.4; t = 4.21, p < 0.001). In the practical skills test, the IT group scored 160.7 ± 22.4, while the TT group scored 135.8 ± 25.6 (t = 5.13, p < 0.001).

CONCLUSIONS

The findings of the study indicate a significant advantage of an integrated approach to radiology teaching over conventional methods. The integration of modern technologies into the learning process has been shown to enhance both short- and long-term educational outcomes in medical education. This finding is of practical significance for educational institutions in this field. It is recommended that integrated teaching methods be introduced in order to improve the quality of specialist training.

CLINICAL TRIAL NUMBER

Not applicable.

Morphometric variation in central airways of ten different human lung

The prevailing scarcity of accurate lung models poses challenges to predicting airborne particle deposition across genders. The present work demonstrates the details of the geometrical specifications of central airways for ten healthy humans (male and female). The data were extracted from HRCT scan images with a minimum resolution of 1 mm. The images cover the trachea to all branches of the G6-G8 generations. The presented data include airway segment diameters, lengths, branching angles, and angles of inclination to gravity, in addition to their average and standard deviation. Our first goal in this study is to generate an average lung model exclusively for humans in laboratory and 1D numerical inhalation investigations. Thus, our primary emphasis in this work is to find the average suitable inclination angle in all generations of central airways for men and women by comparing the available data from previous studies. In the second part of the paper, we have also investigated the particle deposition efficiency in these ten models using the Mimetikos PreludiumTM software package. We compared the regional deposition between males and females and the available respiratory system models.

Mild traumatic brain injury increases cortical iron: evidence from individual susceptibility mapping

Quantitative susceptibility mapping has been applied to map brain iron distribution after mild traumatic brain injury to understand properties of neural tissue which may be related to cellular dyshomeostasis. However, this is a heterogeneous injury associated with microstructural brain changes, and 'traditional' group-wise statistical approaches may lead to a loss of clinically relevant information, as subtle alterations at the individual level can be obscured by averages and confounded by within-group variability. More precise and individualized approaches are needed to characterize mild traumatic brain injury better and elucidate potential cellular mechanisms to improve intervention and rehabilitation. To address this issue, we use quantitative MRI to build individualized profiles of regional positive (iron-related) magnetic susceptibility across 34 bilateral cortical ROIs following mild traumatic brain injury. Healthy population templates were constructed for each cortical area using standardized Z-scores derived from 25 age-matched male controls aged between 16 and 32 years (M = 21.10, SD = 4.35), serving as a reference against which Z-scores of 35 males with acute (<14 days) sports-related mild traumatic brain injury were compared [M = 21.60 years (range: 16-33), SD = 4.98]. Secondary analyses sensitive to cortical depth and curvature were also generated to approximate the location of iron accumulation in the cortical laminae and the effect of gyrification. Primary analyses indicated that approximately one-third (11/35; 31%) of injured participants exhibited elevated positive susceptibility indicative of abnormal iron profiles relative to the healthy population, a finding that was mainly concentrated in regions within the temporal lobe. Injury severity was significantly higher (P = 0.02) for these participants than their iron-normal counterparts, suggesting a link between injury severity, symptom burden, and elevated cortical iron. Secondary exploratory analyses of cortical depth and curvature profiles revealed abnormal iron accumulation in 83% (29/35) of mild traumatic brain injury participants, enabling better localization of injury-related changes in iron content to specific loci within each region and identifying effects that may be more subtle and lost in region-wise averaging. Our findings suggest that individualized approaches can further elucidate the clinical relevance of iron in mild head injury. Differences in injury severity between iron-normal and iron-abnormal mild traumatic brain injury participants identified in our primary analysis highlight not only why precise investigation is required to understand the link between objective changes in the brain and subjective symptomatology, but also identify iron as a candidate biomarker for tissue pathology after mild traumatic brain injury.

Role of coronary artery calcification detection in tailoring patient care, personalized risk assessment, and prevention of future cardiac events

PURPOSE OF REVIEW

We review the utility of coronary artery calcium (CAC) scoring in personalized risk assessment and initiation of cardiovascular disease risk modifying therapy.

RECENT FINDINGS

Many populations - including South Asians, patients with cancer, patients with human immunodeficiency virus (HIV), younger patients, and elderly patients - were not included during the conception of the current risk stratification tools. CAC scoring may allow clinicians to risk-stratify these individuals and help initiate preventive therapy in higher risk populations. Furthermore, CAC scoring may be able to be integrated into current imaging practices to allow for more ubiquitous and equitable screening practices.

SUMMARY

CAC scoring is an additional, objective metric that may allow for nuanced and personalized risk assessment of future atherosclerotic cardiovascular disease (ASCVD) events.

Demonstration of Hepatic Vein Abnormalities Using Contrast-Enhanced Sonography in Liver Diseases

Contrast-enhanced US (CEUS) is now widely used to observe the hemodynamics of the liver. The CEUS diagnosis mainly consists of evaluating hepatic artery and portal vein flow changes in liver diseases, but it has not been widely used for the diagnosis of hepatic venous (HV) abnormalities in the clinical setting. For this background, this review tried to reconsider this problem. In short, observing HV CEUS findings, especially HV transit time, serves to largely narrow the differential diagnosis and increase the diagnostic confidence of the CEUS. However, diagnosing HV CEUS diagnosis in a wide range of liver diseases requires understanding of vascular anatomy of the upper abdomen and vascular structure of each disease. Additionally, interpreting CEUS findings of HCC should be prudent, because its drainage vessels change according to the histological progression, from the HV to the portal vein. Thus, the most important way of making use of the CEUS information is interpreting it in conjunction with the clinical data.

Radiation-induced white matter dysfunction in patients with nasopharyngeal carcinoma

Radiation-induced structural abnormalities in white matter (WM) have been reported in patients with nasopharyngeal carcinoma (NPC); however, the alterations in functional domain were insufficiently investigated. A total of 111 NPC patients were included and these patients, based on whether completed radiation therapy (RT) or not, were divided into pre-RT (n = 47) and post-RT (n = 64) groups. Functional connectivity strength (FCS) between WM regions (WW-FCS) and between WM and gray matter (GM) regions (GW-FCS) was used to investigate the radiation-induced changes in WM function. Compared with the pre-RT patients, post-RT NPC patients showed decreased WW-FCS in the left superior cerebellar peduncle, right anterior limb of internal capsule, bilateral posterior thalamic radiation, and left tapetum. Compared with the pre-RT patients, post-RT NPC patients showed decreased GW-FCS in the left caudate, bilateral visual cortex, and the right ventral prefrontal cortex. In the post-RT group, the GW-FCS in left visual cortex was negatively correlated with radiation dosage for the brain stem (r = -0.35, p = 0.039), and for the left temporal lobe (r = -0.46, p = 0.0058). The GW-FCS in right visual cortex was negatively correlated with radiation dosage for the left temporal lobe (r = -0.38, p = 0.025). Our findings of decreased WW-FCS and GW-FCS in such brain regions (such as visual cortex, posterior thalamic radiation, and anterior limb of internal capsule, as well as superior cerebellar peduncle) suggest potential functional impairments in visual and motor systems.

Harnessing the Power of Metabolomics for Precision Oncology: Current Advances and Future Directions

Metabolic reprogramming is a hallmark of cancer, with cancer cells acquiring many unique metabolic traits to support malignant growth, and extensive intra- and inter-tumour metabolic heterogeneity. Understanding these metabolic characteristics presents opportunities in precision medicine for both diagnosis and therapy. However, despite its potential, metabolic phenotyping has lagged behind genetic, transcriptomic, and immunohistochemical profiling in clinical applications. This is partly due to the lack of a single experimental technique capable of profiling the entire metabolome, necessitating the use of multiple technologies and approaches to capture the full range of cancer metabolic plasticity. This review examines the repertoire of tools available for profiling cancer metabolism, demonstrating their applications in preclinical and clinical settings. It also presents case studies illustrating how metabolomic profiling has been integrated with other omics technologies to gain insights into tumour biology and guide treatment strategies. This information aims to assist researchers in selecting the most effective tools for their studies and highlights the importance of combining different metabolic profiling techniques to comprehensively understand tumour metabolism.

Modeling the Effect of Daughter Migration on Dosimetry Estimates for [225Ac]Ac-DOTATATE

PURPOSE

[225Ac]Ac-DOTATATE is a promising treatment option for patients with neuroendocrine tumors. A concern with 225Ac is that the decay energy can break the bond to the targeting vehicle, producing free daughter radionuclides in the body. Daughter migration is generally not considered in clinical dosimetry, and therefore its effect needs to be studied.

METHODS AND MATERIALS

A compartment model for 225Ac and its daughters was developed, where each daughter isotope was assigned unique transfer coefficients. The model was applied to [225Ac]Ac-DOTATATE. Computer simulations were performed in Python for 2 scenarios: (1) the daughters decay at the site of [225Ac]Ac-DOTATATE decay; and (2) the daughters have unique biokinetics, where each decay of [225Ac]Ac-DOTATATE releases 221Fr off the DOTATATE peptide. Two extreme cases concerning intracellular degradation of [225Ac]Ac-DOTATATE were also examined: 1 in which it remains intact inside the tumor cells, and 1 with complete degradation followed by free 225Ac released back to plasma. Normal organ and tumor absorbed doses were determined in each case. In addition, the model-calculated cumulated activities of 221Fr and 213Bi were compared with recent measurements from a clinical trial.

RESULTS

When modeling the unique daughter kinetics, the average absorbed dose to the kidneys and tumor was 517 (95% CI, 413-622) and 577 (95% CI, 134-1020) mGy/MBq, respectively, with daughter migration resulting in an average increase in the kidney dose of 10.2% (95% CI, 7.9%-12.5%), and an average decrease in the tumor dose of 22.9% (95% CI, 16.3%-29.4%). The model scenario including free 225Ac showed improved agreement with clinical trial data, specifically for the liver, suggesting a fraction of free 225Ac is produced in patients following the administration of [225Ac]Ac-DOTATATE.

CONCLUSIONS

When performing dosimetry for [225Ac]Ac-DOTATATE, our study found that if daughter migration is ignored, the kidney dose is underestimated by ∼10%, and the tumor dose is overestimated by ∼23%. For accurate dosimetry, daughter biokinetics should be considered.

Magnetic Resonance Imaging Radiomics-Based Model for Prediction of Lymph Node Metastasis in Cervical Cancer

Background

Cervical cancer remains a major cause of mortality among women globally, with lymph node metastasis (LNM) being a critical determinant of patient prognosis.

Methods

In this study, MRI scans from 153 cervical cancer patients between January 2018 and January 2024 were analyzed. The patients were assigned to two groups: 103 in the training cohort; 49 in the validation cohort. Radiomic features were extracted from T2-weighted imaging (T2WI) and apparent diffusion coefficient (ADC) maps. The ITK-SNAP software enabled three-dimensional manual segmentation of the tumor regions in cervical cancer to identify regions of interest (ROIs). The collected data was divided for the training and validation of the Support Vector Machine (SVM) model.

Results

The combined T2WI and ADC-based radiomics model exhibited robust diagnostic capabilities, achieving an area under the curve (AUC) of 0.804 (95% CI [0.712-0.890]) in the training cohort and an AUC of 0.811 (95% CI [0.721-0.902]) in the validation cohort. The nomogram that includes radiomic features, International Federation of Gynecology and Obstetrics (FIGO) stage, and LNM has a C-index of 0.895 (95% CI [0.821-0.962]) in the training cohort and a C-index of 0.916 (95% CI [0.825-0.987]) in the validation cohort. The C-statistics are all above 0.80, and the predicted variables are nearly aligned with the 45-degree line, consistent with the results shown in the calibration plot. This indicates that our model demonstrates good discrimination ability and satisfactory calibration.

Conclusion

The MRI radiomics model, leveraging T2WI combined with ADC maps, offers an effective method for predicting LNM in cervical cancer patients.

Impaired Cardiovascular Hemodynamics in Patients Hospitalized with COVID-19 Pneumonia

Background: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection may be associated with impaired cardiac function, especially in severe cases requiring hospitalization. Impedance cardiography (ICG) is a noninvasive method for assessing cardiac function. It could be useful for the early detection of hemodynamic dysfunction, particularly in patients with a severe course of COVID-19. Aim: This study aimed to analyze and compare the hemodynamic profiles of patients hospitalized with SARS-CoV-2-induced pneumonia to those of a control group. Methods: This prospective, observational, clinical study included 30 hospitalized patients (both men and women, mean age: 48 years) diagnosed with COVID-19 pneumonia (COVID group). Their data were compared to those of a retrospective control group (CG). The study participants were propensity score-matched based on clinical characteristics, including age, blood pressure (BP), and body mass index (BMI). ICG measurements of hemodynamic profiles were performed using a Niccomo device and included heart rate (HR), stroke volume index (SI), cardiac index (CI), velocity index (VI), acceleration index (ACI), Heather index (HI), systemic vascular resistance index (SVRI), and thoracic fluid content (TFC). Results: Patients with COVID-19 showed significantly higher HR (p < 0.0001) and SVRI (p = 0.0003) and lower values for several cardiac function parameters, including SI (p < 0.0001), VI (p < 0.0001), ACI (p = 0.004), and HI (p < 0.0001). Additionally, 11 patients (37%) in the COVID group had a low SI (<35 mL/m2), compared to only 1 patient (3%) in the control group (p < 0.0001). A statistically significant difference in left ventricular ejection fraction (LVEF) was also observed (p < 0.0001), although absolute values remained within the normal range. Conclusions: SARS-CoV-2 infection negatively affects the cardiovascular system, leading to impaired heart function even in low-risk patients. Impedance cardiography may serve as a simple, noninvasive tool for identifying individuals with cardiac dysfunction following COVID-19 pneumonia.

The Emerging Role of Nanoparticles Combined with Either Radiotherapy or Hyperthermia in Head and Neck Cancer: A Current Review

Head and neck cancer (HNC) includes various malignancies and represents the seventh most common cancer worldwide. The early diagnosis of HNC results in a 70-90% five-year survival rate, which declines with locally advanced stages of disease. Current care employs a multimodal strategy encompassing surgery, radiation therapy (RT), chemotherapy, and immunotherapy, while treatment options vary according to the stage, tumor features, and patient characteristics. About 75% of patients with HNC will benefit from RT, either as a primary treatment or as adjuvant therapy following surgical resection. Technological improvements in RT, such as intensity-modulated RT (IMRT) and image-guided RT (IGRT), have enhanced tumor targeting and minimized adjacent healthy tissue irradiation while also expanding RT to the recurrent or metastatic setting. Innovative therapeutic strategies for HNC integrate RT with immunotherapy, gene therapy, molecular targeted therapy, photodynamic therapy, photothermal therapy, and nanoparticles (NPs), with the objective of optimizing tumor control while reducing damage to normal tissues. NPs are emerging as possible radiosensitizers in HNC treatment, enhancing the efficacy of RT, chemotherapy, and immunotherapy. In vivo and in vitro studies on the irradiation of tumors containing gold (Au), gadolinium (Gd), and hafnium oxide (HfO2) NPs show promising results in enhancing tumor destruction and survival rates, indicating their potential for clinical application. Hyperthermia, investigated as an adjunct treatment, potentially improves outcomes when combined with RT or chemotherapy, with advancements in nanotechnology renewing interest in this approach in HNC. At present, NBTXR3 is the sole NP that is being investigated in clinical trials for the enhancement of HNC RT.

Integrating CT Radiomics and Clinical Features to Optimize TACE Technique Decision-Making in Hepatocellular Carcinoma

BACKGROUND/OBJECTIVES

To develop a decision framework integrating computed tomography (CT) radiomics and clinical factors to guide the selection of transarterial chemoembolization (TACE) technique for optimizing treatment response in non-resectable hepatocellular carcinoma (HCC).

METHODS

A retrospective analysis was performed on 151 patients [33 conventional TACE (cTACE), 69 drug-eluting bead TACE (DEB-TACE), 49 degradable starch microsphere TACE (DSM-TACE)] who underwent TACE for HCC at a single tertiary center. Pre-TACE contrast-enhanced CT images were used to extract radiomic features of the TACE-treated liver tumor volume. Patient clinical and laboratory data were combined with radiomics-derived predictors in an elastic net regularized logistic regression model to identify independent factors associated with early response at 4-6 weeks post-TACE. Predicted response probabilities under each TACE technique were compared with the actual techniques performed.

RESULTS

Elastic net modeling identified three independent predictors of response: radiomic feature "Contrast" (OR = 5.80), BCLC stage B (OR = 0.92), and viral hepatitis etiology (OR = 0.74). Interaction models indicated that the relative benefit of each TACE technique depended on the identified patient-specific predictors. Model-based recommendations differed from the actual treatment selected in 66.2% of cases, suggesting potential for improved patient-technique matching.

CONCLUSIONS

Integrating CT radiomics with clinical variables may help identify the optimal TACE technique for individual HCC patients. This approach holds promise for a more personalized therapy selection and improved response rates beyond standard clinical decision-making.

The extended impact of the COVID-19 pandemic on medical imaging case volumes: a retrospective study

Objective

This study aims to investigate the long-term effects of the COVID-19 pandemic on medical imaging case volumes.

Methods

This retrospective study analyzed data from the Integrated Radiology Information System-Picture Archive and Communication System (RIS-PACS), including monthly medical imaging case volumes at a public hospital, spanning from January 2019 to December 2022. The study collected data on medical imaging examinations, comparing the pre COVID-19 period, which acted as a control group, with the periods following COVID-19, which were designated as cohort groups.

Results

The total number of medical imaging procedures performed (n = 597,645) was found significantly different (F = 6.69, P < 0.001) between 2019 and 2022. Specifically, the bone mineral density/computed radiography (BMD/CR) modality experienced a significant decrease (P = 0.01) of the procedures performed in 2020 and 2021 compared to 2019. Conversely, the nuclear medicine/computed tomography (NM/CT) and computed tomography (CT) modalities demonstrated a significant increase of the procedures performed in 2021 (P = 0.04) and (P < 0.0001), respectively, and in 2022 (P = 0.0095) and (P < 0.0001), respectively, compared to the pre-pandemic year. The digital X-ray modality (DX) showed the highest volume (67.63%) of the performed procedures overall between 2019 and 2022. Meanwhile, magnetic resonance imaging (MR) and ultrasound (US) modalities experienced a slight drop in the number of procedures in 2020-4.47% for MR and 1.00% for US, which subsequently recovered by 22.15% and 19.74% in 2021, and 24.36% and 17.40% in 2022, respectively, compared to 2019.

Conclusion

The COVID-19 pandemic initially led to a drop in the number of medical imaging procedures performed in 2020, with the most noticeable drop occurring during the early waves of the pandemic. However, this trend revealed a gradual recovery in the subsequent years, 2021 and 2022, as healthcare systems adapted, and pandemic-related restrictions were modified.

Image quality, diagnostic performance of reduced-dose abdominal CT with artificial intelligence model-based iterative reconstruction for colorectal liver metastasis: a prospective cohort study

Background

The optimization of regularization strategies in computed tomography (CT) iterative reconstruction may allow for a reduced dose (RD) without compromising image quality, thus the diagnostic ability of RD imaging must be considered, especially for low-contrast lesions. In this study, we evaluated the image quality and diagnostic performance of 50% RD CT for low-contrast colorectal liver metastasis (CRLM) with artificial intelligence model-based iterative reconstruction (AIIR) and standard-dose (SD) CT with hybrid iterative reconstruction (HIR).

Methods

In this prospective study, consecutive participants with pathologically proven colorectal cancer and suspected liver metastases who underwent portal venous phase CT scans both at SD and RD between June and November 2022 were included. All images were reconstructed by HIR and AIIR. Two radiologists detected and characterized liver lesions with RD HIR, SD HIR, and RD AIIR and scored the image quality. The contrast-to-noise ratio (CNR) for metastases were recorded. The diagnostic performance for CRLM of each reconstruction algorithm was analyzed and compared using the receiver operating characteristic curve and the area under the curves (AUC).

Results

A total of 56 participants with 422 liver lesions were recruited. The mean volume CT dose indices of the SD and RD scans were 9.5 and 4.8 mGy. RD AIIR exhibited superior subjective image quality and higher CNR for liver metastases than did RD/SD HIR. In all liver lesions and lesions ≤10 mm, the detection rates of RD AIIR (83.3% and 71.5%) were both significantly higher than those of RD HIR (76.3% and 62.4%; P=0.002 and P=0.003); meanwhile, they were similar to those of SD HIR (81.4% and 69.6%; P=0.307 and P=0.515). The AUCs of RD AIIR for all liver lesions and lesions ≤10 mm (0.858 and 0.764) were greater than those of RD HIR (0.781 and 0.661; P<0.001) and were similar to those of SD HIR (0.863 and 0.762; P=0.616 and 0.845).

Conclusions

AIIR can improve CT image quality at 50% RD while preserving diagnostic performance and confidence for low-contrast CRLM in all lesions and lesions ≤10 mm and may thus serve as a promising tool for follow-up monitoring in patients with colorectal cancer while inflicting less radiation damage.

The impact of modifiable factors on image quality of prostate magnetic resonance imaging and PI-RADS scores

Background

The diagnostic accuracy of prostate magnetic resonance imaging (MRI) is highly dependent on image quality. Although the effects of spasmolytics and rectal preparation have been previously studied, the findings remain inconsistent and fail to address other critical modifiable factors. This study aimed to evaluate the impact of various modifiable factors on prostate MRI image quality and their subsequent influence on Prostate Imaging Reporting and Data System (PI-RADS) scoring.

Methods

Fifty-six consecutive patients who underwent 3T multiparametric MRI (mpMRI) with the administration of hyoscine butylbromide (HB+) and at least one 3T mpMRI without HB (HB-) ≤3 years earlier were retrospectively evaluated. Two radiologists performed morphometry of the prostate, bladder, rectum, and abdomen and evaluated image quality, artifacts, and motion on a five-point scale and T2 and diffusion-weighted imaging (DWI) PI-RADS v2.1 scores. The influence of HB, rectum and bladder distension, breathing motion, and examination hour were analyzed.

Results

The sharpness and overall image quality of T2 images were significantly better in HB+ compared to HB- (P=0.0047 and P=0.013). T2 motion artifacts were reduced earlier in the day (ρ=0.32, P=0.017). DWI susceptibility artifact correlated with patient diameter (ρ=0.40, P=0.002), but not with rectum diameter (ρ=0.09, P=0.51) or gas content (ρ=0.13, P=0.33). Examinations later in the day were associated with increased motion artifacts on T2 [hazard ratio (HR) =1.36]. T2 and DWI scores were influenced by bladder volume, breathing motion, and rectal air, but not by HB. Breathing motion negatively impacted overall image quality (HR =1.24), and DWI susceptibility artifacts (HR =1.22).

Conclusions

HB administration, daytime, and breathing motion have significant influence on image quality of prostate MRI. The gas content of the rectum influences T2 image quality and T2 scores. Bladder filling is associated with reduced breathing motion, subsequently affecting DWI scores.

Virtual-simulation boosted neural network dose calculation engine for intensity-modulated radiation therapy

The Monte Carlo (MC) dose calculation method is widely recognized as the gold standard for precision in dose calculation. However, MC calculations are computationally intensive and time-consuming. This study aims to develop a neural network-based dose calculation engine using a virtual simulation database, producing dose distributions with accuracy comparable to MC dose calculations. We established an unrestricted virtual simulation database employing specific rules and automated optimization techniques. Individual dose distributions for each beam were stored. A neural network was then constructed and trained using a 3D Dense-U-Net architecture. The model's accuracy was validated in intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma, cervical carcinoma, and lung cancer. A total of 31,967 single-beam doses were collected from 2,382 virtual plans. For clinical beam doses, the gamma passing rates under the 1 mm/1% and 2 mm/2% criteria improved significantly from 13.4 ± 4.8% and 37.5 ± 9.4% to 77.5 ± 7.7% and 95.6 ± 2.5%, respectively, using the model. The mean computation time was 0.017 ± 0.002 s. We successfully developed an automated training workflow for a neural network-based dose calculation model in fixed-beam IMRT. This workflow enables the generation of a substantial training dataset from a relatively small clinical dataset, resulting in a model that excels in accuracy and speed.

Prevalence of Chronic Liver Disease Based on Ultrasound Shear Wave Elastography in an Adult Asian Indian Population Attending Outpatient Preventive Radiology Clinics in India

AIM

To determine the ultrasound shear wave elastography (SWE)-based prevalence of chronic liver disease in an adult Asian Indian population attending preventive radiology outpatient clinics in India.

METHODS

Liver stiffness measures (LSMs) were ascertained using ultrasound SWE and interquartile range/median (IQR/M) ratio ≤ 30% kilopascal (kPa) units were considered a good quality measurement. Details of modifiable risk factors including comorbidity and personal risk behaviors were collected. The liver was graded based on the Society of Radiologists in Ultrasound Liver Elastography Consensus Statement and Grades 4 and 5 indicated compensated advanced chronic liver disease (cACLD) and clinically significant portal hypertension (CSPH). A multivariate logistic regression model was used to analyze associations with chronic advanced liver disease.

RESULTS

The median LSM in the study participants (n = 1145) was 8.0 (IQR 6.5, 9.85) kPa units. 10.65% of the study population had advanced chronic liver disease (cACLD and CSPH) and 22.79% had LSM that was suggestive of cACLD. cACLD and CSPH were significantly associated with comorbidities, personal risk behaviors, and lean and obese body mass indices. Modifiable risk factors were present in 20%-50% of participants with LSM between 7 and 13 kPa.

CONCLUSION

Information on the prevalence of LSM-based cACLD and CSPH and modifiable risk factors in persons with LSM between 7 and 13 kPa will help to design preventative strategies using LSM as an objective imaging biomarker.

Interventions in Budd-Chiari syndrome: an updated review

Budd Chiari syndrome is a potentially treatable disease, and imaging is the key to its diagnosis. Clinical presentations may vary, ranging from asymptomatic to fulminant disease. Subacute BCS is the most common type encountered in clinical practice, characterized by ascites, hepatosplenomegaly, dilated abdominal wall veins, and varicosities in the lower limb and scrotum. While hepatic vein thrombosis is the leading cause in the West, membranous and short segmental occlusion are predominant in the Asian populations. These geographical variations have an impact on the treatment algorithm in managing BCS. Anticoagulation alone often fails to prevent disease progression, demanding further interventional therapy. Interventional therapy carries a lower morbidity and mortality than surgery. Anatomical recanalization and portosystemic shunting form the basis of endovascular management. Membranous or short-segment occlusion are best treated by angioplasty, which restores the physiological venous outflow and possibly disease reversal. Suboptimal results with angioplasty require stenting. Transjugular intrahepatic shunt (TIPS) or direct IVC to portal vein shunt (DIPS) decompresses the portal pressure and reduces the sinusoidal congestion, which in turn diminishes hepatocellular damage and hepatic fibrosis. Despite its ability to modify the disease course, TIPS carries several procedure and shunt-related complications, mainly hepatic encephalopathy. Thus, anatomical recanalization precedes TIPS in the traditional step-up approach in managing BCS. However, this concept is challenged by some authors, necessitating future reseach. TIPS is a valid bridge therapy in BCS with acute live failure awaiting liver transplantation. Despite all, interventional therapies fail in a subset of BCS patients, leaving them with only option of liver transplantation.

Pericardium decellularization in a one-day, two-step protocol

Scaffolds used in tissue engineering can be obtained from synthetic or natural materials, always focusing the effort on mimicking the extracellular matrix of human native tissue. In this study, a decellularization process is used to obtain an acellular, biocompatible non-cytotoxic human pericardium graft as a bio-substitute. An enzymatic and hypertonic method was used to decellularize the pericardium. Histological analyses were performed to determine the absence of cells and ensure the integrity of the extracellular matrix (ECM). In order to measure the effect of the decellularization process on the tissue's biological and mechanical properties, residual genetic content and ECM biomolecules (collagen, elastin, and glycosaminoglycan) were quantified and the tissue's tensile strength was tested. Preservation of the biomolecules, a residual genetic content below 50 ng/mg dry tissue, and maintenance of the histological structure provided evidence for the efficacy of the decellularization process, while preserving the ECM. Moreover, the acellular tissue retains its mechanical properties, as shown by the biomechanical tests. Our group has shown that the acellular pericardial matrix obtained through the super-fast decellularization protocol developed recently retains the desired biomechanical and structural properties, suggesting that it is suitable for a broad range of clinical indications.

Enhancing Diagnostic Quality of Intra-Oral Radiographs Through Targeted Training Interventions and Super User Integration

Dental and oral and maxillofacial surgery professions rely on intra-oral radiographs to effectively diagnose and carry out necessary treatment. A retrospective comparative analysis was carried out on a sample of digital radiographs from two sites within the same National Health Service (NHS) trust. Images were graded as per Faculty of General Dental Practitioners (FGDP) guidelines as either 'Acceptable' or 'Not Acceptable'. The FGDP state that 95% of digital radiographs taken within a department should be rated as "acceptable" in terms of diagnostic quality. Diagnostic quality was assessed based on the ability to identify structures necessary for treatment and whether the radiographs had to be retaken. Additionally, surveys were given out to both the medical and dental radiographers across both sites to gather data on their level of training in dental radiography, experience and confidence. The results revealed significant disparities in diagnostic quality of radiographs across both sites and training events and confidence levels between medical and dental radiographers. This paper outlines strategic improvements to the radiography team training, the establishment of a super user system to standardize training quality, and the introduction of a shared rota to enhance clinical efficiency. These initiatives were placed in order to improve radiograph quality and boost the confidence of medical radiographers in intra-oral imaging, ultimately improving patient care and outcomes and reducing their exposure to excessive radiation.

Cerebral blood flow alterations and host genetic association in individuals with long COVID: A transcriptomic-neuroimaging study

Neuroimaging studies have indicated that altered cerebral blood flow (CBF) was associated with the long-term symptoms of postacute sequelae of SARS-CoV-2 infection (PASC), also known as "long COVID". COVID-19 and long COVID were found to be strongly associated with host gene expression. Nevertheless, the relationships between altered CBF, clinical symptoms, and gene expression in the central nervous system (CNS) remain unclear in individuals with long COVID. This study aimed to explore the genetic mechanisms of CBF abnormalities in individuals with long COVID by transcriptomic-neuroimaging spatial association. Lower CBF in the left frontal-temporal gyrus was associated with higher fatigue and worse cognition in individuals with long COVID. This CBF pattern was spatially associated with the expression of 2,178 genes, which were enriched in the molecular functions and biological pathways of COVID-19. Our study suggested that lower CBF is associated with persistent clinical symptoms in long COVID individuals, possibly as a consequence of the complex interactions among multiple COVID-19-related genes, which contributes to our understanding of the impact of adverse CNS outcomes and the trajectory of development to long COVID.

Quantitative Stress First-Pass Perfusion Cardiac MRI: State of the Art

Quantitative stress perfusion (qPerf) cardiac magnetic resonance (CMR) imaging is a noninvasive approach used to quantify myocardial blood flow (MBF). Compared with visual analysis, qPerf CMR has superior diagnostic accuracy in the detection of myocardial ischemia and assessment of ischemic burden. In the evaluation of epicardial coronary artery disease (CAD), qPerf CMR improves the distinction of single-vessel from multivessel disease, yielding a more accurate estimate of the ischemic burden, and in turn improving patient management. In patients with chest pain without epicardial CAD, the findings of lower stress MBF and myocardial perfusion reserve (MPR) allow the diagnosis of microvascular dysfunction (MVD). Given its accuracy, MBF quantification with stress CMR has been introduced into the most recent recommendations for diagnosis in patients who have ischemia with nonobstructive CAD. Recent studies have shown a greater decrease in stress MBF and MPR in patients with three-vessel CAD compared with those in patients with MVD, demonstrating an important role that quantitative stress CMR can play in differentiating these etiologies in patients with stable angina. In cases of hypertrophic cardiomyopathy and cardiac amyloidosis, qPerf CMR aids in early diagnosis of ischemia and in risk assessment. Ischemia also results from alterations in hemodynamics that may occur with valve disease such as aortic stenosis or in cases of heart failure. qPerf CMR has emerged as a useful noninvasive tool for detection of cardiac allograft vasculopathy in patients who have undergone heart transplant. The authors review the basic principles and current primary clinical applications of qPerf CMR. ©RSNA, 2025 Supplemental material is available for this article. See the invited commentary by Leung and Ng in this issue.

Conventional and Advanced Magnetic Resonance Imaging Biomarkers of Multiple Sclerosis in the Brain

Multiple sclerosis (MS) is a heterogeneous disease, and each MS patient exhibits different clinical symptoms that are reflected in their magnetic resonance imaging (MRI) results. Each MS lesion should be interpreted carefully and evaluated in conjunction with a clinical examination. MRI plays a major role in evaluating how MS lesions are aggregated in the central nervous system and how they change over time. There are several conventional MRI biomarkers of MS that could be utilized to evaluate each MS phenotype. MRI is useful for clinical decisions, aiding in the determination of disease-modifying treatment or disease prognosis. Despite its higher sensitivity, MRI provides low specificity due to the heterogeneity of MS lesions. However, advanced MRI biomarkers show promise in terms of defining MS lesions, as each imaging biomarker correlates differently with the clinical scenario of each MS phenotype. The aim of this review is to summarise the current state of MRI biomarkers for MS in the brain and how they relate to neurological disabilities.

Guidance on biomaterials for periodontal tissue regeneration: Fabrication methods, materials and biological considerations

Regeneration of the multiple tissues and interfaces in the periodontal complex necessitates multidisciplinary evaluation to establish structure/function relationships. This article, an initiative of the Academy of Dental Materials, provides guidance for performing chemical, structural, and mechanical characterization of materials for periodontal tissue regeneration, and outlines important recommendations on methods of testing bioactivity, biocompatibility, and antimicrobial properties of biomaterials/scaffolds for periodontal tissue engineering. First, we briefly summarize periodontal tissue engineering fabrication methods. We then highlight critical variables to consider when evaluating a material for periodontal tissue regeneration, and the fundamental tests used to investigate them. The recommended tests and designs incorporate relevant international standards and provide a framework for characterizing newly developed materials focusing on the applicability of those tests for periodontal tissue regeneration. The most common methods of biofabrication (electrospinning, injectable hydrogels, fused deposition modelling, melt electrowriting, and bioprinting) and their specific applications in periodontal tissue engineering are reviewed. The critical techniques for morphological, chemical, and mechanical characterization of different classes of materials used in periodontal regeneration are then described. The major advantages and drawbacks of each assay, sample sizes, and guidelines on specimen preparation are also highlighted. From a biological standpoint, fundamental methods for testing bioactivity, the biocompatibility of materials, and the experimental models for testing the antimicrobial potential are included in this guidance. In conclusion, researchers performing studies on periodontal tissue regeneration will have this guidance as a tool to assess essential properties and characteristics of their materials/scaffold-based strategies.

Investigation of Varying Durations of Dynamic Stretches on Muscle Stiffness of the Ankle Plantar Flexors Using Shear Wave Ultrasound Elastography

OBJECTIVES

This study investigated the acute effects of dynamic stretch (DS) duration on the muscle stiffness of the ankle plantar flexor using shear wave ultrasound elastography.

METHODS

Eighteen healthy young participants were enrolled in this study. DS with one set (DS1) or four sets (DS4) of 30 s each was performed randomly. Shear wave velocity in the medial gastrocnemius (MG) was measured before and after DS to assess muscle stiffness of the MG.

RESULTS

Two-way repeated-measures analysis of variance (condition × time) showed a significant interaction with the shear wave velocity (p = 0.02). Shear wave velocity significantly decreased after the DS4 than before (before:3.09 ± 0.59 m/s; after: 2.86 ± 0.43 m/s). However, no significant differences were observed in shear wave velocity between before and after DS1 (before: 2.96 ± 0.56 m/s; after: 3.19 ± 0.56 m/s). There were no significant differences in shear wave velocity at baseline condition. After the intervention, significantly lower shear wave velocity was observed in DS4 than in DS1.

CONCLUSIONS

The results of this study demonstrate that DS with four sets of 30 s effectively decreased the muscle stiffness of the MG.

Single coronary artery originating from the right coronary sinus presented with chronic total occlusion: A case report

INTRODUCTION AND IMPORTANCE

A single coronary artery (SCA) is a rare congenital anomaly in which the artery originates from either the left or right coronary sinus. Shortly after its origin, the SCA branches into the right coronary artery (RCA), the left anterior descending artery (LAD), and the left circumflex artery (LCx). When the SCA originates from the right coronary sinus, the LAD may follow one of several abnormal courses, including the posterior atrioventricular groove, retro-aortic, interarterial, intraseptal, prepulmonic, or posterior-anterior interventricular groove. Assessing the anatomical risk and the presence of concomitant coronary artery disease (CAD) in the anomalous vessel is essential for determining the appropriate treatment.

CASE PRESENTATION

We present a very rare case of a retro-aortic LAD course originating from SCA of the right coronary sinus in a patient admitted to our clinic for evaluation of chest pain. Coronary angiography (CA) of the right coronary system revealed a SCA. RCA was occluded, with chronic total occlusion (CTO). Coronary computed tomography angiography (CCTA) was done to specify the course of LAD, which showed a SCA and a posterior course around the aorta of LAD.

CLINICAL DISCUSSION

CA is a valuable tool to identify and classify coronary artery anomalies (CAAs), but due to invasiveness, low spatial resolution, and lack of three-dimensional images, it has been progressively replaced by CCTA. CCTA is the gold standard for diagnosis of the CAAs that enabling three-dimensional visualization of the surrounding cardiac and non-cardiac structures identify patients with malignant CAAs. Taking into account the presence of SCA and CTO, the treatment option is recanalization of CTO or cardiac surgery if refractory angina is present.

CONCLUSION

When the SCA originates from the right coronary sinus, identifying the abnormal course of the LAD is critical, as it may be life-threatening. Alongside CA, CCTA plays a key role in evaluating the anatomy and associated risks of this anomaly. The appropriate treatment is determined based on the presence and severity of concomitant CAD.

Frontal sinus size in South African Later Stone Age Holocene Khoe-San

Frontal size variation is comparatively poorly sampled among sub-Saharan African populations. This study assessed frontal sinus size in a sample of Khoe-San skeletal remains from South African Later Stone Age contexts. Volumes were determined from CT scans of 102 adult crania; individual sex could be estimated in 82 cases. Sinus volume is not sexually dimorphic in this sample. The lack of frontal sinus aplasia is concordant with the low incidences recorded for other sub-Saharan African and most other global populations save those that inhabit high latitudes. There is considerable variation in frontal sinus size among global populations, and the Khoe-San possess among the smallest. The Khoe-San have rather diminutive sinuses compared to sub-Saharan Bantu-speaking populations but resemble a northern African (Sudanese) population. Genetic studies indicate the earliest population divergence within Homo sapiens to have been between the Khoe-San and all other living groups, and that this likely occurred in Africa during the span of Marine Isotope Stages 8-6. There is scant information on frontal sinus development among Late Quaternary African fossils that are likely either closely related or attributable to Homo sapiens. Among these, the MIS 3 cranium from Hofmeyr, South Africa, exhibits distinct Khoe-San cranial affinities and despite its large size has a very small frontal sinus. This raises the possibility that the small frontal sinuses of the Holocene South African Khoe-San might be a feature retained from an earlier MIS 3 population.

Added Value of Dynamic Contrast-Enhanced Ultrasound Analysis for Differential Diagnosis of Small (≤20 mm) Solid Pancreatic Lesions

OBJECTIVE

To evaluate the added value of dynamic contrast-enhanced ultrasound (DCE-US) analysis in pre-operative differential diagnosis of small (≤20 mm) solid pancreatic lesions (SPLs).

METHODS

In this retrospective study, patients with biopsy or surgerical resection and histopathologically confirmed small (≤20 mm) SPLs were included. One wk before biopsy/surgery, pre-operative B-mode ultrasound and contrast-enhanced ultrasound were performed. An ultrasonic system (ACUSON Sequoia, Siemens Medical Solutions, PA, USA) equipped with a 5C1 MHz convex array transducer was utilized. A dose of 1.5 ml SonoVue (Bracco, Italy) was injected as the contrast agent. Time-intensity curves were generated using VueBox software (Bracco) and various DCE-US quantitative parameters were subsequently calculated after curve fitting. Univariate and multivariate logistic regression analysis were utilized.

RESULTS

From August 2020 to November 2023, a total of 76 patients (31 males and 45 females; mean age: 61.9 ± 10.5 y) with 76 small (≤20 mm) SPLs were included. Mean size of the lesions was 16.4 ± 0.4 mm (range: 7-20 mm). Final diagnosis included 37 benign and 39 malignant small SPLs. On B-mode ultrasound, the majority of malignant (37/39, 94.9%) and benign SPLs (30/37, 81.1%) were hypo-echoic lesions with ill-defined borders and irregular shapes (p > 0.05). During the arterial phase of contrast-enhanced ultrasound, most SPLs (59/76, 77.6%) exhibited iso-enhancement when compared with surrounding pancreatic parenchyma. Subsequently, 82.1% (32/39) of malignant SPLs and 35.1% (13/37) of benign SPLs demonstrated wash-out in the venous phase and showed hypo-enhancement in venous and late phases (p > 0.05). Compared with benign SPLs, the time-intensity curves of small malignant SPLs revealed earlier and lower enhancement in the arterial phase, and a faster decline during the venous phase with a decreased area under the curve. Among the quantitative parameters, a lower peak enhancement ratio and higher fall time ratio were more common in small malignant SPLs (p < 0.05). For DCE-US analysis, the combined areas under the curve of significant quantitative parameters was 0.919, with 87.2% sensitivity and 86.5% specificity when differentiating between small malignant and benign SPLs. This result was better than contrast-enhanced computed tomography, which has a sensitivity of 74.4% and a specificity of 75.7%.

CONCLUSION

DCE-US analysis provides added value for the pre-operative differential diagnosis of small malignant SPLs.