Comparison of MR Spectroscopy, 2-Point Dixon, and Multi-Echo T2* Sequences in Assessing Hepatic Fat Fraction Across a Diverse Range of Body Mass Index (BMI) and Waist Circumference Ratio (WCR) Values

Objective

The study aimed to compare and evaluate the accuracy of three magnetic resonance imaging (MRI) sequences-MR liver spectroscopy, 2-point Dixon, and multi-echo T2*-in assessing hepatic fat fraction in patients with various body mass indexes (BMIs).

Methods

167 participants were recruited, including 110 healthy subjects with diverse BMIs and 57 bariatric surgery candidates. The MRI protocol involved three sequences: multi-echo single voxel STEAM 1H spectroscopy, 2-point mDixon, and multi-echo T2* sequence. Hepatic fat fraction was measured using these sequences and analyzed statistically to determine correlations and agreement between the methods.

Results

A strong positive correlation was observed between BMI and waist circumference ratio (WCR) (rs(165) = 0.910, p<0.001). MRS obtained hepatic fat fraction numerical values in 13.33% of the normal BMI group, 48.48% of the overweight group, and 72.97% of the obese group. Strong correlations were found between all methods, with significant agreement, particularly between MRS and multi-echo T2*.

Conclusion

Robust correlations were observed between MR spectroscopy, 2-point Dixon, and multi-echo T2* methods for liver fat fraction measurement, especially in patients with higher BMI and WCR. These findings highlight the importance of BMI and WCR in interpreting fat fraction measurements, as method performance can vary across body composition profiles.

Comparative Study of AI Modes in Ultrasound Diagnosis of Breast Lesions

Objectives: This study evaluated the diagnostic performance of the S-Detect ultrasound system's three selectable AI modes-high-sensitivity (HSe), high-accuracy (HAc), and high-specificity (HSp)-for breast lesion diagnosis, comparing their performance in a clinical setting. Methods: This retrospective analysis evaluated 260 breast lesions from ultrasound images of 232 women (mean age: 50.2 years) using the S-Detect system. Each lesion was analyzed under the HSe, HAc, and HSp modes. The study employed ROC curve analysis to comprehensively compare the diagnostic performance of the AI modes against radiologist diagnoses. Subgroup analyses focused on the age (<45, 45-55, >55 years) and lesion size (<1 cm, 1-2 cm, >2 cm). Results: Among the 260 lesions, 73% were identified as benign and 27% as malignant. Radiologists achieved a sensitivity of 98.6%, specificity of 64.2%, and accuracy of 73.5%. The HSe mode exhibited the highest sensitivity at 95.7%. The HAc mode excelled with the highest accuracy (86.2%) and positive predictive value (71.3%), while the HSp mode had the highest specificity at 95.8%. In the age-based subgroup analyses, the HAc mode consistently showed the highest area under the curve (AUC) across all categories. The HSe mode achieved the highest AUC (0.726) for lesions smaller than 1 cm. In the case of lesions sized 1-2 cm and larger than 2 cm, the HAc mode showed the highest AUCs of 0.906 and 0.776, respectively. Conclusions: The S-Detect HSe mode matches radiologists' performance. Alternative modes provide sensitivity and specificity adjustments. The patient age and lesion size influence the diagnostic performance across all S-Detect modes.

Advances and challenges in echocardiographic diagnosis and management of cardiac amyloidosis

Cardiac amyloidosis is an infiltrative cardiomyopathy characterized by the abnormal accumulation of amyloid proteins within the heart muscle. It is recognized as a rare yet significant cardiac disease that is often overlooked as a potential cause of heart failure and cardiac arrhythmias, particularly in older individuals with rates escalating from 8 to 17 cases per 100,000 individuals. Cardiac amyloidosis primarily manifests as two predominant subtypes: light-chain and transthyretin amyloidosis, collectively accounting for over 95% of clinical cases. Early diagnosis of these conditions is often hindered by overlapping symptoms with other cardiac pathologies, resulting in diagnostic delays and suboptimal patient outcomes. Echocardiography, a non-invasive imaging technique, has become indispensable for diagnosing cardiac amyloidosis, uncovering crucial echocardiographic signs such as thickening of the left ventricular wall, diastolic dysfunction, and a granular appearance of the myocardium. Recent advancements in echocardiography have significantly enhanced the diagnostic accuracy of cardiac amyloidosis and improved patient management. Advanced echocardiographic techniques, including strain imaging, 3D echocardiography, and contrast echocardiography, have significantly enhanced diagnostic accuracy and prognostication. Future directions in echocardiography encompass the integration of artificial intelligence, the development of novel contrast agents, and the refinement of 4D echocardiography to further optimize patient care. This study explores the pivotal role of echocardiography in both diagnosing and managing cardiac amyloidosis, delving into the disease's underlying mechanisms, distinctive imaging characteristics, the significance of regular echocardiographic assessments, and discusses the challenges associated with differentiating between various types of amyloidosis without supplemental imaging or biopsy methods.

Unraveling the Dynamics of Human Filarial Infections: Immunological Responses, Host Manifestations, and Pathogen Biology

Lymphatic filariasis (LF), or elephantiasis, is a neglected tropical disease caused by filarial worms, primarily Wuchereria bancrofti, transmitted through mosquito bites. It often begins in childhood but may not show symptoms until later, leaving many individuals asymptomatic for long periods. LF disrupts the lymphatic system, causing severe swelling in the limbs and genitals, leading to deformities and disabilities. The World Health Organization estimates that around 51 million people are affected globally, with 36 million suffering from chronic conditions like lymphedema and hydrocele. In 2021, approximately 882.5 million people in 44 countries required preventive chemotherapy, making LF the second leading parasitic cause of disability, significantly impacting socioeconomic status. The immune response to filarial parasites is complex, involving both innate and adaptive immune cells. A key feature of LF immunology is the antigen-specific Th2 response, expansion of IL-10-producing CD4+ T cells, and a muted Th1 response. This T cell hypo-responsiveness is crucial for sustaining long-term infections with high parasite densities. While the correlates of protective immunity are not fully understood-due in part to a lack of suitable animal models-T cells, particularly CD4+ Th2 cells, and B cells, play essential roles in immune protection. Moreover, host immune responses contribute to the disease's pathological manifestations. A failure to induce T cell hypo-responsiveness can lead to exaggerated inflammatory conditions such as lymphedema, hydrocele, and elephantiasis. Filarial infections also induce bystander effects on various immune responses, impacting responses to other infectious agents. This intricate immune interplay offers valuable insights into the regulation of immune responses to chronic infections. This review explores recent immunological research on lymphatic filarial worms, highlighting their effects on both innate and adaptive immune responses in humans and the mechanisms underlying this neglected tropical disease.

A pictorial essay on cross-sectional imaging findings of pathologies in the second (D2) segment of the duodenum in adults

The duodenum, the initial segment of the small intestine, is divided into four parts: the superior (D1), descending (second) (D2), horizontal (D3), and ascending (D4) segments. Despite its short length, the descending part (D2 segment) holds clinical significance due to its anatomical proximity to structures such as the gallbladder, right kidney, colon, and pancreas. This anatomical localization and contiguity give rise to various pathologies, including congenital, inflammatory, infectious, neoplastic, vascular, and traumatic conditions. Cross-sectional imaging modalities play a pivotal role in evaluating pathologies of the second (D2) segment of the duodenum. This article aims to provide a comprehensive overview of these pathologies and delineate their imaging characteristics.

MRI findings for the pretreatment diagnosis of small Meckel's cave tumors: comparison of meningiomas and schwannomas

BACKGROUND

Both meningiomas and schwannomas are the most common Meckel's cave (MC) tumors in terms of distinct imaging features. When they are small, they may present with similar imaging characteristics that make their diagnosis difficult. The aim of this study was to diagnose small meningiomas and schwannomas of the MC on the basis of their clinical and MRI findings.

METHODS

The clinical data of 33 patients who were diagnosed with small MC tumors (SMCTs) (17 schwannomas, 16 meningiomas) between August 2002 and August 2023 were retrospectively evaluated. SMCTs were defined as MC tumors that were less than 3 cm in size. We analyzed their clinical and MRI findings, including demographic features, lesion morphologies and changes in adjacent structures.

RESULTS

The rate of subtotal resection of meningiomas less than 3 cm in size was significantly lower than that of schwannomas less than 3 cm in size (43.8% vs. 100%, p = 0.032). The MRI features of meningiomas and schwannomas were as follows: 1) a prominent dura tail sign (8/16 [50%] vs. 0/17 [0%], p < 0.001); 2) few cystic components (0/16 [0%] vs. 9/17 [52.94%], p < 0.001); 3) lower minimum ADC (ADCmin) values (820.575 ± 302.545 [86.1-1144.4] vs. 1372.424 ± 561.337 [355.7-2616.6], p < 0.001); and 4) minimal ipsilateral masticatory muscle atrophy (-6.71% ± 22.43% [-85.71% ~ 13.79%] vs. 11.24% ± 11.98% [-14% ~ 38%], p < 0.001). Very small MC tumors (VSMCTs) were ≤ 2 cm in size, and the subgroup analysis of very small meningiomas and schwannomas revealed no differences in terms of ipsilateral masticatory muscle atrophy (p = 0.078), prominence of the dural tail (p = 0.236), or the presence of cystic components (p = 0. 364). However, the ADCmin values were significantly lower for very small meningiomas than for very small schwannomas (p = 0.009).

CONCLUSION

MRI features such as a prominent dural tail appearance, the presence of fewer cystic components, and less masticatory muscle atrophy may aid in differentiating meningiomas from schwannomas less than 3 cm in size. The ADC and DWI parameters provided additional critical insights, particularly for VSMCTs, thus facilitating preoperative diagnoses.

Ultrasonography reference values for the calcaneus in children and adolescents living at high altitude in Peru

Objective

The evaluation of bone health during the growth stage is extremely important, as it is a key factor to prevent bone diseases in adulthood. The objectives of the study were: a) to verify if there are differences in bone health with other geographic regions, b) to develop bone health curves using quantitative ultrasonography (QUS) through the Broadband Ultrasonic Attenuation (BUA) parameter in children and adolescents residing in a high altitude region of Peru and c) to determine specific cut-off points for bone health assessment in this particular population.

Methods

A cross-sectional study was carried out in schoolchildren in a high altitude region of Peru. The sample consisted of 1468 children and adolescents (724 males and 744 females). The age range was 6.0 to 17.9 years old. Weight and height were evaluated. Body Mass Index (BMI) was calculated. Bone quality was evaluated by quantitative ultrasonography (QUS) of the calcaneus. The parameters measured were Speed of Sound (SOS, m/s); Broadband Ultrasonic Attenuation (BUA, dB/MHz); and Bone Quality Index (BQI= αSOS+αBUA, αβ: temperature corrections).

Results

There were small discrepancies in bone health (BUA) between studies from various geographic regions. Values differed across all age ranges from ~0.36 to ~10.86 in males and from ~0.26 to ~6.68 in females. At later ages during adolescence the values are relatively similar, reaching a plateau around 16 and 17 years of age. Percentiles were calculated for BUA by age and sex. Sensitivity and specificity values in females are slightly higher relative to males. However, the Youden Index reflects 0.84 for both sexes and the appropriate cut-off point for men is ≤67.8 and for women is ≤63.7.

Conclusion

The study demonstrated that there are small discrepancies in bone health (BUA) among children between children and adolescents from different geographic regions. These findings support the creation of specific references and cut-off points for bone health in the pediatric population of a high altitude region of Peru. The results suggest the application of percentiles for the assessment of bone health in school and epidemiological contexts.

Radiation safety: knowledge, attitudes, practices and perceived socioeconomic impact in a limited-resource radiotherapy setting

Healthcare workers in teaching-hospital settings face numerous occupational hazards, necessitating comprehensive safety protocols to protect both staff and patients. Radiation safety is particularly critical in regions like sub-Saharan Africa, where the sharp rise in radiological procedures and radiation treatments demands stringent protocols to mitigate health risks. The study aimed to assess the knowledge, attitudes and practices related to radiation safety among healthcare workers in a limited-resource setting, as well as evaluate the perceived socioeconomic impact of implementing radiation safety protocols. The research was a quantitative case study of one of the largest radiotherapy centres in Africa. Participants were selected using a stratified random sampling technique. Data were collected using a modified structured questionnaire based on the validated International Atomic Energy Agency radiation safety knowledge, attitudes and practice questionnaire. Data were analysed with the Statistical Package for Social Sciences software. Both descriptive and inferential statistical analyses were performed. Data were summarized using frequencies, percentages, means and standard deviations. The study involved 78 participants, comprising 13 physicians, 40 nurses and 25 other health workers. In all, 53.8% were males, whereas 46.2% were females. The mean age was 24.9 years (SD 4.7) ranging from 23 to 47 years. A significant majority (82%) were knowledgeable about effective ways of reducing radiation exposure. All participants considered radiation safety extremely important, with 55% feeling extremely confident in their ability to practice radiation safety measures. The majority (92%) believed that radiation safety was a shared responsibility within the organization. Only 51% frequently checked radiation safety equipment. There was a strong consensus that these protocols positively affect healthcare worker well-being (a mean score of 4.49) and benefit patient care (a mean score of 4.45). Implementation of workplace safety protocols was perceived to improve worker well-being (B = 0.337 and p = 0.001) and benefit patient care (B = 0.391 and p = 0.014). The study highlights a high level of knowledge and positive attitudes towards radiation safety among healthcare workers in a limited-resource radiotherapy setting. While most participants recognized the importance of radiation safety and its shared responsibility, less than half regularly checked safety equipment. There were significant perceptions of the socioeconomic benefits of implementing safety protocols.

Surgical intervention of coronary-pulmonary artery fistula with multiple coronary aneurysms and Vieussens' arterial ring formation

BACKGROUND

To our knowledge, there have been extremely few clinical reports on coronary-pulmonary artery fistula (CPAF) accompanied by coronary artery aneurysm (CAA) and Vieussens' arterial ring (VAR), and few reports on related surgical treatments.

CASE PRESENTATION

A 61-year-old female patient was admitted with dyspnea and fatigue after exertion. Coronary CTA, echocardiography and coronary angiography revealed multiple CPAF, along with formation of multiple CAAs and VAR. The patient underwent successful surgical intervention under general anesthesia and cardiopulmonary bypass and experienced an uneventful recovery.

CONCLUSION

Hereby we reported this clinically unusual case of CPAFs with multiple CAAs and VAR and also the details of a successful surgical procedure.

Immunotherapy and MASLD-Related HCC: Should We Reconsider the Role of Etiology in the Therapeutic Approach to HCC?

Hepatocellular carcinoma (HCC) accounts for 90% of primary liver cancers and typically arises in the context of chronic liver disease. With the increasing prevalence of metabolic disorders, metabolic dysfunction-associated steatotic liver disease (MASLD) has become the leading cause of chronic liver disease and the most rapidly increasing cause of HCC. The role of dysfunctional innate and adaptive immune responses in the development and progression of HCC is well-established, prompting numerous trials to evaluate the efficacy of immune checkpoint inhibitors (ICIs) in targeting tumor cells. These trials have yielded promising results, and ICIs, in combination with anti-vascular endothelial growth factor (VEGF) monoclonal antibodies, are now approved as first-line therapy for patients with metastatic or unresectable HCC, irrespective of the underlying liver disease. Notably, MASLD itself is characterized by immune system dysfunction, as metabolic inflammation plays a central role in its onset and progression. However, clinical studies and post-hoc analyses suggest that immunotherapy may be less effective in MASLD-associated HCC compared to viral-related HCC. This emerging evidence raises the question of whether the underlying liver disease influences the therapeutic response to ICIs in HCC. It may be time to consider tailoring therapeutic strategies for HCC based on the specific etiological, histological, and genotypical subgroups.

Hydrogenated Amorphous Silicon Charge-Selective Contact Devices on a Polyimide Flexible Substrate for Dosimetry and Beam Flux Measurements

Hydrogenated amorphous silicon (a-Si:H) devices on flexible substrates are currently being studied for application in dosimetry and beam flux measurements. The necessity of in vivo dosimetry requires thin devices with maximal transparency and flexibility. For this reason, a thin (<10 µm) a-Si:H device deposited on a thin polyimide sheet is a very valid option for this application. Furthermore, a-Si:H is a material that has an intrinsically high radiation hardness. In order to develop these devices, the HASPIDE (Hydrogenated Amorphous Silicon Pixel Detectors) collaboration has implemented two different device configurations: n-i-p type diodes and charge-selective contact devices.Charge-selective contact-based devices have been studied for solar cell applications and, recently, the above-mentioned collaboration has tested these devices for X-ray dose measurements. In this paper, the HASPIDE collaboration has studied the X-ray and proton response of charge-selective contact devices deposited on Polyimide. The linearity of the photocurrent response to X-ray versus dose-rate has been assessed at various bias voltages. The sensitivity to protons has also been studied at various bias voltages and the wide range linearity has been tested for fluxes in the range from 8.3 × 107 to 2.49 × 1010 p/(cm2 s).

SPECT/CT Scan Images to Evaluate COVID-19 Pulmonary Complications: A Systematic Review

INTRODUCTION

The highly contagious 2019 novel coronavirus that causes coronavirus disease 2019 increased the scientific community's interest in diagnosing and monitoring COVID-19. Due to the findings about the association between COVID-19 infection and pulmonary disturbances, the need for the use of complementary tests that can be carried out, preserving the health of patients, has grown. In this context, single-photon emission computed tomography (SPECT) was performed during the COVID-19 pandemic to assess and try to diagnose lung lesions. The aim of this current review was to investigate the types of SPECT images most commonly used and the main pulmonary parenchymal lesions and different lung perfusion abnormalities observed in these images in individuals with COVID-19 in different countries in the world.

MATERIALS AND METHODS

Electronic searches in the MEDLINE/PubMed, Embase, Scopus, Web of Science, and CINAHL databases were conducted in December 2022. Studies that used SPECT/CT scans to evaluate pulmonary involvements due to COVID-19, with no language restriction, were included. Two reviewers, who independently examined titles and abstracts, identified records through the database search and reference screening, and irrelevant studies were excluded based on the eligibility criteria. Relevant complete texts were analyzed for eligibility, and all relevant studies were included in a systematic review.

RESULTS

Eight studies with regular methodological quality were included. The types of SPECT examinations used in the included articles were SPECT/CT, Q SPECT/CT, and V/Q SPECT. The possible pulmonary complication most observed was pulmonary embolism.

CONCLUSIONS

This systematic review demonstrated that SPECT/CT scans, mainly with perfusion methods, allow the maximum extraction of benefits from pulmonary images, in safety, suggesting efficiency in the differential diagnosis, including of respiratory diseases of different etiology, and with diagnostics and additional analyses, can possibly aid the development of suitable therapeutic strategies for each patient. Randomized clinical trials and studies of good methodological quality are necessary to confirm the findings of this review and help better understand the types of SPECT images most commonly used and the main pulmonary parenchymal lesions observed in the images in individuals with COVID-19.

Coronary anomalies in single ventricles: Insights from selective angiographic assessment

BACKGROUND

Adults with congenital heart disease have a higher risk of coronary artery disease compared to the general population. However, there is limited information on coronary artery distribution in patients with a single ventricle (SV), which is important in understanding potential cardiovascular events. This study aimed to evaluate coronary artery morphology and anomalies in patients with SV based on selective coronary angiography (CAG).

METHODS

We performed a retrospective single-center study including 80 patients with SV [median age, 29 years (range 13-50); 54 % males] who underwent selective CAG at our institution between 2019 and 2023. Patients were classified into either single right or left ventricular (SRV and SLV) morphologies and categorized into D-, L-, and X-loops based on the rules of cardiovascular looping. Coronary artery morphology, dominance, and the abnormality of origin were evaluated.

RESULTS

Of the 80 SV patients, 56 had SRV and 24 had SLV. Patients with coronary artery looping surrounding the rudimentary chamber were more frequent in cases with D-loops. In patients with SV, right coronary artery dominance was observed in 70 %, and anomalous origins of coronary artery origins were found in 36.3 % of cases, with a higher frequency of L-loops. Overall, cardiovascular events were observed in patients with SV as follows: 46 % of patients had arrhythmias, 13 % had heart failure, and 8 % had thrombosis; there were no cardiovascular deaths. A single coronary artery was identified in 9 cases (11 %) of SV patients, exclusively in SRV, of which 2 cases (22 %) had arrhythmias and 1 case (11 %) had thrombus.

CONCLUSION

Selective CAG revealed a high prevalence of coronary artery anomalies in patients with SV, emphasizing the importance of comprehensive assessment and long-term follow-up to manage cardiovascular risk in this patient population.

High-grade eosinophilic renal tumor/eosinophilic vacuolar renal tumor: a case report and literature review

INTRODUCTION

Renal oncocytoma (RO) is an uncommon benign neoplasm of the kidney, while eosinophilic vacuolated tumor (EVT) represents a distinct subtype of renal oncocytoma characterized by specific morphological features. EVT is a rare eosinophilic renal neoplasm distinguished by its unique morphological, immunophenotypic, and molecular genetic attributes. Its biological behavior is generally indolent, and it is associated with a favorable prognosis.

CASE REPORT

This case report provides a comprehensive account of a 52-year-old female patient who presented to the hospital for a medical evaluation, revealing that her left kidney had been occupying space for over one month. Following an abdominal enhanced CT scan, a diagnosis of renal clear cell carcinoma was suspected, leading to the decision to perform a "robot-assisted laparoscopic partial left nephrectomy." During the surgical procedure, a mass measuring approximately 3.8 × 3.5 cm was identified adjacent to the renal hilum in the midsection of the left kidney. Subsequent pathological analysis classified the excised tumor as an eosinophilic vacuolar tumor of the kidney.

CONCLUSION

This case illustrates that EVT represents a novel solid neoplasm of the kidney, with occurrences being exceedingly uncommon. It is imperative for clinicians and pathologists to enhance their comprehension of these tumors and distinguish them effectively, thereby facilitating more precise classification of renal tumors and informing clinical management and prognostic assessment.

Nomogram integrating clinical-radiological and radiomics features for differentiating invasive from non-invasive pulmonary adenocarcinomas presenting as ground-glass nodules

OBJECTIVE

To construct a nomogram incorporating clinical-radiological and radiomics features from computed tomography (CT) for distinguishing invasive adenocarcinoma (IAC) from adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) in ground-glass nodules (GGNs).

METHODS

This retrospective study included 473 GGN patients with postoperative pathological confirmation of AIS, MIA, or IAC. The training set comprised 257 patients from Yantaishan Hospital, while the test set, used for external validation, included 216 patients from the Affiliated Hospital of Binzhou Medical College. Radiomics features were selected, and a radiomics model was constructed using least absolute shrinkage and selection operator (LASSO) and minimum redundancy maximum relevance (mRMR) methods. A clinical-radiological model was developed using univariate and multivariate logistic regression. The nomogram was generated by combining the two models. Its performance was evaluated via receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and decision curve analysis (DCA).

RESULTS

The radiomics model included 11 features, while the clinical-radiological model incorporated lobulation, age, and long diameter. The nomogram outperformed both individual models in terms of accuracy and area under the curve (AUC) in both the training and test sets. Calibration curve analysis confirmed good consistency between actual and predicted outcomes, and DCA indicated the nomogram's clinical utility.

CONCLUSION

The nomogram is a non-invasive, accurate tool for preoperative differentiation of GGN types, providing valuable guidance for clinicians in treatment planning.

Comparative Safety of Ultrasound Enhancing Agents: A Systematic Review and Bayesian Network Meta-Analysis

Ultrasound enhancing agents (UEAs), including OPTISON, DEFINITY, and LUMASON, enhance the diagnostic performance of echocardiography, particularly, in patients with suboptimal acoustic windows. However, there remains a paucity of comparative safety assessments among the Food and Drug Administration-approved UEAs. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic literature review performed in August 2023 searched Medline, Embase, Cochrane Library, and gray literature. Randomized and nonrandomized comparative evidence on safety of contrast-enhanced procedures were included. A feasibility assessment ensured homogeneity across studies by comparing patient characteristics and outcomes. Bayesian hierarchical network meta-regression was used to indirectly compare published safety outcomes across different UEAs. In addition, adverse events (AEs) between 2019 and 2023 for each UEA were retrieved from the Food and Drug Administration Adverse Events Reporting System (FAERS), and comparative safety outcomes were derived using annual UEA administration in the United States. The screening of 4,146 records rendered 19 studies for inclusion in the indirect comparison analysis after feasibility assessment. OPTISON demonstrated favorable safety in direct comparisons with DEFINITY and LUMASON across the majority of investigated AEs. Network meta-regression results on serious AEs within 30 minutes revealed odds ratios (ORs) of 0.59 (95% confidence interval 0.27 to 1.23) and 0.63 (0.29 to 1.33) for OPTISON versus LUMASON and DEFINITY, respectively, indicating a decreased risk of serious AEs for OPTISON versus LUMASON and DEFINITY, further supported by statistically significant ORs within FAERS: 0.01 (0 to 0.02), p <0.001 and 0.15 (0.05 to 0.48), p = 0.001 for OPTISON versus LUMASON and DEFINITY, respectively. In conclusion, our results restate the favorable comparative safety profile of OPTISON, providing new evidence to inform clinical decision-making.

miR-455-3p has superior diagnostic potential to PSA in peripheral blood for prostate cancer

BACKGROUND

Prostate-specific antigen (PSA) is commonly used as a biomarker to diagnose and predict the course of prostate cancer (PCa). However, PSA detection is susceptible to changes in the physiologic environment, which may lead to some misdiagnosis. Thus, it is crucial to find a novel diagnostic marker.

METHODS

We accessed microRNA (miRNA) expression datasets (GSE206793 and GSE112264) from the GEO database, analyzing peripheral blood samples from PCa patients. Differentially expressed miRNAs (DEmiRNAs) were identified using GEO2R. A specific miRNA, miR-455-3p, was pinpointed through rigorous analysis of clinical correlations and ROC curves. Peripheral blood samples from healthy individuals and PCa patients were subjected to qRT-PCR validation, aligning results with the GSE206793 dataset. The miRWalk database was utilized to predict downstream genes, while STRING facilitated the construction of a protein-protein interaction (PPI) network. KEGG pathway analysis enriched our understanding of potential molecular pathways.

RESULTS

We found that miR-455-3p was highly expressed in the peripheral blood of PCa patients with Gleason score (GS) ≥ 8, while independent of T stage, age and PSA. ROC analysis revealed a favorable diagnostic efficacy of miR-455-3p and AUC for the two datasets was respectively 0.943 and 0.847. The qRT-PCR assay also revealed consistent results. Interestingly, the PSA levels of P1 (GS = 5 + 4) and P6 (GS = 3 + 3) were respectively 3.38 and 4.45 ng/ml, while miR-455-3p was highly expressed in both, suggesting its low misdiagnosis. The speculation was validated in GSE206793 dataset. Finally, 9 potential targets of miR-455-3p were predicted. PPI network revealed PPP2R2A, ITGB1 and CDKN1A as key nodes. KEGG pathway analysis revealed that they were enriched in various cancers, biological processes and molecular signals.

CONCLUSION

Our study identifies miR-455-3p as a promising diagnostic marker for PCa, outperforming PSA in terms of specificity and sensitivity. The robustness of miR-455-3p, coupled with its potential downstream targets and associated pathways, highlights its clinical significance for improved PCa diagnosis and management.

Establishing Reference Values for Thyroid Vascularity Using Ultra-Micro Angiography (UMA) Ultrasound Technology

Background/Objectives: Ultra-Micro Angiography (UMA) is an advanced Doppler technique designed to improve the visualization of slow blood flow in small vessels. The Subtraction UMA (sUMA) setting enhances these features by removing background tissue interference, allowing for more precise assessments of microvascularity. This study aims to establish reference values for thyroid vascularity using sUMA technology, providing a foundation for future research in thyroid pathology. Methods: This prospective, single-center study included 106 healthy participants with no evidence of thyroid disease based on biochemical and ultrasound evaluations. All participants underwent multiparametric ultrasound, followed by sUMA to assess thyroid vascularity. The quantitative sUMA measurements were performed using the color pixel percentage (CPP), and three measurements were taken in each thyroid lobe. The median CPP values were calculated and analyzed. Statistical analysis was conducted to evaluate intraobserver reliability and to examine correlations between CPP values and demographic characteristics. Results: The study cohort had a mean age of 41.2 ± 16.3 years, with a predominance of women (82%). CPP sUMA measurements demonstrated excellent feasibility (100%) and intraobserver reliability, with an intraclass correlation coefficient of 0.905 for the right thyroid lobe and 0.897 for the left lobe. The median CPP for the right and left lobes was 26.5% and 27.1%, respectively, with no significant difference between lobes (p = 0.8799). Conclusions: sUMA technology is a reliable and reproducible method for evaluating thyroid microvascularity in healthy individuals. These reference values provide a foundation for future studies investigating thyroid pathology, potentially enhancing the accuracy of diagnostic assessments in clinical practice.

Effect of Balloon Dilatation and Stent Implantation in Iliac Vein Compression Syndrome

OBJECTIVE

 To investigate the efficacy of balloon dilatation combined with stent implantation in the treatment of iliac vein compression syndrome (IVCS).

METHODS

 This research was a retrospective study that enrolled 127 IVCS patients for clinical data. The patients were divided into percutaneous transluminal angioplasty (PTA) group (n = 63) and stent implantation group (n = 64). The PTA group was treated with iliac vein balloon dilatation, and the stent implantation group was treated with combined stent implantation based on the PTA group. In both the groups, the quality of life was assessed using Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ); complications occurring during the perioperative period and at postoperative follow-up were recorded; the vascular patency rate was calculated, and patient's condition was evaluated using the Villalta scale.

RESULTS

 The stent implantation group exhibited lower postoperative CIVIQ scores than the PTA group, and the stent implantation group (4.60%) had lower complication rate than the PTA group (19.05%). At 2 years of follow-up, the stent implantation group (92.19%) had higher vascular patency rate than the PTA group (79.37%). Villalta scores were lower in the stent implantation group than in the PTA group at 6, 12, and 24 months postoperatively.

CONCLUSION

 Iliac vein balloon dilatation combined with stent implantation for the treatment of IVCS can improve vessel patency rates, alleviate patients' clinical symptoms, and enhance their quality of life.

Use of Carbon Fiber Implants to Improve the Safety and Efficacy of Radiation Therapy for Spine Tumor Patients

Current standard of care treatment for patients with spine tumors includes multidisciplinary approaches, including the following: (1) surgical tumor debulking, epidural spinal cord decompression, and spine stabilization techniques; (2) systemic chemo/targeted therapies; (3) radiation therapy; and (4) surveillance imaging for local disease control and recurrence. Titanium pedicle screw and rod fixation have become commonplace in the spine surgeon's armamentarium for the stabilization of the spine following tumor resection and separation surgery. However, the high degree of imaging artifacts seen with titanium implants on postoperative CT and MRI scans can significantly hinder the accurate delineation of vertebral anatomy and adjacent neurovascular structures to allow for the safe and effective planning of downstream radiation therapies and detection of disease recurrence. Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) spine implants have emerged as a promising alternative to titanium due to the lack of artifact signals on CT and MRI, allowing for more accurate and safe postoperative radiation planning. In this article, we review the tenants of the surgical and radiation management of spine tumors and discuss the safety, efficacy, and current limitations of CFR-PEEK spine implants in the multidisciplinary management of spine oncology patients.

Examination of the frequency and localization of sigmoid canal with CBCT: A retrospective study

Recently, a variational canal starting from the sigmoid notch and extending in the ramus has been reported. The aim of this study was not only to investigate the presence and localization of the sigmoid canal (SC) between the sexes, which has not been studied before, but also to define the morphometric characteristics of the SC. The possible complications that this anatomical variation may cause are also being discussed. Between 2022 and 2024, a total of 546 cone beam computed tomography images obtained in sagittal, coronal, and horizontal planes were retrospectively analyzed. The presence, localization, and morphometric characteristics of the SCs were recorded and evaluated using statistical analysis software. The presence of SC was observed in 5.5% of the images and it was determined that 4.0% of these canals were unilateral and 1.5% were bilateral. The rate of right SC was 3.3% and the rate of left SC was 3.7%. When morphometric evaluation is made, the average value of the length of the SC is 8.0 mm, with a minimum value of 3.1 mm and a maximum value of 13.9 mm. Knowledge of the SC will prevent possible complications in surgical procedures, provide a more accurate diagnosis at the diagnostic stage and ensure that the treatment plan is created appropriately. More studies are needed on this subject.

Outcomes and Complications of Chait Trapdoor Cecostomy in Pediatric Patients with Therapy-Resistant Constipation and Fecal Incontinence: A 14-Year Retrospective Study

AIM OF THE STUDY

 To assess the incidence and types of complications and patient-reported outcomes in pediatric patients with therapy-resistant constipation or fecal incontinence (FI) without constipation who underwent Chait Trapdoor™ cecostomy (CTC). The findings contribute to the discussion on selecting the optimal antegrade continence (ACE) procedure for this population.

MATERIALS AND METHODS

 A retrospective review was conducted on all pediatric patients with therapy-resistant constipation or FI without constipation who underwent a CTC procedure at our tertiary referral center between 2009 and 2023. Postoperative complications were classified using the Clavien-Madadi classification. At their most recent follow-up in 2023, patients reported satisfaction with their CTC.

RESULTS

 The study included 62 children (median age 12 years [IQR 8-14; range 1-17], 42% male), with a median follow-up of 4 years (IQR 2-8, range 0-14). Underlying diagnoses were functional constipation (n = 39, 63%), spina bifida (n = 11, 18%), and anorectal malformations (n = 5, 8%). A total of 49/62 patients (79%) experienced 89 CTC-related complications. Minor complications (Clavien-Madadi I-II) affected 29 patients (47%) and most commonly included granulation. Major complications (Clavien-Madadi III-IV) requiring surgery occurred in 32% of patients. Despite these complications, 40/62 (65%) patients reported satisfaction with their CTC, as determined by partial or complete symptom resolution.

CONCLUSIONS

 Although complications were common, 65% of the patients reported satisfaction with their CTC. These findings emphasize the need for thorough patient selection, informed counseling on potential risks, and individualized management strategies to enhance outcomes.

The volumetric and dosimetric impacts of respiratory motion management in lung SBRT: A systematic review from 2019-2024

BACKGROUND

The efficacy of Stereotactic Body Radiation Therapy (SBRT) is contingent upon accurately accounting for respiratory motion. Although several methods have been developed, the extent of volumetric and dosimetric benefit, as well as the criteria for selecting appropriate methods for individual patients remain unclear.

PURPOSE

To assess the extent of target volume reduction and lung dose reduction in lung cancer patients treated with SBRT, comparing active versus non-active respiratory motion management approaches.

MATERIALS AND METHODS

A comprehensive search was conducted across multiple databases, including MEDLINE Ovid (PubMed), EMBASE, and the Web of Science Core Collection, covering the period from 2019 to 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify studies relevant to respiratory motion management in lung SBRT. Data extracted included target volume delineation, target volume sizes, and lung doses reported.

RESULTS

The review included 14 studies involving 273 patients, which examined both active and non-active respiratory motion management approaches. Active respiratory motion management approaches were associated with significant reduced target volume sizes and lung doses compared to non-active approaches. Tracking and deep inspiration breath-hold demonstrated superiority in reduction in target volume and lung protection, with tracking showing the greatest reduction in target volume.

CONCLUSION

Patient selection is crucial when determining the most appropriate respiratory motion management approach. Establishing a consensus on planning objective is necessary for accurate data evaluation. Further research is required to refine these techniques and explore innovative technologies that could enhance the effectiveness and safety of respiratory motion management in lung SBRT.

Accuracy of Ionizing-Radiation-Based and Non-Ionizing Imaging Assessments for the Diagnosis of Periodontitis: Systematic Review and Meta-Analysis

AIMS

To evaluate the diagnostic accuracy of periapical, bitewing or panoramic radiographs (standard 2D radiographs) in detecting and monitoring periodontitis (PICO 1) and to assess the clinical relevance of alternative and emerging diagnostic methods (e.g., cone-beam computed tomography [CBCT], magnetic resonance imaging [MRI], ultrasound imaging [USG]) compared to standard 2D radiographs or clinical/intra-surgical examination in the diagnosis and surveillance of the disease (PICO 2).

MATERIALS AND METHODS

A systematic literature search was conducted through MEDLINE EMBASE, Scopus and Cochrane Library. When feasible (n > 2 comparable studies), a meta-analysis of diagnostic accuracy was performed.

RESULTS

For PICO 1, 26 studies met the inclusion criteria. Pooled-data analysis from three studies showed a sensitivity of 0.77 (95% confidence interval, CI: 0.66-0.85), specificity of 0.76 (95% CI: 0.64-0.84) and accuracy of 0.82, with a diagnostic odds ratio (DOR) of 137.99 (95% CI: 6.99-368.90). For PICO 2, 51 articles were included dealing with different techniques. The meta-analysis for CBCT (three studies) showed a pooled sensitivity and specificity of 0.98 (95% CI: 0.96-1.00) and 0.98 (95% CI: 0.95-1.00), respectively, and a diagnostic accuracy of 0.99 in the detection of furcation involvement compared to intra-surgical measurements.

CONCLUSIONS

Standard 2D radiographs appear to have adequate diagnostic accuracy for periodontitis, while CBCT is highly sensitive and specific to detect and classify furcation involvement. The role of non-ionizing techniques (MRI and USG) in diagnosing periodontitis remains under investigation.

Research Progress on Contrast-Enhanced Ultrasound (CEUS) Assisted Diagnosis and Treatment in Liver-Related Diseases

Liver-related diseases, such as hepatocellular carcinoma (HCC) and cirrhosis, are globally prevalent and significantly contribute to mortality rates. Despite the availability of various imaging techniques for liver evaluation, a consensus regarding the selection of an accurate and safe method remains elusive. As a non-invasive imaging approach, the effectiveness of contrast-enhanced ultrasound (CEUS) in assisting the diagnosis and treatment of liver-related diseases has been established. Compared to conventional methods, CEUS offers notable advantages, including high safety, convenience, accuracy, and cost-effectiveness. Recent advancements have demonstrated the expanded utility of CEUS in liver-related diseases. In addition to diagnosing focal liver lesions, CEUS is increasingly employed for guiding local treatments, assessing liver transplantation suitability, and planning surgical interventions. However, its application requires caution due to the high technical proficiency demanded of operators, time-sensitive imaging processes, and susceptibility to visual interference. This review summarizes the current applications and recent advancements in CEUS-assisted diagnosis and treatment of liver-related diseases, explores its future potential, and proposes possible improvements. The objective is to enhance the accuracy and versatility of non-invasive liver assessments and provide a reference for the broader and more effective utilization of CEUS in liver disease diagnosis and management.

Prophylactic transarterial embolization in patients with bleeding peptic ulcers following endoscopic control of bleeding

BACKGROUND

Bleeding peptic ulcer is a serious condition that often requires immediate endoscopic or surgical intervention to stop the bleeding (haemostasis). Following haemostasis, patients are at risk of rebleeding, leading to reintervention and risk of morbidity or mortality. In order to prevent rebleeding and associated complications, prophylactic measures have been developed and investigated. Prophylactic transarterial embolization (TAE), where the blood vessel leading to the site of the bleeding ulcer is closed via embolization (e.g. using coils to stop blood flow), has emerged as a potential therapeutic approach to address this challenge. However, a comprehensive evaluation of its efficacy and impact on patient outcomes is essential.

OBJECTIVES

To assess the effects of prophylactic transarterial embolization after successful endoscopic treatment compared with endoscopic haemostasis only on the risk of rebleeding after bleeding peptic ulcer, in patients where endoscopic haemostasis has been successful.

SEARCH METHODS

In August 2023 we searched CENTRAL, MEDLINE, Embase, PubMed Central, Clinicaltrials.gov and the International Clinical Trials Registry Platform (ICTRP). There were no language or publication status constraints.

SELECTION CRITERIA

This review included prospective randomized controlled trials that evaluated prophylactic TAE in patients with bleeding peptic ulcers. The selection process involved meticulous screening, full-text reviews, and considerations of study design, intervention, and patient populations.

DATA COLLECTION AND ANALYSIS

Two review authors extracted data and conducted risk of bias assessments. The outcomes of interest were rebleeding within 30 days, need for reintervention within 30 days, 30-day mortality, complications within 30 days, duration of hospitalization and success rate of the embolization. We contacted authors of included studies for missing and more detailed data, allowing us to carry out sensitivity analyses. We used GRADE to assess the certainty of evidence.

MAIN RESULTS

The review includes two studies involving 346 participants. Prophylactic TAE may not reduce the odds of rebleeding within 30 days (odds ratio (OR) 0.58, 95% confidence interval (CI) 0.18 to 1.83; 2 studies, 346 participants; low-certainty evidence). There may be little or no effect on reintervention rates per event (OR 0.68, 95% CI 0.35 to 1.35; 2 studies, 346 participants; low-certainty evidence) or per participant (OR 0.65, 95% CI 0.25 to1.69; 2 studies, 346 participants; low-certainty evidence), and there may be no reduction in 30-day mortality (OR 0.41, 95% CI 0.14 to 1.21; 2 studies, 346 participants; low-certainty evidence). Unfortunately, we were unable to analyze complications other than rebleeding, reintervention and mortality, as data for these outcomes were not available in the included studies. The duration of hospitalization may be shorter for participants undergoing prophylactic TAE (mean difference (days) -2.41, 95% CI -4.06 to -0.76; 2 studies, 346 participants; low-certainty evidence). Overall, the risk of bias in the included studies was low, but there was a high risk of performance bias and detection bias as none of the included studies were blinded. Further, one study had a high risk of selection bias as the randomization lists were created by the primary investigator.

AUTHORS' CONCLUSIONS

In conclusion, there is low-certainty evidence that prophylactic TAE may not reduce the odds of rebleeding, reintervention or mortality for participants following peptic ulcer bleeding. It may, however, reduce the duration of hospitalization. Ultimately, due to the limited number of studies and participants, further research with larger populations is warranted to validate these findings and explore additional outcomes, including adverse events other than rebleeding, reintervention and mortality.

Detection of dental caries under fixed dental prostheses by analyzing digital panoramic radiographs with artificial intelligence algorithms based on deep learning methods

BACKGROUND

The aim of this study was to evaluate the efficacy of detecting dental caries under fixed dental prostheses (FDPs) through the analysis of panoramic radiographs utilizing convolutional neural network (CNN) based You Only Look Once (YOLO) models. Deep learning algorithms can analyze datasets of dental images, such as panoramic radiographs to accurately identify and classify carious lesions. Using artificial intelligence, specifically deep learning methods, may help practitioners to detect and diagnose caries using radiograph images.

METHODS

The panoramic radiographs of 1004 patients, who had FDPs on their teeth and met the inclusion criteria, were divided into 904 (90%) images as training dataset and 100 (10%) images as the test dataset. Following the attainment of elevated detection scores with YOLOv7, regions of interest (ROIs) containing FDPs were automatically detected and cropped by the YOLOv7 model. In the second stage, 2467 cropped images were divided into 2248 (91%) images as the training dataset and 219 (9%) images as the test dataset. Caries under the FDPs were detected using both the YOLOv7 and the improved YOLOv7 (YOLOv7 + CBAM) models. The performance of the deep learning models used in the study was evaluated using recall, precision, F1, and mean average precision (mAP) scores.

RESULTS

In the first stage, the YOLOv7 model achieved 0.947 recall, 0.966 precision, 0.968 mAP and 0.956 F1 scores in detecting the FDPs. In the second stage the YOLOv7 model achieved 0.791 recall, 0.837 precision, 0.800 mAP and 0.813 F1 scores in detecting the caries under the FDPs, while the YOLOv7 + CBAM model achieved 0.827 recall, 0.834 precision, 0.846 mAP, and 0.830 F1 scores.

CONCLUSION

The use of deep learning models to detect dental caries under FDPs by analyzing panoramic radiographs has shown promising results. The study highlights that panoramic radiographs with appropriate image features can be used in combination with a detection system supported by deep learning methods. In the long term, our study may allow for accurate and rapid diagnoses that significantly improve the preservation of teeth under FDPs.

Evaluation of the Performance of a YOLOv10-Based Deep Learning Model for Tooth Detection and Numbering on Panoramic Radiographs of Patients in the Mixed Dentition Period

Objectives: This study evaluated the performance of a YOLOv10-based deep learning model in detecting and numbering teeth in the panoramic radiographs of pediatric patients in the mixed dentition period. Methods: Panoramic radiographic images from 200 pediatric patients in the mixed dentition period, each with at least 10 primary teeth and underlying permanent tooth germs, were included in the study. A total of 8153 teeth in these panoramic radiographs were manually labeled. The dataset was divided for the development of a YOLOv10-based artificial intelligence model, with 70% used for training, 15% for testing, and 15% for validation. Results: The precision, recall, mAP50, mAP50-95, and F1 score of the model for tooth detection and numbering were found to be 0.90, 0.94, 0.968, 0.696, and 0.919, respectively. Conclusions: YOLOv10-based deep learning models can be used to accurately detect and number primary and permanent teeth in the panoramic radiographs of pediatric patients in the mixed dentition period, which can support clinicians in their daily practice. Future works may focus on model optimization across varied pediatric cases to enhance clinical applicability.

Comprehensive analysis of endoscopic ultrasound (EUS) in mediastinal lesions: patient characteristics, diagnostic outcomes, safety, and efficacy: a multi-country study

Background

Mediastinal lesions are tumors that develop mainly from structures commonly located in the three compartments of the mediastinum and the paravertebral areas. The diagnosis of these lesions is primarily based on imaging studies such as computed tomography and magnetic resonance imaging, which confirm the presence of the lesions and suspected metastatic disease. The study aims to determine the factors that determine the diagnostic accuracy and yield of endoscopic ultrasound (EUS) in diagnosing mediastinal lesions.

Methods

This multi-country study involved a list of centers providing EUS services across ten countries—the United Kingdom, Algeria, Egypt, Iraq, Kingdom of Saudi Arabia (KSA), Lebanon, Morocco, Pakistan, Romania, and Thailand. The appropriate information was collected regarding EUS-FNA and EUS-FNB procedures, including needle types, nature of lesion, needle passes, and complications of the techniques. The frequency/percentage conveyed data on the qualitative variables. The p-values were obtained using the Chi-square two-tailed exact test. The significance of the analysis was defined as p < 0.05. All the syntheses were performed using the Statistical Package for the Social Sciences (SPSS version 27; SPSS Inc., Chicago, IL, USA).

Results

A total of 439 participants were involved in this study, 255 (58.1%) males and 184 (41.9%) females, with a mean age of 55.73 $$\pm$$ ±  14.93 years. EUS-FNA and EUS-FNB diagnostic yield was influenced by needle types, needle size, number of needle passes, and lesion size. Among females, 44.6% were diagnosed with EUS-FNA, 42.8% with EUS-FNB, and 50.0% with EUS-FNA and FNB. Conversely, 55.4% of males were diagnosed using EUS-FNA and 57.2% with EUS-FNB. The association between gender and the diagnostic method, however, was statistically insignificant (p = 0.197). Needles with smaller diameters (22G) offered greater diagnostic yield than needles with larger diameters (19G). A minimal number of needle passes (between 2 and 4) showed a higher diagnostic yield than a higher number of needle passes (> 5). EUS-FNB accounted for a 0.5% complication incidence rate each for fever, pain, thoracic pain, and hemorrhage. EUS-FNA had no complication rate. Patients undergoing EUS-FNA, EUS-FNB, or both procedural examinations had no significant complications (p = 0.085).

Conclusion

The diagnostic yield of EUS procedures is affected by needle types, number of needle passes, lesion size, and needle size. Besides, EUS-FNA and EUS-FNB are infrequently associated with various complication rates. These techniques are safe and offer higher diagnostic yield when utilized responsibly by endosonographers.

The Prediction Model of High-Frequency Ultrasound Combined with Artificial Intelligence-Assisted Scoring System Improved the Diagnosis of Sclerosing Adenosis and Early Breast Cancer

Objective

The study aimed to apply an artificial intelligence (AI)-assisted scoring system, and improve the diagnostic efficiency of Sclerosing adenosis and early breast cancer.

Methods

This study retrospectively collected adenopathy patients (156 cases) and early breast cancer patients (150 cases) in Henan Provincial People's Hospital from August 2020 to April 2023.

Results

The area under the curve of the model constructed by clinical ultrasound features and combined AI features to predict and identify the two in the training group was 0.89 and 0.94, respectively. The combined AI model with the best performance (training AUC, 0.94, 95% CI, 0.91-0.97 and validation AUC, 0.95, 95% CI, 0.90-0.99) was superior to the clinical ultrasound feature model, and the decision curve also showed that the clinical ultrasound combined with AI Nomogram had good clinical practicability. In the training group, the AUC of the sonographer and AI in differential diagnosis was 0.67(95% CI, 0.62-0.71) and 0.89(95% CI, 0.84-0.93), respectively, and the sonographer's assessment showed better sensitivity (1.00 VS 0.73), but AI showed a higher accuracy rate (0.66 VS 0.80).

Conclusion

Age, lesion size, burr, blood flow, and AI risk score are independent predictors of sclerosing adenosis and early breast cancer. The combined clinical ultrasound feature and AI model are correlated with AI risk score, US routine features, and clinical data, superior to the clinical ultrasound model and BI-RADS grading, and have good diagnostic performance, which can provide clinicians with a more effective diagnostic tool.

Treatment of primary esophageal lymphomas: A review

Primary esophageal lymphoma is a rare malignancy that is difficult to diagnose and treat. While there have been significant advances in understanding the pathogenesis, clinical features, and treatment options, there is a lack of consensus on the most effective treatment approach. This literature review provides a comprehensive overview of the use of available treatment options for primary esophageal lymphoma, including surgery, radiotherapy, and chemotherapy. The review also highlights the current knowledge gaps that need to be addressed through further research. While no single treatment modality has emerged as a clear front-runner, a combination of these treatments may be the most effective approach in managing primary esophageal lymphoma, tailored to the histological subtypes.

Long-Term Results of Intensity Modulated Radiotherapy (IMRT) with Helical Tomotherapy in Non-Metastatic Breast Cancer Patients: Final Analysis

Background: Intensity modulated radiotherapy with helical tomotherapy (IMRT-HT) is used in the breast cancer (BC) treatment for years now to obtain homogeneous dose distribution in the treated volumes and reduce the doses to organs at risk. The purpose of this study was to evaluate our experience in terms of local control, overall survival, progression free survival and adverse events in BC patients treated with IMRT-HT with long term follow-up. Methods: This study is a retrospective data analysis of patients irradiated with IMRT-HT. Overall survival (OS) and progression free survival (PFS) curves were plotted with Kaplan-Meier method. We also analyzed the OS and PFS data by molecular subgroups of the population. Long-term toxicities including skin, cardiac and pulmonary complications were also evaluated. Multivariant logistic regression analysis was performed to determine the independent predictors of the side effects. Results: Between 2009 and 2015, a total of 194 breasts in 179 women with nonmetastatic breast cancer were treated. Most of the tumors were grade III and N+. With a median follow-up of 10 years, we observed 9 local recurrences, 2 loco-regional recurrences, and 29 patients experienced metastatic disease. Only 18 patients are dear, of them 7 cases with breast cancer death. At 10 years, the Local recurrence free survival was 95.3% [95%CI: 92.1-98.5], the loco-regional relapse free survival was 94.5% [91.1-98.1]. The metastases free survival was 82.9% [76.9-89.3]. The progression free survival was 79.9 [73.6-86.7]. The cancer specific survival was 94.3%, and the overall survival 88% [82.8-93.5]. At long term, there were no cardiac, lung, thyroid, digestive radio induced toxicities. A small number of patients experienced grade I or II fibrosis. Conclusions: IMRT-HT could be safely used for adjuvant breast cancer irradiation in patients with complex anatomy. IMRT-HT provides favourable long-term prognosis, while late toxicity is acceptable.

Association of Quadratus Lumborum Muscle Stiffness with Chronic Low Back Pain Features: An Observational Study

Background and Objectives: Low back pain (LBP) is highly prevalent and often associated with altered muscle function, including in the quadratus lumborum (QL) muscle. While some studies have highlighted the clinical relevance of QL muscle stiffness in LBP, the findings remain inconsistent, and the role of this parameter in relation to clinical severity indicators is not well understood. Considering the high prevalence of myofascial trigger points among patients, objectively and reliably quantifying QL stiffness and its association with other clinical parameters could improve the identification of early stages of the condition before other alterations become apparent. Therefore, this study aimed to explore the association between QL stiffness and multiple indicators of LBP severity. Materials and Methods: A cross-sectional observational study was conducted involving the participation of seventy-six patients suffering from chronic LBP. An ultrasound scanner with shear-wave elastography (SWE) was used to determine the participants' QL stiffness. Additional information was collected on LBP-associated pain intensity, disability, central sensitization, and quality of life. Results: QL muscle stiffness was negatively correlated with pain intensity (p < 0.01) and central sensitization (p < 0.01), and it was positively correlated with physical quality of life (p < 0.01). Muscle stiffness influenced the variance in pain intensity along with physical quality of life, central sensitization, and chronicity (together explaining 49% of the variance) but did not explain the variance in central sensitization. Conclusions: Assessing QL muscle stiffness in patients with LBP is recommended, as greater muscle softness is linked to higher pain intensity, central sensitization, and poorer physical quality of life. Regression analyses further highlighted that QL stiffness helps explain the variance in pain intensity, physical quality of life, central sensitization, and chronicity, but it did not directly affect the central sensitization variance.

Anomalous origin of the left main coronary artery in a 62‑year‑old woman: a case report and review of the literature

INTRODUCTION

Abnormalities of the coronary arteries, including abnormal origins, are often detected in heart patients who undergo coronary angiography. Although only a small percentage of these abnormalities lead to serious complications, the consequences can be extremely fatal.

CASE PRESENTATION

We report the case of a 62-year-old woman who presented with chest pain. The patient has a history of hypertension and complains of chest pain that worsens with walking and improves with rest. A basic electrocardiogram (ECG) showed sinus rhythm with no signs of arrhythmia or ischemic changes. Coronary angiography revealed an anomalous left coronary artery originating from the right sinus of Valsalva (RSoV).

CONCLUSIONS

We report a rare case of an anomalous left coronary artery originating from the RSoV without specific clinical symptoms. The patient presented with unstable angina, and after further investigation, this anomaly was diagnosed. Investigating these abnormalities, especially in young individuals with cardiac symptoms, should be prioritized. Cardiologists should also be aware of this rare condition that can have fatal consequences.

Advanced External Beam Stereotactic Radiotherapy for Skull Base Reirradiation

BACKGROUND/OBJECTIVES

Stereotactic body radiation therapy (SBRT) for skull base reirradiation is particularly challenging, as patients have already received substantial radiation doses to the region, and nearby normal organs may have approached their tolerance limit from prior treatments. In this study, we reviewed the characteristics and capabilities of four advanced external beam radiation delivery systems and four modern treatment planning systems and evaluated the treatment plan quality of each technique using skull base reirradiation patient cases.

METHODS

SBRT plans were generated for sixteen skull base reirradiation patients using four modalities: the GK plan for the Elekta Leksell Gamma Knife Perfexion/ICON, the CyberKnife (CK) plan for the Accuray CyberKnife, the intensity-modulated proton therapy (IMPT) plan for the Hitachi ProBeat-FR proton therapy machine, and the volumetric-modulated arc therapy (VMAT) plan for the Varian TrueBeam STx. These plans were evaluated and compared using two novel gradient indices in addition to traditional dosimetry metrics for targets and organs at risk (OARs). The steepest border gradient quantified the percent prescription dose fall-off per millimeter at the boundary between the target and adjacent critical structures. This gradient index highlighted the system's ability to spare nearby critical OARs. The volume gradient assessed the extent of dose spread outside the target toward the patient's body.

RESULTS

All plans achieved comparable target coverage and conformity, while IMPT and VMAT demonstrated significantly better uniformity. The GK plans exhibited the highest border gradient, up to 20.9%/mm, followed by small-spot-size IMPT plans and CK plans. Additionally, IMPT plans showed the benefit of reduced dose spread in low-dose regions and the lowest maximum and mean doses to the brainstem and carotid artery.

CONCLUSIONS

The advanced external beam radiotherapy modalities evaluated in this study are well-suited for SBRT in skull base reirradiation, which demands precise targeting of tumors with highly conformal doses and steep dose gradients to protect nearby normal structures.

Overall Staging Prediction for Non-Small Cell Lung Cancer (NSCLC): A Local Pilot Study with Artificial Neural Network Approach

BACKGROUND

Non-small cell lung cancer (NSCLC) has been the most common cancer globally in the recent decade. CT is the most common imaging modality for the initial diagnosis of NSCLC. The gold standard for definitive diagnosis is the histological evaluation of a biopsy or surgical sample, which usually requires a long processing time for the confirmation of diagnosis. This study aims to develop artificial intelligence models to predict overall staging based on patient demographics and radiomics retrieved from the initial CT images, so as to prioritize later-stage patients for histology evaluation to facilitate cancer diagnosis.

METHOD

Two cohorts of NSCLC patient datasets were utilized for this study. The NSCLC-radiomics dataset from The Cancer Imaging Archive (TCIA) was divided into 70% for the training group and 30% for the internal testing group. Another cohort from a local hospital was collected for the an external testing group. Patient demographics and 107 radiomic features were retrieved from the gross tumor volume delineated by clinical oncologists on CT images. Artificial neural networks were used to build models for NSCLC overall staging (stage I, II, or III) prediction. Four traditional classifiers were also adopted to build models for comparison.

RESULT

The proposed feed-forward neural network (FFNN) model showed good performance in predicting overall staging with an accuracy of 88.84%, 76.67%, and 74.52% in overall accuracies in validation, internal cohort testing, and external cohort testing, respectively. The sensitivity and specificity are balanced in all the stages, with average precision and F1 score in each of the stages.

CONCLUSION

The FFNN demonstrated good performance in overall staging prediction for NSCLC patients. It has the benefit of predicting multiple overall stages in a single model. The software required and the proposed model are simple. It can be operated on a general-purpose computer in the radiology department. The application will eventually be used as a prediction tool to prioritize the biopsy or surgery sample for histological analysis and molecular investigation, thus shortening the time for diagnosis by pathologists, which supports the triage of patients for further testing.

Identifying Biomarkers for Remyelination and Recovery in Multiple Sclerosis: A Measure of Progress

Background: Multiple sclerosis (MS) pathology is characterized by acute and chronic inflammation, demyelination, axonal injury, and neurodegeneration. After decades of research into MS-related degeneration, recent efforts have shifted toward recovery and the prevention of further damage. A key area of focus is the remyelination process, where researchers are studying the effects of pharmacotherapy on myelin repair mechanisms. Multiple compounds are being tested for their potential to foster remyelination in different clinical settings through the application of less or more complex techniques to assess their efficacy. Objective: To review current methods and biomarkers to track myelin regeneration and recovery over time in people with MS (PwMS), with potential implications for promyelinating drug testing. Methods: Narrative review, based on a selection of PubMed articles discussing techniques to measure in vivo myelin repair and functional recovery in PwMS. Results: Non-invasive tools, such as structural Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET), are being implemented to track myelin repair, while other techniques like evoked potentials, functional MRI, and digital markers allow the assessment of functional recovery. These methods, alone or in combination, have been employed to obtain precise biomarkers of remyelination and recovery in various clinical trials on MS. Conclusions: Combining different techniques to identify myelin restoration in MS could yield novel biomarkers, enhancing the accuracy of clinical trial outcomes for remyelinating therapies in PwMS.

Machine learning-assisted diagnosis of parotid tumor by using contrast-enhanced CT imaging features

PURPOSE

This study aims to develop a machine learning diagnostic model for parotid gland tumors based on preoperative contrast-enhanced CT imaging features to assist in clinical decision-making.

MATERIALS AND METHODS

Clinical data and contrast-enhanced CT images of 144 patients with parotid gland tumors from the Peking University School of Stomatology Hospital, collected from January 2019 to December 2022, were gathered. The 3D slicer software was utilized to accurately annotate the tumor regions, followed by exploring the correlation between multiple preoperative contrast-enhanced CT imaging features and the benign or malignant nature of the tumor, as well as the type of benign tumor. A prediction model was constructed using the k-nearest neighbors (KNN) algorithm.

RESULTS

Through feature selection, four key features-morphology, adjacent structure invasion, boundary, and suspicious cervical lymph node metastasis-were identified as crucial in preoperative discrimination between benign and malignant tumors. The KNN prediction model achieved an accuracy rate of 94.44 %. Additionally, six features including arterial phase CT value, age, delayed phase CT value, pre-contrast CT value, venous phase CT value, and gender, were also significant in the classification of benign tumors, with a KNN prediction model accuracy of 95.24 %.

CONCLUSION

The machine learning model based on preoperative contrast-enhanced CT imaging features can effectively discriminate between benign and malignant parotid gland tumors and classify benign tumors, providing valuable reference information for clinicians.

Imaging of the skull base and orbital tumors

The skull base and orbit have complicated anatomical structures where various tumors can occur. The tumor may present with neurological symptoms; however, its diagnosis is clinically difficult owing to accessibility issues. Therefore, diagnostic imaging is crucial in assessing tumors in the skull base and orbit and guiding subsequent management. Notably, some tumors have a predilection for a specific site of origin, and identifying the site of origin on imaging can help narrow the differential diagnosis. At the skull base, chordomas typically occur in the clivus, chondrosarcomas in the paramedian areas, paragangliomas in the jugular foramen, neurogenic tumors, and perineural spread in the neural foramen. Among orbital tumors, cavernous hemangiomas usually occur in the intraconal space, and pleomorphic adenomas and adenoid cystic carcinomas occur in the lacrimal glands. Some skull base and orbital tumors exhibit distinctive imaging features. Chordomas and chondrosarcomas of the skull base show high signal intensities on T2-weighted images, with chondrosarcomas often displaying cartilaginous calcifications. Paragangliomas are characterized by their hypervascular nature. In the orbit, cavernous hemangiomas and pleomorphic adenomas present unique dynamic patterns. Immunoglobulin G4-related disease forms lesions along the nerves. Identifying the tumor origin and its imaging characteristics can help narrow the differential diagnosis of skull base and orbital tumors.

Systemic Air Embolism Leading to Cardiorespiratory Arrest Following a CT-Guided Biopsy: A Case Report

CT-guided transthoracic lung biopsy is a commonly performed procedure for diagnosing pulmonary lesions. While generally safe, it has known risks. Pneumothorax, pulmonary hemorrhage, and hemoptysis are among the most frequent complications. Although rare, serious complications such as air embolism can occur, and while uncommon, it is a potentially life-threatening condition that may result from this procedure. It can lead to acute ischemic stroke or acute myocardial infarction, which can be fatal. Here, we describe a case of a 72-year-old man with a right lower lobe pulmonary nodule who had a cardiorespiratory arrest due to air embolism due to a CT-guided biopsy of the pulmonary nodule found on a previous CT scan of the chest. The patient was successfully resuscitated and intubated for mechanical ventilation and admitted to an intensive care unit. He was later transferred to the pulmonology unit and discharged home in stable condition.

The Value of Low-dose Multi-slice Computed Tomography protocol of the Chest at Mzuzu Central Hospital, Malawi

Objective

To evaluate low-dose Computed Tomography (LDCT) chest vs. routine CT chest for image quality and diagnosis in suspected lung lesions, aiming to optimize LDCT protocol.

Methods

We retrospectively analyzed 85 patients with suspected lung lesions who underwent non-contrast enhanced (NCE) CT chest at Mzuzu Central Hospital from July 2023 to April 2024. The study divided patients into routine dose (43 patients, 120 kV, 300 mAs) and low-dose groups (42 patients, 120 kV with automatic tube current modulation) based on a transition point on February 16th, 2024. Both groups used filtered back projection (FBP) reconstruction with a 1mm layer thickness. Data were analyzed for signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and radiation dose parameters on AVW post-processing workstation, and for background noise and image quality on PACS.

Results

(1) Objective evaluation revealed significantly higher SNR and CNR (6.58 ± 1.70, 175.96 ± 26.06) in the routine dose group compared to the low-dose group (4.17 ± 1.02, 141.23 ± 19.04) (P < 0.001). Additionally, the routine dose group had significantly higher CTDIvol, DLP, and ED [(9.95 ± 0) mGy, (372.84 ± 25.52) mGy·cm, (5.22 ± 0.37) mSv] compared to the low-dose group [(5.76 ± 1.12) mGy, (211.48 ± 50.64) mGy·cm, (2.96 ± 0.71) mSv] (P < 0.001). (2) Subjective evaluation showed no significant difference in scoring for background noise and overall image quality between the routine dose group [(1.95 ± 0.21) points, (4.09 ± 0.42) points] and the low-dose group [(1.93 ± 0.26) points, (3.98 ± 0.34) points] (P > 0.05).

Conclusion

The image quality of LDCT protocol is comparable to that of routine dose, while radiation dose is significantly reduced. The image quality meets the requirements for imaging diagnosis of lung lesions, and this protocol can be widely promoted in clinical practice.

Critical analysis of anatomy and classification of retromolar canal: an observational CBCT study

BACKGROUND

The retromolar canal (RMC) is an anatomical structure of the mandibular bone located distal to the last molar. The frequency of anatomical variation in human anatomy is approximately 30-35%. This study aimed to evaluate the prevalence of the retromolar canal in a population subjected to cone beam computed tomography (CBCT).

METHODS

The radiographic images belonged to 200 patients (100 males and 100 females; older than 13 years old) were examined following a strict protocol. Four hundred hemi-mandibles of 100 male and 100 female patients were examined between 2019 and 2022.

RESULTS

The collected data showed 136 patients presented the RMC, bilateral in 72 cases (68%) and unilateral in the other 64 cases (32%). Gender variation did not yield statistically significant differences, with 76 male (56%) and 60 female (44%) patients affected (P>0.05). A statistically significant difference was observed for side predilection, with unilateral RMC more prevalent on the right side in 24 cases (37.5%) and on the left side in 40 cases (62.5%) (P<0.05).

CONCLUSIONS

Based on the results obtained and other anatomical considerations, this study proposes a new classification for RMC.

Guidelines for Performing Ultrasound-Guided Vascular Cannulation: Recommendations of the American Society of Echocardiography

Vascular access is a commonly performed procedure to facilitate patient care. This document provides expert consensus from diverse specialists on best practices and techniques for incorporating ultrasound (US) into vascular access procedures. This update replaces the 2011 American Society of Echocardiography guidelines for US-guided vascular cannulation. It includes recommendations for US-guided access to central and peripheral veins and arteries in adult and pediatric patients based on the strength of the scientific evidence present in the literature. The major roles of US during vascular access include (1) precannulation vessel assessment, (2) dynamic US guidance during cannulation, and (3) identification of local complications. This document discusses the general aspects of anatomic and US imaging of vessels, US-guided vascular cannulation techniques, and the identification of local vascular cannulation complications. Proper training should impart the cognitive knowledge and technical skills necessary to perform US-guided cannulation. There is an increasing body of literature indicating that US-guided vascular access improves success rates and reduces complications, although the quality of the evidence to date remains weak. A gap remains between the existing evidence and guidelines for the use of US in clinical practice. The availability of US equipment and clinical proficiency will more likely influence the role of US-guided vascular access as a standard of care than will future research studies.

Functional implications of age-related atrophy of the corpus callosum

The corpus callosum plays a critical role in inter-hemispheric communication by coordinating the transfer of sensory, motor, cognitive, and emotional information between the two hemispheres. However, as part of the normal aging process, the corpus callosum undergoes significant structural changes, including reductions in both its size and microstructural integrity. These age-related alterations can profoundly impact the brain's ability to coordinate functions across hemispheres, leading to a decline in various aspects of sensory processing, motor coordination, cognitive functioning, and emotional regulation. This review aims to synthesize current research on age-related changes in the corpus callosum, examining the regional differences in atrophy, its underlying causes, and its functional implications. By exploring these aspects, we seek to emphasize the clinical significance of corpus callosum degeneration and its impact on the quality of life in older adults, as well as the potential for early detection and targeted interventions to preserve brain health during aging. Finally, the review calls for further research into the mechanisms underlying corpus callosum atrophy and its broader implications for aging.

Innovations in intraoperative therapies in neurosurgical oncology: a narrative review

PURPOSE

High-grade gliomas (HGG) represent the most aggressive primary brain tumors in adults, characterized by high recurrence rates due to incomplete resection. This review explores the effectiveness of emerging intraoperative therapies that may extend survival by targeting residual tumor cells. The main research question addressed is: What recent intraoperative techniques show promise for complementing surgical resection in HGG treatment?

METHODS

A comprehensive literature review was conducted, examining recent studies on intraoperative therapeutic modalities that support surgical resection of HGG. Techniques reviewed include laser interstitial thermal therapy (LITT), intraoperative brachytherapy, photodynamic therapy (PDT), sonodynamic therapy (SDT), and focused ultrasound (FUS). Each modality was evaluated based on clinical application, evidence of effectiveness, and potential for integration into standard HGG treatment protocols.

RESULTS

Findings indicate that these therapies offer distinct mechanisms to target residual tumor cells: LITT provides localized thermal ablation; intraoperative brachytherapy delivers sustained radiation; PDT and SDT activate cytotoxic agents in tumor cells; and FUS enables precise energy delivery. Each method has shown varying levels of clinical success, with PDT and LITT currently more widely implemented, while SDT and FUS are promising but under investigation.

CONCLUSION

Intraoperative therapies hold potential to improve surgical outcomes for HGG by reducing residual tumor burden. While further clinical studies are needed to optimize these techniques, early evidence supports their potential to enhance the effectiveness of surgical resection and improve patient survival in HGG management.

Predictive Evaluation of Septal Cartilage-bone Complex for Rhinoplasty Using Cone Beam Computed Tomography

Background

Septal extension grafting (SEG) is commonly used for correcting Asian short noses. When septal cartilage is limited, septal bone can be included. This study evaluates the outcomes of SEG using a septal cartilage-septal bone complex (SCBC) and assesses preoperative cone beam computed tomography (CBCT) for predicting septal bone suitability.

Methods

A retrospective review was conducted of Korean women planned for SEG with SCBC from July 2021 to June 2022. Preoperative CBCT scans measured Hounsfield Unit (HU) values for septal cartilage, perpendicular plate of the ethmoid (PPE), and vomer. Of 27 patients, 19 underwent SEG with SCBC, whereas 8 did not due to unsuitable septal bone. Clinical outcomes and satisfaction were assessed through surveys and photographs.

Results

For the 19 patients using SCBC, the average HU for PPE was 286.5 ± 126.6 (ratio 6.8 ± 2.1), and for vomer, HU was 230.3 ± 95.2 (ratio 5.7 ± 1.8). SEG significantly improved nasal length and tip projection, although tip softness was less favorable. Among the 8 patients not using SCBC, 5 had bones that were too thick and stiff (PPE: 667.8 ± 102.2, ratio 15.5 ± 2.7; vomer: 342.8 ± 55.1, ratio 8.1 ± 2.3), and 3 had fragile bones (PPE: 148.7 ± 45.4, ratio 3.1 ± 0.7; vomer: 199.0 ± 68.6, ratio 4.1 ± 0.9).

Conclusions

SEG using SCBC effectively corrects short noses in Asian patients. Preoperative HU ratios from CBCT can help predict septal bone quality and guide surgical planning. Further research with larger cohorts is needed to confirm these findings.

Diagnostic accuracy of radiomics and artificial intelligence models in diagnosing lymph node metastasis in head and neck cancers: a systematic review and meta-analysis

INTRODUCTION

Head and neck cancers are the seventh most common globally, with lymph node metastasis (LNM) being a critical prognostic factor, significantly reducing survival rates. Traditional imaging methods have limitations in accurately diagnosing LNM. This meta-analysis aims to estimate the diagnostic accuracy of Artificial Intelligence (AI) models in detecting LNM in head and neck cancers.

METHODS

A systematic search was performed on four databases, looking for studies reporting the diagnostic accuracy of AI models in detecting LNM in head and neck cancers. Methodological quality was assessed using the METRICS tool and meta-analysis was performed using bivariate model in R environment.

RESULTS

23 articles met the inclusion criteria. Due to the absence of external validation in most studies, all analyses were confined to internal validation sets. The meta-analysis revealed a pooled AUC of 91% for CT-based radiomics, 84% for MRI-based radiomics, and 92% for PET/CT-based radiomics. Sensitivity and specificity were highest for PET/CT-based models. The pooled AUC was 92% for deep learning models and 91% for hand-crafted radiomics models. Models based on lymph node features had a pooled AUC of 92%, while those based on primary tumor features had an AUC of 89%. No significant differences were found between deep learning and hand-crafted radiomics models or between lymph node and primary tumor feature-based models.

CONCLUSION

Radiomics and deep learning models exhibit promising accuracy in diagnosing LNM in head and neck cancers, particularly with PET/CT. Future research should prioritize multicenter studies with external validation to confirm these results and enhance clinical applicability.

Distinguishing spheno-orbital metastatic prostate cancer mimicking a meningioma using novel 18F-PSMA PET/CT imaging

A 78-year-old man presented with acute-onset left temporal pain, eyelid swelling, and double vision. Computed tomography (CT) demonstrated a left sphenoid wing mass with extra-osseous intra-orbital and intracranial extension, thought to be a typical sphenoid wing meningioma by the primary team. The patient was admitted for an urgent craniotomy, which was planned for the following day. However, upon consultation with ophthalmic plastic surgery, concern was raised for an alternative diagnosis given the atypical timeline, inflammatory changes, and uncharacteristic imaging findings of mixed lytic and sclerotic bony changes without hyperostosis on CT and extensive peri-lesional dural thickening and enhancement on magnetic resonance imaging. A serum prostate-specific antigen was elevated to 206 ng/mL. Subsequent positron emission tomography (PET)/CT using 18F-fluorodeoxyglucose radiotracer was negative for metastatic disease. A prostate-specific membrane antigen (PSMA) PET/CT was then obtained and demonstrated extensive metastases. An orbital biopsy revealed poorly differentiated prostatic adenocarcinoma. The significant incongruence between the standard PET/CT and PSMA PET/CT highlights the value of this novel advanced radiographic modality in narrowing the differential diagnosis and determining the extent of disease. Findings of widespread metastasis on the PSMA PET/CT ultimately helped to avoid a large, morbid neurosurgical intervention in this patient, allowing for a minimally invasive orbital biopsy to characterize the tumor for therapeutic targeting.

Personalized medicine in colorectal cancer: a comprehensive study of precision diagnosis and treatment

Colorectal cancer is a common and fatal disease that affects many people globally. CRC is classified as the third most prevalent cancer among males and the second most frequent cancer among females worldwide. The purpose of this article is to examine how personalized medicine might be used to treat colorectal cancer. The classification of colorectal cancer based on molecular profiling, including the detection of significant gene mutations, genomic instability, and gene dysregulation, is the main topic of this discussion. Advanced technologies and biomarkers are among the detection methods that are explored, demonstrating their potential for early diagnosis and precise prognosis. In addition, the essay explores the world of treatment possibilities by providing light on FDA-approved personalized medicine solutions that provide individualized and precise interventions based on patient characteristics. This article assesses targeted treatments like cetuximab and nivolumab, looks at the therapeutic usefulness of biomarkers like microsatellite instability (MSI) and circulating tumor DNA (ctDNA), and investigates new approaches to combat resistance. Through this, our review provides a thorough overview of personalized medicine in the context of colorectal cancer, ultimately highlighting its potential to revolutionize the field and improve patient care.