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Background:  The aim of the study is to identify the potential risk factors for postoperative AKI in hip fracture patients., Design and Methods:  Using our local neck of femur (NOF) registration data, patient details were selected using inclusion and exclusion criteria. Electronic records of patients were assessed retrospectively, including blood results, radiological investigations, clinical documentation, and drug charts. The time period was from the start of January 2022 to the end of June 2022., Inclusion Criteria: All patients > 50 years old with NOF fractures underwent operative management from January 2022 to June 2022., Exclusion Criteria: 1. Pathological fractures. 2. Non-operative management. 3. Died directly postoperative., Results: Two hundred and fifty patients underwent hip fracture surgery at our hospital in 6 months (January 2022-June 2022) (Cemented procedures were 133 [53%], while fixation procedures were 117 [47%]). Female patients were 174 (70%), and male patients were 76. The average age was 83.4 years, and the number of operations done over the weekend (Friday-Sunday) = 123 (49%). The incidence of postoperative AKI was 56 (22.4%). Forty-five of the fifty-six cases were stage one (80.4%), while seven cases (12.5%) were stage 2. The studied risk factors for postoperative AKI were cemented procedures (61% of postoperative AKI incidence), female gender (66%), time from admission to operation (>24 hours = 33%), day of operation (operations done Friday/Saturday/Sunday = 55%), and postoperative antibiotics (71%)., Conclusion:  We need strategies to reduce the incidence of postoperative AKI, like AKI alert on laboratory results, IV fluid prescription preoperatively since the arrival of patients to the ED, avoiding/stopping nephrotoxic medications on admission, regular review of postoperative renal function tests and fluid balance, especially in high-risk patients, increase nursing staff and junior doctors on wards over weekends, and we need to review our policy of giving postoperative IV antibiotics., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. University hospital sussex nhs foundation trust issued approval 1876. This is a retrospective audit or quality improvement project and it was approved by the audit department of the mentioned institution and the assignment number is attached. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Metry et al.)

Introduction: Open reduction and fixation are the standard of care for treating mandibular fractures and usually lead to successful healing. However, complications such as delayed healing, non-union, and infection can compromise patient outcomes and increase healthcare costs. The initial inflammatory response, particularly the response involving specific CD8 + T cell subpopulations, is thought to play a critical role in healing long bone fractures. In this study, we investigated the role of these immune cell profiles in patients with impaired healing of mandibular fractures., Materials and Methods: In this prospective study, we included patients with mandibular fractures surgically treated at Charité - Universitätsmedizin Berlin, Germany, between September 2020 and December 2022. We used follow-up imaging and clinical assessment to evaluate bone healing. In addition, we analyzed immune cell profiles using flow cytometry and quantified cytokine levels using electrochemiluminescence-based multiplex immunoassays in preoperative blood samples., Results: Out of the 55 patients enrolled, 38 met the inclusion criteria (30 men and 8 women; mean age 32.18 years). Radiographic evaluation revealed 31 cases of normal healing and 7 cases of incomplete consolidation, including 1 case of non-union. Patients with impaired healing exhibited increased levels of terminally differentiated effector memory CD8 + T cells (T EMRA ) and a higher T EMRA to regulatory T cell (T reg ) ratio, compared with those with normal healing., Conclusions: Our analysis of mandibular fracture cases confirms our initial hypothesis derived from long bone fracture healing: monitoring the T EMRA to T reg ratio in preoperative blood can be an early indicator of patients at risk of impaired bone healing. Radiologic follow-up enabled us to detect healing complications that might not be detected by clinical assessment only. This study highlights the potential of individual immune profiles to predict successful healing and may form the basis for future strategies to manage healing complications., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Voss, Pivetta, Elkilany, Schmidt-Bleek, Duda, Odaka, Dimitriou, Ort, Streitz, Heiland, Koerdt, Reinke and Geissler.)

Background: Bennett's fracture, a fracture-dislocation of the base of the first metacarpal, poses significant challenges due to the unique biomechanics of the thumb's carpometacarpal (CMC) joint. Effective management is critical to restoring thumb function and preventing long-term complications such as arthritis and instability., Objective: This article provides a comprehensive overview of Bennett's fracture, including its mechanism of injury, diagnostic considerations, and management strategies, with a focus on conservative and surgical options., Methods: A detailed review of the current literature was conducted to outline the principles and techniques of closed reduction with percutaneous pinning (CRPP), open reduction and internal fixation (ORIF), and emerging methods such as arthroscopic-assisted fixation., Results: Conservative management is appropriate for minimally displaced fractures but is often inadequate for displaced injuries due to persistent muscle forces acting on the metacarpal. CRPP offers a minimally invasive option for fractures with moderate displacement, while ORIF provides superior stability for complex fractures. Emerging techniques, including arthroscopy and bioabsorbable implants, show promise in minimizing complications and improving outcomes., Conclusion: The management of Bennett's fractures requires a tailored approach based on fracture displacement, patient needs, and surgeon expertise. Timely diagnosis, appropriate treatment selection, and structured rehabilitation are essential for optimal recovery. Advances in imaging, surgical methods, and materials hold the potential to further refine treatment strategies and improve long-term outcomes.

Purpose: To quantitatively and qualitatively evaluate and compare the performance of leading large language models (LLMs), including proprietary models (GPT-4, GPT-3.5 Turbo, Claude-3-Opus, and Gemini Ultra) and open-source models (Mistral-7b and Mistral-8×7b), in simplifying 109 interventional radiology reports., Methods: Qualitative performance was assessed using a five-point Likert scale for accuracy, completeness, clarity, clinical relevance, naturalness, and error rates, including trust-breaking and post-therapy misconduct errors. Quantitative readability was assessed using Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), SMOG Index, and Dale-Chall Readability Score (DCRS). Paired t-tests and Bonferroni-corrected p-values were used for statistical analysis., Results: Qualitative evaluation showed no significant differences between GPT-4 and Claude-3-Opus for any metrics evaluated (all Bonferroni-corrected p-values: p = 1), while they outperformed other assessed models across five qualitative metrics (p < 0.001). GPT-4 had the fewest content and trust-breaking errors, with Claude-3-Opus second. However, all models exhibited some level of trust-breaking and post-therapy misconduct errors, with GPT-4-Turbo and GPT-3.5-Turbo with few-shot prompting showing the lowest error rates, and Mistral-7B and Mistral-8×7B showing the highest. Quantitatively, GPT-4 surpassed Claude-3-Opus in all readability metrics (all p < 0.001), with a median FRE score of 69.01 (IQR: 64.88-73.14) versus 59.74 (IQR: 55.47-64.01) for Claude-3-Opus. GPT-4 also outperformed GPT-3.5-Turbo and Gemini Ultra (both p < 0.001). Inter-rater reliability was strong (κ = 0.77-0.84)., Conclusions: GPT-4 and Claude-3-Opus demonstrated superior performance in generating simplified IR reports, but the presence of errors across all models, including trust-breaking errors, highlights the need for further refinement and validation before clinical implementation., Clinical Relevance/applications: With the increasing complexity of interventional radiology (IR) procedures and the growing availability of electronic health records, simplifying IR reports is critical to improving patient understanding and clinical decision-making. This study provides insights into the performance of various LLMs in rewriting IR reports, which can help in selecting the most suitable model for clinical patient-centered applications., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Objectives: Critically ill patients with severe pancreatitis exhibit substantial muscle wasting, which limits in-hospital and post-hospital outcomes. Survivors of critical illness undergo extensive recovery processes. Previous studies have explored pancreatic function, quality of life, and costs post-hospitalization for AP patients, but none have comprehensively quantified muscle loss and recovery post-discharge. By applying an AI-based automated segmentation tool, we aimed to quantify muscle mass recovery in ICU patients after discharge., Materials: Muscle segmentation was performed on 22 patients, with a minimum of three measurements taken during hospitalization and one clinically indicated examination after hospital discharge. Changes in psoas muscle area (PMA) between admission, discharge and follow up were calculated. T-Test was performed to identify significant differences between patients able and not able to recover their muscle mass., Results: Monitoring PMA shows muscle loss during and gain after hospitalization: The mean PMA at the first scan before or at ICU admission (TP1) was 17.08 cm², at the last scan before discharge (TP2), mean PMA was 9.61 cm². The percentage change in PMA between TP1 and TP2 ranged from - 85.42% to -2.89%, with a mean change of -40.18%. The maximum muscle decay observed during the stay was - 50.61%. After a mean follow-up period of 438.73 days most patients (81%) were able to increase their muscle mass. Compared to muscle status at TP1, only 27% of patients exhibited full recovery, with the majority still presenting a deficit of 31.96%., Conclusion: Muscle recovery in ICU patients suffering from severe AP is highly variable, with only about one third of patients recovering to their initial physical status. Opportunistic screening of post-ICU patient recovery using clinically indicated imaging and AI-based segmentation tools enables precise quantification of patients' muscle status and can be employed to identify individuals who fail to recover and would benefit from secondary rehabilitation. Understanding the dynamics of muscle atrophy may improve prognosis and support personalized patient care., (© 2024. The Author(s).)

Tantalum, known for its superior mechanical properties and biocompatibility, has revolutionized the field of acetabular reconstruction, especially in revision total hip arthroplasty (rTHA). This review explores the clinical indications, biomechanical and biological properties, benefits, risks, and outcomes associated with tantalum acetabular components, particularly in managing complex cases of acetabular deficiencies. Extensive research has highlighted tantalum's ability to promote osseointegration, provide high survivorship rates, and maintain mechanical stability even in the most challenging cases, such as pelvic discontinuity and severe bone loss. However, challenges remain, including high costs and the need for long-term studies in primary total hip arthroplasty (THA). This article aims to provide a comprehensive overview of tantalum's current role in THA, discussing the potential for broader applications in primary surgeries and the implications of its high cost on healthcare systems.

Ankle fractures are common injuries treated in accident and emergency (A&E) departments, often requiring prompt reduction to restore joint alignment. Traditional pain management methods, including intravenous sedation and general anaesthesia, carry risks of systemic complications. The ankle block, a form of regional anaesthesia, is increasingly used for ankle fracture reduction due to its ability to provide localized pain relief while minimizing systemic side effects. This article reviews the techniques, recent trends, advantages, and disadvantages of ankle blocks in A&E settings. Ultrasound guidance has enhanced the precision and success of the procedure, leading to improved outcomes. Despite challenges, such as the need for specialized training and occasional incomplete analgesia, the ankle block is emerging as a preferred opioid-sparing alternative. Continued advancements in regional anaesthesia and training programs are expected to broaden its use in emergency care. Further research may focus on optimizing techniques to ensure consistent results.

Intraoperative blood loss management is a critical concern in orthopaedic surgeries, particularly in trauma and complex elective procedures. Traditionally, allogeneic blood transfusions have been used to manage significant blood loss, but they carry risks such as transfusion reactions, infections, and increased healthcare costs. Cell salvage, or autotransfusion, offers a safer alternative by collecting, processing, and reinfusing the patient's own blood during surgery. This article explores recent trends in the use of cell salvage in orthopaedic trauma and elective surgeries, highlighting its growing adoption in high-blood-loss procedures such as pelvic fractures, long bone injuries, and revision arthroplasties. We discuss the indications, including use in patients with rare blood types, religious objections to donor blood, and pre-existing anaemia. The advantages of cell salvage, such as reducing dependency on allogeneic transfusions, minimizing transfusion reactions, and providing cost-effectiveness, are weighed against its limitations, including high initial costs, contraindications in certain procedures, and the need for specialized training. Recent advances in cell salvage technology, which enhance the safety and efficiency of the process, are also examined. As orthopaedic practices evolve toward more patient-centered, cost-effective care, the role of cell salvage is expected to grow, making it a valuable tool in modern blood management strategies.

Metal artifacts notoriously pose significant challenge in computed tomography (CT), leading to inaccuracies in image formation and interpretation. Artifact reduction tools have been designed to improve cone beam computed tomography (CBCT) image quality by reducing artifacts caused by certain high-density materials. Metal artifact reduction (MAR) tools are specific algorithms that are applied during image reconstruction to minimize or eliminate artifacts degrading CBCT images. The purpose of the study is to evaluate the effect of a MAR algorithm on image quality in CBCT performed for evaluating patients before transarterial radioembolization (TARE). We retrospectively included 40 consecutive patients (aged 65 ± 13 years; 23 males) who underwent 45 CBCT examinations (Allura FD 20, XperCT Roll protocol, Philips Healthcare, Best, The Netherlands) in the setting of evaluation for TARE between January 2017 and December 2018. Artifacts caused by coils, catheters, and surgical clips were scored subjectively by four readers on a 5-point scale (1 = artifacts affecting diagnostic information to 5 = no artifacts) using a side-by-side display of uncorrected and MAR-corrected images. In addition, readers scored tumor visibility and vessel discrimination. MAR-corrected images were assigned higher scores, indicating better image quality. The differences between the measurements with and without MAR were most impressive for coils with a mean improvement of 1.6 points (95%CI [1.5 1.8]) on the 5-point likert scale, followed by catheters 1.4 points (95%CI [1.3 1.5]) and clips 0.7 points (95%CI [0.3 1.1]). Improvements for other artifact sources were consistent but relatively small (below 0.25 points on average). Interrater agreement was good to perfect (Kendall's W coefficient = 0.68-0.95) and was higher for MAR-corrected images, indicating that MAR improves diagnostic accuracy. A metal artifact reduction algorithm can improve diagnostic and interventional accuracy of cone beam CT in patients undergoing radioembolization by reducing artifacts caused by diagnostic catheters and coils, lowering interference of metal artifacts with adjacent major structures, and improving tumor visibility., (© 2024. The Author(s).)

The use of tourniquet is common in orthopaedic surgeries as it reduces blood loss, enhances visualization of the operating field, and leads to quicker procedures. However, the use of tourniquet has certain risks which can be avoided by following guidelines like British Orthopaedic Association Standards for Trauma (BOAST) guidelines for safe use of tourniquet. This audit study was done in a District general hospital to check the compliance of two trauma theatres with BOAST guidelines. The audit found that there was poor documentation of tourniquet details in the operation notes (10%). Regarding tourniquet time and pressure, the compliance in the two theatres was 95 % & 97.5 %. The recommendations of this audit were to use a template to improve documentation of tourniquet details in the operation notes and training of theatre staff on BOAST guidelines for safe use of tourniquet.

The restoration of the joint line is important for a good functional outcome after a Total Knee Arthroplasty(TKA). Knee joint biomechanics need to be restored as near normal as possible. Joint line elevation leads to anterior knee pain, decrease in range of motion, patella baja ,mid-flexion instability and impingement of patellar tendon. Joint line depression on the other hand leads to patella alta, risk of patellar subluxation and mid-flexion instability of the knee. Various studies have demonstrated various range of acceptable joint line variation but there is no clear acceptable range of joint line variation. More studies are required for establishing the acceptable range of joint line variation and standard practices should be established for arthroplasty surgeons for preventing variation of joint line.

Fractures of the metacarpal particularly the 5th metacarpal is quite common among all hand fractures and has a high incidence in male adult population. Proper management of these fractures plays a key role in rehabilitation and early return to work thus reducing the economic burden. Treatment of these injuries depends on the type of injury: whether it is a closed/open fracture, degree of angulation at the fracture site and also mal-rotation and shortening of the finger. Non-operative management is suitable for fractures which are closed, non-displaced and without angulation or rotation. Open fractures, fractures with angulation and/or mal-rotation and fractures with neuro-vascular injury are more suitable for operative management. The acceptable angulation for conservative management for most studies is 70 degrees. Buddy strapping with a Futura splint provides good functional results. In fractures requiring operative intervention, K-wire fixation is a minimally invasive method of fixation, which in most cases has good functional results. Plate and screw fixation, however, is preferred for cases with significant comminution or multiple metacarpal fractures.

Traditionally, it was believed that both proximal and distal locking are essential for achieving stability during intra-medullary fixation for extra-capsular hip fractures. However, recent literature has presented varying perspectives on the necessity of distal locking. Distal locking plays a significant role in managing hip fractures with uncertainties regarding longitudinal and rotational stability. This includes cases of comminuted intertrochanteric fractures with subtrochanteric extension, reverse oblique and high oblique fractures, broad medullary canals, comminution of the lateral wall, diaphyseal fractures, and large posteromedial fragments extending below the level of the lesser trochanter. In stable pertrochanteric fractures, with the lag screw passing through the lateral cortex of the distal fragment, may not require a distal locking screw. Distal locking has been associated with potential complications, including irritation of the fascia lata, prolonged operation time, increased radiation exposure, greater blood loss, implant loosening, secondary femoral stress fractures, and damage to the femoral artery. Thus, although distal locking is of doubtful significance in stable pertrochanteric fractures it is essential in unstable fracture patterns.

Introduction: The Boyd approach allows excellent access to the elbow and is used to treat complex elbow injuries using a single incision approach., Materials and Methods: In this study, we retrospectively evaluated 16 patients with complex elbow injuries treated with open reduction and internal fixation using the Boyd approach between 2016 and 2018., Results: All fractures were well united in anatomical position. Postoperatively, the range of motion was not significantly different between the affected and unaffected elbows. The mean Mayo Elbow Performance Index score was 95 ± 5 (range 90 to 100). All study participants had satisfactory results and recovered to full activity. There was no incidence of posttraumatic arthritis of the elbow joint or synostosis of the radius and ulna., Conclusion: Thus, according to our study, the Boyd elbow approach is a safe and effective method of treating elbow injuries., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Sain et al.)

Fluoroscopy is an indispensable tool that forms a significant part of the standard practice in many trauma and orthopaedic (T&O) procedures, as it facilitates dynamic assessment and aids intraoperative visualization and decision-making. It exposes patients and theatre staff to the potential hazards of ionizing radiation. Thus, the awareness of these hazards and proper use of personal protective equipment (PPE) will help mitigate increased exposure. This audit aimed to assess awareness regarding the safe use of fluoroscopy in T&O theatres, evaluate the level of PPE use and the knowledge of relevant guidelines, such as the British Orthopaedic Association (BOA) recommendations and local trust policy.A prospective audit was performed between June and July 2023 using an online survey sent to healthcare professionals working in T&O theatres across two hospital sites. Data were collected using an online questionnaire and responses kept anonymous and thus implied consent was applied. Standards followed the local trust policy at the University Hospitals Sussex NHS Trust and the BOA guidelines.Of the 49 respondents, 59% were fully aware of radiation hazards, and only the theatre radiographers were all fully aware. Surgeons (56%) and anaesthetists (46%) considered themselves to have adequate knowledge of these hazards. Just over half of the respondents (69%) could identify the major source of radiation, while only 37% understood the effect of distance on dose exposure. Of those surveyed, 49% knew the local trust policy, while 39.6% knew the BOA guidelines; less than half had formal training (40.8%). The results showed that less than half of the participants used the full PPE highlighted in the guidelines. Statistical analysis showed that only 46% of participants used a protective lead apron/lead skirt with a coat and thyroid shield. Of the survey participants, 84% never used eye protection during fluoroscopy procedures, and 58% had never received any formal training on radiation safety.The findings from this audit highlight the lack of awareness of the guidelines, resulting in suboptimal use of PPE in procedures with fluoroscopy. Recommendations for improvement include mandatory training for all theatre personnel. Methods of increasing awareness include using posters, performing regular audits to monitor the usage of PPE, and discussing the results in clinical governance meetings.

Orthopaedic surgeries pose various risks to the health of orthopaedic surgeons: radiation, noise, infection, chemical exposure, and musculoskeletal injury. These are associated with short and long-term health problems including malignancy and teratogenicity. Orthopaedic surgeons' health is critical to ensure optimal patient care. Most of these hazards can be obviated or minimized by adopting rigorous prevention protocols and raising awareness. Further related research is warranted and guidelines regarding prevention need to be framed by regulatory bodies.

Objectives: Lymph node metastases (LNM) are frequent in patients with intrahepatic cholangiocarcinoma (iCC) and worsen their prognosis even after surgery. Our aim was to investigate the predictive value of lymph node (LN) short axis, the most common discriminator for identifying LNM in tumor-imaging and to develop a predictive model for regional LNM in iCC taking computed tomography (CT) features of extranodal disease into account., Materials and Methods: We enrolled 102 patients with pathologically proven iCC who underwent CT prior to hepatic resection and hilar lymph node dissection (LND) from 2005 to 2021. Two blinded radiologists assessed various imaging characteristics and LN diameters, which were analyzed by bivariate and multivariate logistic regression to develop a prediction model for LNM., Results: Prevalence of LNM was high (42.4 %) and estimated survival was shorter in LN-positive patients (p = 0.07). An LN short axis diameter of ≥ 9 mm demonstrated the highest predictive power for LNM. Three additional, statistically significant imaging features, presence of intrahepatic metastasis (p = 0.003), hilar tumor infiltration (p = 0.003), and tumor growth along the liver capsule (p = 0.004), were integrated into a prediction model, which substantially outperformed use of LN axis alone in ROC analysis (AUC 0.856 vs 0.701)., Conclusions: LN diameter alone proved to be a relevant but unreliable imaging-marker for LNM prediction in iCC. Our proposed prognostic model, which additionally considers intrahepatic metastases and hilar and capsular infiltration, significantly improves discriminatory power. Hilar and capsular involvement might indicate direct tumor extension to lymphatic liver structures., (© 2023. The Author(s).)

Lisfranc injury refers to a group of bony or ligamentous injuries in which one or more of the metatarsals are displaced with respect to the tarsus. These injuries can occur as a result of either high-energy trauma like motor vehicle accidents and falls from height, or low-energy trauma from sports activities. A significant proportion of Lisfranc injuries are missed initially. The effects of delayed and missed diagnosed cases can be devastating as patients may develop progressive midfoot instability, collapse of arch, abduction of forefoot, and post-traumatic osteoarthritis, which can cause chronic pain, stiffness, and foot and ankle complex dysfunction. Favourable outcomes are associated with early diagnosis and prompt treatment. Open reduction and internal fixation (ORIF) with arthrodesis has better results than ORIF alone in functional outcomes. Dorsal bridge plates are currently the preferred mode of fixation due to advantages over trans-articular screws., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Sain et al.)

Serious complications after pancreaticoduodenectomy include rupture of pseudoaneurysms arising from pancreatic fistula and pancreatojejunostomy leakage. We report a case of successful endovascular minimally invasive treatment using a covered stent endoprosthesis of a right hepatic artery stump bleeding following pylorus-preserving pancreaticoduodenectomy that was not suitable for coil or glue embolization due to an insufficiently short neck., (© 2023 The Authors.)

The routine use of dynamic-contrast-enhanced MRI (DCE-MRI) of the liver using hepatocyte-specific contrast agent (HSCA) as the standard of care for the study of focal liver lesions is not widely accepted and opponents invoke the risk of a loss in near 100% specificity of extracellular contrast agents (ECA) and the need for prospective head-to-head comparative studies evaluating the diagnostic performance of both contrast agents. The Purpose of this prospective intraindividual study was to conduct a quantitative and qualitative head-to-head comparison of DCE-MRI using HSCA and ECA in patients with liver cirrhosis and HCC. Twenty-three patients with liver cirrhosis and proven HCC underwent two 3 T-MR examinations, one with ECA (gadoteric acid) and the other with HSCA (gadoxetic acid). Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), wash-in, wash-out, image quality, artifacts, lesion conspicuity, and major imaging features of LI-RADS v2018 were evaluated. Wash-in and wash-out were significantly stronger with ECA compared to HSCA (P < 0.001 and 0.006, respectively). During the late arterial phase (LAP), CNR was significantly lower with ECA (P = 0.005), while SNR did not differ significantly (P = 0.39). In qualitative analysis, ECA produced a better overall image quality during the portal venous phase (PVP) and delayed phase (DP) compared to HSCA (P = 0.041 and 0.008), showed less artifacts in the LAP and PVP (P = 0.003 and 0.034) and a higher lesion conspicuity in the LAP and PVP (P = 0.004 and 0.037). There was no significant difference in overall image quality during the LAP (P = 1), in artifacts and lesion conspicuity during the DP (P = 0.078 and 0.073) or in the frequency of the three major LI-RADS v2018 imaging features. In conclusion, ECA provides superior contrast of HCC-especially hypervascular HCC lesions-in DCE-MR in terms of better perceptibility of early enhancement and a stronger washout., (© 2022. The Author(s).)

For management of Budd-Chiari syndrome (BCS), a step-wise therapeutic approach starting with medical treatment, followed by endovascular recanalization, transjugular intrahepatic portosystemic shunt, and finally liver transplantation has been adopted. We retrospectively analyzed 51 patients with symptomatic short segment (≤ 30 mm) hepatic vein (HV)-type BCS who underwent percutaneous transluminal balloon angioplasty (PTBA) with/without stenting to determine the feasibility, clinical effectiveness, and long-term outcomes. The intervention was technically successful in 94.1% of cases (48/51)-32 patients underwent PTBA and 16 patients underwent HV stenting. Procedure-related complications occurred in 14 patients (29.1%). The clinical success rate at 4 weeks was 91.7% (44/48). Nine patients underwent reintervention, six patients due to restenosis/occlusion and three patients with clinical failure. The mean primary patency duration was 64.6 ± 19.9 months (CI, 58.5-70.8; range, 1.2-81.7 months). The cumulative 1-, 2-, and 5-year primary patency rates were 85.4, 74.5, and 58.3%, respectively. The cumulative 1-, 2-, and 5-year secondary patency rates were 93.8, 87.2, and 75%, respectively. The cumulative 1-, 2-, and 5-year survival rates were 97.9, 91.5, and 50%, respectively. Percutaneous transluminal angioplasty with and without stenting is effective and achieves excellent long-term patency and survival rates in patients with symptomatic HV-type BCS. With its lower incidence of re-occlusion and higher clinical success rate, HV angioplasty combined with stenting should be the preferred option especially in patients with segmental HV-type BCS., (© 2022. The Author(s).)

The implementation of radiomics in radiology is gaining interest due to its wide range of applications. To develop a radiomics-based model for classifying the etiology of liver cirrhosis using gadoxetic acid-enhanced MRI, 248 patients with a known etiology of liver cirrhosis who underwent 306 gadoxetic acid-enhanced MRI examinations were included in the analysis. MRI examinations were classified into 6 groups according to the etiology of liver cirrhosis: alcoholic cirrhosis, viral hepatitis, cholestatic liver disease, nonalcoholic steatohepatitis (NASH), autoimmune hepatitis, and other. MRI examinations were randomized into training and testing subsets. Radiomics features were extracted from regions of interest segmented in the hepatobiliary phase images. The fivefold cross-validated models (2-dimensional-(2D) and 3-dimensional-(3D) based) differentiating cholestatic cirrhosis from noncholestatic etiologies had the best accuracy (87.5%, 85.6%), sensitivity (97.6%, 95.6%), predictive value (0.883, 0.877), and area under curve (AUC) (0.960, 0.910). The AUC was larger in the 2D-model for viral hepatitis, cholestatic cirrhosis, and NASH-associated cirrhosis (P-value of 0.05, 0.05, 0.87, respectively). In alcoholic cirrhosis, the AUC for the 3D model was larger (P = 0.01). The overall intra-class correlation coefficient (ICC) estimates and their 95% confident intervals (CI) for all features combined was 0.68 (CI 0.56-0.87) for 2D and 0.71 (CI 0.61-0.93) for 3D measurements suggesting moderate reliability. Radiomics-based analysis of hepatobiliary phase images of gadoxetic acid-enhanced MRI may be a promising noninvasive method for identifying the etiology of liver cirrhosis with better performance of the 2D- compared with the 3D-generated models.

Purpose: To investigate the added value of gadoxetic acid-enhanced MRI in monitoring liver function and disease progression in patients with primary sclerosing cholangitis (PSC)., Methods: We retrospectively identified 104 consecutive patients (75 males; mean age 41.98 ± 12.5 years) with confirmed diagnosis of PSC who underwent 227 gadoxetic acid-enhanced MRI examinations between January 2008 and May 2019. Relative enhancement (RE) of the liver was correlated with the results of liver function tests (LFTs), scoring models (Model for End-Stage Liver Disease (MELD) score, Mayo Risk Score (MRS), Amsterdam-Oxford model (AOM)), and qualitative MRI findings. In addition, results were analyzed separately for excretory MRI examinations (n = 164) and nonexcretory examinations (n = 63) depending on excretion of gadoxetic acid into the common bile duct in the hepatobiliary phase (HBP)., Results: There was a significant correlation of RE with MRS (r = - 0.652), MELD score (r = - 0.474), AOM (r = - 0.468), and LFTs (P < 0.001). RE and albumin were significantly higher in the excretory group whereas scoring models, bilirubin, aspartate aminotransferase, alkaline phosphatase, and international normalized ratio were lower (P < 0.001). RE was lower in segments with absent HBP gadoxetic acid excretion into dilated bile ducts, reduced HBP parenchymal enhancement, atrophy, T2 hyperintensity, and bile duct abnormalities (P < 0.001)., Conclusion: Relative enhancement of the liver in gadoxetic acid-enhanced MRI can be used to evaluate global and regional liver function and monitor disease progression in patients with PSC. Hepatobiliary phase gadoxetic acid biliary excretion appears to be a reproducible qualitative parameter for evaluating disease severity that can be easily integrated into routine clinical practice.

Objectives: To investigate the impact of the interventionalist's experience and gender on radiation dose and procedural time in CT-guided interventions., Methods: We retrospectively analyzed 4380 CT-guided interventions performed at our institution with the same CT scanner from 2009 until 2018, 1287 (29%) by female and 3093 (71%) by male interventionalists. Radiation dose, number of CT fluoroscopy images taken per intervention, total procedural time, type of intervention, and degree of difficulty were derived from the saved dose reports and images. All 16 interventionalists included in this analysis performed their first CT-guided interventions during the study period, and interventions performed by each interventionalist were counted to assess the level of experience for each intervention in terms of the number of prior interventions performed by her or him. The Mann-Whitney U test (MWU test), multivariate regression, and linear mixed model analysis were performed., Results: Assessment of the impact of gender with the MWU test revealed that female interventionalists took a significantly smaller number of images (p < 0.0001) and achieved a lower dose-length product per intervention (p < 0.0001) while taking more time per intervention (p = 0.0001). This finding was confirmed for most types of interventions when additionally accounting for other possible impact factors in multivariate regression analysis. In linear mixed model analysis, we found that radiation dose, number of images taken per intervention, and procedural time decreased statistically significantly with interventionalist's experience., Conclusions: Radiation doses of CT-guided interventions are reduced by interventionalist's experience and, for most types of interventions, when performed by female interventionalists., Key Points: • Radiation doses in CT-guided interventions are lower when performed by female interventionalists. • Procedural times of CT-guided interventions are longer when performed by female interventionalists. • Radiation doses of CT-guided interventions decrease with the interventionalist's experience.

Background: Considering the limitations in both uncovered self-expandable metallic stents (USEMS) and covered self-expandable metallic stents (CSEMS), it is difficult to make a general recommendation for their application in percutaneous decompression of malignant biliary obstruction (MBO)., Purpose: To compare percutaneous transhepatic CSEMSs versus USEMSs for the palliative treatment of MBO in terms of technical success, clinical success, stent patency, patient survival, complications, and stent dysfunction., Material and Methods: This prospective randomized study included 66 patients with unresectable MBO. CSEMSs were inserted in 31 patients (26 men, 5 women; mean age = 63.8 ± 7.96 years) and USEMSs were inserted in 35 patients (26 men, 9 women; mean age = 62.3 ± 11.7 years)., Results: Mean primary stent patency duration was 138 ± 92.7 days in CSEMSs versus 150 ± 77.9 days in USEMSs ( P  = 0.578). Tumor overgrowth occurred exclusively in one patient with CSEMS ( P  = 0.470) and tumor ingrowth exclusively in two patients with USEMS ( P  = 0.494). Stent migration occurred in two patients with CSEMSs versus one patient with USEMSs ( P  = 0.579). Hemobilia occurred in five patients with CSEMSs versus three patients with USEMSs while bile leakage occurred in one patient in each group despite the larger introducer sheath caliber with CSEMSs (9 F vs. 6-7 F). There was no significant difference regarding patient survival ( P  = 0.969)., Conclusion: In our cohort of patients with rather poor life expectancy, there was no significant difference between covered and uncovered stents for the palliative treatment of MBO. However, considering the higher cost of CSEMs and the larger introducer diameter necessary for their placement, USEMSs can be preferred.

Purpose: To evaluate the hepatotoxicity of different chemotherapeutic agents used to treat neuroendocrine tumours (NETs) with gadoxetic acid-enhanced magnetic resonance imaging (MRI)., Material and Methods: A total of 129 patients with NETs who underwent two or more serial gadoxetic-acid-enhanced MRI examinations between 2014 and 2018 and started chemotherapy in the beginning of that time period were retrospectively analysed. Linear mixed model analysis evaluating relative enhancement (RE) of the liver in the hepatobiliary phase with respect to time between MRI examinations, primary chemotherapy, hepatotoxicity score of preceding and subsequent chemotherapies as well as age and gender as fixed variables was performed. Binary logistic regression was used to verify whether the hepatotoxicity score predicts a significant impact of a chemotherapeutic regimen on RE and hence liver function., Results: Linear mixed model analysis of a total of 539 MRI examinations identified all chemotherapeutic agents with known hepatoxicity as a factor with a statistically significant negative impact on RE of the liver in gadoxetic-acid-enhanced MRI in addition to age. This result was confirmed by binary logistic regression analysis., Conclusion: Our results confirm that gadoxetic acid-enhanced MRI can be used as an imaging-based liver function test for assessing hepatotoxicity of chemotherapeutic agents used for NETs. The findings underscore the known degrees of hepatotoxicity of the chemotherapeutic agents currently used in the treatment of NETs., Competing Interests: Declaration of Competing Interest Drs. Geisel and Hamm have received travel support and honoraria from Bayer AG. Beyond that there is nothing to disclose., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: To assess the consistency of liver enhancement in gadoxetic acid-enhanced magnetic resonance imaging (MRI) over serial examinations., Methods: This retrospective study included 554 patients who underwent at least 2 serial gadoxetic acid-enhanced MRI scans at either 1.5 or 3.0 Tesla at our institution between 2014 and 2018. Signal intensities (SI) were measured on T1-weighted images before and approx. 20 min after intravenous injection of gadoxetic acid. Relative enhancement (RE) of the liver, liver-to-spleen SI ratio (LSR), and liver-to-muscle SI ratio (LMR) were calculated. Means were compared with the paired t test, Greenhouse-Geisser test, and linear mixed model analysis, accordingly. Multiple linear regression analysis was used to elucidate possible predictors of RE and bivariate correlation analysis of patient age with RE was performed., Results: No statistically significant difference in RE, LSR, and LMR between two consecutive MRI scans was found when tested with paired t test or Greenhouse-Geisser test (n = 554, 519, and 554, respectively), while the latter revealed a statistically significant difference between the first and fourth MRI scan which was not confirmed in the linear mixed model. Patient age correlated negatively with RE of the liver (p = 0.002), LSR (p < 0.001), and LMR (p = 0.006)., Conclusions: Relative enhancement of the liver in the hepatobiliary phase of gadoxetic acid-enhanced MRI is consistent over successive examinations, different scanner types, and field strengths while correlating negatively with age, which further underscores the validity of gadoxetic acid-enhanced MRI as an imaging-based liver function test.

Association of vitamin D receptor (VDR) gene polymorphisms with sepsis risk and mortality was studied. VDR FokI CC genotype was associated with increased sepsis risk (OR = 13.396, p = .000009) compared to the TT genotype. Results suggest possible role of VDR FokI (rs2228570) as a molecular biomarker of increased sepsis risk., (© 2017 John Wiley & Sons Ltd.)

Background: This study examined the association between objectively measured physical activity patterns and risk factors of metabolic syndrome (MetS) in Saudi men., Methods: The study was cross-sectional, and 84 healthy men from the Saudi population (age 37.6 ± 8.8 years, body mass index [BMI] 28.4 ± 5.4 kg/m(2)) were recruited. Measurements of physical activity were made using triaxial accelerometers over 7 consecutive days of leisure time physical activity. Waist circumference and blood pressure were measured, and fasting blood samples taken to measure glucose, high density lipoprotein cholesterol (HDL), and triglycerides (TG)., Results: A total 21.4 % of participants had three or more risk factors for MetS, with low HDL levels the most frequent factor. Light physical activity (LPA) and BMI explained 13 % of the variation in TG. Moderate to vigorous physical activity (MVPA) with a minimum 10-min per session (10-min MVPA), LPA, and BMI explained 16 % of the variation in HDL. Sedentary behavior was not significantly associated with risk factors of MetS, although odds ratios indicated that decreased sedentarism does have a protective effect against MetS., Conclusions: LPA and 10-min MVPA were associated with elevated HDL levels among Saudi men. Future studies should confirm whether time spent physically active independent of intensity is an important factor in improving HDL levels.