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We herein report the case of a pediatric patient suffering from subarachnoid hemorrhage (SAH) due to a ruptured internal carotid artery (ICA) saccular aneurysm. Considering the unfavorable anatomy and irregular shape of the aneurysm, a flow diverter (FD) stent was positioned in addition to coils in an acute setting. Cangrelor (Kengreal, Chiesi, USA) IV bolus followed by maintenance IV infusion was administered in addition to ASA at the time of intervention. Transitioning from cangrelor to thienopyridine (clopidogrel) was done the day after the procedure without any ischemic or hemorrhagic complications. The patient was discharged symptom-free 24 days later. We discuss technical considerations focusing specifically on antiplatelet therapy management., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Distinguishing tumours from other conditions is a primary challenge in paediatric neuro-radiology. This paper aims to describe mimics, which are non-neoplastic conditions that have features similar to a neoplastic process caused by a non-neoplastic entity, and chameleons, which are uncommon presentations of brain tumours that are mistaken for other diagnoses. By doing so, we aim to raise awareness of these conditions and prevent inappropriate investigations or treatment in children. When suspecting a brain tumour, a detailed history, physical examination, and appropriate laboratory investigations can provide important clues about the nature of the lesion and narrow the list of possible differential diagnoses. Presented here is a collection of cases that have puzzled us for various reasons, including the absence of symptoms, coincidental timing, or misleading radiological features. Included in this pictorial essay are cases in which only a biopsy has helped us to make the correct diagnosis, as well as cases in which an unsuccessful biopsy has allowed us to evaluate hypotheses that were previously unaddressed. The paper also highlights the limited knowledge we have about the intercausality between malformations and later onset tumours, and the spectrum of manifestations that metabolic and genetic disorders can have., Competing Interests: Declarations. Ethical approval: Not applicable. Informed consent: Not applicable. Conflict of interest: The authors certify that there is no conflict of interest with any financial organisation regarding the material discussed in the manuscript., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The described evolution in prenatal and postnatal periods appears to support the hypothesis that the torcular pseudomass (TP) is probably a physiological, highly frequent and transient developmental finding. Neverthless, it remains to be determined whether TP has any relation with the final anatomy of the adjacent venous sinuses or any anatomic variants. We aimed to explore the relation of the TP with the adjacent dural venous anatomy/anatomic variants in the prenatal period, using MR angiography (2D TOF MRA)., Methods: We conducted a single centre retrospective study (September 2018-April 2024), by selecting all the fetal brain MRIs with MRA acquisition (2D TOF). Two neuroradiologists independently reviewed all MRIs, assessing the TP anatomy and adjacent venous sinuses., Results: Forty-five brain MRIs were obtained, from pregnant women with median maternal age of 31 years, and a median gestational age of 31 weeks. At least one anatomic variant of the venous drainage system was present in 48.9% of cases (n = 22), mainly a venous drainage dominance (40%). The TP was present in 75.6% of cases; it was focal and bulky in 10 cases each, and crescentic in the remainder; 70.6% were median/symmetric and 29.4% were left paramedian. We found a significant association of TP position and TP category; all of those with lateralization were left-sided, with a large proportion (80%) being bulky. The TP position was significantly associated with a pattern of right venous drainage dominance., Conclusion: We have provided an assessment of the relationship of the TP with the surrounding venous anatomy, particularly regarding its correlation with anatomic variants., Competing Interests: Declarations Ethical approval The Ethical Board of the Unidade Local de Saude Sao Joao approved this study; written informed consent was waived due to its retrospective nature. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent Specific written informed to this study was waived due to its retrospective nature. Competing interests The authors have no other relevant financial or non-financial interests to disclose., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The Respiratory Intensive Care Assembly of the European Respiratory Society gathered in Berlin to organise the third Respiratory Failure and Mechanical Ventilation Conference in February 2024. The conference covered key points of acute and chronic respiratory failure in adults. During the 3-day conference ventilatory strategies, patient selection, diagnostic approaches, treatment and health-related quality of life topics were addressed by a panel of international experts. In this article, lectures delivered during the event have been summarised by early career members of the Assembly and take-home messages highlighted., Competing Interests: Conflict of interest: C. Bianquis reports grants from ASTEN santé and support for attending meetings from Vitalaire. G. De Leo, G. Morana, M. Duarte-Silva and S. Nolasco have nothing to disclose. R. Vilde reports support for attending meetings from Chiesi and has a leadership role with Latvian Junior doctors’ association as a Board member. A. Tripipitsiriwat and P. Viegas have nothing to disclose. M. Purenkovs reports leadership roles with the Latvian Society of Sleep Medicine (Board member), Latvian Society of Innovative Pneumonology and Respiratory Medicine (board member), and Latvian Society of Tuberculosis and Lung Diseases doctors (board member). M. Duiverman reports grants from Fisher & Paykel (High-TeC trial), Vivisol BV (High-TeC trial and Noctivent trial), RESMED Ltd (RECAPTURE trial), Löwenstein BV (Noctivent trial), and Secure BV (Noctivent trial), payment or honoraria for lectures from Vivisol BV, Chiesi, Breas, and AstraZeneca, and a leadership role with ERS as the chair of the NIV group of Assembly 2. C. Karagiannidis and C. Fisser have nothing to disclose., (Copyright ©ERS 2024.)

Background/Objectives : PET imaging with [ 18 F]F-DOPA has demonstrated high potential for the evaluation and management of pediatric brain gliomas. Manual extraction of PET parameters is time-consuming, lacks reproducibility, and varies with operator experience. Methods : In this study, we tested whether a semi-automated image processing framework could overcome these limitations. Pediatric patients with available static and/or dynamic [ 18 F]F-DOPA PET studies were evaluated retrospectively. We developed a Python software to automate clinical index calculations, including preprocessing to delineate tumor volumes from structural MRI, accounting for lesions with low [ 18 F]F-DOPA uptake. A total of 73 subjects with treatment-naïve low- and high-grade gliomas, who underwent brain MRI within two weeks of [ 18 F]F-DOPA PET, were included and analyzed. Static analysis was conducted on all subjects, while dynamic analysis was performed on 32 patients. Results : For 68 subjects, the Intraclass Correlation Coefficient for T/S between manual and ground truth segmentation was 0.91. Using our tool, ICC improved to 0.94. Our method demonstrated good reproducibility in extracting static tumor-to-striatum ratio ( p = 0.357); however, significant differences were observed in tumor slope ( p < 0.05). No significant differences were found in time-to-peak ( p = 0.167) and striatum slope ( p = 0.36). Conclusions : Our framework aids in analyzing [ 18 F]F-DOPA PET images of pediatric brain tumors by automating clinical score extraction, simplifying segmentation and Time Activity Curve extraction, reducing user variability, and enhancing reproducibility.

This narrative review examines the existing literature on minimally invasive image-guided sampling techniques of mediastinal lesions gathered from international databases (Medline, PubMed, Scopus, and Google Scholar). Original studies, systematic reviews with meta-analyses, randomized controlled trials, and case reports published between January 2009 and November 2023 were included. Four authors independently conducted the search to minimize bias, removed duplicates, and selected and evaluated the studies. The review focuses on the recent advancements in mediastinal sampling techniques, including EBUS-TBNA, EUS-FNA and FNB, IFB, and nodal cryobiopsy. The review highlights the advantages of an integrated approach using these techniques for diagnosing and staging mediastinal diseases, which, when used competently, significantly increase diagnostic yield and accuracy.

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The term gliomatosis cerebri (GC), a radiology-defined highly infiltrating diffuse glioma, has been abandoned since molecular GC-associated features could not be established., Methods: We conducted a multinational retrospective study of 104 children and adolescents with GC providing comprehensive clinical and (epi-)genetic characterization., Results: Median overall survival (OS) was 15.5 months (interquartile range, 10.9-27.7) with a 2-year survival rate of 28%. Histopathological grading correlated significantly with median OS: CNS WHO grade II: 47.8 months (25.2-55.7); grade III: 15.9 months (11.4-26.3); grade IV: 10.4 months (8.8-14.4). By DNA methylation profiling (n = 49), most tumors were classified as pediatric-type diffuse high-grade glioma (pedHGG), H3-/IDH-wild-type (n = 31/49, 63.3%) with enriched subclasses pedHGG&#95;RTK2 (n = 19), pedHGG&#95;A/B (n = 6), and pedHGG&#95;MYCN (n = 5), but only one pedHGG&#95;RTK1 case. Within the pedHGG, H3-/IDH-wild-type subgroup, recurrent alterations in EGFR (n = 10) and BCOR (n = 9) were identified. Additionally, we observed structural aberrations in chromosome 6 in 16/49 tumors (32.7%) across tumor types. In the pedHGG, H3-/IDH-wild-type subgroup TP53 alterations had a significant negative effect on OS., Conclusions: Contrary to previous studies, our representative pediatric GC study provides evidence that GC has a strong predilection to arise on the background of specific molecular features (especially pedHGG&#95;RTK2, pedHGG&#95;A/B, EGFR and BCOR mutations, chromosome 6 rearrangements)., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Neuro-Oncology.)

Background: Amino-acid (AA) PET has recently been endorsed by the ESTRO-EANO guidelines for RT-planning in glioblastomas, with recommended lesion-to-brain-ratio thresholds (1.6-1.8) derived from a biopsy-controlled FET-PET study. We aimed to compare target definition at [ 18 F]DOPA-PET between the ESTRO-EANO thresholds and other biological-tumor-volume (BTV) thresholds (derived from the striatum) typically used in [ 18 F]DOPA-PET., Methods: A retrospective analysis was conducted on glioma patients scanned with [ 18 F]DOPA-PET/CT at our center between April 2021 and January 2024. 3D BTV was semi-automatically computed using a dedicated workstation (Philips HealthCare) with four thresholds: 1.6xSUVmean of background, 1.8xSUVmean of background, SUVmean and SUVmax of the contralateral striatum. The delineation accuracy of different thresholds was visually evaluated and a t-test was used to compare the different VOIs volumes (0.05 significance-level)., Results: 50 patients were included (36 previously received surgery). Volume definition based on the striatum SUVmax was significantly smaller compared to other thresholds (2.1 cm 3 ), resulting in inaccurate VOIs at visual inspection in 21/50 patients. No significant differences were highlighted in BTV defined based on 1.6 or 1.8xSUVmean of background (15.7 vs. 12.7 cm 3 ; VOIs accurate in 49/50 and 46/50 patients, respectively). BTV based on striatum SUVmean was significantly smaller compared to the 1.6xSUVmean threshold only in surgically-treated patients (P=0.04), while no significant differences were highlighted compared to the 1.8xSUVmean threshold regardless of the patients' group., Conclusions: The ESTRO-EANO FET-PET thresholds proved to be interchangeable in patients scanned with [ 18 F]DOPA-PET, while the use of a threshold based on the contralateral-striatum SUVmean provided partially overlapping results prompting further investigation.

Introduction: Medical thoracoscopy is a minimally invasive and safe procedure mostly performed for unexplained exudative pleural effusions but may be considered for pneumothorax (PNX)., Methods: This retrospective study included participants affected by PNX who underwent medical thoracoscopy with talc poudrage at a single academic hospital from 2008 to 2021. The primary endpoint was the observation of complete radiographical lung re-expansion and absence of air supply from the chest drain within 7 days of medical thoracoscopy. The secondary endpoint was achieving no recurrence of ipsilateral PNX at 24 months post-discharge., Results: A total of 95 patients affected by primary spontaneous PNX (PSP), secondary spontaneous PNX (SSP), iatrogenic, and traumatic PNX were enrolled. An additional procedure was required by 17.89% of patients, and only one patient with SSP required subsequent surgery. Recurrence of PNX occurred on the same side within 24 months after discharge in 9.47% of patients, with a median time to recurrence of 13.5 months. The PSP group was significantly more likely to achieve the primary endpoint. Pleural morphology was significantly associated with reaching the primary endpoint, while receiving a cumulative dose of talc greater than or equal to 4 g during hospitalization was associated with a lower risk of meeting it. Receiving a cumulative dose of talc greater than or equal to 4 g led in all cases to the achievement of the secondary endpoint. Patients with iatrogenic and traumatic PNX had an excellent prognosis in both the short- and long-term evaluation., Conclusion: Medical thoracoscopy is an effective procedure for treating PNX in the acute setting in selected cases while preventing long-term relapses. Large prospective clinical studies are needed to support and better define the role of medical thoracoscopy in current clinical practice., (© 2024. The Author(s).)

Introduction: The SafeBoosC-III trial investigated the effect of cerebral oximetry-guided treatment in the first 72 h after birth on mortality and severe brain injury diagnosed by cranial ultrasound in extremely preterm infants (EPIs). This ancillary study evaluated the effect of cerebral oximetry on global brain injury as assessed by magnetic resonance imaging (MRI) at term equivalent age (TEA)., Methods: MRI scans were obtained between 36 and 44.9 weeks PMA. The Kidokoro score was independently evaluated by two blinded assessors. The intervention effect was assessed using the nonparametric Wilcoxon rank sum test for median difference and 95% Hodges-Lehmann (HL) confidence intervals (CIs). The intraclass correlation coefficient (ICC) was used to assess the agreement between the assessors., Results: A total of 210 patients from 8 centers were included, of whom 121 underwent MRI at TEA (75.6% of alive patients): 57 in the cerebral oximetry group and 64 in the usual care group. There was an excellent correlation between the assessors for the Kidokoro score (ICC agreement: 0.93, 95% CI: 0.91-0.95). The results showed no significant differences between the cerebral oximetry group (median 2, interquartile range [IQR]: 1-4) and the usual care group (median 3, IQR: 1-4; median difference -1 to 0, 95% HLCI: -1 to 0; p value 0.1196)., Conclusions: In EPI, the use of cerebral oximetry-guided treatment did not lead to significant alterations in brain injury, as determined by MRI at TEA. The strong correlation between the assessors highlights the potential of the Kidokoro score in multicenter trials., (© 2024 S. Karger AG, Basel.)

Conventional T1- and T2-weighted magnetic resonance imaging (MRI) of the pancreas can vary significantly due to factors such as scanner differences and pulse sequence variations. This review explores T1 and T2 mapping techniques, modern MRI methods providing quantitative information about tissue relaxation times. Various T1 and T2 mapping pulse sequences are currently under investigation. Clinical and research applications of T1 and T2 mapping in the pancreas include their correlation with fibrosis, inflammation, and neoplasms. In chronic pancreatitis, T1 mapping and extracellular volume (ECV) quantification demonstrate potential as biomarkers, aiding in early diagnosis and classification. T1 mapping also shows promise in evaluating pancreatic exocrine function and detecting glucose metabolism disorders. T2* mapping is valuable in quantifying pancreatic iron, offering insights into conditions like thalassemia major. However, challenges persist, such as the lack of consensus on optimal sequences and normal values for healthy pancreas relaxometry. Large-scale studies are needed for validation, and improvements in mapping sequences are essential for widespread clinical integration. The future holds potential for mixed qualitative and quantitative models, extending the applications of relaxometry techniques to various pancreatic lesions and enhancing routine MRI protocols for pancreatic pathology diagnosis and prognosis., Competing Interests: 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., (© 2024 The Authors. Published by Elsevier Ltd.)

Given the importance of maximizing resection for prognosis in patients with HGG and the potential risks associated with ventricle opening, this study aimed to assess the actual increase in post-surgical complications related to lateral ventricle opening and its influence on OS and PFS. A retrospective study was conducted on newly diagnosed HGG, dividing the patients into two groups according to whether the lateral ventricle was opened (69 patients) or not opened (311 patients). PFS, OS, subependymal dissemination, distant parenchymal recurrences, the development of hydrocephalus and CSF leak were considered outcome measures. A cohort of 380 patients (154 females (40.5%) and 226 males (59.5%)) was involved in the study (median age 61 years). The PFS averaged 10.9 months (±13.3 SD), and OS averaged 16.6 months (± 16.3 SD). Among complications, subependymal dissemination was registered in 15 cases (3.9%), multifocal and multicentric progression in 56 cases (14.7%), leptomeningeal dissemination in 12 (3.2%) and hydrocephalus in 8 (2.1%). These occurrences could not be clearly justified by ventricular opening. The act of opening the lateral ventricles itself does not carry an elevated risk of dissemination, hydrocephalus or cerebrospinal fluid (CSF) leak. Therefore, if necessary, it should be pursued to achieve radical removal of the disease.

Background and Objective: Medical thoracoscopy (MT) is an endoscopic technique performed by interventional pulmonologists with a favorable safety profile and few contraindications, providing diagnostic and therapeutic intervention in a single sitting. This narrative review was designed to summarize the therapeutic role of MT based on the latest results from the available literature., Methods: Pertinent literature published in English, relative to human studies, between 2010-2022 was searched in Medline/PubMed and Cochrane databases. Publications regarded as relevant were considered for inclusion in this review; additional references were added based on the authors' knowledge and judgment. The review considered population studies, meta-analyses, case series, and case reports., Key Content and Findings: MT has mostly been described and is currently used globally in the diagnostic approach to exudative pleural effusion of undetermined origin. Carefully evaluating the literature, it is clear that there is initial evidence to support the use of MT in the therapeutic approach of malignant pleural effusion, pneumothorax, empyema, and less frequently hemothorax and foreign body retrieval., Conclusions: MT is an effective procedure for treating the clinical entities presented in this document; it must be carried out in selected patients, managed in centers with high procedural expertise. Further evidence is needed to assess the optimal indications and appropriate patients' profiles for therapeutic MT. The endpoints of length of hospital stay, surgical referral, complications and mortality will have to be considered in future studies to validate it as a therapeutic intervention to be applied globally., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-1745/coif). The series “Malignant and Benign Pleural Effusions” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare., (2024 Journal of Thoracic Disease. All rights reserved.)

Background: Adherence to continuous positive air pressure (CPAP) in patients with obstructive sleep apnoea (OSA) has remained invariably low over the last decades. Remote monitoring of the nocturnal CPAP treatment, within telemedicine (TM)-based follow-up programs, in these patients has been suggested as a potential tool to improve adherence and release the workload of sleep units. The aim of this study was therefore to assess whether a follow-up program carried out by a Remote Medical Care Centre (RMCC), outside the sleep unit, improves adherence to CPAP in the short and long term in patients with OSA., Methods: In this pilot protocol, we enrolled 37 patients starting CPAP in our Sleep Centre (SC). After three months of standard care in our SC, patients initiated a six-month remote follow-up carried out by the RMCC, functioning as an intermediary between patients and SC. Monthly reports and indication for face-to-face visits were sent to the SC for six months. After this period patients returned to usual care for one year. Results were compared with those obtained in 38 patients (controls) followed with usual care over the same time range., Results: Mean nightly use of CPAP increased from 3.2 ± 2.4 h pre-RMCC to 5.2 ± 1.9 h post-RMCC ( p  < 0.0001). Nights/month of CPAP use improved from 19.8 ± 9.2 to 25.2 ± 2.5 ( p  < 0.05) and nights/month with CPAP use >4 h from 12.5 ± 10 to 21.03 ± 8.9 ( p  < 0.05). This improvement remained stable after 12 months from the return of patients to usual care. No significant changes in CPAP use were observed in controls over the time., Conclusion: A six-month follow-up through a remote facility can significantly improve adherence to CPAP in the short and long term. This pilot study provides a solid base for the design of multicentre randomized trials focusing on new models which are able to increase the long-term efficacy of TM programs., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

MR is a powerful diagnostic tool in the diagnosis and management of most hepatic and pancreatic diseases. Thanks to its multiple sequences, the use of dedicated contrast media and special techniques, it allows a multiparametric approach able to provide both morphological and functional information for many pathological conditions. The knowledge of correct technique is fundamental in order to obtain a correct diagnosis. In this paper, different MR sequences will be illustrated in the evaluation of liver and pancreatic diseases, especially those sequences which provide information not otherwise obtainable with other imaging techniques. Practical MR protocols with the most common indications of MR in the study of the liver and pancreas are provided.