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SignificanceX-ray-induced acoustic computed tomography (XACT) offers a promising approach to biomedical imaging, leveraging X-ray absorption contrast. It overcomes the shortages of traditional X-ray, allowing for more advanced medical imaging.AimThe review focuses on the significance and draws onto the potential applications of XACT to demonstrate it as an innovative imaging technique.ApproachThis review navigates the expanding landscape of XACT imaging within the biomedical sphere. Integral topics addressed encompass the refinement of imaging systems and the advancement in image reconstruction algorithms. The review particularly emphasizes XACT's significant biomedical applications.ResultsKey uses, such as breast imaging, bone density maps for osteoporosis, and X-ray molecular imaging, are highlighted to demonstrate the capability of XACT. A unique niche for XACT imaging is its application in in vivo dosimetry during radiotherapy, which has been validated on patients.ConclusionsBecause of its unique property, XACT has great potential in biomedicine and non-destructive testing. We conclude by casting light on potential future avenues in this promising domain.

Backgrounds: Preoperative imaging, particularly with magnetic resonance imaging (MRI) and computed tomography (CT) scans, plays a crucial role in distinguishing between benign and malignant parotid gland tumors, while the reliability of Ultrasound-Guided Fine Needle Aspiration (FNA) in diagnosing these masses remains a topic of debate. Methods: This two-center retrospective analysis was conducted on 347 patients with parotid gland tumors who had FNA and preoperative imaging (CT or MRI). All patients underwent surgery and final histopathological examination was available, along with complete medical records between January 2008 and May 2023. Results: Among the 347 patients, 318 (92%) had benign and 10 (3%) had malignant tumors based on FNA, with 19 (5%) unsatisfactory specimens. Final histological diagnosis revealed 303 (87%) benign and 44 (13%) malignant lesions, with a false-negative rate of 10.6% for FNA. Multivariate analysis identified irregular shape and invasion as independent predictors of malignancy in patient with benign or unsatisfactory FNA results. The odds ratio for irregular shape was 3.06 and for invasion was 12.73. Conclusion: Imaging characteristics, such as irregular shape and invasion may indicate towards malignant parotid tumors, even in patients with false-negative benign findings in FNA. [ABSTRACT FROM AUTHOR]

Background: Orbital cellulitis is a severe, potentially life-threatening condition that often arises as a complication of sinusitis, trauma, or dental infections. Prompt diagnosis and effective management are crucial to prevent serious outcomes such as vision loss and intracranial complications. This case series explores the diverse clinical presentations, radiological findings, and management strategies for orbital cellulitis, with a particular focus on cases complicated by underlying systemic conditions and coexisting orbital pathologies. Methods: A retrospective analysis was conducted on five patients diagnosed with orbital cellulitis at a tertiary care center in India. The cases included orbital cellulitis secondary to sinusitis, trauma, dental infections, and in an immunocompromised patient with uncontrolled diabetes. Each case was evaluated based on clinical presentation, radiological imaging (CT and MRI), bacteriological findings, and treatment outcomes. The results were compared with findings from other studies to provide a comprehensive understanding of the condition. Results: Sinusitis was the most common etiology, consistent with global data, but trauma and dental infections also played significant roles. Radiological imaging, particularly CT scans, was essential in identifying abscess formation and guiding surgical intervention. MRI was crucial in cases with suspected intracranial extension. Complications such as intracranial abscess and prolonged recovery were observed, particularly in the immunocompromised patient. Multidisciplinary management, including intravenous antibiotics and timely surgical intervention, was vital in achieving favorable outcomes. Conclusion: This case series underscores the complexity of orbital cellulitis, particularly when complicated by systemic conditions or coexisting orbital pathologies. Accurate and timely diagnosis using radiological imaging, coupled with a multidisciplinary approach, is critical in managing this condition effectively. Future research should continue to explore the impact of emerging antibiotic resistance and refine treatment protocols for high-risk populations. [ABSTRACT FROM AUTHOR]

Right subclavian artery aneurysms are rare vascular anomalies that can present significant diagnostic and management challenges, especially in elderly patients. We present a case of a 72-year-old female who presented with sudden onset chest pain and was diagnosed with an unruptured right subclavian artery aneurysm with partial thrombus formation. Advanced imaging, including chest X-ray and contrast-enhanced CT scan, confirmed the diagnosis and guided a successful endovascular repair, stabilizing the patient. Follow-up care included regular clinical assessments and imaging studies to monitor the aneurysm's status and detect potential complications. This case underscores the critical role of early radiological diagnosis and prompt intervention in managing subclavian artery aneurysms, highlighting the effectiveness of endovascular techniques in such cases.

Abstract Backgrounds Preoperative imaging, particularly with magnetic resonance imaging (MRI) and computed tomography (CT) scans, plays a crucial role in distinguishing between benign and malignant parotid gland tumors, while the reliability of Ultrasound-Guided Fine Needle Aspiration (FNA) in diagnosing these masses remains a topic of debate. Methods This two-center retrospective analysis was conducted on 347 patients with parotid gland tumors who had FNA and preoperative imaging (CT or MRI). All patients underwent surgery and final histopathological examination was available, along with complete medical records between January 2008 and May 2023. Results Among the 347 patients, 318 (92%) had benign and 10 (3%) had malignant tumors based on FNA, with 19 (5%) unsatisfactory specimens. Final histological diagnosis revealed 303 (87%) benign and 44 (13%) malignant lesions, with a false-negative rate of 10.6% for FNA. Multivariate analysis identified irregular shape and invasion as independent predictors of malignancy in patient with benign or unsatisfactory FNA results. The odds ratio for irregular shape was 3.06 and for invasion was 12.73. Conclusion Imaging characteristics, such as irregular shape and invasion may indicate towards malignant parotid tumors, even in patients with false-negative benign findings in FNA.

Rhabdomyolysis is a rare condition characterised by muscle oedema and inflammation. Radiological imaging, particularly Magnetic Resonance Imaging (MRI), plays a crucial role in the diagnosis and management of patients with muscle injuries. Hereby, the authors present a case report of a 21-year-old male who recently joined a gym a month ago. After a recent upper body workout, he began experiencing vague pain around the posterior aspect of the entire right arm, radiating towards the shoulder and elbow. An MRI was performed to evaluate the musculature of the right arm and forearm. T2-weighted axial images revealed hyperintense signals within the long head of the triceps muscle. Short Tau Inversion Recovery (STIR) coronal and STIR axial sequences showed increased signal intensity in the short field of view sequences, consistent with the presence of subcutaneous inflammation. The patient was managed conservatively with anti-inflammatory medications. A follow-up scan after one month showed complete resolution of muscle oedema. The ability of MRI to accurately assess the degree and severity of muscle injury allows for appropriate treatment planning and monitoring of disease progression. In cases of suspected muscle injury, prompt radiological evaluation can facilitate early diagnosis and intervention, ultimately improving patient outcomes.

Hepatocellular carcinoma (HCC) is the most common primary carcinoma arising from the liver. Although HCC can arise de novo, the vast majority of cases develop in the setting of chronic liver disease. Hepatocarcinogenesis follows a well-studied process during which chronic inflammation and cellular damage precipitate cellular and genetic aberrations, with subsequent propagation of precancerous and cancerous lesions. Surveillance of individuals at high risk of HCC, early diagnosis, and individualized treatment are keys to reducing the mortality associated with this disease. Radiological imaging plays a critical role in the diagnosis and management of these patients. HCC is a unique cancer in that it can be diagnosed with confidence by imaging that meets all radiologic criteria, obviating the risks associated with tissue sampling. This article discusses conventional and emerging imaging techniques for the evaluation of HCC. [ABSTRACT FROM AUTHOR]

Abstract Introduction To explore the diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias (IAHs), and to analyze the potential causes for missed diagnosis and misdiagnosis of IAHs in children. Methods A retrospective analysis was conducted on 45 children with surgically confirmed IAHs. The diagnostic rate of IAHs by preoperative high-resolution ultrasound combined with MSCT was compared with that of intraoperative examination, and the potential causes for missed diagnosis and misdiagnosis by the combination method were analyzed. Results Forty-five cases of pediatric IAHs were categorized into primary (25/45, 55.5%) and acquired secondary hernias (20/45, 44.5%). Among children with primary hernias, mesenteric defects were identified as the predominant subtype (40%). Acquired secondary hernias typically resulted from abnormal openings in the abdominal wall or band adhesions due to trauma, surgery, or inflammation. In particular, adhesive band hernias were the major type in children with acquired secondary hernias (40%). The diagnostic rate of high-resolution ultrasound was 77.8%, with “cross sign” as a characteristic ultrasonic feature. Among 10 cases of missed diagnosis or misdiagnosis, 5 were finally diagnosed as IAHs by multi-slice computer tomography (MSCT). Overall, the diagnostic rate of pediatric IAHs by preoperative ultrasound combined with radiological imaging reached 88.9%. Discussion IAHs in children, particularly mesenteric defects, are prone to strangulated intestinal obstruction and necrosis. High-resolution ultrasound combined with MSCT greatly enhances the diagnostic accuracy of pediatric IAHs.

The diagnosis and treatment of non-unions still represents an interdisciplinary challenge. Therefore, prevention, early detection and specific treatment are of great importance. Non-unions of the upper extremities, although less common than that of the lower extremities, requires special attention for successful treatment due to the central role of the shoulder girdle and arm in day to day activities. Successful treatment of non-unions requires a comprehensive evaluation of the patient's medical history, a thorough clinical examination and in particular radiological imaging. In order to effectively treat the pseudarthrosis it is crucial to distinguish between pseudarthroses that are suspected to be due to infections and those that are not. This article presents a treatment algorithm for managing both pseudarthrosis due to infection and pseudarthrosis without infection in the upper extremities. [ABSTRACT FROM AUTHOR]

Introduction: To explore the diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias (IAHs), and to analyze the potential causes for missed diagnosis and misdiagnosis of IAHs in children. Methods: A retrospective analysis was conducted on 45 children with surgically confirmed IAHs. The diagnostic rate of IAHs by preoperative high-resolution ultrasound combined with MSCT was compared with that of intraoperative examination, and the potential causes for missed diagnosis and misdiagnosis by the combination method were analyzed. Results: Forty-five cases of pediatric IAHs were categorized into primary (25/45, 55.5%) and acquired secondary hernias (20/45, 44.5%). Among children with primary hernias, mesenteric defects were identified as the predominant subtype (40%). Acquired secondary hernias typically resulted from abnormal openings in the abdominal wall or band adhesions due to trauma, surgery, or inflammation. In particular, adhesive band hernias were the major type in children with acquired secondary hernias (40%). The diagnostic rate of high-resolution ultrasound was 77.8%, with "cross sign" as a characteristic ultrasonic feature. Among 10 cases of missed diagnosis or misdiagnosis, 5 were finally diagnosed as IAHs by multi-slice computer tomography (MSCT). Overall, the diagnostic rate of pediatric IAHs by preoperative ultrasound combined with radiological imaging reached 88.9%. Discussion: IAHs in children, particularly mesenteric defects, are prone to strangulated intestinal obstruction and necrosis. High-resolution ultrasound combined with MSCT greatly enhances the diagnostic accuracy of pediatric IAHs. [ABSTRACT FROM AUTHOR]

Background and purpose: The low-dose EOS Imaging System is an emerging tool for 3-dimensional measurements in orthopedics. The clinical feasibility for measuring total hip arthroplasty (THA) liner wear has not yet been investigated. We aimed to evaluate the feasibility of using EOS to measure THA liner wear by examining the experimental accuracy using a THA phantom and clinical precision of patients with THA, considering a clinically relevant precision at the 95% repeatability limit to be 0.2 mm. Methods: An experimental THA phantom with movable stem and a fixed cup with a plastic liner was constructed to simulate progressive 3D liner wear. Series of 11 pairs of radiographs with 50 μm femoral movement in between were obtained for each 3D axis in EOS. 30 patients with a THA were scanned twice using EOS to assess precision. Model-based radiostereometric analysis (RSA) was used for wear measurement. Results: The mean difference (true minus simulated wear) with standard deviation (SD) and 95% limits of agreement for experimental THA wear were 0.005 (0.037) and [–0.069 to 0.079] mm for the vertical (y) axis. The mean (SD) and 95% repeatability limit for precision for clinical measurement were –0.029 (0.105) and 0.218 mm. Conclusion: Experimental THA liner wear using EOS was within clinically relevant tolerances and without bias. The clinical precision was just outside our defined clinically relevant precision. Compared with conventional RSA, EOS is less accurate and precise but may still be of value for certain clinical applications, provided larger sample size or longer follow-up are available.

Abstract Artificial intelligence (AI) is revolutionizing the field of medical imaging, holding the potential to shift medicine from a reactive “sick-care” approach to a proactive focus on healthcare and prevention. The successful development of AI in this domain relies on access to large, comprehensive, and standardized real-world datasets that accurately represent diverse populations and diseases. However, images and data are sensitive, and as such, before using them in any way the data needs to be modified to protect the privacy of the patients. This paper explores the approaches in the domain of five EU projects working on the creation of ethically compliant and GDPR-regulated European medical imaging platforms, focused on cancer-related data. It presents the individual approaches to the de-identification of imaging data, and describes the problems and the solutions adopted in each case. Further, lessons learned are provided, enabling future projects to optimally handle the problem of data de-identification. Critical relevance statement This paper presents key approaches from five flagship EU projects for the de-identification of imaging and clinical data offering valuable insights and guidelines in the domain. Key Points ΑΙ models for health imaging require access to large amounts of data. Access to large imaging datasets requires an appropriate de-identification process. This paper provides de-identification guidelines from the AI for health imaging (AI4HI) projects.

Artificial intelligence (AI) is revolutionizing the field of medical imaging, holding the potential to shift medicine from a reactive "sick-care" approach to a proactive focus on healthcare and prevention. The successful development of AI in this domain relies on access to large, comprehensive, and standardized real-world datasets that accurately represent diverse populations and diseases. However, images and data are sensitive, and as such, before using them in any way the data needs to be modified to protect the privacy of the patients. This paper explores the approaches in the domain of five EU projects working on the creation of ethically compliant and GDPR-regulated European medical imaging platforms, focused on cancer-related data. It presents the individual approaches to the de-identification of imaging data, and describes the problems and the solutions adopted in each case. Further, lessons learned are provided, enabling future projects to optimally handle the problem of data de-identification. Critical relevance statement: This paper presents key approaches from five flagship EU projects for the de-identification of imaging and clinical data offering valuable insights and guidelines in the domain. Key Points: ΑΙ models for health imaging require access to large amounts of data. Access to large imaging datasets requires an appropriate de-identification process. This paper provides de-identification guidelines from the AI for health imaging (AI4HI) projects. [ABSTRACT FROM AUTHOR]

Maxillary lateral sinus floor elevation, or external sinus lift, is a widespread surgical intervention in the dental field. Insertion of implants in the posterior region of the maxilla often requires reconstruction of the remaining native bone that has insufficient volume. Background and aims. Much of the research published involves using artificial products, like xenografts and resorbable collagen membranes, after a prior Cone Beam Computer Tomography (CBCT) investigation. Nowadays, more accessible access, less financial costs, a biological approach, and faster healing are objectives that surround this procedure. Leucocytes and platelets rich in Fibrin (L-PRF) are a natural component with a high concentration of growth factors. Due to its regenerative properties and lack of complications, it is used in several medical fields, like orthopedics, dermatology, and oral surgery. This retrospective study aims to compare results in bone height and volume obtained through external sinus lift, either by using xenografts or autologous plasma rich in fibrin, by evaluating the quantity of new bone formation from a radiological point of view. Methods. Fifty-eight Caucasian patients were included in this retrospective study; 48 were submitted to xenograft procedure, and 10 were selected for L-PRF grafting material with simultaneous implant placement. Lack of clinical and histological studies performed on patients with L-PRF surgeries limited us in choosing a larger group for the radiological analysis. CBCT evaluation was performed before surgery and 6 months after. All patients selected for the study presented good general and oral health, acute oral and sinus infections excluded; smoking and periodontal disease were also criteria of exclusion. Two operators performed the measurements in pre-established landmarks in different time frames. The two independent groups were compared with the Wilcoxon rank-sum test for quantitative data. Qualitative characteristics were described as counts and percentages. All analyses were performed in an R environment for statistical computing and graphics. Results. Mean bone height gain in the xenograft group in the regions was as follows: 7.44 for the anterior landmark, 12.14 for the median and 8.28 for the distal. The mean group height gained for the L-PRF group was 0.1 anteriorly, -0.18 for the median measurement, and 0.23 distally. We obtained excellent overall reliability for all the height measurements between the two operators. Conclusions. Further studies must be conducted to establish new sets of surgical protocols in case L-PRF alone is found to be a reliable, stable, biological alternative to the welldocumented xenografts in external sinus lifts. Radiological results, although promising, must be further applied in long term clinical survival of the implants in the grafted sites. Also, studies combining L-PRF in conjunction with xenograft might bring improved clinical results in terms of reduced postoperative complications and accelerated healing. [ABSTRACT FROM AUTHOR]

Recent European Association of Urology (EAU) guidelines and a clinical prediction rule developed by Van Nieuwkoop et al. suggest simple criteria for performing radiological imaging for patients with a febrile urinary tract infection (UTI). We analysed the records of patients with a UTI from four hospitals in Switzerland. Of 107 UTI patients, 58% underwent imaging and 69% (95%CI: 59–77%) and 64% (95%CI: 54–73%) of them were adequately managed according to Van Nieuwkoop's clinical rule and EAU guidelines, respectively. However, only 47% (95%CI: 33–61%) and 57% (95%CI: 44–69%) of the imaging performed would have been recommended according to their respective rules. Clinically significant imaging findings were associated with a history of urolithiasis (OR = 11.8; 95%CI: 3.0–46.5), gross haematuria (OR = 5.9; 95%CI: 1.6–22.1) and known urogenital anomalies (OR = 5.7; 95%CI: 1.8–18.2). Moreover, six of 16 (38%) patients with a clinically relevant abnormality displayed none of the criteria requiring imaging according to Van Nieuwkoop's rule or EAU guidelines. Thus, adherence to imaging guidelines was suboptimal, especially when imaging was not recommended. However, additional factors associated with clinically significant findings suggest the need for a new, efficient clinical prediction rule. [ABSTRACT FROM AUTHOR]

Introduction: Hyperbaric oxygen treatment (HBOT) remains a recognised treatment for acute carbon monoxide (CO) poisoning, but the utility of HBOT in treating CO-induced delayed neurological sequelae (DNS) is not yet established. Case description: A 26-year old woman presented with reduced consciousness secondary to CO exposure from burning charcoal. She underwent a single session of HBOT with US Navy Treatment Table 5 within six hours of presentation, with full neurological recovery. Eight weeks later, she represented with progressive, debilitating neurological symptoms mimicking Parkinsonism. Magnetic resonance imaging of her brain demonstrated changes consistent with hypoxic ischaemic encephalopathy. The patient underwent 20 sessions of HBOT at 203 kPa (2 atmospheres absolute) for 115 minutes, and received intravenous methylprednisolone 1 g per day for three days. The patient's neurological symptoms completely resolved, and she returned to full-time professional work with no further recurrence. Discussion: Delayed neurological sequelae is a well-described complication of CO poisoning. In this case, the patient's debilitating neurocognitive symptoms resolved following HBOT. Existing literature on treatment of CO-induced DNS with HBOT consists mainly of small-scale studies and case reports, many of which similarly suggest that HBOT is effective in treating this complication. However, a large, randomised trial is required to adequately determine the effectiveness of HBOT in the treatment of CO-induced DNS, and an optimal treatment protocol. [ABSTRACT FROM AUTHOR]

Background and purpose: Knowledge concerning the use AI models for the classification of glenohumeral osteoarthritis (GHOA) and avascular necrosis (AVN) of the humeral head is lacking. We aimed to analyze how a deep learning (DL) model trained to identify and grade GHOA on plain radiographs performs. Our secondary aim was to train a DL model to identify and grade AVN on plain radiographs. Patients and methods: A modified ResNet-type network was trained on a dataset of radiographic shoulder examinations from a large tertiary hospital. A total of 7,139 radiographs were included. The dataset included various projections of the shoulder, and the network was trained using stochastic gradient descent. Performance evaluation metrics, area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were used to assess the network’s performance for each outcome. Results: The network demonstrated AUC values ranging from 0.73 to 0.93 for GHOA classification and > 0.90 for all AVN classification classes. The network exhibited lower AUC for mild cases compared with definitive cases of GHOA. When none and mild grades were combined, the AUC increased, suggesting difficulties in distinguishing between these 2 grades. Conclusion: We found that a DL model can be trained to identify and grade GHOA on plain radiographs. Furthermore, we show that a DL model can identify and grade AVN on plain radiographs. The network performed well, particularly for definitive cases of GHOA and any level of AVN. However, challenges remain in distinguishing between none and mild GHOA grades.

Recent European Association of Urology (EAU) guidelines and a clinical prediction rule developed by Van Nieuwkoop et al. suggest simple criteria for performing radiological imaging for patients with a febrile urinary tract infection (UTI). We analysed the records of patients with a UTI from four hospitals in Switzerland. Of 107 UTI patients, 58% underwent imaging and 69% (95%CI: 59–77%) and 64% (95%CI: 54–73%) of them were adequately managed according to Van Nieuwkoop’s clinical rule and EAU guidelines, respectively. However, only 47% (95%CI: 33–61%) and 57% (95%CI: 44–69%) of the imaging performed would have been recommended according to their respective rules. Clinically significant imaging findings were associated with a history of urolithiasis (OR = 11.8; 95%CI: 3.0–46.5), gross haematuria (OR = 5.9; 95%CI: 1.6–22.1) and known urogenital anomalies (OR = 5.7; 95%CI: 1.8–18.2). Moreover, six of 16 (38%) patients with a clinically relevant abnormality displayed none of the criteria requiring imaging according to Van Nieuwkoop’s rule or EAU guidelines. Thus, adherence to imaging guidelines was suboptimal, especially when imaging was not recommended. However, additional factors associated with clinically significant findings suggest the need for a new, efficient clinical prediction rule.

Radiological imaging is essential for acute patient management in Intensive Care Units (ICUs); however, it introduces the risk of exposure to ionizing radiation. This review synthesizes research on radiation exposure in ICU settings, highlighting its rise during the COVID-19 pandemic and the rise in repetitive imaging. Our analysis extends to radiation safety thresholds, revealing that some ICU patients exceed the diagnostic reference level, emphasizing the need to balance diagnostic utility against potential long-term risks, such as cancer. Prospective studies have demonstrated an increase in the median cumulative effective dose in patients with trauma over time, prompting calls for improved awareness and monitoring. Moreover, innovative dose-reduction strategies and optimized protocols, especially in neuro-ICUs, promise to mitigate these risks. This review highlights the essential but risky role of radiological imaging in critical care. It advocates for rigorous radiation management protocols to safeguard patient health while ensuring the continuity of high-quality medical care.

Orbital lymphangioma is a rare benign lymphatic and vascular malformation, which is distinguished by its abnormal endothelial ducts and can cause proptosis in the patients. Radiological imaging is essential in confirming the diagnosis. Sclerotherapy is an alternative treatment option if surgery is not an option or is too risky. This report presents a rare case of a 4-year-old girl who had complained of bulging her right eye since she was 3 years old. Because surgery can be challenging to the surrounding vital orbital structure, the patient underwent several sclerotherapy sessions which yielded good results on the patient.

Primary pulmonary synovial sarcoma is a rare type of soft tissue tumor. Exceptionally it can occur during pregnancy, representing a challenge in management and treatment given its notable aggressiveness and the not infrequent incidence of maternal death. We report our case of metastatic recurrence of pulmonary synovial sarcoma during pregnancy, with the aim to emphasize the decision-making, diagnostic, and therapeutic multidisciplinary processes and the evolution of the pathology. Besides, we focused on the analysis of the limited literature data available on the topic. [ABSTRACT FROM AUTHOR]

Radiological imaging is essential for acute patient management in Intensive Care Units (ICUs); however, it introduces the risk of exposure to ionizing radiation. This review synthesizes research on radiation exposure in ICU settings, highlighting its rise during the COVID-19 pandemic and the rise in repetitive imaging. Our analysis extends to radiation safety thresholds, revealing that some ICU patients exceed the diagnostic reference level, emphasizing the need to balance diagnostic utility against potential long-term risks, such as cancer. Prospective studies have demonstrated an increase in the median cumulative effective dose in patients with trauma over time, prompting calls for improved awareness and monitoring. Moreover, innovative dose-reduction strategies and optimized protocols, especially in neuro-ICUs, promise to mitigate these risks. This review highlights the essential but risky role of radiological imaging in critical care. It advocates for rigorous radiation management protocols to safeguard patient health while ensuring the continuity of high-quality medical care. [ABSTRACT FROM AUTHOR]

This review presents a comprehensive analysis of pituitary adenomas, a type of brain tumor with diverse behaviors and complexities. We cover various treatment approaches, including surgery, radiotherapy, chemotherapy, and their integration with newer treatments. Key to the discussion is the role of biomarkers in oncology for risk assessment, diagnosis, prognosis, and the monitoring of pituitary adenomas. We highlight advances in genomic, epigenomic, and transcriptomic analyses and their contributions to understanding the pathogenesis and molecular pathology of these tumors. Special attention is given to the molecular mechanisms, including the impact of epigenetic factors like histone modifications, DNA methylation, and transcriptomic changes on different subtypes of pituitary adenomas. The importance of the tumor immune microenvironment in tumor behavior and treatment response is thoroughly analyzed. We highlight potential breakthroughs and innovations for a more effective management and treatment of pituitary adenomas, while shedding light on the ongoing need for research and development in this field to translate scientific knowledge into clinical advancements, aiming to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Die Radiologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Opening remarks: These guidelines are the result of discussions within a diverse group of RSA researchers. They were approved in December 2023 by the board and selected members of the International Radiostereometry Society to update the guidelines by Valstar et al. [1]. By adhering to these guidelines, RSA studies will become more transparent and consistent in execution, presentation, reporting, and interpretation. Both authors and reviewers of scientific papers using RSA may use these guidelines, summarized in the Checklist, as a reference. Deviations from these guidelines should have the underlying rationale stated.

Background and purpose: Adults treated surgically for lumbar disc herniation in adolescence have a higher degree of lumbar disc degeneration than controls. We aimed to establish whether the degree of lumbar degeneration differs at diagnosis or at follow-up between surgically and non-surgically treated individuals. Methods: We identified individuals with a lumbar disc herniation in adolescence diagnosed with magnetic resonance imaging (MRI) and contacted them for follow-up MRI. Lumbar degeneration was assessed according to Pfirrmann, Modic, and total end plate score (TEP score). Patient-reported outcome measures at follow-up comprised the Oswestry Disability Index (ODI), EQ-5D-3-level version, 36-Item Short Form Health Survey (SF-36), and Visual Analogue Scale (VAS) for back and leg pain. Fisher’s exact test, Mann–Whitney U tests, Wilcoxon tests, and logistic regression were used for statistical analysis. Results: MRIs were available at diagnosis and after a mean of 11.9 years in 17 surgically treated individuals and 14 non-surgically treated individuals. Lumbar degeneration was similar at diagnosis (P = 0.2) and at follow-up, with the exception of higher TEP scores in surgically treated individuals at levels L4–L5 and L5–S1 at follow-up (P ≤ 0.03), but this difference did not remain after adjustment for age and sex (P ≥ 0.8). There were no significant differences in patient-reported outcome measures between the groups at follow-up (all P ≥ 0.2). Conclusion: Adolescents with a lumbar disc herniation have, irrespective of treatment, a similar degree of lumbar degeneration at the time of diagnosis, and similar lumbar degeneration and patient-reported outcomes at long-term follow-up.

Background and purpose: We aimed to evaluate the long-term predictive value of radiographic abnormality and/or hip pain assessed 5 years following primary total hip arthroplasty (THA) and the occurrence of revision for aseptic loosening between 5 and 25 years postoperatively. Patients and methods: We included all primary THAs performed between 1996 and 2011 (same uncemented cup, polyethylene-ceramic bearing, 28 mm head, cemented stem) and prospectively enrolled in the institutional registry, for whom baseline and follow-up radiographs were available. At 5 years radiographically we assessed femoral osteolysis and/or stem migration. Pain was evaluated with the Harris Hip pain subscore. Kaplan–Meier survival and Cox regression analyses were performed. Results: 1,317 primary THAs were included. 25 THAs (2%) were revised for aseptic stem loosening. Any abnormal radiographic sign at 5 years was present in 191 THAs (14%). Occasional hip pain was reported by 20% and slight to severe pain by 12% of patients at 5 years. In patients < 60 years, 10 of the 12 later revised for aseptic stem loosening had abnormal radiographs at 5 years vs. 5 of the 13 later revised in those ≥ 60 years. Hazard ratios (HR) were 34 (95% confidence interval [CI] 7–155) in younger vs. 4 (CI 1–11) in the older group. HR for association of hip pain at 5 years with future revision was 3 (CI 1–5). Conclusion: The presence of abnormal radiographic signs 5 years after THA was strongly associated with later revision for aseptic stem loosening, especially in patients < 60 years. The association between pain at 5 years and future revision was much weaker.

Background and purpose: Pain in the sacroiliac joint may be caused by abnormal joint motion. Diagnosis is mainly based on clinical tests. The aims of this study were to examine whether low-dose computed tomography with provocation of the hip could detect sacroiliac joint motion, and to study whether provocation of the hip results in greater sacroiliac joint motion in the ipsilateral than in the contralateral sacroiliac joint. Patients and methods: 12 patients with sacroiliac joint pain were examined with low-dose computed tomography scans of the sacroiliac joint, one with the hips in the neutral position, and one each in provocation with the left or the right hip in a figure-of-4 position. Accuracy was tested by comparing internal rotation of the sacrum with internal rotation in the sacroiliac joint. Motion in the sacroiliac joint was assessed by comparing the position of each of the ilia with the reference, the sacrum. Data is shown as mean with 95% confidence interval (CI). Results: We observed greater motion in the sacroiliac joint than internally in the sacrum, i.e., 0.57° (CI 0.43–0.71) vs. 0.20° (CI 0.11–0.28). The motion of the geometric center of the moving object for the sacroiliac joint was larger on the provoked side; mean difference 0.17 mm (CI 0.01–0.33), P = 0.04. Corresponding figures for rotation were mean difference 0.19° (CI 0.10–0.28), P < 0.001. Compared with the sacrum, the largest motion was seen at the anterior superior iliac spine; mean difference 0.38 mm (CI 0.10–0.66), P = 0.001. Conclusion: Provocation in the figure-of-4 position of the hip results in sacroiliac joint motion measurable with computed tomography motion analysis. Provocation of the hip induces larger motion on the ipsilateral than on the contralateral sacroiliac joint.

Vernix caseosa peritonitis (VCP) is a rare condition previously thought to be a complication of Caesarean section caused by the spillage of amniotic fluid and or meconium into the maternal peritoneal cavity during operation.1 This triggered an inflammatory reaction symptom such as an acute abdomen. A total of 34 cases has been reported since 1976.2 Nine of the 10 cases reported have been diagnosed in postpartum period after uneventful Caesarean section and only three reported cases of antenatal leakage since in 1998.3 VCP following vaginal delivery was first reported in 2013, involving a 28 year old with one previous scar who developed acute abdomen symptoms as early as 3 hours post vacuum delivery, with initial diagnosis of possible uterine scar rupture.4 Here we report a case of VCP in a post spontaneous vaginal delivery who presented with impending catastrophe and survived the ordea. [ABSTRACT FROM AUTHOR]

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Introduction: Performance of routine chest X-rays (CXRs) in asymptomatic individuals to assess hyperbaric exposure risk is controversial. The radiation risk may overshadow the low yield in many settings. However, the yield may be higher in certain settings, such as tuberculosis-endemic countries. We evaluated the utility of routine CXR in diving and submarine medical examinations in South Africa. Methods: Records of 2,777 CXRs during 3,568 fitness examinations of 894 divers and submariners spanning 31 years were reviewed to determine the incidence of CXR abnormality. Associated factors were evaluated using odds ratios and a binomial logistic regression model, with a Kaplan-Meier plot to describe the duration of service until first abnormal CXR. Results: An abnormal CXR was reported in 1.1% per person year of service, yielding a cumulative incidence of 6.5% (58/894) of the study participants. Only four individuals had a clinical indication for the CXR in their medical history. A range of potential pathologies were seen, of which 15.5% were declared disqualifying and the rest (84.5%) were treated, or further investigation showed that the person could be declared fit. Conclusions: In South Africa, a routine CXR has a role to play in detecting abnormalities that are incompatible with pressure exposures. The highest number of abnormalities were found during the initial examinations and in individuals with long service records. Only four individuals had a clinical indication for their CXR during the 31-year span of our study. Similar studies should be performed to make recommendations in other countries and settings. [ABSTRACT FROM AUTHOR]

Background: Worldwide, one of the most common abdominal emergencies is appendicitis. Routine histopathological examination of appendectomy samples is not at all questioned. Aim of the study: Is to identify the results of the routine histopathological examinations of appendectomy specimens and to correlate them with the preoperative imaging tools. Subjects and methods: In a single secondary health care hospital, a retrospective analysis of 365 appendectomies, for patients operated initially for acute appendicitis, was carried out between April 2020 till April 2023. Demographic, imaging and histopathologic data were retrieved from the patients’ medical records. Results: Out of the studied patients, 95.3% were aged between 12-50 years. One third of the cases was females (32.1%). Laparoscopic appendectomy was operated for the majority of them (77%). Leukocytosis was significantly more frequent between those with positive appendicitis histopathologically. Positive appendicitis was reported between 96.4% of the histopathology reports. The most prevalent diagnosis was acute appendicitis, suppurative appendicitis, gangrenous appendicitis and perforation (50.7%, 41.6%, 2.5% and 1.6%; respectively). Negative appendectomy rate was 3.6%. In diagnosing acute appendicitis, Ultrasound (US) imaging had 66.7% accuracy rate while Computerized Tomography (CT) had a rate of 96.9%. Conclusion: It is evident that although histopathological examination is beneficial in acute appendicitis diagnosis, it advantageous in recognizing the unusual pathological findings. Negative appendectomy rate can be reduced by the use of modern diagnostic modalities, CT is advisable.

Background and purpose: Accurate measuring tools are essential in preoperative planning and for the study of the association between postoperative alignment and clinical outcome in total knee arthroplasty (TKA). We aimed to describe a simple method to measure preoperative hip–knee–femoral shaft (HKFS) angle and postoperative coronal alignment in TKA with the use of standard 3D CT and to compare preoperative HKFS angles and postoperative coronal alignment measured with the 3D CT technique and with standing long-leg hip–knee–ankle (HKA) radiographs. Patients and methods: HKA radiographs and 3D CT were taken preoperatively and 3 months after the operation in 121 knees. The interrater reliability for the 3D CT method was calculated with intra-class correlation coefficient (ICC). The preoperative HKFS angles and the postoperative deformity measured with the 2 methods were compared and illustrated on Bland–Altman plots, frequency tables, and by Cohen’s kappa coefficients (k). Results: The 3D CT method was feasible in all knees and the ICC was excellent. Mean (SD, range) difference in HKFS angle measured on HKA radiographs and on 3D CT was –0.3° (0.9°, –4.1° to 2.4°). Mean (SD, range) difference in postoperative deformity was 0.1° (1.6°, –5° to 6°). The 95% limits of agreement were 1.4° and –2° for HKFS and ±3° for postoperative alignment. The agreement in outlier (≥ 3°) identification was moderate with a k (95% confidence interval) of 0.48 (0.32–0.64). Conclusion: 3-dimensional computer tomography was feasible and was shown to be more accurate than traditional long-leg radiographs

Radiological imaging plays a crucial role in the detection and treatment of pancreatic ductal adenocarcinoma (PDAC). However, there are several challenges associated with the use of these techniques in daily clinical practice. Determination of the presence or absence of cancer using radiological imaging is difficult and requires specific expertise, especially after neoadjuvant therapy. Early detection and characterization of tumors would potentially increase the number of patients who are eligible for curative treatment. Over the last decades, artificial intelligence (AI)-based computer-aided detection (CAD) has rapidly evolved as a means for improving the radiological detection of cancer and the assessment of the extent of disease. Although the results of AI applications seem promising, widespread adoption in clinical practice has not taken place. This narrative review provides an overview of current radiological CAD systems in pancreatic cancer, highlights challenges that are pertinent to clinical practice, and discusses potential solutions for these challenges. [ABSTRACT FROM AUTHOR]

Background: Worldwide, one of the most common abdominal emergencies is appendicitis. Routine histopathological examination of appendectomy samples is not at all questioned. Aim of the study: Is to identify the results of the routine histopathological examinations of appendectomy specimens and to correlate them with the preoperative imaging tools. Subjects and methods: In a single secondary health care hospital, a retrospective analysis of 365 appendectomies, for patients operated initially for acute appendicitis, was carried out between April 2020 till April 2023. Demographic, imaging and histopathologic data were retrieved from the patients' medical records. Results: Out of the studied patients, 95.3% were aged between 12-50 years. One third of the cases was females (32.1%). Laparoscopic appendectomy was operated for the majority of them (77%). Leukocytosis was significantly more frequent between those with positive appendicitis histopathologically. Positive appendicitis was reported between 96.4% of the histopathology reports. The most prevalent diagnosis was acute appendicitis, suppurative appendicitis, gangrenous appendicitis and perforation (50.7%, 41.6%, 2.5% and 1.6%; respectively). Negative appendectomy rate was 3.6%. In diagnosing acute appendicitis, Ultrasound (US) imaging had 66.7% accuracy rate while Computerized Tomography (CT) had a rate of 96.9%. Conclusion: It is evident that although histopathological examination is beneficial in acute appendicitis diagnosis, it advantageous in recognizing the unusual pathological findings. Negative appendectomy rate can be reduced by the use of modern diagnostic modalities, CT is advisable. [ABSTRACT FROM AUTHOR]

Background: Forensic osteology, the scientific study of human skeletal remains, occupies a pivotal position in the realm of forensic science. Its significance lies in its capacity to unveil the hidden narratives within bones and offer critical insights into the identification of skeletal injuries. This research endeavors to illuminate the multifaceted role played by forensic osteology in the detection, analysis, and interpretation of injuries sustained by skeletal remains. Objective: This research explores the pivotal role of forensic osteology in assessing injuries related to the chest and pulmonology conducted at Qazi Hussain Ahmed Medical Complex, Nowshera - Pakistan. Methods: A diverse sample of 85 skeletal remains was systematically examined, incorporating techniques such as osteological assessment, radiological imaging, histological analysis, and statistical analysis. Demographic characteristics, trauma patterns, radiological findings, and histological insights were meticulously documented. Results: The findings unveiled a diverse spectrum of trauma patterns, with 49.4% of cases exhibiting skeletal trauma, including those relevant to the chest and pulmonary region. Radiological imaging was instrumental in uncovering hidden fractures in 32.9% of cases, with implications for chest injuries. Additionally, histological analysis allowed for the differentiation of recent and healed injuries in 53.3% of cases, shedding light on pulmonary trauma. Conclusion: Forensic osteology, as exemplified in this study, plays a crucial role in identifying skeletal injuries, particularly those related to the chest and pulmonology. Its multidisciplinary approach not only advances our understanding of trauma patterns in these regions but also significantly contributes to the resolution of forensic cases and disaster victim identification efforts. This research underscores the critical role played by forensic osteology in delivering justice, resolving unresolved cases, and providing closure to individuals and their families. [ABSTRACT FROM AUTHOR]

Abstract Background Aggressive Angiomyxoma is a benign, slowly growing, locally aggressive and recurrent tumour that occurs in the pelvic-perineal region of females in their reproductive years. It presents as a painless, soft, gelatinous mass and metastasizes rarely. Suspicion can be made based on clinical examination and radiological imaging but final diagnosis is confirmed only after histopathology and immunohistochemistry. The choice of treatment is surgical wide local excision. Case presentation We hereby present a case of a 19-year, unmarried lady, with a body mass index of 21 kg/m2, who presented with a chief complaint of painless mass in left vulva which progressively increased in size in the past one year. Clinical examination revealed a large, cauliflower like, exophytic mass of 10 cm × 10 cm size. Radiological imaging confirmed involvement of lymph nodes. Wide local excision with adequate tumour free margin and depth was used as a treatment modality. The diagnosis was confirmed via histopathological examination of the excised specimen. There is no recurrence in the patient up to date. Conclusion Aggressive Angiomyxoma is a rare tumour and it is most often misdiagnosed. This report highlights the importance of considering Aggressive Angiomyxoma as a differential diagnosis of vulval masses and the two-step surgical approach for its treatment in low resource setting.

Background. Ciliated hepatic foregut cysts (CHFCs) are uncommon cystic lesions within the liver. CHFCs can undergo a malignant transformation to form a primary squamous cell carcinoma of the liver. The true incidence and natural history of CHFCs is unknown and the risk of malignant transformation is unclear. We present a single centre's experience of CFHC management. Methods. A retrospective review of a departmental database identified all patients with CHFCs over a 4 year time period. Patients with CHFCs confirmed on histological assessment or suspected on radiological imaging were included in this study. Clinical information regarding patient demographics, symptomatic presentation, surgical management and histopathological features were noted. The radiological characteristics of CHFCs were recorded and the malignant transformation rate was calculated. Results. 15 patients with CHFC were identified (7 histologically confirmed and 8 radiologically suspected cases). All patients were asymptomatic and the CHFCs were incidental findings. No CHFC developed an interval change in cyst features or underwent a malignant transformation during follow up. MRI serves as the most sensitive modality to diagnose CHFC. Conclusions. CHFCs may be more prevalent than previously reported. Definitive management should encompass a patient centred discussion regarding the merits of long term follow up with serial imaging versus resection on an individual basis once CHFC is diagnosed. [ABSTRACT FROM AUTHOR]

Determining the shooting direction in gunshot wounds is very important, especially in cases where the number of suspects is more than one. In cases of gunshot wounds, a detailed anamnesis should be taken and an examination should be performed, it should be investigated whether the injury caused a bone fracture, and the diagnosis should be confirmed by radiological examinations. With the use of radiological examinations, the direction of the shot can be determined by evaluating the appearance of the metal fragments separated from the bullet core, which crashes into the bone tissue and bone fragments. Radiological imaging of a 32-year-old male patient who was injured in the left leg area with a firearm and was sent to Forensic Medicine Department of Medical School of Manisa Celal Bayar University to determine the shooting direction was evaluated. The case, whose entrance-exit holes were distinguished and the direction of the shot was determined by radiological imaging, is presented to guide the medicolegal evaluation. [ABSTRACT FROM AUTHOR]

Primary pulmonary synovial sarcoma is a rare type of soft tissue tumor. Exceptionally it can occur during pregnancy, representing a challenge in management and treatment given its notable aggressiveness and the not infrequent incidence of maternal death. We report our case of metastatic recurrence of pulmonary synovial sarcoma during pregnancy, with the aim to emphasize the decision-making, diagnostic, and therapeutic multidisciplinary processes and the evolution of the pathology. Besides, we focused on the analysis of the limited literature data available on the topic.

Aim: Patients with vertigo present to the emergency department with their clinical status and social comfort significantly impaired. More importantly, diseases that can pose a life-threatening risk may also underlying vertigo. In our study, we aimed to detect lifethreatening conditions in vertigo patients early, and to alleviate the economic burden by preventing unnecessary radiological imaging in emergency services. Materials and Methods: Three hundred eighteen patients were included in the study. The patients were divided into two groups as peripheral and central vertigo. Patients' age, sex, temperature, pulse, and arterial blood pressure values were examined. The complaints at admission were grouped as dizziness, dizziness+nausea-vomiting, and dizziness+ neurological complaint. Furthermore, patients' examination findings, history of diseases, and laboratory data were recorded. Radiological imaging methods used in the emergency department, the requested consultations, peripheral-central vertigo, and hospitalization-discharge status were examined. Results: Of all patients, 287 (90.3%) and 31 (9.7%) had peripheral and central vertigo, respectively. The mean age of patients with peripheral vertigo was 52.34±17.38 years, while the mean age of patients with central vertigo was 68.06±19.56 years. There was a statistically significant difference between peripheral-central vertigo and age. A statistically significant difference was revealed between peripheral-central vertigo and systolic and diastolic blood pressure. In laboratory data, we found a significant difference between peripheral-central vertigo and glucose and CRP. Hypertension was the most common disease in the history. Conclusion: The etiology of vertigo should be clarified quickly and reliably in emergency departments. To this end, the patient's complaints and the findings obtained as a result of the examination along with auxiliary radiological imaging methods are vital. Thus, the diagnosis and treatment of patients with severe vertigo will be performed earlier, and unnecessary radiological imaging will be prevented. As a result, the economic burden will also decrease with the decrease in the examinations performed. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a granulomatous disease of unknown etiology. At present the best diagnostic imaging procedure to assess stage and activity of sarcoidosis is controversial. We report the case of a 50-year-old male admitted with a history of dyspnea and fatigue with past medical history negative for smoking, occupational and environmental risk factors. Physical examination, routine blood tests, and pulmonary function tests were normal except for hypercalciuria. A chest radiograph showed bilateral hilar lymphadenopathy. Single photon emission computed tomography and/or computed tomography (SPECT and/or CT) In-111 Octreotide (Octreoscan) scintigraphy confirmed morphologic involvement of bilateral hilar lymph nodes and a mediastinoscopy biopsy specimen provided diagnosis of pulmonary sarcoidosis (stage 0). This clinical case shows the effectiveness of In-111 Octreotide SPECT and/or CT in the early diagnosis of pulmonary sarcoidosis.

Background and purpose: Aseptic loosening, mainly caused by migration, is one of the most common indications for revisions in unicompartmental knee arthroplasty (UKA). In this study, we investigated the early migration of the Persona Partial Knee (PPK, Zimmer Biomet, Warsaw, IN), a cemented medial fixed-bearing unicompartmental knee prosthesis, and evaluated the clinical results. Patients and methods: 26 primary PPKs were implanted. Radiographs were obtained direct postoperatively, at 6 weeks, 6, 12 and 24 months postoperatively. Migration of the femoral and tibial component was calculated using model-based radiostereophotogrammetric analysis (mRSA) in terms of translations and rotations. Patient-reported outcome measures (PROMs) were also registered. Results: At 24 months postoperatively, we found low migration of both the femoral and tibial component in the first 6 months, after which both components stabilized. Only the rotation of the tibial component about the z-axis did not stabilize. All PROMs improved after 24 months compared with preoperative PROMs. Conclusion: The Persona Partial Knee shows low migration of both the femoral and tibial component and PROMs were improved at 24 months follow-up. Long-term follow-up is needed to investigate the performance of the prosthesis compared with other prostheses.