Advanced Imaging Modalities Research Articles

Diagnosis and treatment of pneumocystis pneumonia - a review article

This study aims to comprehensively evaluate the literature on recent advances in the diagnosis and treatment of Pneumocystis Pneumonia (PCP). A thorough review of relevant literature was conducted. Data were sourced from electronic databases such as PubMed, Scopus, Google Scholar, and Medline, focusing on articles published within the last ten years. The review included 41 articles. The diagnosis of PCP has evolved with the development of molecular techniques, advanced imaging modalities, and artificial intelligence models. Trimethoprim-sulfamethoxazole (TMP-SMX) remains the mainstay of treatment. Corticosteroid adjunctive therapy (CAT) has demonstrated efficacy in improving outcomes, while emerging research suggests a potential role for immunomodulatory agents. Chemoprophylaxis with TMP-SMX remains the main stay of prevention in populations at risk. Despite advances in diagnostic technologies, treatment options for PCP have largely remained unchanged. There are currently no vaccines, and chemoprophylaxis remains the mainstay of prevention. Practical Immediate treatment is essential. New ELISA techniques are viable, while real-time PCR proves superior to nested PCR. Clinical judgment plays a critical role in supporting laboratory diagnoses. High-resolution CT scans may be warranted for evaluating immunosuppressed patients with suspected pneumonia when chest X-rays appear normal. Radiomics can assist in distinguishing PCP from other types of pneumonia in non-HIV patients. Trimethoprim-sulfamethoxazole remains the preferred treatment, with alternative options including dapsone with trimethoprim, clindamycin with primaquine, atovaquone, or pentamidine. Corticosteroid adjunct therapy (CAT) is beneficial in treating PCP, and chemoprophylaxis is essential for high-risk populations.

Transforming Heart Failure Management: The Power of Strain Imaging, 3D Imaging, and Vortex Analysis in Echocardiography.

Heart failure (HF) remains a critical global health challenge, necessitating advancements in diagnostic and therapeutic strategies. This review explores the evolution of imaging technologies and their impact on HF management, focusing on three-dimensional echocardiography (3DE), myocardial strain imaging, and vortex dynamics imaging. Three-dimensional echocardiography enhances traditional echocardiography by providing more accurate assessments of cardiac structures, while myocardial strain imaging offers the early detection of subclinical myocardial dysfunction, crucial in conditions such as chemotherapy-induced cardiotoxicity and ischemic heart disease. Vortex dynamics imaging, a novel technique, provides insights into intracardiac flow patterns, aiding in the evaluation of left ventricular function, valve diseases, and congenital heart anomalies. The integration of these advanced imaging modalities into clinical practice facilitates personalized treatment strategies, enabling the earlier diagnosis and more precise monitoring of disease progression. The ongoing refinement of these imaging techniques holds promise for improving patient outcomes and advancing the field of precision medicine in HF care.

Tricuspid Regurgitation Complicating Heart Failure: A Novel Clinical Entity.

With the escalating incidence of heart failure, accurate diagnosis is paramount for tailored therapeutic interventions. The tricuspid valve, particularly tricuspid regurgitation, once relegated as the "forgotten valve", has gained prominence due to increasing evidence implicating severe tricuspid valve disease in the prognosis of diverse cardiovascular conditions. This review delineates recent significant advancements in imaging modalities, transcatheter interventions, and epidemiological and pathophysiological insights regarding tricuspid regurgitation complicating heart failure. A comprehensive understanding of these innovative concepts and technologies can significantly improve patient outcomes.

The Current and Novel Imaging Modalities for Ocular Vasculitis in Behcet's Disease: A Review.

Behcet's syndrome is a multisystem inflammatory disorder characterized by a chronic relapsing course and diverse clinical manifestations, prominently affecting young adults along the ancient Silk Road and beyond. The disease pathogenesis involves complex interactions between genetic predisposition, environmental triggers, and dysregulated immune responses, leading to systemic vasculitis and tissue damage. Ocular involvement, a hallmark of Behcet's Disease (BD), significantly impacts morbidity, with uveitis as a common initial presentation that can progress to severe vision-threatening complications like retinal vasculitis and occlusive disease. This review consolidates current knowledge on ocular manifestations in BD, emphasizing the pivotal role of multimodal imaging in diagnostic evaluation and management. Fundus photography serves as a baseline tool for documenting intraocular lesions and monitoring treatment responses. Fluorescein angiography remains the gold standard for detecting acute inflammatory changes and vascular leakage patterns essential for disease staging and prognostication. Recent advancements in imaging, such as ultra-wide field imaging (UWF), indocyanine green angiography (ICGA), Doppler ultrasonography, Optical Coherence Tomography (OCT), OCT angiography (OCTA), adaptive optics (AO), and retinal function imaging (RFI), provide unprecedented insights into microvascular dynamics, structural changes, and functional impairments associated with ocular BD. Integration of these advanced imaging modalities enhances early detection of subclinical disease, facilitates precise localization of inflammatory lesions, guides therapeutic interventions, and monitors treatment efficacy. OCT and OCTA, in particular, offer non-invasive, high-resolution assessments of macular edema, vascular perfusion abnormalities, and choroidal thickness alterations critical for optimizing patient care. In conclusion, multimodal imaging represents the cornerstone in the comprehensive management of ocular manifestations in Behcet's Disease, offering clinicians invaluable tools for accurate diagnosis, treatment planning, and long-term monitoring of disease progression and treatment outcomes.

Prevalence of anatomic variations of temporomandibular joint on orthopantomogram and cone-beam computed tomography: A retrospective study

Maxillofacial radiography by means of orthopantamogram is used as a routine screening tool in the diagnosis and treatment planning in various fields of dentistry and is found to be less expensive when compared to other advanced imaging modalities like computed tomography, magnetic resonance imaging and cone-beam computed tomography. Morphological variations in the shape of mandibular condyle, coronoid process and sigmoid notch have been documented in the literature as indispensable aids in anthropological and forensic studies. 100 OPG and CBCT scans of same participants, comprising of 200 temporo-mandibular joints were evaluated for anatomical variations in shapes of mandibular condyle, coronoid process and sigmoid notch. The prevalence of various morphological variations were correlated with age and gender and subjected to statistical analysis. The most common shape of condyle, coronoid process and sigmoid notch on OPG was round, whereas on CBCT the most common shape of condyle, coronoid process and sigmoid notch were flat, triangular and wide respectively. Variations in the morphology of shape of mandibular condyle, coronoid process and sigmoid notch using panoramic radiographs can be tentatively used as a screening tool in human identification, owing to its ready availability and low cost.

Advanced Imaging Techniques in Preoperative Planning for Brain Tumor Resection: Evaluating the Impact on Surgical Precision and Neurological Outcomes

This study investigates advanced imaging techniques and their impact on surgical precision and neurological outcomes in preoperative planning for brain tumor resections. Selected studies include large human sample sizes, peer-reviewed research, systematic reviews, and meta-analyses focusing on advanced imaging techniques and their impact on surgical precision and neurological outcomes. Latest imaging modalities experiments on animal studies are considered. Systematic review of recent literature on advanced imaging modalities—such as MRI, fMRI, PET, and DTI—and their application in preoperative planning. Our findings suggest advanced imaging techniques, including Functional MRI, Ultra-High Field MRI, Diffusion Tensor Imaging (DTI), PET/CT and Deuterium Magnetic Resonance Spectroscopy (2H MRS) improve surgical precision and neurological outcomes in brain tumor resections by enhancing tumor targeting, reducing morbidity, and improving resection accuracy. Future advancements should focus on integrating and optimizing these technologies to further improve preoperative planning and patient-specific treatment strategies.

Integration of spectral computed tomography in arterial imaging.

Artery imaging, a crucial component in the diagnosis and management of vascular disease, assumes a significant role in the field of medical research. Utilizing advanced imaging modalities such as computed tomography (CT) and magnetic resonance angiography (MRA), artery imaging provides detailed insights into blood flow, detecting conditions such as atherosclerosis, aneurysms, and other vascular abnormalities with high precision. Spectral CT is an innovative imaging technique that goes beyond traditional CT scans, capturing data at multiple energy levels to provide detailed insights into the composition of tissues and materials within the scanned region. Notably, recent studies and clinical applications have underscored the diagnostic advantages offered by spectral CT in the detection and characterization of various arterial diseases. The integration of spectral CT into the realm of arterial imaging presents a promising avenue for improving the diagnosis and management of vascular disease. This comprehensive review aims to provide an extensive overview, delving into the potential benefits, optimization, challenges, and future of spectral CT in arterial imaging.

The Importance of Digital Lung Tomosynthesis in Overcoming Computed-Tomography-to-Body Divergence During Bronchoscopic Biopsies of Peripheral Lung Nodules.

The advent of robotic bronchoscopy coupled with electromagnetic navigation bronchoscopy (EMN) and shape-sensing technology have increased diagnostic yields for peripheral pulmonary nodules compared to traditional bronchoscopy. Yet, diagnostic yields from these bronchoscopic platforms still fall short of where they should be. This shortfall is in large part due to a lack of advanced imaging during peripheral bronchoscopy and computed tomography (CT)-to-body divergence (CTBD). Digital lung tomosynthesis (DLT) is an advanced imaging modality that helps overcome CTBD during bronchoscopic biopsies of lung nodules. DLT is a quasi-3D imaging technique, which reconstructs tomographic images of the lung from a series of 2D fluoroscopic projection images. These images can be acquired either using a digital flat panel fluoroscopy machine or a fluoroscopy machine with a more traditional image-intensifier present in most standard bronchoscopy suites. This review aims to explain the mechanisms of both CTBD and DLT to help diagnose early-stage lung cancer more effectively.

2024 Update of the TSOC Expert Consensus of Fabry Disease.

As an X-linked inherited lysosomal storage disease that is caused by α-galactosidase A gene variants resulting in progressive accumulation of pathogenic glycosphingolipid (Gb3) accumulation in multiple tissues and organs, Fabry disease (FD) can be classified into classic or late-onset phenotypes. In classic phenotype patients, α-galactosidase A activity is absent or severely reduced, resulting in a more progressive disease course with multi-systemic involvement. Conversely, late-onset phenotype, often with missense variants (e.g., IVS4+919G>A) in Taiwan, may present with a more chronic clinical course with predominant cardiac involvement (cardiac subtype), as they tend to have residual enzyme activity, remaining asymptomatic or clinically silent during childhood and adolescence. In either form, cardiac hypertrophy remains the most common feature of cardiac involvement, potentially leading to myocardial fibrosis, arrhythmias, and heart failure. Diagnosis is established through α-galactosidase enzyme activity assessment or biomarker analyisis (globotriaosylsphingosine, Lyso-Gb3), advanced imaging modalities (echocardiography and cardiac magnetic resonance imaging), and genotyping to differentiate FD from other cardiomyopathy. Successful therapeutic response relies on early recognition and by disease awareness from typical features in classic phenotype and cardiac red flags in cardiac variants for timely therapeutic interventions. Recent advances in pharmacological approach including enzyme replacement therapy (agalsidase alfa or beta), oral chaperone therapy (migalastat), and substrate reduction therapy (venglustat) aim to prevent from irreversible organ damage. Genotype- and gender-based monitoring of treatment effects through biomarker (Lyso-Gb3), renal assessment, and cardiac responses using advanced imaging modalities are key steps to optimizing patient care in FD.

Concussions in Soccer.

The identification, management, and prevention of concussion across all competitive sports and athletic populations has been a notable topic of research over the last decade. Soccer is no exception, with over a billion participants worldwide. In soccer, 3 distinct subsets of head injuries are often the contributors to concussion: head-to-equipment, head-to-surface, and head-to-player collisions. Recognition of concussion is crucial, and ideally made on the sideline during competitive play. Recently updated screening tools include the SCAT6 and ChildSCAT6, which are widely utilized at all levels of play. Management of concussion is divided into on-field and in clinic management. Initial management includes removal from the field of play. There is increased emphasis on earlier incorporation of exercise prescription as a means to improve recovery in the concussed athlete. While few objective diagnostic tests exist to identify concussion, many are in development, most notably advanced imaging and biomarker modalities.

Implementing safety standards in radiographic practices: challenges and solutions

Ensuring the safety of patients and healthcare workers in radiographic practices is a critical concern in modern healthcare. The use of ionizing radiation, while invaluable for diagnostic and therapeutic purposes, carries inherent risks that necessitate stringent safety standards. Despite advances in technology and regulatory frameworks, the consistent implementation of these safety standards remains a challenge across various healthcare settings. The discussion addresses the complexities of navigating diverse regulatory environments, where enforcement and adherence to safety guidelines can vary significantly. These inconsistencies are particularly pronounced in low-resource regions, where limited access to modern radiographic equipment and inadequate training further exacerbate the risks of radiation exposure. Technological advancements in radiography, such as digital radiography, dose-reduction software, and advanced imaging modalities, offer significant benefits in terms of diagnostic accuracy and efficiency. However, they also introduce new challenges in maintaining up-to-date safety protocols. The rapid pace of innovation often outstrips the ability of regulatory bodies to update guidelines, leading to gaps in safety practices. Additionally, the effectiveness of these technologies depends heavily on proper usage and understanding by radiographic professionals, highlighting the need for continuous education and training. A strong safety culture within radiographic practices is essential for minimizing radiation risks. Leadership commitment, ongoing education, effective communication, and the empowerment of radiographic professionals are critical components of this culture. When these elements are in place, they foster an environment where safety is prioritized, and all staff members are actively engaged in maintaining and improving safety standards. The multifaceted approach required to enhance radiographic safety underscores the importance of harmonizing regulatory efforts, investing in modern technologies, and cultivating a safety-first mindset among healthcare professionals. These efforts collectively contribute to the safe and effective use of radiographic technology, ultimately protecting both patients and healthcare workers from unnecessary radiation exposure.

Multimodality imaging of urinary tract tuberculosis.

Imaging is a key component of diagnosis and treatment response evaluation of urinary tract tuberculosis (UT TB). Tuberculosis can have a long latency, but if found early, one may have the opportunity to prevent complications such as ureteral strictures, obstructive nephropathy, contracted (thimble) bladder, renal parenchymal destruction/calcification, and renal failure. Imaging can aid in diagnosis and differential diagnoses, evaluate the extent of disease and complications, and guide image-directed biopsy, surgical planning, and evaluation of treatment response. Imaging abnormalities in the renal parenchyma and urinary tract at different stages of the disease, lymphadenopathy, and extra-urinary tract organ involvement are suggestive of UT TB. Recent advances in imaging modalities aid in UT TB diagnosis, follow-up, and guiding treatment.

Comparison of two different VMAT radiotherapy TPSs for pancreatic cancer using flattening filter free photon beam energy

BackgroundPancreatic cancer is a devastating disease with a poor prognosis, and radiation therapy plays a crucial role in its treatment and management. Conventional radiation therapy (RT) techniques have limitations in delivering adequate doses to the tumor while sparing surrounding normal tissues. However, modern RT techniques such as intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic body radiation therapy (SBRT) have led to the development of novel approaches that can reduce toxicity. The incorporation of advanced imaging modalities, like four-dimensional computed tomography (4D-CT) and magnetic resonance imaging (MRI), enables enhancement of tumor control and improves conformality and treatment outcomes. Additionally, using flattening filter-free (FFF) beams can further enhance treatment efficiency and efficacy. PurposeThis study aims to compare two different VMAT techniques using two different treatment planning systems (TPSs), Monaco and Eclipse, in the treatment of pancreatic cancer II stage infiltrating duct carcinoma patients using an FFF photon beam. Materials and methods20 pancreatic cancer II stage infiltrating duct carcinoma patients were retrospectively analyzed, and each patient's plans were designed using the two TPSs. The dose distribution of the target using 6 MV FFF for TrueBeam-Varian and organs at risk (OARs) were compared. The monitor unit (MU), treatment time, conformity (CI), and homogeneity (HI) indices were also evaluated. ResultsFor pancreatic cancer patients, the mean dose of the planning target volume (PTV) in the Monaco plan was lower than the Eclipse plan. The plan evaluation parameters in Monaco and Eclipse were similar without significant differences (p-value = 0.152). The Monaco plan was better than the Eclipse plan regarding mean dose and V15Gy of the kidneys; the spinal cord was lowest in the Monaco plan, and the maximum dose and V45Gy of the spinal cord were 592.1 cGy and 1.37% lower than the Eclipse plan, respectively. ConclusionThe VMAT Monaco plan is a favorable TPS for pancreatic cancer patients, providing improved sparing of critical organs while maintaining adequate target coverage.

Preoperative planning of total ankle prosthesis – What are we aiming at?

IntroductionAnkle osteoarthritis poses significant challenges, affecting patients’ quality of life and often necessitating surgical intervention. Total ankle replacement (TAR) has emerged as an effective treatment, in patients with post-traumatic arthritis. Precise preoperative planning is crucial for achieving optimal outcomes in TAR procedures. This article explores the use of advanced imaging techniques, virtual modeling, and surgical strategies in preoperative planning for TAR. MethodsThe preoperative planning process involves thorough patient assessment, including clinical examination and imaging studies such as Weight Bearing CT scans (WBCT) and MRI. Classification systems like the Canadian Orthopedic Foot & Ankle Society (COFAS) classification help guide treatment decisions and staging of procedures. Virtual foot/ankle models derived from WBCT scans enable accurate assessment of deformities and facilitate precise implant positioning. DiscussionOptimal TAR outcomes rely on restoring normal ankle anatomy and function while addressing associated deformities and pathology. Precise alignment, joint congruency, and rotational positioning of implant components are Important considerations. Virtual planning allows for simulation of implant placement and axis correction, aiding surgical decision-making and predicting outcomes. However, it has limitations in predicting soft tissue effects and final implant size. ConclusionPreoperative planning plays a important role in TAR procedures, understanding optimal implant placement. Advanced imaging modalities, classification systems, and virtual modeling techniques enhance surgical precision. Continued refinement of preoperative planning strategies is essential for further advancing TAR outcomes and patient satisfaction.10.1016/j.fuspru.2024.07.001

Gliomagenesis, Epileptogenesis, and Remodeling of Neural Circuits: Relevance for Novel Treatment Strategies in Low- and High-Grade Gliomas.

Gliomas present a complex challenge in neuro-oncology, often accompanied by the debilitating complication of epilepsy. Understanding the biological interaction and common pathways between gliomagenesis and epileptogenesis is crucial for improving the current understanding of tumorigenesis and also for developing effective management strategies. Shared genetic and molecular mechanisms, such as IDH mutations and dysregulated glutamate signaling, contribute to both tumor progression and seizure development. Targeting these pathways, such as through direct inhibition of mutant IDH enzymes or modulation of glutamate receptors, holds promise for improving patient outcomes. Additionally, advancements in surgical techniques, like supratotal resection guided by connectomics, offer opportunities for maximally safe tumor resection and enhanced seizure control. Advanced imaging modalities further aid in identifying epileptogenic foci and tailoring treatment approaches based on the tumor's metabolic characteristics. This review aims to explore the complex interplay between gliomagenesis, epileptogenesis, and neural circuit remodeling, offering insights into shared molecular pathways and innovative treatment strategies to improve outcomes for patients with gliomas and associated epilepsy.

Charting the Unseen: How Non-Invasive Imaging Could Redefine Cardiovascular Prevention.

Cardiovascular diseases (CVDs) remain a major global health challenge, leading to significant morbidity and mortality while straining healthcare systems. Despite progress in medical treatments for CVDs, their increasing prevalence calls for a shift towards more effective prevention strategies. Traditional preventive approaches have centered around lifestyle changes, risk factors management, and medication. However, the integration of imaging methods offers a novel dimension in early disease detection, risk assessment, and ongoing monitoring of at-risk individuals. Imaging techniques such as supra-aortic trunks ultrasound, echocardiography, cardiac magnetic resonance, and coronary computed tomography angiography have broadened our understanding of the anatomical and functional aspects of cardiovascular health. These techniques enable personalized prevention strategies by providing detailed insights into the cardiac and vascular states, significantly enhancing our ability to combat the progression of CVDs. This review focuses on amalgamating current findings, technological innovations, and the impact of integrating advanced imaging modalities into cardiovascular risk prevention, aiming to offer a comprehensive perspective on their potential to transform preventive cardiology.

Deciphering the Radiation Dose Summary Page in Interventional Fluoroscopy.

Fluoroscopy is an advanced medical imaging modality that utilizes x-rays to acquire real-time images throughout a medical examination. It is commonly used in various procedures such as in interventional radiology, cardiac catheterization, and gastrointestinal and genitourinary studies. While fluoroscopy is a valuable diagnostic and therapeutic tool, it exposes patients and medical staff to ionizing radiation, which carries health risks. A radiation dose summary page is a report generated by the fluoroscope that displays important information about the procedure. It provides an overview of the radiation doses administered during a fluoroscopic procedure, as well as certain technical parameters used during the irradiation events. The contents of a radiation dose summary page may vary depending on the make and model of the fluoroscope but some common elements include the cumulative reference air kerma, which serves as a surrogate of radiation dose delivered to the patient, and the dose-area product, which takes account of the x-ray beam area and is a measure of the total amount of energy imparted on the patient. Other imaging acquisition parameters may be also included in the dose summary page, including tube voltage, tube current, pulse width, pulse rate, spectral filters, primary and secondary angles, and source-to-image distance. The radiation dose summary page for fluoroscopy is a useful tool for physicians, technologists, and medical physicists, allowing them to comprehend the technical details of a fluoroscopically guided procedure. ©RSNA, 2024.

Exploring Angiogenesis and Artificial Intelligence in Alzheimer’s Disease: Implications for Early Detection and Therapeutic Strategies

Background: Alzheimer’s disease (AD) presents a significant global health challenge, affecting millions and imposing substantial socioeconomic burdens, with healthcare costs exceeding US$100 billion annually. The disease's complexity is underscored by its slow progression and the pivotal role of amyloid plaques in its pathology. Despite advancements in understanding AD, critical questions regarding the mechanisms of amyloid plaque development and their relationship with neuroinflammation and angiogenesis remain. Methods: This study employed advanced imaging techniques and artificial intelligence (AI) to investigate the interplay between amyloid beta (Aβ) accumulation, neuroinflammation, and angiogenesis in AD. Magnetic resonance imaging (MRI) facilitated detailed assessments of brain structure alterations, while machine learning models enhanced diagnostic accuracy by analyzing imaging data and identifying patterns linked to disease progression. Results: The findings revealed a significant association between Aβ deposition and increased angiogenesis, contributing to neurovascular dysfunction and exacerbating neuroinflammation. AI-driven analyses demonstrated improved diagnostic capabilities, detecting early changes in brain structure associated with mild cognitive impairment (MCI) and AD. Specifically, convolutional neural networks (CNNs) such as AlzheimerNet achieved remarkable accuracy in distinguishing AD from other neurodegenerative conditions. Conclusion: This research underscores the multifaceted nature of AD, highlighting the critical roles of amyloid plaques, neuroinflammation, and angiogenesis. The integration of AI and advanced imaging modalities offers promising avenues for early diagnosis and intervention, potentially transforming patient management strategies. Continued exploration of these pathways may yield effective therapeutic targets to mitigate the progression of AD and enhance patient outcomes.

CEREBRAL RADIONECROSIS IN PATIENTS IRRADIATED FOR CAVUM CANCER: RETROSPECTIVE STUDY OF 15 CASES

Introduction: Cerebral radionecrosis is a rare but a serious complication induced by radiotherapy of the nasopharyngeal cancer. Since nasopharyngeal cancer is common to have skull base infiltration, radiation fields cover inevitably the temporal lobes despite the use of the more advanced intensity-modulated radiotherapy (IMRT). Even though the development of imaging means and the systematic practice of CT and MRI in post-therapeutic monitoring, the diagnosis and treatment of cerebral remain challenging. Materiel and Method:A retrospective study including fifteen cases of cerebral radionecrosis occurring after radiotherapy of cavum cancer, based on data from 382 irradiated for cavum cancer during the period from January 2017 to January 2022 and who were regularly followed in post-therapeutic monitoring. Results: The incidence of cerebral radionecrosis in our patients was 3,9%. The average age of patients was 47.5 years (range 28 - 62 years), with a female predominance (sex ratio: 4M/11F = 0.36). All our patients were followed for locally advanced UCNT of the cavum (73% stage IVA and 27 % stage III). 80% of cases have benefited from conformal radiotherapy technique by intensity modulation (VMAT archtherapy). And all cases have had concomitant chemotherapy. Cerebral radionecrosis occurred after an average delay of 31.6 months (11-77 months) from the end of irradiation. The location of the cerebral radionecrosis lesions was temporal in all our patients. Exploring dosimetric data of our patients, we noted that in 58% of cases the dose constraint at the level of the temporal lobe affected by radionecrosis was not respected. Cerebral radionecrosis was initially discovered on MRI of the cavum, a brain MRI was subsequently requested to show areas of cerebral radionecrosis. Spectroscopy was carried out in 33% of patients. Cerebral radionecrosis was treated with corticosteroid therapy in 53% of cases. After a mean follow-up of 19.8 months (2-63 months) the evolution of cerebral radionecrosis in patients irradiated fornasopharyngeal cancer, was marked by radiological stability without the appearance of clinical symptoms in 53% of cases. Conclusion: Cerebral radionecrosis of radiation-treated cavum patients could be a devastating complication. Furthermore, the differential diagnosis remains challenging and may require the use of advanced imaging modalities. The intricate relationship between dose parameters and radionecrosis incidence requires large-scale longitudinal studies. Despite the fact that there is no definitive treatment for cerebral radionecrosis, bevacizumab has proven to be an encouraging treatment option.

Recent Advances in the Management of Non-rheumatic Atrial Fibrillation: A Comprehensive Review.

Atrial fibrillation (AF) is a prevalent cardiac arrhythmia characterized by irregular atrial electrical activity, posing significant challenges to patient management and healthcare systems worldwide. Non-rheumatic AF, distinct from AF due to rheumatic heart disease, encompasses a spectrum of etiologies, including hypertension, coronary artery disease, and structural heart abnormalities. This review examines the latest advancements in managing non-rheumatic AF, encompassing diagnostic approaches, pharmacological therapies, and innovative non-pharmacological interventions. Diagnostic strategies ranging from traditional electrocardiography to advanced imaging modalities are explored alongside emerging biomarkers and wearable technologies facilitating early detection and management. Pharmacological management options, including novel anticoagulants and rhythm control agents, are evaluated in light of current guidelines and recent clinical trials. Non-pharmacological interventions, such as catheter ablation and device-based therapies, are discussed regarding their evolving techniques and outcomes. Special considerations for diverse patient populations, including elderly individuals and athletes, are addressed, emphasizing personalized approaches to optimize therapeutic outcomes. The review concludes with insights into future directions for AF management, highlighting promising avenues in gene therapy, regenerative medicine, and precision medicine approaches. By synthesizing recent research findings and clinical innovations, this review provides a comprehensive overview of the dynamic landscape of non-rheumatic AF management, offering insights for clinicians, researchers, and healthcare stakeholders.