Imaging Assessment Research Articles

Rectus Abdominis Muscle Endometriosis: A Unique Case Report with a Literature Review

Introduction and importance: Extrapelvic endometriosis, confined exclusively to the body of the rectus abdominis muscle, is a rare form of abdominal wall endometriosis. While its etiopathology remains unclear, it is often diagnosed in healthy women who present with atypical symptoms and localization unrelated to any incision site, or in the absence of a history of endometriosis or previous surgery. Presentation of the case: Here, we describe a unique case of intramuscular endometriosis of the rectus abdominis muscle in a healthy 39-year-old Caucasian woman. The condition was located away from any prior incisional scars and presented without typical symptoms or concurrent pelvic disease, making diagnostic imaging unclear. After partial surgical resection of the endometriotic foci, the diagnosis was confirmed histologically. Progestogen-based supportive medication was initiated to prevent the need for additional surgeries and to reduce the risk of recurrence. After 6 years of follow-up and continued progestogen treatment, the patient remains symptom-free and has shown no recurrence of the disease. Clinical discussion: Endometriosis of the rectus abdominis muscle exhibits specific characteristics in terms of localization, etiopathology, symptomatology, and diagnostic imaging, suggesting that it should be considered a distinct clinical entity. Conclusions: Although rare, primary endometriosis of the rectus abdominis muscle should be included in the differential diagnosis for women of childbearing age. Early diagnosis is essential to avoid delayed recognition, tissue damage, and to minimize the risk of recurrence or malignant transformation. Given the increasing frequency of gynecologic and laparoscopic surgeries worldwide, it is crucial to establish standardized reporting protocols, follow-up timelines, and imaging assessments during specific phases of the menstrual cycle. Standardization will help raise awareness of this disease, and further our understanding of its pathogenesis, risk factors, recurrence patterns, and potential for malignant transformation—factors that are still not fully understood.

A hypocaloric protein-rich diet before metabolic surgery improves liver function in patients with obesity and diabetes

PurposeObesity and type 2 diabetes (T2DM) are major risk factors for hepatic steatosis. Diet or bariatric surgery can reduce liver volume, fat content, and inflammation. However, little is known about their effects on liver function, as evaluated here using the LiMAx test.MethodsIn the MetaSurg study (RCT on the effects of different Roux-en-Y gastric bypass (RYGB) limb lengths on diabetes remission in patients with BMI ≥ 27 to ≤ 60 kg/m2 and T2DM; trial registration: DRKS00007810, German Clinical Trials Register Freiburg), 24 consecutive patients underwent liver function (LiMAx) and imaging assessments (MRI, transient elastography; TE) before and after diet and surgery. Two weeks before surgery, the patients received a hypocaloric protein-rich diet.ResultsNine of 18 patients had a pathologic LiMAx value (≤ 315 µg/kg/h) at baseline. After two weeks of diet, LiMAx values improved (p = 0.01, paired t test, n = 15). LiMAx values further recovered six months after RYGB (p = 0.01, paired t test, n = 15), which was accompanied by decreased liver volumes (p = 0.005, paired t test, n = 10), proton density fat fraction (p = 0.003, paired t test, n = 12), and TE measurements (p = 0.032, paired t test, n = 14). The need for medical diabetes treatment decreased from 100 to 35%.ConclusionLiver function improved after a two-week hypocaloric protein-rich diet and metabolic surgery in patients with obesity and T2DM. These data suggest that a two-week diet for this group of patients prior to abdominal surgery could improve a presumably impaired liver function.

Enhancing safety in CT-guided lung biopsies: correlation of MinIP imaging with pneumothorax risk prediction

ObjectivesThis study aimed to evaluate whether minimum-intensity projection (MinIP) images could predict complications in CT-guided lung biopsies.MethodsWe retrospectively analyzed 72 procedures from January 2019 to December 2023, categorizing patients by pneumothorax and the severity of hemorrhage (grade 2 or higher). Radiodensity measurements were performed using lung window (LW) and MinIP (10-mm slab) images. Regions of interest (ROIs) were placed at sites of the lowest density along the biopsy pathway. Absolute values were recorded, categorized by a radiodensity level of −850 HU, and assessed using our bridged radiological observations with measurement-optimized model (BROM-OLB) model with validation from three additional ROIs. Emphysema was visually scored. Statistical analysis included univariate analysis (Fisher’s exact and Mann–Whitney U-tests) and binomial logistic regression to identify confounders.ResultsLower radiodensity values in MinIP images in the access route, particularly with the BROM-OLB MinIP method, were significantly associated with a higher risk of pneumothorax (5/39, 13% vs 27/33, 82%, p < 0.01; Sensitivity 81.8% and Specificity 87.2%). Pneumothorax was more common with longer procedures (p < 0.05). Lower LW density values correlated with higher pulmonary hemorrhage rates (p < 0.01). Binomial logistic regression identified positive BROM-OLB MinIP results (OR 28.244, 95% CI: 7.675–103.9, p < 0.01) and lower LW density (OR 0.992, 95% CI: 0.985–0.999, p = 0.025) as independent risk factors. The optimal threshold values to predict pneumothorax were −868 HU in MinIP images and −769 HU in LW.ConclusionThe assessment of MinIP images is superior, and in combination with relative quantitative measurement of radiodensity for access route planning, it can reduce the risk of pneumothorax in CT-guided lung biopsies.Critical relevance statementThis article critically evaluates the risk factors for complications in CT-guided lung biopsies, highlighting the potential of MinIP images for predicting pneumothorax risk, thereby advancing clinical radiology practices to improve patient safety and reduce healthcare costs.Key PointsThis work investigates if MinIP images efficiently predict CT-guided lung biopsy complications.MinIP imaging identified higher pneumothorax risk post-CT lung biopsy with superior accuracy.Our method detects high-risk lung changes linked to pneumothorax without additional software.Graphical

Multimodality Imaging Assessment of a Multi-Organ Hydatid Cyst.

Multimodality Imaging Assessment of a Multi-Organ Hydatid Cyst.

Accuracy of interpretation of nasogastric tube position on chest radiographs by diagnostic radiographers: A multi-case, multi-reader study

IntroductionFeeding via a misplaced nasogastric tube (NGT) is a common but preventable cause of patient harm. The aim of this study was to determine the accuracy of diagnostic radiographers’ assessment of NGT position on chest radiographs (CXRs) and safe-to-feed decisions. MethodsA multi-case, multi-reader study was conducted using an online image interpretation platform. A test bank consisting of 15 CXRs with an NGT in-situ was created. Diagnostic radiographers without formal qualifications in CXR interpretation were recruited via two international conferences. Participants placed an electronic marker on each CXR to identify the location of the tip of the NGT and indicated whether or not they believed that the tube was safely positioned. Results68 participants were recruited. Each participant reviewed 15 CXRs, providing 1020 unique image assessments. 76 % (n = 778/1020) image assessments were completely correct (both the position of the tip of the NGT was accurately located and an appropriate safe-to-use decision made). In 5 % (n = 56/1020) of cases the NGT was safely positioned and the location of the tip was correctly identified by the participant but the tube was erroneously determined to be unsafe for feeding. In a further 6 % (n = 59/1020) of cases the participant correctly located the tip of an NGT in an unsafe position but indicated that the tube was safe to use. Participants failed to correctly identify the tip of the NGT in the remaining 12 % (n = 127/1020) of cases. ConclusionConsistent with previous studies involving other staff groups, diagnostic radiographers without formal qualification in CXR interpretation can assess NGT positioning on radiographs with moderate accuracy but require further training, including strategies for the identification of poorly-visualised tube tips, to achieve the 100 % accuracy necessary for this safety-critical task. Implications for practiceA bespoke training programme which includes teaching on image quality, tube tip identification and assessment of tube positioning using the National Patient Safety Agency (NPSA) four criteria, should be delivered prior to implementation of a radiographer-led NGT CXR evaluation service.

Evaluating the pathological and clinical implications of errors made by an artificial intelligence colon biopsy screening tool

ObjectiveArtificial intelligence (AI) tools for histological diagnosis offer great potential to healthcare, yet failure to understand their clinical context is delaying adoption. IGUANA (Interpretable Gland-Graphs using a Neural Aggregator) is...

Effects of bright light therapy on cingulate cortex dynamic functional connectivity and neurotransmitter activity in young adults with subthreshold depression.

The neurobiological mechanisms behind the antidepressant effect of bright light therapy (BLT) are unclear. We aimed to explore the dynamic functional connectivity (dFC) changes of the cingulate cortex (CC) in subthreshold depression (StD). The StD participants (38 BLT and 39 placebo) underwent resting-state functional magnetic resonance imaging (rs-fMRI) and mood assessment before and after eight-week BLT. Seed-based whole-brain dFC analysis was conducted and multivariate regression model was adopted to predict Hamilton Depression Rating Scale (HDRS) and Centre for Epidemiologic Studies Depression Scale (CESD) scores changes after BLT. JuSpace toolbox was used to calculate the associations between dFC and neurotransmitter activity in the BLT group. BLT group showed decreased CESD and HDRS scores. Also, BLT group showed increased dFC of the right supracallosal anterior cingulate cortex (supACC)-right temporal pole (TP), left middle cingulate cortex (MCC)-right insula, and left supACC-pons, and decreased dFC of the right supACC- right middle frontal gyrus (MFG). Changes in dFC of the right supACC-right TP showed positive correlation with changes in CESD and HDRS. Moreover, combining the baseline dFC variability of the CC could predict HDRS changes in BLT. Finally, compared to baseline, the supACC and MCC dFC changes showed significant correlations with the neurotransmitter activities. BLT alleviates depressive symptoms and changes the CC dFC variability in StD, and pre-treatment dFC variability of the CC could be used as a biomarker for improved BLT treatment in StD. Furthermore, dFC changes with specific neurotransmitter systems after BLT may underline the antidepressant mechanisms of BLT.

Clinical insights into cross-sectional imaging integration in radiography education

IntroductionClinical practice is a critical component of radiography curricula, offering students with essential skills and training for proficient practice. Educational institutions are challenged to review and develop strategies to meet evolving service demands regularly. This study aims to gain insight into the inclusion of cross-sectional imaging within pre-registration radiography training. MethodsAn online questionnaire, based on previous European Federation of Radiographer Societies (EFRS) surveys, included closed-ended questions and ascertained the level of qualification, cross-sectional imaging incorporation, and tasks and assessments within programmes. The questionnaire was distributed through the EFRS Research Hub at the European Congress of Radiology (ECR) 2023 and online via social media. Closed-ended questions were summarised using descriptive statistics. ResultsResponses were received from 64 individual radiography educators across 29 different countries. Fifty-seven respondents (91.9 %) reported including cross-sectional imaging training in their institution's pre-registration radiography programme. An increase in the amount of time dedicated to clinical training in cross-sectional imaging was reported by 24 respondents (42.1 %). Overall, 32 individuals (53.3 %) stated that CT is a specialised modality, and dedicated training should be for radiographers once they obtain their basic qualifications. In contrast, 36 respondents (61 %) agreed that MRI should also be reserved as a specialised modality. ConclusionStudy findings indicate a lack of consistency among pre-registration radiography programmes in terms of how they include cross-sectional imaging in their curricula. Differing opinions on this issue are likely to be guided by national standards and workforce requirements upon qualification. Implications for practiceVariations in training curricula can present significant challenges for graduates. To align with the most recent Standards of Proficiency, curricula must be regularly reviewed and updated. Such Standards now typically require radiographers to perform a range of CT scans, including those of the head, C-spine, chest, and abdomen. Therefore, integrating comprehensive training in cross-sectional imaging into pre-registration education is crucial to ensure that future professionals meet these essential competencies and are fully prepared for their roles.

Three-Year Outcomes of a US Pivotal Trial Substudy for Conformable Endoprosthesis in >=10 mm Non-Angulated Neck Anatomy

To report the midterm clinical outcomes from the GORE® EXCLUDER® Conformable AAA Endoprosthesis system (EXCC) pivotal regulatory trial in the United States (U.S.). This is a prospective, multicenter, investigational device exemption clinical trial at 31 US. sites with Core Laboratory assessment of imaging and independent adjudication of safety. The study enrolled patients with abdominal aortic aneurysms (AAA) with a minimum proximal landing zone ≥10mm and proximal neck angulation of ≤60 degrees between December 2017 and February 2019 as part of a larger study to gain indications of the EXCC device. Endpoints included patient survival, freedom from secondary interventions, and stent-graft related outcomes. There were 80 patients enrolled (88.8% male, mean 73.5± 8.14 years-old). Mean maximum aortic diameter was 57.7±8.0mm (range, 42.5-82.7). There was 100% freedom from type I and III endoleak and aneurysm-related mortality at 36-months. Freedom from secondary intervention was 91.9± (0.83, 0.96, 95% C.I.) at 36-months. There were no device fractures, migrations (≥10mm), or aneurysm ruptures. At 36months, thirteen patients (26.5%) had type 2 endoleak, 32 patients (58.2%) had AAA sac regression, 17 (30.9%) had no change in diameter, and 6 (10.9%) had sac enlargement. Seven patients (8.8%) through 36months underwent reintervention. The 3-year outcomes have continued to show an adequate safety and efficacy profile of the EXCC device with no aneurysm related mortality or Type I/III endoleak. These results demonstrate durability for an EVAR device in US regulatory trials.

Computed Tomographic Assessment of the Main Abdominal Vessels in Dogs.

Computed tomographic (CT) characterisation of abdominal vessels is poorly studied. The objectives of this retrospective study were to assess during growth, by CT angiography, the evolution of the aorta (Ao), caudal vena cava (CVC), portal vein (PV), length of the second lumbar vertebra (L2) and different ratios between these structures; and to determine the influence of weight and age on the vessels' sizes and ratios. The first group included six beagles scanned every month from 4 to 12 months old, then every 3 months up to 24 months old. The second group included 26 dogs of different breeds and weights that were considered haemodynamically normal. These dogs were divided into three weight intervals: < 10, 10-30 and > 30 kg. The measurements were repeated three times by three operators. The diameter of the Ao, CVC and PV, the aortic length and the L2 length increased up to 7 months. Similarly, the different ratios, such as CVC/Ao, VP/Ao, Ao/L2 and CVC/L2, were variable up to 7 months old and became stable after 7 months. The diameter of the Ao, CVC and PV, the previously cited ratios and L2 length were variable between weight intervals but stable within one interval. The adult vascular standards and ratios published in the literature should not be used in medium-size dogs younger than 7 months old. As variability is observed between the weight intervals, measurements should be used with care in very small or very large dogs.

Changes in Cerebral Hemodynamics and Progression of Subclinical Vascular Brain Disease: A Population-Based Cohort Study.

Cerebral hypoperfusion is associated with vascular brain injury and neurodegeneration, but their longitudinal relationship is largely unknown, especially in healthy older adults. We investigated the longitudinal relationship between cerebral hemodynamics and subclinical vascular brain disease in community-dwelling older adults without stroke or dementia at baseline. Participants underwent brain magnetic resonance imaging scans every 3 to 4 years between 2005 and 2016. Cerebral blood flow (CBF) was measured through 2-dimensional phase-contrast magnetic resonance imaging; the cerebrovascular resistance index (CVRi) was defined as the ratio of mean arterial blood pressure to total CBF. Simultaneous progression in subclinical brain disease was evaluated through repeated magnetic resonance imaging assessment of white matter hyperintensities (WMH), cerebral microbleeds, lacune, and brain atrophy. The longitudinal relationship was estimated using generalized estimating equations, with adjustment for age, sex, smoking habits, body mass index, systolic blood pressure (for CBF measures), lipid level, history of diabetes and cardiovascular disease, and the baseline burden of magnetic resonance imaging markers. Among 3623 older adults (mean age, 61.4±9.3 years; 54.6% women), large decreases and increases in CBF and increases in CVRi over time were associated with white matter hyperintensity progression. The risk ratios for white matter hyperintensity progression were 1.36 (95% CI, 1.19-1.55) for large decreases in total CBF (lowest quartile), 1.02 (95% CI, 0.91-1.14) for moderate decreases (second quartile), and 1.28 (95% CI, 1.14-1.45) for large increases (highest quartile), compared with stable CBF (third quartile). The corresponding risk ratios for changes in CVRi were 1.13 (95% CI, 1.00-1.30), 1.25 (95% CI, 1.09-1.43), and 1.33 (95% CI, 1.16-1.52) for the second to fourth (versus lowest) quartiles, respectively, showing a dose-response relationship. The changes in CBF also demonstrate a similar U-shaped association with the progression of brain atrophy and incident microbleeds, whereas increases in CVRi were associated with lower microbleed risk. Longitudinal changes in CBF and CVRi may capture distinct pathophysiologies linking cerebral hemodynamics to subclinical brain disease, extending beyond single-time point measurements.

Explainable AI improves task performance in human–AI collaboration

Artificial intelligence (AI) provides considerable opportunities to assist human work. However, one crucial challenge of human–AI collaboration is that many AI algorithms operate in a black-box manner where the way how the AI makes predictions remains opaque. This makes it difficult for humans to validate a prediction made by AI against their own domain knowledge. For this reason, we hypothesize that augmenting humans with explainable AI improves task performance in human–AI collaboration. To test this hypothesis, we implement explainable AI in the form of visual heatmaps in inspection tasks conducted by domain experts. Visual heatmaps have the advantage that they are easy to understand and help to localize relevant parts of an image. We then compare participants that were either supported by (a) black-box AI or (b) explainable AI, where the latter supports them to follow AI predictions when the AI is accurate or overrule the AI when the AI predictions are wrong. We conducted two preregistered experiments with representative, real-world visual inspection tasks from manufacturing and medicine. The first experiment was conducted with factory workers from an electronics factory, who performed assessments of whether electronic products have defects. The second experiment was conducted with radiologists, who performed assessments of chest X-ray images to identify lung lesions. The results of our experiments with domain experts performing real-world tasks show that task performance improves when participants are supported by explainable AI with heatmaps instead of black-box AI. We find that explainable AI as a decision aid improved the task performance by 7.7 percentage points (95% confidence interval [CI]: 3.3% to 12.0%, ) in the manufacturing experiment and by 4.7 percentage points (95% CI: 1.1% to 8.3%, ) in the medical experiment compared to black-box AI. These gains represent a significant improvement in task performance.

Advantages to interspace-level analyses over person-level analyses when studying relationships between lumbar spinal degeneration findings : a cross-sectional study.

To examine associations between lumbar intervertebral disc degeneration (LDD) and type II Modic changes (MC) when retaining information at each interspace ("interspace-level analysis"), as compared to aggregating information across interspaces as is typically done in spine research ("person-level analysis") . The study compared results from (1) interspace-level analyses assuming a common relationship across interspaces (the "interspace-level, common-relationship" approach), (2) interspace-level analyses allowing for interspace-specific associations (an "interspace-level, interspace-specific" approach), and (3) a conventional person-level analytic approach. Adults in primary care (n=147) received lumbar spine magnetic resonance imaging (MRI) and neuroradiologist-evaluated assessments of prevalent disc height narrowing (DHN), type II MC, and other LDD parameters. Analyses examined associations between DHN and type II MC in interspace-level, common-relationship analyses, interspace-level, interspace-specific analyses, and conventional person-level analyses. Cross-sectional, interspace-level, common-relationship analyses found large-magnitude DHN-type II MC associations (adjusted OR [aOR]=6.5, 95% confidence intervals (CIs) 3.3-13; p<0.001). The magnitude of this association was larger and more precise than that yielded by person-level analyses (aOR=2.9 [95% CI 1.2-7]), and substantially more precise than interspace-level, interspace-specific analyses which allowed the association between DHN and type II MC to vary across levels. Across exploratory analyses of disc signal intensity and other MC types, interspace-level, common-relationship analyses produced larger-magnitude and more precise associations than person-level analyses in most situations, and were more precise than interspace-level, interspace-specific analyses. Interspace-level analytic approaches offer some advantages to person-level analyses that may be useful in understanding relationships between spinal degeneration findings.

Внутрішньосудинна візуалізація, оцінка коронарної фізіології та перкутанна терапія в пацієнта з уразливою атеросклеротичною бляшкою в коронарній артерії

Coronary artery disease (CAD) is one of the leading causes of mortality and morbidity worldwide, requiring modern approaches to diagnosis and treatment. Coronary angiography has long been considered the «gold standard» for diagnosing CAD; however, this method does not account for the functional significance of stenoses. The 2024 European Society of Cardiology (ESC) guidelines emphasize the importance of intravascular imaging and coronary physiology assessment as key diagnostic methods. This article describes a clinical case of a patient in whom coronary angiography revealed suspected destabilization of an atherosclerotic plaque, leading to the development of acute coronary syndrome. Through the use of modern technologies, including fractional flow reserve (FFR), diastolic hyperemia-free ratio (DFR) and intravascular ultrasound (IVUS), the key pathophysiological stages of plaque destabilization were documented, successful coronary stenting was performed, and myocardial blood flow was restored. This clinical case highlights the importance of innovative approaches to the diagnosis and treatment of vulnerable plaques and confirms their relevance in contemporary cardiology practice.

IMPACT OF IMAGING METHODS ON THE DIFFERENTIAL DIAGNOSIS OF LOCAL COMPLICATIONS IN ACUTE PANCREATITIS

The aim of this study is to evaluate the diagnostic value of imaging methods in identifying the morphological characteristics of local complications of acute pancreatitis and to establish indications for their use, thereby optimizing the resource utilization of medical institutions. Materials and Methods. This study analyzed the examination and treatment outcomes of 116 patients with local complications of acute pancreatitis. Visual assessment of pancreatic changes and associated local complications was performed using transabdominal ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) with intravenous contrast enhancement. Results. The diagnostic capabilities of ultrasound examination and computed tomography (CT) were comparable for detecting the edematous form of acute pancreatitis with local complications. However, for the necrotic form of acute pancreatitis, CT and magnetic resonance imaging (MRI) proved to be more informative than ultrasound in visualizing the extent and boundaries of inflammation, enabling precise measurement of lesion size. Ultrasound and MRI were particularly effective in assessing the internal architecture of localized fluid collections. Both MRI and CT demonstrated high diagnostic value in identifying acute pancreatitis and its local complications. Across all stages of the disease, imaging methods (ultrasound, CT, and MRI) were highly informative in detecting local complications. Conclusion. The progression and nature of morphological changes in acute pancreatitis with local complications can be accurately determined by comparing pancreatic and peripancreatic tissue changes observed on CT, ultrasound, or MRI. An optimized imaging assessment algorithm enhances the timing and selection of surgical treatment approaches for patients with acute pancreatitis and local complications while promoting the efficient use of technical resources within medical institutions.

Evaluating the effectiveness of cone-beam computed tomography reverse contrast images in the diagnosis of vertical root fractures: An in vitro pilot study

Abstract Introduction: The aim of this study is to investigate the effectiveness of cone-beam computed tomography (CBCT) reverse contrast images in the diagnosis of vertical root fractures (VRFs). Materials and Methods: In this study, 20 single-canal premolar teeth without cracks and internal resorption were selected and after root canal treatment, divided into two: experimental and control groups. In each of the teeth in the experimental group, an artificial fracture was created with the SANTAM device, then the teeth of both groups were randomly placed in the dental sockets of a dry mandible, and after preparing CBCT images of the teeth, the images were processed by reverse contrast software. Initial and reverse contrast images were examined by two radiologists and two endodontists. The data were analyzed by SPSS software version 22. Results: Observers reported higher sensitivity and positive and negative predictive value in normal contrast images than in reverse contrast images, but the specificity reported by endodontists in reverse contrast images was slightly higher than in normal contrast images. In comparing the results of radiologists and endodontists, there was a significant agreement in the review of the initial images (κ =0/59), but there was no significant agreement in the images with reverse contrast (κ = −0/1). There was not any notable distinction observed in the assessment of normal and reverse contrast images among the observers, nor in the comparison between radiologists and endodontists, except for the examination of normal contrast images by the two groups of radiologists and endodontists (P = 0.00). From this, it can be inferred that the diagnostic power of reverse contrast images in identifying VRFs is inferior to that of normal contrast images (P &gt; 0.05). Conclusion: According to the obtained results, it was concluded that reverse contrast CBCT images are not effective in diagnosing VRFs and cause error in diagnosis.

Investigation of organs dosimetry precision using ATOM phantom and optically stimulated luminescence detectors in computed tomography

The primary objective of this study was to compare organ doses measured using optically stimulated luminescent dosimeters (OSLDs) with those estimated by the CT-EXPO software for common CT protocols. An anthropomorphic ATOM phantom was employed to measure organ doses across head, chest, and abdominal CT scans performed on a Hitachi Supria 16-slice CT scanner. These OSLD measurements were then compared to the estimates provided by the widely used CT-EXPO software. Organ doses were assessed using OSLDs placed in an adult anthropomorphic phantom, with calibration performed through a comprehensive process involving multiple tube potentials and sensitivity corrections. Results from three CT acquisitions per protocol were compared to estimates provided by CT-EXPO software. Findings reveal significant discrepancies between measured and estimated organ doses, with p-values consistently below 0.05 across all organs. For head CT, measured eye lens doses averaged 33.51 mGy, 6.0% lower than the estimated 35.65 mGy. In chest CT, the thyroid dose was 9.82 mGy, 13.5% higher than the estimated 8.65 mGy. For abdominal CT, the liver dose measured 12.11 mGy, 9.6% higher than the estimated 11.05 mGy. Measured doses for the rest of organs were generally lower than those predicted by CT-EXPO, showing some limitations in current estimation models and the importance of precise dosimetry. This study highlights the potential of OSLD measurements as a complementary method for organ dose assessment in CT imaging, emphasizing the need for more accurate organ dose measurement to optimize patient care.

Endoscopic Epidurolysis for the Management of Chronic Spinal Pain: A Delphi-Based Italian Experts Consensus.

Endoscopic epidurolysis (EE) is a minimally invasive procedure used to manage chronic spinal pain, particularly in cases unresponsive to traditional treatments. Despite its growing recognition, the literature lacks comprehensive guidelines on its optimal use. This study utilized a modified Delphi approach to gather expert consensus on best practices for EE in the Italian pain therapy network. The study's scientific board conducted an extensive literature review to define key investigation topics, including clinical indications, preoperative assessments, and technical aspects of EE. A semi-structured questionnaire was developed and administered to a panel of experts. A two-round Delphi process was implemented, with consensus defined as at least 70% agreement on a 7-point Likert scale (agree or strongly agree). Statements that did not reach consensus in the first round were rephrased and resubmitted in the second round. Twenty-six clinicians participated in the study, with a 100% response rate in both rounds. In the first round, consensus was achieved for 9 out of 19 statements. In the second round, 8 out of 10 rephrased statements reached the consensus threshold. Key areas of agreement included the clinical indications for EE, the importance of preoperative imaging and anesthetic assessments, and the use of specific techniques and tools for EE. However, consensus was not reached on the use of EE for disc herniation with radicular pain and the safety of interlaminar access compared to sacral hiatus access. The study highlights the need for standardized protocols in EE to ensure consistent and effective treatment of chronic spinal pain. The consensus reached by the expert panel provides a framework for best practices, which can guide clinical decision-making and improve patient outcomes. Further research is necessary to validate these findings and address areas where consensus was not achieved.

Contrast-enhanced ultrasound for diagnosing testicular infarction: Findings from a retrospective cohort analysis.

This study aims to evaluate the ultrasonographic features associated with testicular infarction, determine the diagnostic effectiveness of contrast-enhanced ultrasound (CEUS) in assessing the testicular vascular system, and investigate the etiological factors contributing to testicular infarction. A retrospective analysis was performed involving 12 patients with confirmed testicular infarction. Each participant underwent standard superficial ultrasound examinations, followed by CEUS. The acquired imaging data were subsequently analyzed, taking into consideration the clinical conditions preceding the imaging assessments. A total of 13 lesions were detected across the 12 patients, with 1 individual exhibiting bilateral infarcts in the left testis. Based on the CEUS imaging findings, a classification system was developed to categorize the lesions into 4 distinct types: mediastinal branch infarction, small vessel infarction, capillary infarction, and mixed testicular infarction. This classification system offers a structured approach for understanding and potentially mitigating the causes of testicular infarction. CEUS markedly improves the diagnostic accuracy for testicular infarction and serves as a crucial tool in both the diagnosis and etiological assessment of this condition.

Cineangiography versus standard digital subtraction angiography in mechanical thrombectomy: lowering the radiation exposure without sacrificing the outcome

BackgroundEndovascular thrombectomy has become a standard procedure for the treatment of acute ischemic stroke caused by large vessel occlusion. Radiation exposure to the patient and operators during mechanical thrombectomy procedures...