Imaging Assessment Research Articles

An evaluation of a checklist in musculoskeletal radiographic image interpretation when using artificial intelligence.

Artificial intelligence (AI) is being used increasingly in image interpretation tasks. Human reliance on technology and bias can cause decision errors. A checklist, used with the AI to mitigate against such biases, may optimise the use of AI technologies and promote good decision hygiene. A checklist to aid radiographic image interpretation for radiographers using AI for image interpretation was formed. This study investigates the effect of a checklist for musculoskeletal (MSK) radiographic image assessment when using AI interpretive assistance. Radiographers were asked to interpret five MSK examinations with AI feedback. They were then provided with the checklist and asked to reinterpret the same five examinations with the AI feedback (n = 140 interpretations). During the interpretation sessions, participants were asked to provide a diagnosis and a confidence level on the diagnosis provided. Participants were then asked to complete a questionnaire to gain feedback on the use of the checklist. Fourteen radiographers were recruited. Nine participants found the checklist alongside the AI most useful and five participants found the AI element to be most useful on its own. Five participants found the AI feedback to be useful as it helped to critique the radiographic image interpretation more closely and rethink their own initial diagnosis. The checklist for use with AI in MSK image interpretation contained useful elements to the user, but further developments can be made to enhance its use in clinical practice.

Assessing the stability of photon-counting CT: insights from a 2-year longitudinal study.

Among the advancements in computed tomography (CT) technology, photon-counting computed tomography (PCCT) stands out as a significant innovation, providing superior spectral imaging capabilities while simultaneously reducing radiation exposure. Its long-term stability is important for clinical care, especially longitudinal studies, but is currently unknown. This study sets out to comprehensively analyze the long-term stability of a first-generation clinical PCCT scanner. Over a 2-year period, from November 2021 to November 2023, we conducted weekly identical experiments utilizing the same multi-energy CT protocol. Throughout this period, notable software and hardware modifications were meticulously recorded. Various tissue-mimicking inserts were scanned weekly to rigorously assess the stability of Hounsfield Units (HU) and image noise in Virtual Monochromatic Images (VMIs) and iodine density maps. Spectral results consistently demonstrated the quantitative stability of PCCT. VMIs exhibited stable HU values, such as variation in relative error for VMI 70 keV measuring 0.11% and 0.30% for single-source and dual-source modes, respectively. Similarly, noise levels remained stable with slight fluctuations linked to software changes for VMI 40 and 70 keV that corresponded to changes of 8 and 1 HU, respectively. Furthermore, iodine density quantification maintained stability and showed significant improvement with software and hardware changes, especially in dual-source mode with nominal errors decreasing from 1.44 to 0.03 mg/mL. This study provides the first long-term reproducibility assessment of quantitative PCCT imaging, highlighting its potential for the clinical arena. Question Photon-counting CT (PCCT) provides critical spectral imaging for improved diagnostic accuracy, but its long-term quantitative stability over time is still unknown. Findings The clinical PCCT system demonstrated stable Hounsfield Units (HU) and image noise over 2 years, ensuring reliable quantitative imaging and improving diagnostic accuracy. Clinical relevance This study showcased the exceptional value of PCCT in diagnostic radiology, particularly for its application in longitudinal studies.

The Clinical Features and Surgical Outcomes of Traumatic Optic Neuropathy in Pediatric Patients.

This study aimed to examine the clinical features and assess the surgical outcomes of traumatic optic neuropathy in pediatric patients. A retrospective analysis was conducted on the clinical data of 15 cases (17 eyes) of traumatic optic neuropathy in pediatric patients aged 1 to 6 years between January 2015 and July 2024. Two of them presented with binocular trauma, resulting in a total of 17 affected eyes. The injuries were attributed to various causes: 4 cases resulted from falls, 5 from car accidents, and 6 from localized impact trauma. Of the 15 patients (17 eyes), 10 patients (12 eyes) demonstrated postoperative improvement. Preoperatively, 3 eyes had residual vision, all of which revealed improvement following surgery. Among the 14 eyes with no light perception, 9 exhibited postoperative improvement. In one case (1 eye), where the interval between trauma and surgery was within 7 days, treatment was effective postoperatively. In 14 cases (16 eyes), where the interval exceeded 7 days, 11 eyes revealed postoperative improvement. Radiologic examination revealed optic canal fractures or optic nerve swelling in 6 cases. All patients underwent surgical intervention: 1 patient (1 eye) underwent transnasal endoscopic left orbital apex decompression combined with left periorbital hematoma evacuation, while 14 patients (16 eyes) underwent transnasal endoscopic optic nerve decompression. Imaging assessments should be integrated into the diagnostic process to help in selecting the most appropriate surgical approach for pediatric patients with traumatic optic neuropathy. Transnasal endoscopic optic nerve decompression significantly enhances the prognosis in these cases.

Dedifferentiated Liposarcoma of Kidney: A Rare Entity

Liposarcoma is an uncommon mesenchymal tumor. There are several histological variants. Dedifferentiated liposarcoma is often located retroperitoneally. Renal localization is exceptional. In this article, we report a case of primary renal dedifferentiated liposarcoma treated by radical total nephrectomy. Imaging assessment suspected a malignant tumor. It was the histological examination with an immunohistochemical complement that confirmed the diagnosis of dedifferentiated renal liposarcoma. The prognosis remains poor.

Return to Sport in Professional Athletes After Cartilage Restoration Surgery of the Knee: A Systematic Review and Meta-Analysis Demonstrates Gender Inequality and the Need for Improved Reporting.

To synthesize the literature concerning return to sport (RTS) and related outcomes after cartilage restoration surgery of the knee in professional athletes. Cochrane, PubMed, and OVID/Medline databases were queried for data pertaining to RTS after knee cartilage surgery in professional athletes. Demographic information, cartilage lesion characteristics, and RTS-specific information were extracted. Freeman-Tukey Double-Arscine Transformations with Dersimonian-Laerd random-effects estimators were constructed to quantitatively describe the cumulative incidence of RTS, while heterogeneous data described narratively. Eleven studies (476 athletes; mean age 27.5 ± 2.1 years; 96.6% male) were included. Nine (81.8%) studies investigated a form of microfracture as treatment, with 6 (54.5%) performing isolated microfracture. The remaining studies investigated osteochondral allograft transplantation and mosaicplasty. More than half (n = 6; 54.5%) did not report cartilage lesion location or size. The pooled RTS rate was 84.3% (95% CI: 75.4%-91.8%) at a mean 39.9 (range, 12-104) weeks postoperatively. In 6 studies reporting competition level, a trend toward returning to a lower than pre-injury level was observed. The definition of RTS was only provided in 6 (54.5%) studies, while the criteria for RTS was only reported in 2 (18.2%) studies, suggesting limited transparency. One study reported an objective imaging assessment of reparative tissue, while none reported formal RTS testing protocols or minimum RTS timeline. Although the majority of professional athletes are reported to achieve a successful RTS after cartilage restoration surgery of the knee, the literature predominantly reflects microfracture treatment. Current limitations in this literature include a substantial lack of female representation and infrequent reporting of cartilage lesion characteristics, rehabilitation and RTS criteria, and objective imaging assessments of reparative tissue.

Novel Otolaryngological and Radiological Manifestations in GAPO Syndrome.

GAPO syndrome is an exceptionally-rare autosomal recessive disorder characterized by growth retardation, alopecia, pseudoanodontia, and optic abnormalities, with fewer than 60 cases reported globally. We present the first documented case in Syria, highlighting novel otolaryngological and radiological findings that expand the clinical spectrum of this syndrome. A 27-year-old male presented with chronic right-sided otalgia, unilateral conductive hearing loss, and persistent sinonasal symptoms. Examination revealed hallmark features of GAPO syndrome, including craniofacial anomalies, external auditory canal stenosis, and pseudoanodontia. Computed tomography demonstrated total aplasia of the paranasal sinuses and mastoid air cells-findings not previously reported in GAPO syndrome. Audiological evaluation revealed moderate conductive hearing loss attributed to external auditory canal stenosis and eustachian tube dysfunction, contrasting with the predominantly-sensorineural hearing loss reported in earlier cases. Additionally, unique ophthalmic findings, including peripheral congenital cataracts and a myelinated retinal nerve fiber layer, were observed. This case underscores the importance of comprehensive evaluations, including advanced imaging and audiological assessments, in identifying subtle or atypical manifestations of GAPO syndrome. It also highlights challenges in airway management due to craniofacial anomalies. The findings emphasize the necessity for a multidisciplinary approach to optimize care and improve outcomes in patients with GAPO. Further research is needed to clarify genotype-phenotype correlations and refine diagnostic criteria.

Case report: Detecting giant cell arteritis in [68Ga]Ga-DOTA-Siglec-9-PET/CT

ObjectivesThis study aimed to evaluate the diagnostic utility of [68Ga]Ga-DOTA-Siglec-9 positron emission tomography-computed tomography (PET/CT) in assessing disease activity in a patient experiencing a relapse of giant cell arteritis (GCA).Case presentationA 90-year-old male patient with GCA, diagnosed in 2018, was enrolled. Demographic data, disease history, and laboratory parameters, including soluble VAP-1 (sVAP-1) levels, were recorded. The patient underwent a [68Ga]Ga-DOTA-Siglec-9 PET/CT scan. Additional imaging assessments included vascular ultrasound of the superficial temporal arteries, their branches, and the facial, axillary, subclavian, carotid, and vertebral arteries, along with magnetic resonance imaging (MRI) of the aorta.The patient’s sVAP-1 level was 284 ng/ml compared to 123 ng/ml in the control group (SD ± 55). The [68Ga]Ga-DOTA-Siglec-9 PET/CT scan revealed increased tracer uptake (SUVmax) in the subclavian artery (2.5), aortic arch (2.9), and heart (2.9). Notably, the increased uptake in the descending aorta (3.5) abruptly diminished to 2.2 when passing the diaphragm, with no changes in vessel caliber observed in CT. The injection of [68Ga]Ga-DOTA-Siglec-9 was well tolerated. Aortic MRI revealed no signs of inflammatory involvement.ConclusionsThis study introduces the first application of [68Ga]Ga-DOTA-Siglec-9 PET/CT in a patient with GCA experiencing a relapse, revealing enhanced tracer uptake in the subclavian artery and aortic arch with a localized and abrupt reduction, absent in conventional imaging. These findings suggest that [68Ga]Ga-DOTA-Siglec-9 PET/CT has significant potential for precise, inflammation-specific detection of affected vascular tissue in GCA during relapse.

Basal cell carcinoma: A report of a case in the upper lip

Basal cell carcinoma (BCC) is a malignant epithelial tumor that develops from the basal cell layer of the epidermis. It is predominantly found in older adults, with a high incidence in people aged 40 to 80. This form of cancer rarely metastasizes but is known to be locally invasive. In this report, we present a case of a 43-year-old male with a swelling on his upper lip. After thorough clinical, histopathological, and imaging assessments, a BCC was confirmed. He underwent full excision of the lesion with the surrounding tissue to ensure clear margins.

Good functional outcome but high rates of instability recurrence after posterior open‐wedge glenoid osteotomy for the treatment of posterior shoulder instability with increased glenoid retroversion at mid‐term follow‐up

AbstractPurposeTo evaluate clinical, functional and radiological mid‐term outcomes following posterior open‐wedge glenoid osteotomy (POWGO) for the treatment of posterior shoulder instability (PSI) associated with increased glenoid retroversion.MethodsPatients who underwent POWGO for the treatment of symptomatic PSI with glenoid retroversion >10° and participated in a previous study assessing short‐term outcomes were included after a minimum follow‐up of 5 years. Clinical (Rowe score and physical examination) and functional outcomes (Oxford Shoulder Instability Score [OSIS] and visual analogue scale [VAS] for pain) were assessed. Preoperative versus follow‐up magnetic resonance imaging (MRI) assessments were compared for changes in posterior humeral head subluxation (PHHS) and progression of osteoarthritis (shoulder osteoarthritis severity [SOAS] score).ResultsEight patients (nine shoulders) were included 92.0 months (88.0–109.5 months) post‐operatively, of which seven patients (eight shoulders) underwent MRI. Shoulder function was good (Rowe score: 80.0 [76.3–91.3], OSIS: 41.0 [31.0–41.5]) and pain levels were low (VAS for pain: 3.0 [1.0–3.0]) at follow‐up. Overall, the degree of PHHS did not change between preoperatively and follow‐up (p > 0.05). Four shoulders demonstrated PHHS preoperatively, of which two had a centred humeral head at follow‐up. Shoulder osteoarthritis progressed significantly (SOAS score: 17.0 [11.0–24.5] to 33.0 [31.0–45.0], p = 0.018). Residual PSI was evident in 75.0% of shoulders.ConclusionAt mid‐term follow‐up, POWGO for PSI associated with increased glenoid retroversion led to good functional outcomes but failed to reliably restore posterior shoulder stability and prevent osteoarthritis progression.Level of EvidenceLevel IV.

Automated Assessment of the Pulmonary Artery-to-Ascending Aorta Ratio in Fetal Cardiac Ultrasound Screening Using Artificial Intelligence.

The three-vessel view (3VV) is a standardized transverse scanning plane used in fetal cardiac ultrasound screening to measure the absolute and relative diameters of the pulmonary artery (PA), ascending aorta (Ao), and superior vena cava, as required. The PA/Ao ratio is used to support the diagnosis of congenital heart disease (CHD). However, vascular diameters are measured manually by examiners, which causes intra- and interobserver variability in clinical practice. In the present study, we aimed to develop an artificial intelligence-based method for the standardized and quantitative evaluation of 3VV. In total, 315 cases and 20 examiners were included in this study. We used the object-detection software YOLOv7 for the automated extraction of 3VV images and compared three segmentation algorithms: DeepLabv3+, UNet3+, and SegFormer. Using the PA/Ao ratios based on vascular segmentation, YOLOv7 plus UNet3+ yielded the most appropriate classification for normal fetuses and those with CHD. Furthermore, YOLOv7 plus UNet3+ achieved an arithmetic mean value of 0.883 for the area under the receiver operating characteristic curve, which was higher than 0.749 for residents and 0.808 for fellows. Our automated method may support unskilled examiners in performing quantitative and objective assessments of 3VV images during fetal cardiac ultrasound screening.

Automated Pediatric Brain Tumor Imaging Assessment Tool from CBTN: Enhancing Suprasellar Region Inclusion and Managing Limited Data with Deep Learning

Automated Pediatric Brain Tumor Imaging Assessment Tool from CBTN: Enhancing Suprasellar Region Inclusion and Managing Limited Data with Deep Learning

Comprehensive diagnostic and therapeutic approaches to uterine teratoma in postmenopausal women: a case study and review.

Uterine teratomas are extremely rare in postmenopausal women and pose significant challenges in diagnosis and treatment. This study reports a case of a 54-year-old postmenopausal woman diagnosed with a uterine teratoma during a routine gynecological ultrasound. The study aims to explore the diagnosis and treatment of uterine teratomas in postmenopausal women through detailed imaging assessment and hysteroscopy surgery, aiming to enhance the understanding of this rare uterine tumor and improve patient treatment outcomes and quality of life. This study utilized hysteroscopic surgery to excise a mass initially suspected to be a uterine fibroid and performed pathological analysis. The analysis revealed the presence of fat and hair, confirming the diagnosis of a mature benign uterine teratoma. Additionally, the study includes a literature review summarizing the clinical characteristics, diagnostic methods, and treatment strategies for uterine teratomas. Hysteroscopic surgery effectively identified and removed the complex uterine teratoma. Pathological analysis confirmed the teratoma contained various mature tissues, including neural tissue, bone, and cartilage. Comparative analysis of imaging features with surgical outcomes helped propose more precise diagnostic criteria and treatment guidelines. Hysteroscopy surgery plays a crucial role in diagnosing uterine teratomas in postmenopausal women and showcases its advantages of minimal trauma and quick recovery in treatment. In addition, the literature review emphasizes the diagnostic challenges of uterine teratomas in clinical practice, particularly in expanding clinical awareness of the differences between premenopausal and postmenopausal presentations. It also summarizes the diagnostic and treatment strategies for rare uterine masses, contributing to the improved recognition of these rare cases.

Advancing neural aesthetic assessment of artistic images based on bundle features integration

Advancing neural aesthetic assessment of artistic images based on bundle features integration

A Novel Image-Based Assessment for Pork Quality Classification via Electrochemical Impedance Combined With Sensory Evaluation.

Rapid detection of pork quality has garnered increasing attention due to its status as one of the most widely consumed meats in the world. This study developed an electrochemical impedance combined with sensory evaluation method to achieve real-time imaging and quality assessment of pork. The optimal parameters for pork detection were determined through system performance tests and a Design of Experiment, which included the use of an adjacent excitation pattern, an excitation current of 15 mA at 10 kHz, a detector diameter of 5 cm, and stainless-steel electrodes embedded in the pork. This method facilitated real-time imaging, evaluated the distribution of lean and fat, and accurately distinguished different qualities, demonstrating strong correlation with sensory assessments. Furthermore, it could assess pork with varying levels of freshness, achieving a distinguishing index of 99.93. Hence, this approach holds promising potential for applications in the domain of meat quality assessment.

Evaluating the efficacy of AI systems in diabetic retinopathy detection: A comparative analysis of Mona DR and IDx-DR.

To compare two artificial intelligence (AI)-based Automated Diabetic Retinopathy Image Assessment (ARIA) softwares in terms of concordance with specialist human graders and referable diabetic retinopathy (DR) diagnostic capacity. Retrospective comparative study including 750 consecutive diabetes mellitus patients imaged for non-mydriatic fundus photographs. For each patient four images (45 degrees field of view) were captured, centered on the optic disc and macula. Images were manually graded for severity of DR as no DR, any DR (mild non-proliferative diabetic retinopathy [NPDR] or more), referable DR (RDR (more than mild DR)), or sight-threatening DR (severe NPDR or more severe disease and/or clinically significant diabetic macular edema [CSDME]). IDx-DR and MONA DR output was compared with manual grading and with each other. Total sample size was 750 patients, of which 55 were excluded due to ungradable images. Out of the remaining 695 patients 522 (75%) were considered as having no DR by manual consensus grading, and 106 (15%) as having RDR. Agreement between raters varied between moderate to substantial. IDx-DR showed moderate agreement with human grading (k = 0.4285) while MONA DR had substantial agreement (k = 0.6797). Out of 106 patients with a ground truth of RDR, IDx-DR identified 105 and MONA DR identified 99. The sensitivity and specificity rates for RDR detection of IDx-DR were 99.1 and 71.5% compared with MONA DR of 93.4 and 89.3% respectively. Of note, both ARIAs had 100% sensitivity for the detection of STDR. Both ARIAs performed well in this study population, both with sensitivity for RDR screening over 90%, with IDx-DR showing higher sensitivity and MONA DR higher specificity. MONA DR showed superior agreement with human certified graders.

Immunoarchitectural Pattern and Its Potential Prognostic Value in Mucoepidermoid Carcinoma.

To define tumor immunoarchitectural patterns (IPs) and characterize the immune profile in salivary gland mucoepidermoid carcinoma (MEC) toward assessing MEC prognostic significance and implications for immunotherapy. This study analyzed 41 MEC cases, evaluating the tumor IPs and tumor-infiltrating lymphocyte (TIL) parameters by using whole-slide imaging and AI-assisted assessment. Immunohistochemistry of CD3 and CD8 markers was performed to assess key lymphocyte subpopulations. Immune-rich (I-rich) tumors were characterized by high TIL density and were associated with aggressive tumor behavior, particularly in histological high-grade MEC, with a significant increase in TIL density observed in the inner invasive margin compartment (p < 0.05). I-rich tumor cases were linked to poorer disease-free survival (DFS) (Breslow = 4.686, p = 0.03). Aggressive MEC cases displayed a highly heterogeneous TIL profile, however, no TIL patterns showed a significant impact on DFS (p > 0.05). Despite the high immunogenicity suggested by the abundance of T lymphocytes, the protective role of CD8+ T lymphocytes was not prominent in MEC. I-rich tumors appeared more aggressive and unfavorable MEC cases exhibited high heterogeneity in their TIL profiles. Interrogating the role of TILs in the inner invasive tumor margin may offer a new mechanistic understanding for future immunotherapy discovery.

New virtual contrast enhancement boost technique can reduce the dose of intravenous contrast medium used in computer tomography angiography of the abdominal aorta.

This study aims to evaluate the image quality of computed tomography (CT) angiograms obtained using a virtual contrast augmentation technique, adding an iodine map to the contrast-enhanced images, obtained through a digital subtraction technique, reducing the dose of intravenous iodinated contrast medium compared to the conventional institutional standard technique. This prospective investigation enrolled patients previously diagnosed with abdominal aortic aneurysms, who underwent two successive computed tomography angiographies (CTAs) of the aorta. One CTA was performed employing the virtual contrast enhancement boost technique with a 40% decrease in the intravenous contrast medium dose, while the other adhered to the conventional protocol without any reduction in contrast medium volume. After imaging, both qualitative and quantitative assessments were conducted to evaluate the opacification level of the aorta and its branching vessels. The study analyzed 28 examinations from 14 subjects (two per participant). Qualitative analysis revealed that image quality was deemed adequate for diagnostic purposes, with nearly all arterial segments in both protocols rated as good or excellent. Although no statistically significant differences were detected, the average attenuation across all arterial segments in the angiograms exhibited a trend towards higher values in the virtual contrast enhancement boost technique, compared to the conventional protocol. Similarly, the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) demonstrated comparable levels between the two methodologies. The application of virtual contrast enhancement in the acquisition of CT angiograms of the aorta maintains comparable image quality, while reducing the dosage of intravenous contrast medium by 40%. This approach suggests a potential for optimizing contrast use in vascular imaging, aligning with goals related to patient safety and radiological efficiency.

Fractional amplitude of low-frequency fluctuations in right dorsal cingulum bundle associated with depression symptoms in AD patients: effects of donepezil intervention.

Our aim was to investigate the mechanisms of spontaneous brain activity of white matter functional signals in Alzheimer's disease (AD) patients after donepezil intervention. We used resting-state functional magnetic resonance imaging and the fractional amplitude of low-frequency fluctuations (fALFF) approach to investigate changes in spontaneous brain activity of white matter functional signals in AD patients before and after donepezil intervention. A total of 32 subjects participated in the study, including 16 healthy subjects (HCs) and 16 AD patients. The 16 AD patients underwent brain imaging and neuropsychological assessment before and after donepezil. ANOVA and post hoc t-test analysis were used to compare the differences in fALFF between the three groups. Pearson correlations were used to investigate the relationships between abnormal fALFF values and clinical variables in AD patients before and after intervention (P < 0.05). Compared to HCs, AD patients before donepezil intervention had an abnormal fALFF in superior longitudinal fasciculus 2; AD patients after donepezil intervention had an abnormal fALFF in right superior longitudinal fasciculus 1,2 and right dorsal cingulum, Compared with baseline, AD patients after donepezil intervention had an abnormal fALFF in the right dorsal cingulum. Compared with the baseline, AD patients after donepezil intervention had significantly decreased depression scores (P < 0.0003). Our study showed that spontaneous activity of functional signalling in the cholinergic pathway was altered in AD patients after donepezil intervention and that this change was associated with depressive symptoms in AD patients.

Imaging Assessment of the Pituitary Gland and Long-Term Endocrinological Abnormalities in Pediatric Brain Cancer Survivors.

Pediatric brain cancer survivors often experience hypothalamic-pituitary dysfunction due to cranial irradiation and chemotherapy. While hormone deficiencies have been studied, the changes in pituitary size and shape on long-term MRI and their relationship to endocrine dysfunction remain under-explored. To evaluate pituitary gland height, volume, and shape in relation to long-term endocrine abnormalities in pediatric brain tumor survivors. Retrospective cohort study. A total of 56 pediatric brain tumor survivors (50% male) with an average follow-up of 10.8 ± 1.6 years; 44.6% underwent radiotherapy, and 48% were treated with chemotherapy. One-third of the cohort experienced at least one pituitary hormone deficiency. 3 T, including volumetric 1 mm sagittal post-contrast T1 images. Pituitary height, volume, and shape (concave, horizontal, convex) were measured. Endocrine abnormalities were diagnosed through routine serum hormone testing. The t test, chi-square test, and Pearson test with significance at P < 0.05 were used. Receiver-operating characteristic (ROC) analysis assessed the association of imaging parameters and pituitary dysfunction. Radiation and chemotherapy treatment were significantly associated with pituitary hormone deficiencies. There were significant differences in pituitary height and volume in patients with pituitary hormone deficiencies compared with normal pituitary function (4.0 ± 1.3 vs. 5.5 ± 1.5 mm, and 354.2 ± 198.0 vs. 568.3 ± 184.4 mm3, respectively). There was a significant association between radiation therapy and pituitary gland shape, with 60.0% of patients who received radiation therapy exhibiting a pituitary shape categorized as concave, 32.0% as horizontal, and 8.0% as convex, compared to 9.7%, 74.2%, and 16.1%, respectively. ROC analysis for association with pituitary hormone deficiency was 0.81, 0.8, and 0.74 for pituitary height, volume, and shape, respectively. Cranial irradiation and chemotherapy in pediatric brain tumors are associated with endocrine dysfunction, with decreased pituitary height, volume, and concave shape in long-term MRI surveillance are associated with such late endocrine dysfunction. 4 TECHNICAL EFFICACY: Stage 2.

Real-world efficacy and safety of combined first-line treatment with PARP inhibitors and novel hormonal therapy in mCRPC patients with HRR gene mutations.

This study evaluated the real-world efficacy and safety of combining PARP inhibitors with novel hormonal therapy (NHT) as a first-line treatment in Chinese patients with metastatic castration-resistant prostate cancer (mCRPC) harboring homologous recombination repair (HRR) gene mutations. We enrolled 41 mCRPC patients who received at least 1month of combined treatment with PARP inhibitors and NHT. Patients were divided into two groups: Cohort A (mutations in BRCA1, BRCA2, or ATM genes) and Cohort B (mutations in other HRR genes). The primary endpoint was imaging-based progression-free survival (PFS), with secondary endpoints including objective response rate (ORR), disease control rate (DCR), overall survival (OS), PSA50 response, and adverse events (AEs). To ensure accurate research results and control confounding factors, we will employ multivariate Cox proportional hazards models to evaluate key variables affecting mCRPC patient survival outcomes. This study enrolled 41 patients, 22 in Cohort A and 19 in Cohort B. The median PFS for all patients was 21.8months, and the median OS had yet to be reached. The overall ORR was 48.8%, and the DCR was 61.0%. Specifically, the median PFS for Cohort A was 21.8months compared to 14.5months for Cohort B. The median OS had yet to be reached for either cohort. Regarding efficacy, 81.8% of patients in Cohort A and 73.7% in Cohort B achieved a PSA50 response. Imaging assessments showed ORRs of 54.6% for Cohort A and 42.1% for Cohort B, with DCRs of 72.7% and 47.4%, respectively. 85.4% of patients experienced grade 1 or 2 adverse events, and 51.2% encountered grade 3 or 4. In the multivariate Cox regression analysis focusing on PFS, the Gleason score was identified as a significant predictor (HR = 5.8, 95% CI: 1.65-20.2, p = 0.006). Combined first-line treatment with PARP inhibitors and NHT is effective and well-tolerated in mCRPC patients with HRR gene mutations, particularly those with BRCA1, BRCA2, or ATM mutations. These findings underscore the potential of this therapeutic combination in managing mCRPC in the Chinese population, suggesting a favorable outcome for those with specific genetic backgrounds.