Use Of Imaging Modalities Research Articles

Robotic acquisition of echocardiographic images, a proof of concept and safety study

Abstract Background/Introduction Though echocardiography remains the most utilized imaging modality in daily cardiology practice, a major challenge remains the physical strain and injury that can be induced in the echocardiographer. Purpose We developed a prototype robotic arm assisted echocardiography system which incorporates robotics with traditional echocardiography. We assessed the safety and feasibility of the system in 31 volunteers. Methods An ultrasound transducer was mounted upon a robotic arm (UR10 robotic arm, Universal Robots, Odense, Denmark). The transducer was connected to a Philips EPIQ 7C system. The position of the transducer was modified by the echocardiographer who could manipulate a remote stick controller in their hand whilst orientating its position in relation to the real-time images acquired upon the monitor of the echocardiography scanner. This enabled the sonographer to optimize the images and to initiate recordings of parasternal and apical 2D and 3D images. The maximal force on the robot arm was set to 5 Newtons (N) which was deemed to be both safe and to allow for adequate image quality. The force induced by the probe upon the chest wall was measured continuously. Acquired images were assessed for quality ranging from excellent to poor. Results 17 males and 14 females were scanned. The number of images acquired varied from a minimum of 16 and a maximum of 61. The mean time taken to scan an individual was 17.4 minutes with a standard deviation (SD) of 9.9 minutes. This equated to an average of 1.9 images per minute (SD 0.7). No statistical difference was noted between the number of images per minute obtained between male and female participants (mean (+/- SD) for males was 2.1(0.8) and for females 1.8 (0.7) P=0.27). The average force that was applied by the probe was 3.95+/-0.83 Newtons. None of the volunteers reported significant discomfort in the acquisition of the images. Of the 3D images obtained 5 of the participants had poor apical 3D datasets and 3 had poor parasternal datasets but the remaining images acquired were adequate for diagnostic quality. Conclusion(s) Our study demonstrates the feasibility and safety of acquiring 2D and 3D images using a prototype robotic arm assisted echocardiography system. Despite using a low force to the chest wall, the majority of images obtained were of diagnostic quality. Future studies will assess the techniques validity within a routine patient population compared to standard imaging performed by an experienced sonographer. Set up of robot-arm echocardioghy

Diagnostic approach in giant cell arteritis.

Giant cell arteritis (GCA), also known as temporal arteritis, is the most common form of vasculitis in the elderly. While initially described as involving the temporal arteries, GCA can also affect the aorta and its major branches. Despite the increased use of imaging modalities and the availability of temporal artery biopsy, diagnosing GCA remains challenging. GCA should be considered a spectrum, with diagnostic methodologies tailored to the prevalent symptoms. The sensitivity and specificity of different diagnostic approaches can vary depending on the clinical setting. Timing in diagnosing GCA is crucial to prevent serious complications, such as blindness and cerebrovascular ischemic events. While the prompt initiation of glucocorticoids (GCs) has reduced the incidence of major ischemic events, an uncertain diagnosis may expose the patient to unnecessary harm, such as complications from overtreatment or organ damage due to inadequate control of vasculitis. This narrative review will summarize the most widely available diagnostic techniques for GCA and outline our approach for cases where the diagnosis may be uncertain.

Assessment of the Knowledge of Healthcare Professionals Regarding Radiological Examination in Lactating Mothers: A Cross-Sectional Survey Study in the Kingdom of Bahrain.

Objectives Breastfeeding is critical for a mother's health, as well as the development and survival of her infant. Healthcare personnel are a reliable source of information for breastfeeding mothers during and after radiological procedures, assuming their understanding is appropriate. As a result, this study analyzed healthcare professionals' knowledge of breastfeeding and radiological tests on lactating mothers. Methods A cross-sectional survey was implemented using a validated questionnaire containing 25 items about breastfeeding habits and radiation imaging including male and female healthcare staff in primary and tertiary hospitals in Bahrain. The survey comprised 384 responders who were doctors, nurses, radiology technicians, and other allied health professionals. Results In general, 284 (74%) participants scored outstanding knowledge on questions about the health benefits of breastfeeding for both mothers and newborns. However, there was a clear lack of awareness concerning the use of imaging modalities and contrasts on lactating mothers, with only 117 (30.5%) participants scoring an "Excellent" knowledge score. Factors associated with basic knowledge included breastfeeding practice, source of knowledge, and years of experience. The availability of CT/MRI/nuclear scans was one factor related to radiological imaging knowledge. Participants' age, academic background, and profession had strong correlations with fundamental and radiological knowledge. Conclusion Overall, health professionals' awareness and understanding of breastfeeding was average; there is a lack of knowledge of radiological imaging on lactating mothers, which may lead to the discontinuation of breastfeeding following radiological examination. Our study advises incorporating the impacts of exposure to radiological imaging into breastfeeding education programs to increase healthcare providers' knowledge and thereby encourage breastfeeding practice.

Association Between Physician Age and Imaging Utilization in Emergency Department Abdominal Pain Evaluation

BackgroundEmergency department workup of abdominal pain commonly utilizes substantial healthcare resources including labs and advanced imaging. Although studies have explored various characteristics that influence resource utilization, the relationship between physician age and use of imaging modalities is unclear. ObjectivesDetermine the correlation between physician age and ordering of abdominal imaging in the ED. MethodsWe extracted data from five years of patient visits across multiple EDs. The primary outcome was use of abdominal imaging, with secondary outcomes of hospital admission, ED length of stay (LOS), and 72-hour revisits. Multivariable logistic regression was used to assess binary outcomes, and multivariable linear regression was used for LOS. Physician age was categorized into cohorts of <36, 36-44, 45-54, ≥55 years. ResultsEvaluation of 91,922 unique encounters revealed that the most senior physicians had lower odds of ordering imaging than younger physicians of any group and had lower odds of 72-hour revisits with no difference in admission or ED LOS when compared to physicians <36 years. The middle groups (36-44 and 45-54 years) had higher odds of hospital admission than the youngest. The two most senior groups had lower odds of 72-hour ED revisits than physicians <36 years. ConclusionFor patients presenting to the ED with abdominal pain, more senior physicians utilize fewer imaging resources, have fewer 72-hour revisits, while maintaining equivalent hospital admissions and ED LOS as the youngest cohort of physicians. Further research is needed to discern what specific features of senior physicians contribute to the associations highlighted in this study.

Pediatric Cystic Echinococcosis in Tehran, Iran: A 9-Year Retrospective Epidemiological and Clinical Survey of Hospitalized Cases.

Cystic echinococcosis (CE), the second most significant foodborne parasitic disease worldwide, poses a significant global health burden. Understanding its clinical and laboratory features is crucial for effective management. This study aimed to investigate the epidemiological, laboratory, and clinical characteristics of pediatric CE in an Iranian referral hospital. A cross-sectional study reviewed hospital records of patients with CE admitted to Children's Medical Center, Tehran, Iran, from 2011 to 2020. Data on demographics, diagnostics, clinical presentation, laboratory findings, and treatment were collected and analyzed. A total of 114 patients, with a mean age of 7.33 ± 2.9 years, were diagnosed with CE. The male-to-female ratio was 1.78, and 73.7% were urban residents. Abdominal pain (69%) and coughing (65%) were the most common symptoms. In confirming the cyst involvement across anatomical sites, pathology emerged as the most reliable method, with effectiveness ranging from 95% to 100%. Abdominal ultrasonography and computed tomography scan were frequently utilized imaging modalities, displaying effectiveness percentages of 71-85%. Liver and lung involvement predominated (66%), with 39% of cases showing multiorgan involvement. Spleen involvement was less common (6%), and neurological involvement was rare (1-2%). The majority of patients (n = 63, 67.7%) displayed cysts larger than 50 mm. All patients received albendazole treatment, and 104 patients (91.2%) underwent surgical procedures, with three postsurgical deaths. In conclusion, hospital records over 9 years indicate an increasing prevalence of CE, emphasizing the need for heightened awareness and effective public health interventions to control this parasitic infection.

Inadequate staging and excessive surveillance imaging: Evaluating the magnitude of benefit of targeted therapies in lung cancer

Several phase III trials have altered the management of oncogenic driven non-small cell lung cancer (NSCLC) including those harboring EGFR and ALK mutations. However, several of these pivotal trials deviated from standard-of-care practices for either baseline imaging or surveillance imaging. This occurred despite sponsor acknowledgement in a clinical trial protocol that historical trials utilized imaging modalities that potentially under-staged patients. Inadequate baseline imaging for adjuvant trials instead of PET/CT may not identify individuals with metastatic disease, and thereby subject such individuals with metastatic disease to inferior treatment if randomized to the control arm. Similarly, more frequent surveillance imaging than what is considered standard-of-care may identify disease progression earlier than what is expected in real-world clinical practice and therefore embellish the magnitude of benefit between a targeted therapy and the control arm. While targeted therapies have provided clinical benefit for individuals with oncogenic driven NSCLC, physicians and patients must be cognizant that clinical trial deviations from standard-of-care imaging practices may have embellished the magnitude of benefit for several of these therapies.

An interdisciplinary consensus approach to pulmonary hypertension in developmental lung disease.

It is increasingly recognised that diverse genetic respiratory disorders present as severe pulmonary hypertension (PH) in the neonate and young infant, but many controversies and uncertainties persist regarding optimal strategies for diagnosis and management to maximise long-term outcomes. To better define the nature of PH in the setting of developmental lung disease (DEVLD), in addition to the common diagnoses of bronchopulmonary dysplasia and congenital diaphragmatic hernia, we established a multidisciplinary group of expert clinicians from stakeholder paediatric specialties to highlight current challenges and recommendations for clinical approaches, as well as counselling and support of families. In this review, we characterise clinical features of infants with DEVLD/DEVLD-PH and identify decision-making challenges including genetic evaluations, the role of lung biopsies, the use of imaging modalities and treatment approaches. The importance of working with team members from multiple disciplines, enhancing communication and providing sufficient counselling services for families is emphasised to create an interdisciplinary consensus.

Outcomes of Laparoscopic Partial Nephrectomy for small renal masses

Background: Due to the increased use of imaging modalities in daily medical practices, more and more small renal masses are detected. For these SRMs, nephron sparing procedures are more commonly opted rather than radical nephrectomy for the sake of preservation of renal function and proven similar oncological outcomes. This surgery has evolved from open, laparoscopic to Robot-assisted approaches. This article summarizes our institutional experience of laparoscopic partial nephrectomy. Materials and Methods: Patients with small renal masses who underwent laparoscopic partial nephrectomy at B.P. Koirala Memorial Cancer Hospital from January 2023 to June 2024 were retrospectively retrieved. Altogether 23 case notes fulfilled the criteria for analysis. All the demographic, preoperative, intraoperative, postoperative data were collected form the notes and plotted. All the issues within 30 days of surgery were defined as early complications. Clavein-Dindo Classification used for analysis. SPSS 25 software was used. Results: Twenty three patients underwent partial nephrectomy with lapascopic method. All were done trans-peritoneally. Average age of patient was 50.96±12.8 years with range of 33-76. Male were 14 and 9 were females. Average hospital stay was 8 days. The majority of patients after PN recovered well. Nonetheless, 8 developed postoperative complications. GI complications were 8.7%, infections related 13%, Wound related 8.7% and others. Two patients (8.3%) were required to undergo reoperation and nephrectomy for haematuria. Conclusion: Laparoscopic partial nephrectomy is a surgery with steep learning curve. As it requires advanced laparoscopic suturing skills, complications in early period was common. After maturity the complications are as par to open PN.

Large bilateral non-functional adrenal myelolipomas: A rare case report

Myelolipomas are rare, benign, and non-functional neuroendocrine tumors that are usually discovered incidentally. The widespread use of imaging modalities has increased the detection of incidental tumors over the last decades. Most myelolipomas are small, unilateral, and asymptomatic. Occasionally, tumors grow over time and become symptomatic due to the mass effect on adjacent structures. As a therapeutic approach, surgery is known as the standard treatment for symptomatic or large lesions. We report a patient presented with persisted abdominal pain which had been initiated two months ago. Ultrasonography examination showed large, bilateral, and well-defined hyperechoic lesions without calcification in both adrenal glands. Tumors were non-functional with hormone secretion-wise. After laparoscopic resection, on the macroscopic examination, two adrenal lesions with 60×50×40 mm and 35×30×10 mm size, respectively, were observed. The subsequent microscopic assessment also confirmed the diagnosis of bilateral adrenal myelolipomas.

ESR Essentials: diagnostic work-up in patients with symptomatic breast disease-practice recommendations by the European Society of Breast Imaging.

Breast complaints are frequent reasons for consultations in primary care or breast clinics. Breast pain, breast lumps, and nipple discharge are the most common complaints. Less common symptoms such as skin changes and axillary abnormalities also require specific diagnostic approaches. Imaging the symptomatic breast should be performed by appropriately trained breast radiologists following the best practice guidelines and quality standards. Full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), and breast ultrasound (US) are the main modalities used in this primary setting. The choice depends on the patient's age and symptoms. Women younger than 30-years-old are first imaged byUS, whereas women over 40-years-old usually require both FFDM or DBT and US. For women between 30-years-old and 40-years-old, the US is the modality of choice, whereas FFDM or DBT might also be performed if needed. Pregnant or lactating women with palpable lesions or nipple discharge are imaged with US as the first method; FFDM or DBT can also be performed depending on the degree of suspicion as the dose to the fetus is minimal, and shielding may even further reduce the dose. More advanced techniques such as breast magnetic resonance imaging or contrast-enhanced mammography are not indicated in this first diagnostic setting and are reserved for cases of established malignancy (local staging) or rare cases of equivocal findings not otherwise resolved or inflammatory breast cancer. Last, but not least, male breast symptoms should also be addressed with US and/or FFDM. CLINICAL RELEVANCE STATEMENT: It is equally important to correctly diagnose an underlying malignancy and to avoid false positives that would lead to unnecessary biopsies, increased costs, and anxiety for the patient. Proper use of imaging modalities ensures optimal diagnostic approach and minimizes false negatives. KEY POINTS: Ultrasound, full-field digital mammography, or digital breast tomosynthesis are the main imaging modalities in the diagnostic setting, while MRI or contrast-enhanced mammography should be reserved to selected cases. Initial imaging modality includes ultrasound combined with mammography or digital breast tomosynthesis depending on women's age and the presence (or not) of inconclusive findings. A negative imaging evaluation should not deter biopsy when a highly suspicious finding is found on physical examination.

Multimodal diagnostic strategies and precision medicine in mucinous ovarian carcinoma: a comprehensive approach.

Mucinous ovarian carcinoma (MOC) represents a distinct entity within ovarian malignancies, characterized by diagnostic challenges due to its rarity and the potential overlap with other tumor types. The determination of tumor origin is important for precise postsurgical treatment. This article highlights the accurate diagnosis and management of MOC, including the use of imaging modalities, serological tumor markers, immunohistochemistry, and genomic analyses. Transabdominal and transvaginal ultrasonography, complemented by MRI and CT, plays a pivotal role in differentiating MOC from other mucinous tumors and in surgical planning, particularly for fertility preservation. Serological markers like CA19-9, CA-125, and CEA, though not definitive, provide valuable preoperative insights. Immunohistochemistry aids in distinguishing primary MOC from metastatic mucinous carcinomas, while genomic profiling offers the potential for precision medicine through the identification of specific molecular signatures and treatment susceptibilities. Despite advancements in diagnostic techniques, no single method conclusively differentiates between primary and metastatic tumors intraoperatively. The paper reviews the origins, diagnosis, and differential diagnosis of primary mucinous ovarian carcinoma highlights the need for a multimodal diagnostic approach and advocates for the inclusion of MOC patients in clinical trials for personalized therapies, recognizing the heterogeneity of the disease at the molecular level.

Brain Tumor Classification Using DenseNet CNN Model

Abstract: In recent years, Due to its powerful soft tissue comparison and non-invasive nature, magnetic resonance imaging,or MRI, has attracted a lot of attention recently. MRI is a frequently utilized imaging modality for the purpose of locating brain cancers in infants. The MRI generates a huge volume of data. Tumor heterogeneity, isointense and hypointense characteristics limit manual segmentation within a reasonable time frame, which in turn limits the application of trustworthy quantitative metrics in clinical practice. Manual segmentation tasks in clinical practice take a lot of time, and the operator's experience has a big impact on how well they execute. Tumor segmentation methods must be accurate and automated, however due to the extreme spatial and structural variety of brain tumors, this is a challenging task. We have suggested completely automatic brain categorization in our project. Using the DenseNet model, we have presented a fully automatic way to classify brain cancers. Tests conducted on the datasets demonstrate the effectiveness of our suggested approach for identifying baby brain cancers from MRI (MRI).

Characteristics, trends, and management of Penile cancer in the United States: A population-based study

BackgroundPenile cancer (PeCa) is a rare disease. HPV infection, smoking, phimosis, and lichen sclerosus represent well-known associated risk factors. ObjectivesPrimary aim of our study is to evaluate the incidence and risk factors of PeCa and to outline the adopted diagnostic and therapeutic approaches. Secondary aim is to investigate risk factors associated with aggressive disease and to identify the complications arising from its surgical treatment. Materials and MethodsWe conducted a retrospective analysis using the PearlDiver™ Mariner database, from January 1, 2011, to December 31, 2021, identifying all patients diagnosed with PeCa and PeIN, evaluating comorbidities, risk factors, and social and economic conditions. We evaluated the imaging modalities employed for staging as well as the treatment strategies. Finally, we evaluated the most frequent complications associated with inguinal lymphadenectomy (ILND). ResultsDuring the study period, 17,494 patients were diagnosed with PeCa and 5,965 with penile intraepithelial neoplasia (PeIN). US was the most frequently utilized imaging modality, followed by PET and PET/CT. Use of CT and MRI was around 5%. Surgical treatment was the predominant strategy, utilized in 31.3% of PeCa and 22.9% of PeIN. Wide Local Excision/Glansectomy emerged as the most common surgical procedures. MLR analysis identified smoking as a risk factor for metastatic PeCa (OR; 95% CI = 1.49; 1.379–1.609), HPV infections were associated with a 35% decrease in risk (OR; 95% CI = 0.65; 0.562–0.744) (all P < 0.001). Lichen sclerosus and phimosis were associated with a doubled risk of demolitive surgery. Approximately 40% of patients experienced complications associated with ILND. ConclusionDespite advances in PeCa management, there's no significant move toward more conservative treatments. Surgical treatments are still marked by high rates of complications, potentially affect the sexual and psychosocial health of patients. These issues may foster a tendency toward avoidance behaviors, contributing to a delayed clinical presentation and treatment.

An Umbrella Review and Updated Meta-Analysis of Imaging Modalities in Occult Scaphoid and Hip and Femoral Fractures.

Background: Occult fractures may cause multiple morbidities. If occult fractures were detected earlier, complications may be preventable. This umbrella review and updated meta-analysis will aim to evaluate the use of imaging modalities in detecting occult scaphoid and hip fractures. Methods: The protocol for this study is available in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42024525388). The literature search started and ended on 17 March 2024. We searched seven academic databases: MEDLINE, Cochrane Library, Pubmed, Science Direct, Google Scholar, WHO International Clinical Trials Registry Platform, and The Joanna Briggs Institute (JBI) database. The meta-analysis was conducted with the STATA program using the "midas" command. Results: There are four systematic reviews evaluating occult hip and femoral fractures with 6174 patients and two reviews evaluating occult scaphoid fractures with 1355 patients. The prevalence of occult scaphoid fracture and occult hip and femoral fractures is 23.87% (95% CI 18.25-29.49) and 44.8% (95% CI 39.38-51.4), respectively. Magnetic resonance imaging (MRI) had the best posterior probability of positive likelihood ratio (LR+) with 95% and 96% and negative likelihood ratio (LR-) with 0.15% and 1% for both occult scaphoid and hip fractures, respectively, assuming a 25% baseline. MRI could both confirm and exclude occult hip fractures while it can only confirm occult scaphoid fractures. Bone scans are inappropriate for either type of occult fractures The level of evidence for occult scaphoid fracture is weak while it is suggestive for occult hip fractures. Conclusion: The findings strengthen the use of MRI after an initially negative radiograph fracture for occult hip and femoral fractures, with a CT scan as a viable second option.

Familial Resemblance of Bone Health in Maternal Lineage Pairs and Triads: A Scoping Review.

Female bone health is influenced by familial resemblance, health parameters and maturational periods (puberty and menopause); this combination has been researched using familial multi-generational cross-sectional studies. This scoping review aimed to compile bone health research which uses sexually mature (grandmother-) mother-daughter pairs (and triads) and to determine the trends in its methodologies and familial comparisons. The Joanna Briggs Institute methodology for scoping reviews was used. Extraction included study and population characteristics, methodology (with an emphasis on imaging) and family-based results. Twenty-nine studies were included, and their generations were categorized into four developmental categories: late adolescent to young adult, pre-menopause, mixed-menopause, and post-menopause. Eleven different pair/triad combinations were observed; the most common was pre-menopausal daughters and post-menopausal mothers. Dual-energy X-ray absorptiometry (DXA) was the most utilized imaging modality, and the hip was the most imaged region of interest (ROI). Regardless of pairing, imaging modality and ROI, there was often a trend toward significant familial resemblance and heritability (h2 and h2L). This scoping review highlights the trends in bone health linked to familial resemblance, as well as the importance of menopause and late adolescence. This review compiles the commonalities and challenges within these studies to inform future research.

Acute Appendicitis in the Elderly: Current Update on Management: Review Article

Acute appendicitis in the elderly is a difficult condition to diagnose and treat due to its atypical clinical presentation, the co-morbidities that these patients have and the risk of developing complications like perforation. The diagnosis involves the use of imaging modalities like computerized tomography and the treatment is by performing an appendectomy. Laparoscopic appendectomy is slowly becoming the gold standard in the surgical treatment of acute appendicitis in the elderly. We have conducted this review article to look at the diagnosis and management of acute appendicitis in the elderly. The role of laparoscopic appendectomy in the surgical treatment of acute appendicitis in the elderly is also investigated.

A ten-year literature review of oral malignant melanoma cases: A meta-analysis study

AimOral malignant melanoma (OMM) is a rare and aggressive malignant tumour arising from the proliferation of melanocytes and accounts for only 0.5 % of all oral malignancies. It is invasive and tends to metastasise. The aim of this study is to determine the patient profile of OMM and to provide information about the clinical features and treatment plans of the disease. Materials and MethodsThe Pubmed database was searched for OMM cases published as case reports in the last 10 years. The search was limited to English and open-access case reports. A total of 49 OMMs in 45 patients from 43 case reports were analyzed. In addition to the age, gender, smoking and alcohol consumption habits of the patients, data on the signs and symptoms of OMM, location of the lesion, imaging modalities used in diagnosis and treatment, lymph node involvement, presence of metastasis, survival time, and treatment modalities were recorded. ResultsIn OMM cases, 18 (40 %) of the patients were female, 27 (60 %) were male, and the mean age was 53.13 ± 16.09 years. The most common symptom was "swelling" (n = 23, 33.8 %) and the most common finding was "hyperpigmentation" (n = 40, 24.4 %). The most common site of OMM was the maxilla (n = 21, 46.7 %). According to the rate of use of imaging modalities in the cases, it was determined that "advanced imaging modalities" were mostly used (n = 24, 53.3 %). It was determined that 22.2 % (n = 10) of the patients died within the first 5 years. Combined treatment (n = 21, 46.5 %) were mostly applied to the patients. ConclusionOMM is more common in the maxilla, in males and in the fifth decade of life, and advanced imaging modalities are most commonly used to detect the disease. Because of its poor prognosis, knowing the patient profile and common clinical features of OMM will increase the clinical awareness of physicians.

An Update on the Use of Artificial Intelligence in Digital Pathology for Oral Epithelial Dysplasia Research.

Oral epithelial dysplasia (OED) is a precancerous histopathological finding which is considered the most important prognostic indicator for determining the risk of malignant transformation into oral squamous cell carcinoma (OSCC). The gold standard for diagnosis and grading of OED is through histopathological examination, which is subject to inter- and intra-observer variability, impacting accurate diagnosis and prognosis. The aim of this review article is to examine the current advances in digital pathology for artificial intelligence (AI) applications used for OED diagnosis. We included studies that used AI for diagnosis, grading, or prognosis of OED on histopathology images or intraoral clinical images. Studies utilizing imaging modalities other than routine light microscopy (e.g., scanning electron microscopy), or immunohistochemistry-stained histology slides, or immunofluorescence were excluded from the study. Studies not focusing on oral dysplasia grading and diagnosis, e.g., to discriminate OSCC from normal epithelial tissue were also excluded. A total of 24studies were included in this review. Nineteen studies utilized deep learning (DL) convolutional neural networks for histopathological OED analysis, and 4 used machine learning (ML) models. Studies were summarized by AI method, main study outcomes, predictive value for malignant transformation, strengths, and limitations. ML/DL studies for OED grading and prediction of malignant transformation are emerging as promising adjunctive tools in the field of digital pathology. These adjunctive objective tools can ultimately aid the pathologist in more accurate diagnosis and prognosis prediction. However, further supportive studies that focus on generalization, explainable decisions, and prognosis prediction are needed.

MODERN IMAGING TECHNIQUES IN THE ASSESSMENT&#x0D; OF MALIGNANCY IN GLIAL BRAIN TUMORS:&#x0D; LITERATURE REVIEW

Relevance: Gliomas represent a major group of primary central nervous system tumors, accounting for approximately 80% of all&#x0D; malignant brain neoplasms. Recent advances in molecular diagnostics, including the identification of mutations in the isocitrate dehydrogenase(IDH) gene, offer new opportunities to improve the classification of gliomas and to understand the mechanisms of their development. IDH&#x0D; mutations, which are found in a large proportion of gliomas, are associated with a better prognosis and represent an important biomarker&#x0D; for the development of targeted therapeutic strategies. Diagnostic techniques, particularly magnetic resonance imaging (MRI), also play&#x0D; an important role, providing additional ways to assess the morphological and biological characteristics of gliomas, contributing to a more&#x0D; accurate determination of tumor malignancy and molecular profile, which is key to treatment decisions.&#x0D; The purpose: To study the possibilities of magnetic resonance imaging in assessing the degree of malignancy of glial brain tumors.&#x0D; Method: A literature review was performed using the keywords: glioma, IDH mutation, IDH wild-type, MRI, magnetic resonance&#x0D; spectroscopy (MRS), apparent diffusion coefficient (ADC), diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), diffusion kurtosis&#x0D; image (DKI), Susceptibility Weighted Imaging (SWI) in PubMed, BMC Medicine, and Google Scholar databases. The review includes the results&#x0D; of an analysis of 45 literature reviews on the diagnostic capabilities of molecular diagnostics and MRI to assess the malignancy of gliomas.&#x0D; Results: This review highlights the importance of current approaches to the diagnosis of gliomas, demonstrating that different grades of&#x0D; malignancy and IDH mutation status are associated with unique features on MR imaging, including differences in localization, signal, and&#x0D; enhancement patterns. DTI and DWI extend the ability of MRI to assess tissue microstructure, allowing for more precise tumor characterization.&#x0D; Studies combining MRI morphologic features, ADC and DTI parameters offer a non-invasive approach to glioma prognosis, highlighting the&#x0D; importance of integrated use of imaging modalities to improve diagnosis and therapy.&#x0D; Conclusion: The use of magnetic resonance imaging allows for more accurate morphologic and metabolic characterization of gliomas&#x0D; in assessing the degree of malignancy, allowing physicians to make more accurate prognostic assessments and select the most appropriate&#x0D; treatment strategy.&#x0D; Keywords: Glioma, IDH mutation, wild-type IDH, MRI, magnetic resonance spectroscopy, ADC, DWI, DTI, DKI, SWI

The Evolving Field of Acute Coronary Syndrome Management: A Critical Appraisal of the 2023 European Society of Cardiology Guidelines for the Management of Acute Coronary Syndrome.

Acute coronary syndromes (ACS), encompassing conditions like ST-elevation myocardial infarction (STEMI) and non-ST-elevation acute coronary syndromes (NSTE-ACS), represent a significant challenge in cardiovascular care due to their complex pathophysiology and substantial impact on morbidity and mortality. The 2023 European Society of Cardiology (ESC) guidelines for ACS management introduce several updates in key areas such as invasive treatment timing in NSTE-ACS, pre-treatment strategies, approaches to multivessel disease, and the use of imaging modalities including computed tomography (CT) coronary angiography, magnetic resonance imaging (MRI), and intracoronary imaging techniques, such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS). They also address a modulation of antiplatelet therapy, taking into consideration different patient risk profiles, and introduce new recommendations for low-dose colchicine. These guidelines provide important evidence-based updates in practice, reflecting an evolution in the understanding and management of ACS, yet some potentially missed opportunities for more personalized care and technology adoption are discussed.