Imaging Options Research Articles

Comparison of Low-Brilliance X-Ray Phase-Contrast Tomography and Contrast-Enhanced Attenuation-Contrast Micro-Computed Tomography of Rat Kidneys.

Structural analysis of soft biological tissues is conventionally done with destructive 2D histology. 3D information can be accessed with non-invasive imaging methods, such as X-ray micro-computed tomography (micro-CT). While attenuation-based X-ray imaging alone does not provide reasonable contrast with soft-tissue samples, the combination with contrast-enhancing staining has proven effective. The staining process, however, comes with several disadvantages, such as tissue alterations and laboriousness. A novel X-ray imaging method known as phase-contrast imaging has emerged as an interesting alternative to contrast-enhanced micro-CT. Our objective is to show the feasibility of laboratory-based phase-contrast imaging in (murine) kidney research. X-ray phase-contrast images of male rat kidneys were acquired with a Talbot-Lau interferometer. Moreover, attenuation-based X-ray images of the same unstained kidneys were acquired with a regular micro-CT device. Afterwards, the kidneys were stained with phosphotungstic acid for several months. Attenuation-based micro-CT images were re-acquired after the staining. Contrast-to-noise ratio was evaluated for all three cases. For unstained kidneys, the phase-contrast images show significantly improved contrast in comparison with attenuation images. Several key features, including the cortex, inner and outer medulla, papilla, as well as the main blood vessels can be identified. While the contrast in attenuation images improves significantly after staining, the benefit is deteriorated by sample areas that the contrast agent did not reach properly; even after 206 days. Our results indicate that X-ray phase-contrast imaging is a viable option for kidney imaging in a laboratory setting providing comparable or better results than contrast-enhanced micro-CT. With imaging setups optimized for image resolution and faster imaging times, the advantages of phase-contrast imaging will be even greater.

Pharmacoeconomic evaluation of intravascular ultrasound for imaging in cardiac interventions

Introduction: Intravascular ultrasound (IVUS) is an imaging modality used primarily in interventional cardiology to characterize lesion morphology, quantify plaque significance, guide stent sizing, assess stent implantation, and identify procedural complications. Aim: This analysis aims to present a cost-effectiveness analysis and budget impact analysis of intravascular ultrasound for imaging in patients undergoing cardiac catheterization and percutaneous coronary interventions. Material and methods: A model evaluating the cost-effectiveness of IVUS-guided PCI versus PCI with the classic angiography-guided strategy was created. The analyses used a healthcare perspective of the payer - the National Health Insurance Fund (NHIF). The economic method chosen to evaluate IVUS is of the cost-utility analysis type. In addition, a cost-effectiveness analysis was conducted. Health benefits for patients in the applied model were measured as quality-adjusted life years (QALYs) and life-years added (LYs). Results: Performing IVUS-guided PCI generated an additional total cost of BGN 2,329.40 at 0.2660 additional QALYs and 0.4932 LYs gained, compared with PCI guided by conventional coronary angiography in patients with STEMI. Similarly, performing IVUS-guided PCI gener-ated an additional total cost of BGN 2,213.11 at 0.1363 additional QALYs and 0.2457 LYs gained, compared with PCI guided by conventional coronary angiography in patients with UA/NSTEMI. Conclusion: The IVUS-guided PCI strategy is a cost-effective option for intravascular imaging.

Retrospective study on Encephalitozoon cuniculi infections in 118 cat and 9 dog eyes.

This study aims to inform about the clinical image, diagnostic possibilities, and treatment options for cats and dogs diagnosed with ocular encephalitozoonosis. Medical records of 7 dogs and 75 cats with ocular encephalitozoonosis presented at the Clinical Unit of Ophthalmology of the University of Veterinary Medicine Vienna between 08/2006 and 02/2022 have been compiled. Diagnosis was based on the presence of cataracts and positive antibody titer against Encephalitozoon cuniculi. Patient history, details on the characteristics of the cataracts, level of antibody titers, and the treatment regimen were summarized, as are the results of histological stainings of surgical samples to determine the presence of Encephalitozoon cuniculi, as well as PCR analyses to identify its sub-strains. Our analysis of the clinical data shows that focal cortical anterior cataracts often associated with anterior uveitis and lesions in the fundus are the most prevalent manifestation of ocular encephalitozoonosis in cats and dogs. Serological testing and PCR analysis of lens material are the most important diagnostic tools. Timely phacoemulsification with adjuvant anti-inflammatory and antiparasitic medication is the most promising therapy for Encephalitozoon cuniculi-induced cataracts.

Bridging high resolution sub-cellular imaging with physiologically relevant engineered tissues

While high-resolution microscopic techniques are crucial for studying cellular structures in cell biology, obtaining such images from thick 3D engineered tissues remains challenging. In this review, we explore advancements in fluorescence microscopy, alongside the use of various fluorescent probes and material processing techniques to address these challenges. We navigate through the diverse array of imaging options available in tissue engineering field, from wide field to super-resolution microscopy, so researchers can make more informed decisions based on the specific tissue and cellular structures of interest. Finally, we provide some recent examples of how traditional limitations on obtaining high-resolution images on sub-cellular architecture within 3D tissues have been overcome by combining imaging advancements with innovative tissue engineering approaches.

Impact of shortening time on diagnosis of 18F-florbetaben PET

Background18F-Florbetaben amyloid positron emission tomography (PET) scan is crucial for diagnosing Alzheimer’s disease, typically involving a 20 min acquisition. However, maintaining such prolonged scans can be challenging in some cases. This study explores the diagnostic impact and feasibility of reducing scan durations by comparing quantitative measures between shortened and standard scans. Additionally, we identified the optimal Centiloid threshold to distinguish between positive and negative amyloid results.ResultsWe analyzed 307 PET scans from our memory clinic, each followed up for a minimum of two years. The scans, conducted 90 to 110 min after approximately 300 MBq of 18F-Florbetaben injection, were categorized into four sets of 5 min durations: 5, 10, 15, and 20 min. Nuclear medicine physicians validated and rated each scan as either amyloid-positive or negative. For quantitative assessments, we employed the standardized uptake value ratio (SUVR) and Centiloid scales, comparing total SUVR and Centiloid values across five subregions (global, frontal, posterior cingulate-precuneus, lateral temporal, and parietal) using Bland–Altman analysis. Receiver operator characteristic (ROC) curves were utilized to develop optimal Centiloid thresholds. Comparing the images at 5, 10, 15, and 20 min images, SUVR and Centiloid values gradually increased with prolonged scan times. The mean SUVR difference between 5 and 20 min was 0.03 for the amyloid-positive and 0.01 for the amyloid-negative groups; Centiloid differences were 4.60 and 2.38, respectively. Additionally, no significant variation was observed in total SUVR and Centiloid values among the durations across all subregions in positive and negative groups (all p > 0.1). ROC analysis indicated that a Centiloid threshold of 21.86 at 5 min provided optimal agreement with visual assessments (AUC = 0.985, sensitivity = 0.950, specificity = 0.972), especially using the global area.ConclusionsThis study demonstrated that 5 min image scans with an optimal threshold of CL = 21.86 exhibited minimal bias in SUVR and Centiloid values compared to longer scans (10, 15, and 20 min). Our findings suggest that shorter scan times are a viable and effective option for brain amyloid PET imaging in clinical settings.

The Role of High-Resolution Ultrasound in the Diagnosis of Nerve Trauma New Perspective: A Preliminary Systematic Review and Meta-Analysis of the Recent Evidence.

Precise localization of peripheral nerve injuries and evaluation of their prognosis based on clinical and electrodiagnostic examinations are particularly challenging in the acute phase. High-resolution ultrasound (HRUS) may offer a viable and cost-effective imaging option for assessing the morphology of nerve injuries. Consequently, a systematic review and meta-analysis of studies on the use of ultrasound for diagnosing traumatic nerve injuries were conducted. A total of 15 studies were included, reporting the most recent findings on using HRUS in the diagnosis of traumatic nerve injury. These studies assessed the diagnostic test accuracy of ultrasound for the detection of traumatic nerve injury in 272 participants, with the cross-sectional area at the site of traumatic nerve injury also reported in 1,249 participants. The pooled sensitivity and specificity of the included studies were 92% confidence interval (CI) (0.89-0.95) and 86% CI (0.82-0.89), respectively. The positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 13.76 CI (1.41-134.34), 0.08 CI (0.03-0.18), and 286.23 CI (21.22-3,860.40), respectively. In the summary of the receiver operating characteristic curve, the area under the curve was 0.986, and the Q* index was 0.949. Based on the current literature, HRUS has shown promising results in addition to its availability and feasibility. HRUS can serve as a valuable complement to clinical and electrodiagnostic examinations for diagnosing traumatic peripheral nerve injuries. Further research is recommended to better understand the ultrasound characteristics of these injuries.

Robotic Assisted Ultrasound-Guided Endovascular Stent Implantation in a Vascular Model.

Endovascular procedures are the preferred method for treating peripheral arterial disease. However, limited imaging options during these procedures, such as X-rays and contrast media, expose patients and healthcare professionals to potentially harmful radiation. This study introduces a robotic ultrasound system (RUSS) for navigating endovascular procedures in order to reduce radiation and provide additional information. The RUSS comprises a seven-degree-of-freedom robotic arm that navigates an ultrasound transducer across a specific region of interest. The system is controlled by a self-programed software designed to navigate the robotic arm in a methodical and reproducible manner using a foot switch. An endovascular surgeon investigated the guidance and visibility of various guidewires and successfully implanted three stents in a vascular leg phantom using the RUSS without further radiation exposure. The innovative set-up has several potential applications, including radiation-free endovascular procedures as well as health screening and diagnostic support in vascular medicine.

Computed tomography of the head with and without contrast in imaging focal and unknown epilepsy – A prospective observational study

PurposeBrain imaging is needed when investigating epilepsy. Imaging options available include MRI and CT scan which may be non-contrast (NCCT) or contrast-enhanced (CECT). The specific clinical question and probable epilepsy substrate in the epidemiological context and socioeconomic milieu are important in determining the choice of imaging. In patients with well-controlled focal or unknown epilepsy who are unlikely to be surgical candidates, is CECT essential or can NCCT be an acceptable choice? MethodsA prospective observational study was conducted at a tertiary care centre in India. Consecutive patients with focal or unknown epilepsy who were relatively well-controlled on medical treatment underwent NCCT followed by CECT brain. Three neuroradiologists independently reported the images. Proportion of abnormalities missed on NCCT and picked only on CECT were determined. How often abnormalities picked on CECT changed patient management was also analysed. ResultsTwo hundred and nineteen patients with focal (87 %) or unknown (13 %) epilepsy underwent NCCT followed by CECT brain. Most had epilepsy for >3 months and an annual seizure frequency of 2–10 seizures. There was a nearly perfect inter-observer agreement between 3 neuroradiologists in reporting the NCCT and CECT as 'normal' or 'abnormal' with kappa (κ) values of 0.9 and 1.0 respectively. The sensitivity of NCCT compared to CECT in detecting an abnormality was 97 % (CI 92.6 - 99.5 %) and the specificity was 99 % (CI 94.9 - 99.9 %). There was no significant difference in the proportion of NCCTs and CECTs found abnormal (50.22 % vs 51.14 %, p = 0.91). A solitary calcified granuloma was the most common abnormality reported on NCCT as well as CECT, 21.0 % and 19.1 % respectively. New findings picked on CECT alone, did not change management in any patient. ConclusionWhen imaging focal or unknown epilepsy, an NCCT performs as well as a CECT, especially in regions where calcified lesions contribute a significant etiological burden. The role of imaging in epilepsy varies between patients and a universal recommendation of an MRI or a CECT in all patients is neither cost-efficient nor evidence-based. In drug responsive focal or unknown epilepsy of longstanding duration, CT scans are either normal or have calcified lesions that are easily picked on NCCT.

Measurable progression of giant cell tumour of bone associated with pregnancy - A tertiary sarcoma centre analysis

IntroductionGiant cell tumour of bone (GCTB) is a benign but locally aggressive bone tumour with a higher predilection for females of reproductive age. GCTB management poses a unique set of challenges during pregnancy due to risks associated with imaging and treatment options. Pregnancy has been implicated in GCTB progression and tumour recurrence, however an exact mechanism has not been established. This study aims to confirm the relationship between the diagnosis and progression of GCTB during pregnancy. MethodsA 17-year retrospective analysis of our tertiary sarcoma referral centre database was performed to identify the relevant patients. Pregnancy-associated tumours were defined by those already present or diagnosed during pregnancy, and up to 12 months postpartum. Lesion volume was determined by mathematical ellipsoidal modelling technique to simplify the estimation, with cross-sectional measurements obtained from the three standard orthogonal planes on initial and surveillance imaging. Due to logistical challenges, follow-up imaging was performed at either our tertiary sarcoma centre or under guidance at regional imaging centres convenient to the patient. ResultsThe diagnosis of GCTB was made in 113 female patients during this 17-year period, of which 20 were associated with pregnancy with a mean age of 28.8 years (range 19–40 years). 12 patients had their primary or recurrent GCTB diagnosed, or known tumour progress during pregnancy, whilst the remaining 8 were diagnosed shortly thereafter to within 12 months postpartum. The most common tumour sites were located around the knee (30 %) and distal radius (25 %). A statistically significant pattern of growth was observed through the surveillance period (p 0.018), within a relatively short mean follow-up period of only 89.8 days (SD 54.5; 13–192 days). ConclusionThis study demonstrates the significant association that pregnancy has with the growth and progression of both primary and recurrent GCTB. Pregnant patients should be subject to close surveillance well into the postpartum period due to possible accelerated disease progression and potential for disease recurrence.

Diverticulitis evaluation and management among United States emergency departments over an eight-year period

IntroductionDiverticulitis is a common reason for presentation to the Emergency Department (ED). However, as imaging options, risk stratification tools, and antibiotic options have expanded, there is a need for current data on the changes in incidence, computed tomography (CT) performance, antibiotic usage, and disposition over time. MethodsThis was a cross-sectional study of ED patients with a diagnosis of diverticulitis from 1/1/2016 to 12/31/2023. Using the Epic Cosmos database, all ED visits for acute diverticulitis were identified using ICD-10 codes. Outcomes included total ED presentations for diverticulitis, admission rates, CTs performed, outpatient antibiotic prescriptions, and antibiotics administered in the ED for admitted patients. ResultsThere were 186,138,130 total ED encounters, with diverticulitis representing 927,326 (0.50 %). The rate of diverticulitis diagnosis increased from 0.40 % to 0.56 % over time. The admission rate declined over time from 33.6 % to 27.7 %, while the CT rate rose from 83.0 % to 92.6 %. Among those discharged, 90.4 % received an antibiotic, which remained consistent over time. Metronidazole (55.1 %) and ciprofloxacin (40.8 %) were the most commonly prescribed antibiotics, followed by amoxicillin-clavulanate (36.1 %). Among those admitted, most received either metronidazole (62.0 %), a fluoroquinolone (40.4 %), a third-generation cephalosporin (18.9 %), or a penicillin-based agent (38.1 %). Among both discharged and admitted patients, there was a marked shift to penicillin-based agents as the primary antibiotic regimen. ConclusionDiverticulitis remains a common ED presentation, with a gradually rising incidence over time. Admission rates have decreased, while CT imaging has become more common. Most patients receive antibiotics, though the specific antibiotic has shifted in favor of penicillin-based agents. These findings can provide key benchmarking data and inform future initiatives to guide imaging and antibiotic use.

Non-Acute Shoulder Pain: Correlation between Ultrasonography and MRI Findings

Abstract Background Shoulder pain affects people of all ages and activity levels, from elite athletes to sedentary individuals. The imaging workup of shoulder pain is important because it is the second most common musculoskeletal complaint after back pain for which patients seek medical attention. Magnetic resonance imaging (MRI) is well established as a powerful imaging modality for the shoulder. In the last decade, ultrasound has emerged as an effective imaging option alongside MRI for evaluation of the shoulder. With MRI and ultrasound, clinicians now have two viable advanced imaging options for the diagnostic evaluation of shoulder pain. Aim to assess the value added, sensitivity and specificity of US in non-acute shoulder pain using conventional MRI as a gold standard. Material & Method Our study was carried out on 47 patients, based on age ≥ 18 years, having shoulder pain for 6 months &more. the patients had both US & MRI examination, the findings of the 2 modalities were recorded and compared. Results There was significant statistical agreement (P value <0.001) between US & conventional MRI, US demonstrated SST, SS partial &full thickness tear, LHBT pathologies, AC morphological changes and bursitis. Conclusion Based on the results, high resolution US with dynamic real-time assessment was proven to be fairly sensitive, specific with significant agreement to conventional MRI in detecting different causes of chronic shoulder pain. So US can be used as an initial modality for patients with painful shoulder.

Multimodality Imaging in the Diagnostic Work-Up of Patients With Cardiac Masses: JACC: CardioOncology State-of-the-Art Review.

Cardiac masses encompass a diverse range of benign and malignant tumors as well as pseudotumors. Accurate histologic identification is essential for guiding appropriate treatment, yet the diagnostic process remains challenging. Although biopsy is traditionally the diagnostic gold standard, its invasive nature and associated risks limit its application. A noninvasive multimodality imaging approach has recently emerged as an alternative, but standardized protocols and supporting evidence are still lacking. Echocardiography is typically the initial imaging modality, with cardiac magnetic resonance recognized as the noninvasive diagnostic gold standard. Cardiac computed tomography provides complementary data to aid in diagnosis and management, while positron emission tomography serves as a third-level imaging option. This state-of-the-art review highlights the role of current multimodality imaging techniques in diagnosing and managing cardiac masses and explores future directions for their applications.

Clinical impact of whole-body MRI in staging and surveillance of patients with myxoid liposarcoma: a 14-year single-centre retrospective study.

To assess the clinical impact of regular whole-body magnetic resonance imaging (WBMRI) surveillance in myxoid liposarcoma patients. This was a retrospective cohort study of myxoid liposarcoma patients who underwent at least one WBMRI at our institution between October 2006 and December 2020. The effect of WBMRI on clinical management, namely treatment modification or additional diagnostic investigations was studied. A standardised WBMRI surveillance protocol was instituted in 2015. We compared patient outcomes for the metastatic patients who had and had not received regular WBMRI surveillance and performed survival analysis for both subgroups. Of the 56 patients (60.7% male, median age: 48.1 years) who underwent 345 WBMRI, 17 (30.3%) had metastases, and 168 WBMRI were performed in this group. The median imaging follow-up for the entire cohort was 35 months; the metastatic group had a median follow-up of 42 months. WBMRI changed the clinical management in 13 (76.5%) metastatic patients, with 33 instances of treatment modification. Thirty-five lesions were labelled 'indeterminate,' 16 (45.7%) had additional investigations/interventions, and 4 (11.4%) were confirmed to be metastatic. Twenty-one metastatic lesions were missed initially on WBMRI and confirmed on subsequent WBMRI, of which 5 (23.8%) were clinically significant. The 5-year survival since the detection of metastasis was better in the regular surveillance subgroup (85.7% vs. 45%), but this was not statistically significant (p = 0.068). Five patients (8.9%) developed their first metastasis more than 5 years after diagnosing the primary lesion. Regular WBMRI surveillance of myxoid liposarcoma patients considerably impacts clinical management by frequently influencing treatment decisions. WBMRI has been recently recommended as an imaging option for the staging and surveillance of myxoid liposarcoma patients. Our study highlights the impact of regular WBMRI surveillance on the clinical management of these patients and how it affects their survival.

The Alpha Angle.

➢ The alpha angle was originally defined on magnetic resonance imaging (MRI) scans, using a plane, parallel to the axis of the femoral neck. However, much of the literature on the alpha angle has used radiographs or other imaging modalities to quantify the alpha angle.➢ The measurement of the alpha angle can be unreliable, particularly on radiographs and ultrasound.➢ If radiographs are used to measure the alpha angle, the circle of best-fit method should be used on multiple different views to capture various locations of the cam lesion, and "eyeballing" or estimating the alpha angle should be avoided.➢ The cam lesion is a dynamic and 3-dimensional (3D) problem and is unlikely to be adequately defined or captured by a single angle.➢ Modern technology, including readily available 3D imaging modalities, as well as intraoperative and dynamic imaging options, provides novel, and potentially more clinically relevant, ways to quantify the alpha angle.

Scaphoid Fractures and Nonunion: A Survey-based Review of Hand Surgeon’s Practice and the Evidence

The Evidence-Based Practice Committee of the American Society for Surgery of the Hand set out to assess the membership's practice patterns (PPs) and familiarity with evidence-based principles for scaphoid fracture and nonunion management. Using a consensus-generated 25-item online survey, all the American Society for Surgery of the Hand members were invited to participate via email in September 2023. Two question types were used including evidence-based practice (EBP) and PPs. The survey was divided into the following subtopics: minimally displaced scaphoid fracture, operative options for scaphoid fixation, and treatment of scaphoid nonunion. Of 9 EBP questions, only one was answered with the preferred response by >80% of surgeons. The remaining seven EBP questions had greater frequencies of less preferred responses. These questions concerned the current evidence for initial imaging options, optimal nonsurgical immobilization, percutaneous management, and the identification and treatment of nonunion. Of the PP questions, there were substantial differences of opinion on the choice of bone graft for nonunion, revisions, and patients with avascular necrosis. Nearly unanimous agreement was found for the use of headless compression screws for scaphoid fixation; however, the choice of approach for waist fixation was split between dorsal and volar percutaneous techniques and an open dorsal approach. Scaphoid fracture and nonunion management continues to be an area of expanding evidence. There remain opportunities for our community to improve knowledge and familiarization with current evidence-based data. Many PPs areas demonstrated substantial agreement among the membership; however, there are areas of differences particularly graft choice, optimal approach for waist fixation, and postfixation protocols. Knowledge and familiarity with peer practices may help develop future areas of research and help to optimize patient care through a critically review and interpretation of the evidence. Economic/decision analyses V.

113mIn]In-PSMA: high potential agent for SPECT imaging of prostate cancer

Abstract The prevalence rate of prostate cancer is very high and unfortunately causes many deaths worldwide. This study aimed to prepare [113mIn]In-PSMA as a novel agent for single photon emission computed tomography (SPECT) imaging of prostate cancer. 113mIn was eluted from an in-house made 113Sn/113mIn generator in chloride form, and its radionuclide, chemical and radiochemical purities was studied. [113mIn]In-PSMA was prepared with radiochemical purity (RCP) > 99 % under optimal labeling conditions. The biodistribution of the labeled compound was studied in normal rats, showed the major activity in the urine and kidneys as the main excretion route from the body. Considerable uptake was observed in the prostate and salivary glands as the PSMA-expressing organs. These data are in complete agreement with the other published data on PSMA-labeled compounds both in animals and humans. The results demonstrated [113mIn]In-PSMA can be considered as a good option for SPECT imaging of prostate cancer.

Radiotracer Innovations in Breast Cancer Imaging: A Review of Recent Progress.

This review focuses on the pivotal role of radiotracers in breast cancer imaging, emphasizing their importance in accurate detection, staging, and treatment monitoring. Radiotracers, labeled with radioactive isotopes, are integral to various nuclear imaging techniques, including positron emission tomography (PET) and positron emission mammography (PEM). The most widely used radiotracer in breast cancer imaging is 18F-fluorodeoxyglucose (18F-FDG), which highlights areas of increased glucose metabolism, a hallmark of many cancer cells. This allows for the identification of primary tumors and metastatic sites and the assessment of tumor response to therapy. In addition to 18F-FDG, this review will explore newer radiotracers targeting specific receptors, such as estrogen receptors or HER2, which offer more personalized imaging options. These tracers provide valuable insights into the molecular characteristics of tumors, aiding in tailored treatment strategies. By integrating radiotracers into breast cancer management, clinicians can enhance early disease detection, monitor therapeutic efficacy, and guide interventions, ultimately improving patient outcomes. Ongoing research aimed at developing more specific and sensitive tracers will also be highlighted, underscoring their potential to advance precision medicine in breast cancer care.

Beyond balance: The role of the Vestibular system in action recognition

BackgroundAction recognition is a fundamental aspect of human interaction. This process is mediated by the activation of shared sensorimotor representations during action execution and observation. Although complex movements involving balance or head and trunk rotations require vestibular signals for effective execution, their role in the recognition of others' actions is still unknown. ObjectiveTo investigate the causal involvement of the vestibular system in the discrimination of actions performed by others and whether this is influenced by motor familiarity. MethodsIn a single-blind design involving 25 healthy participants, Galvanic Vestibular Stimulation (GVS) was administered during an Action Discrimination Task (ADT), in which videos of actions categorized as vestibular/non-vestibular and familiar/unfamiliar were presented. Following each video, participants were required to identify the climax of the previously viewed action between two image options, using a two-alternative forced choice paradigm. The ADT was performed in active and sham GVS conditions, with left or right anodal montages. Response Times (RTs), Accuracy, and subjective motor familiarity were recorded for each action category. ResultsIn sham GVS condition, an overall familiarity effect was observed, where RTs for familiar actions were faster than RTs for unfamiliar ones, regardless of vestibular engagement (p < .001; ηp2 = .80). Conversely, under active GVS, a selective interference of the identification of vestibular familiar actions was observed compared to sham. Specifically, GVS prolonged RTs for recognizing familiar vestibular actions (p = .004, d = .59) while concurrently enhancing visual sensitivity (d’) for the same actions (p = .03, r = .21). ConclusionThese findings demonstrate the contribution of the vestibular system to action recognition. GVS disrupted the sensorimotor representation of vestibular actions and led to increased reliance on an alternative processing system focused on visual analysis of limb positions. This dissociation provides valuable insights for future investigations into the complex relationship between vestibular signals and cognitive processes involved in action identification, essential for developing innovative GVS interventions, particularly for individuals with sensorimotor or vestibular disorders.

Differential Access to Breast Magnetic Resonance Imaging Compared with Mammography and Ultrasound

For high-risk women, breast magnetic resonance (MR) is the preferred supplemental imaging option, but spatial access differences may exacerbate disparities in breast care. This was a cross-sectional study examining distance between ZIP codes and the nearest breast imaging facility (MR, mammography, ultrasound) using 2023 data from the Food and Drug Administration and the American College of Radiology. Linear regression was used to assess distance differences controlling for Area Deprivation Index (ADI), urbanicity, and population size. Analyses were conducted in 2024. Among the 29,629 ZIP codes with an ADI and known urbanicity, unadjusted mean distance to breast MR was 23.2±25.1 miles (SD) compared with 8.2±8.3 for mammography and 22.2±25.0 for ultrasound. Hence, the average distance to breast MR facilities was 2.8 times further than to mammography facilities. ADI and urbanicity were associated with increased distance to the nearest breast imaging facility. The additional miles associated with the least advantaged areas compared with most advantaged areas was 12.2 (95%CI: 11.3, 13.2) for MR, 11.5 miles (95%CI: 10.6, 12.3) for ultrasound, and 2.4 (95%CI: 2.1, 2.7) for mammography. Compared with metropolitan areas, the additional miles to breast MR facilities was 23.2 (95%CI: 22.5, 24.0) for small/rural areas. Spatial access is substantially better for mammography sites compared with breast MR or ultrasound sites. Given these findings, consideration of options to mitigate the impact of differential access should be considered. For example, mammography sites could offer contrast-enhanced mammography. Future research should examine the feasibility and effectiveness of this and other options.

PSMA PET/MR is a New Imaging Option for Identifying Glioma Recurrence and Predicting Prognosis.

Glioma is characterized by a high recurrence rate, while the results of the traditional imaging methods (including magnetic resonance imaging, MRI) to distinguish recurrence from treatment-related changes (TRCs) are poor. Prostate-specific membrane antigen (PSMA) (US10815200B2, Deutsches Krebsforschungszentrum, German Cancer Research Center) is a type II transmembrane glycoprotein overexpressed in glioma vascular endothelium, and it is a promising target for imaging and therapy. The study aimed to assess the performance of PSMA positron emission tomography/ magnetic resonance (PET/MR) for diagnosing recurrence and predicting prognosis in glioma patients. Patients suspected of glioma recurrence who underwent 18F-PSMA-1007 PET/MR were prospectively enrolled. Eight metabolic parameters and fifteen texture features of the lesion were extracted from PSMA PET/MR. The ability of PSMA PET/MR to diagnose glioma recurrence was investigated and compared with conventional MRI. The diagnostic agreement was assessed using Cohen κ scores and the predictive parameters of PSMA PET/MR were obtained. Kaplan-Meier method and Cox proportional hazard model were used to analyze recurrence- free survival (RFS) and overall survival (OS). Finally, the expression of PSMA was analyzed by immunohistochemistry (IHC). Nineteen patients with a mean age of 48.11±15.72 were assessed. The maximum tumorto- parotid ratio (TPRmax) and texture features extracted from PET and T1-weighted contrast enhancement (T1-CE) MR showed differences between recurrence and TRCs (all p <0.05). PSMA PET/MR and conventional MRI exhibited comparable power in diagnosing recurrence with specificity and PPV of 100%. The interobserver concordance was fair between the two modalities (κ = 0.542, p = 0.072). The optimal cutoffs of metabolic parameters, including standardized uptake value (SUV, SUVmax, SUVmean, and SUVpeak) and TPRmax for predicting recurrence were 3.35, 1.73, 1.99, and 0.17 respectively, with the area under the curve (AUC) ranging from 0.767 to 0.817 (all p <0.05). In grade 4 glioblastoma (GBM) patients, SUVmax, SUVmean, SUVpeak, TBRmax, TBRmean, and TPRmax showed improved performance of AUC (0.833-0.867, p <0.05). Patients with SUVmax, SUVmean, or SUVpeak more than the cutoff value had significantly shorter RFS (all p <0.05). In addition, patients with SUVmean, SUVpeak, or TPRmax more than the cutoff value had significantly shorter OS (all p <0.05). PSMA expression of glioma vascular endothelium was observed in ten (10/11, 90.9%) patients with moderate-to-high levels in all GBM cases (n = 6/6, 100%). This primitive study shows multiparameter PSMA PET/MR to be useful in identifying glioma (especially GBM) recurrence by providing excellent tumor background comparison, tumor heterogeneity, recurrence prediction and prognosis information, although it did not improve the diagnostic performance compared to conventional MRI. Further and larger studies are required to define its potential clinical application in this setting.