Imaging Techniques Research Articles

Enabling Technologies in the Management of Cervical Spine Trauma.

Narrative review. The objective of this study is to explore and evaluate the role of novel technologies in enhancing the diagnosis, surgical precision, and rehabilitation of cervical spine trauma, and to discuss their potential impact on clinical outcomes. Traumatic cervical spine injuries are challenging to manage due to their complex anatomy, the potential for long-term disability, and severe neurological deficits. Traditional management approaches are being supplemented by emerging technologies that promise to improve patient care and outcomes. A literature review was conducted to identify and analyze advancements in imaging, navigation, robotics, and wearable technologies in the context of cervical spine trauma. The review focuses on the potential of these technologies to improve early detection, surgical accuracy, and postoperative recovery. Technological innovations, including advanced imaging techniques, machine learning for diagnostics, augmented reality, and robotic-assisted surgery, are transforming the management of cervical spine trauma. These tools contribute to more efficient, accurate, and personalized treatment approaches, potentially improving clinical outcomes and reducing patient care burdens. Although these technologies hold great promise, challenges such as implementation costs and the need for specialized training must be addressed. With continued research and interdisciplinary collaboration, these advancements can significantly enhance the management of cervical spine trauma, improving patient recovery and quality of life. Level V.

Comprehensive Review of the Utility of Dynamic Contrast-Enhanced MRI for the Diagnosis and Treatment Assessment of Spinal Benign and Malignant Osseous Disease.

Conventional MRI is currently the preferred imaging technique for detection and evaluation of malignant spinal lesions. However, this technique is limited in its ability to assess tumor viability. Unlike conventional MRI, dynamic contrast-enhanced (DCE) MRI provides insight into the physiologic and hemodynamic characteristics of malignant spinal tumors and has been utilized in different types of spinal diseases. DCE has been shown to be especially useful in the cancer setting; specifically, DCE can discriminate between malignant and benign vertebral compression fractures as well as between atypical hemangiomas and metastases. DCE has also been shown to differentiate between different types of metastases. Furthermore, DCE can be useful in the assessment of radiation therapy for spinal metastases, including the prediction of tumor recurrence. This review considers data analysis methods utilized in prior studies of DCE-MRI data acquisition and clinical implications.

Radioanatomy of Salivary Glands

Salivary glands are the first organs of digestion secreting their digestive juices into the oral cavity. Parotid, submandibular, and sublingual glands are the major paired salivary glands in the decreasing order of their size. In addition, multiple small minor salivary glands are noted randomly distributed in the upper aerodigestive tract, including paranasal sinuses and parapharyngeal spaces. The imaging is directed to the major salivary glands. Commonly used imaging methods include plain radiography and conventional sialography. Recently, high-resolution ultrasonography (HRUS) is being increasingly used for targeted salivary gland imaging. However, the advent of cross-sectional imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) have revolutionized the imaging of salivary glands. This article illustrates the role of imaging in evaluating the variegated disease pattern of the major salivary glands.

Use of dual-energy x-ray absorptiometry for body composition in chronic disease management

As individuals age or contend with chronic diseases, shifts in body composition often emerge, characterized by a loss of muscle mass and an increase in fat mass, even among those with stable body weight. Both obesity and sarcopenia are key drivers of frailty, disability, and heightened morbidity and mortality. The simultaneous decline in skeletal muscle and accumulation of visceral fat can work synergistically, magnifying their detrimental effects on physical function and metabolic health. Today, dual-energy x-ray absorptiometry (DEXA) is widely recognized as one of the most versatile imaging techniques for assessing not only osteoporosis but also sarcopenia and obesity. Whole-body DEXA facilitates comprehensive analysis, offering detailed insights into fat mass, non-bone lean mass, and bone mineral content at both total and regional levels. DEXA is highly valued for its accuracy, reproducibility, speed, affordability, and low radiation exposure. Furthermore, advancements in DEXA technology and software now allow for precise estimation of visceral adipose tissue. This review underscores the clinical applications of whole-body DEXA, focusing on the use of muscle and fat mass indices in diagnosing low muscle mass, sarcopenia, and sarcopenic obesity, aligned with the latest research and guidelines.

What is new in imaging to assist in the diagnosis of giant cell arteritis and Takayasu's arteritis since the EULAR and ACR/VF recommendations?

Over the past decades, fundamental insights have been gained to establish the pivotal role of imaging in the diagnosis of large-vessel vasculitis, including giant cell arteritis (GCA) and Takayasu's arteritis (TAK). A deeper comprehension of imaging modalities has prompted earlier diagnosis leading to expedited treatment for better prognosis. The European Alliance of Associations in Rheumatology (EULAR) recommended in 2023 that ultrasound should be the initial imaging test in suspected GCA, and Magnetic Resonance Imaging (MRI) remains the first-line imaging modality in suspected TAK. We summarize the recent advances in diagnostic imaging in large vessel vasculitis, highlighting use of combination imaging modalities, and discuss progress in newer imaging techniques such as contrast-enhanced ultrasound, shear wave elastography, ocular ultrasound, ultrasound biomicroscopy, integration of Positron Emission Tomography (PET) with MRI, novel tracer in PET, black blood MRI, orbital MRI, and implementation of artificial intelligence (AI) to existing imaging modalities. Our aim is to offer a perspective on ongoing advancements in imaging for the diagnosis of GCA and TAK, particularly innovative technology, which could potentially boost diagnostic precision.

Applying Deep-Learning Algorithm Interpreting Kidney, Ureter, and Bladder (KUB) X-Rays to Detect Colon Cancer.

Early screening is crucial in reducing the mortality of colorectal cancer (CRC). Current screening methods, including fecal occult blood tests (FOBT) and colonoscopy, are primarily limited by low patient compliance and the invasive nature of the procedures. Several advanced imaging techniques such as computed tomography (CT) and histological imaging have been integrated with artificial intelligence (AI) to enhance the detection of CRC. There are still limitations because of the challenges associated with image acquisition and the cost. Kidney, ureter, and bladder (KUB) radiograph which is inexpensive and widely used for abdominal assessments in emergency settings and shows potential for detecting CRC when enhanced using advanced techniques. This study aimed to develop a deep learning model (DLM) to detect CRC using KUB radiographs. This retrospective study was conducted using data from the Tri-Service General Hospital (TSGH) between January 2011 and December 2020, including patients with at least one KUB radiograph. Patients were divided into development (n = 28,055), tuning (n = 11,234), and internal validation (n = 16,875) sets. An additional 15,876 patients were collected from a community hospital as the external validation set. A 121-layer DenseNet convolutional network was trained to classify KUB images for CRC detection. The model performance was evaluated using receiver operating characteristic curves, with sensitivity, specificity, and area under the curve (AUC) as metrics. The AUC, sensitivity, and specificity of the DLM in the internal and external validation sets achieved 0.738, 61.3%, and 74.4%, as well as 0.656, 47.7%, and 72.9%, respectively. The model performed better for high-grade CRC, with AUCs of 0.744 and 0.674 in the internal and external sets, respectively. Stratified analysis showed superior performance in females aged 55-64 with high-grade cancers. AI-positive predictions were associated with a higher long-term risk of all-cause mortality in both validation cohorts. AI-enhanced KUB X-ray analysis can enhance CRC screening coverage and effectiveness, providing a cost-effective alternative to traditional methods. Further prospective studies are necessary to validate these findings and fully integrate this technology into clinical practice.

Assessing diagnostic accuracy: 18F-FDG PET-CT scans in low-grade infection detection among post-traumatic long bone non-unions; a literature review and clinical data

IntroductionThe diagnosis of low-grade infection in post-traumatic long bone non-unions poses challenges due to the absence of clinical signs. This study aimed to review the available literature on the diagnostic accuracy of imaging techniques for low-grade infections and assess the diagnostic accuracy of 18F-FDG PET-CT scans for low-grade infection in post-traumatic long bone non-unions. MethodsA mini-review was conducted using Pubmed in March 2024. A retrospective study was conducted including adult patients with a long bone non-union, suspected of infection. All patients underwent 18F-FDG PET-CT scans as the index test before surgical intervention, with peri‑operative cultures obtained during surgery serving as the reference standard. Quantitative analyses were performed on the standardized uptake value (SUV) measurements obtained from the 18F-FDG PET-CT scans. Diagnostic accuracy measures including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the discriminatory ability of SUV measurements. ResultsLiterature suggests that 18F-FDG PET-CT is the most accurate imaging technique to detect low-grade infections. The study included a total of 51 18F-FDG PET-CT scans and cultures from 50 patients with long bone non-unions. The diagnostic accuracy was found to be 0.67 (95 % CI 0.44–0.87). The PPV and NPV were calculated as 0.79 (95 % CI 0.53–1.00) and 0.52 (95 % CI 0.30–0.73), respectively. Quantitative analyses of SUV measurements demonstrated a low level of accuracy, with all area under the curve (AUC) values < 0.75 and ROC curves showing a trajectory fairly parallel to the diagonal line. Conclusion and discussionThe findings of this study indicate that in post-traumatic long bone non-unions, where a low-grade fracture-related infection (FRI) is suspected, the 18F-FDG PET-CT has a performance that is advantageous over other imaging techniques. A careful interpretation of the scan results is warranted, possibly including the quantitative analysis on tracer uptake as an adjunct. Nevertheless, the diagnostic accuracy in this condition is not as good as in early-onset FRI cases, and this should be taken into account when treating these challenging cases.

Giant Epididymal Cyst in the Right Testicle: Case Report and Literature Review.

Introduction: Cystic intratesticular lesions can occur in the second and fourth decades of life and are typically identified via ultrasound. Testicular cysts, usually under 2 cm, result from epididymal-lymphatic obstruction or hormonal changes. Larger lesions with sperm and lymphocytes are spermatoceles. Epididymal cysts are asymptomatic but can cause discomfort or pain, sometimes requiring surgery. Clinical case: A 38-year-old male with no chronic diseases presented with a giant tumor in the right testicle, experiencing pain and hypersensitivity. Physical examination and ultrasound revealed an irregular, painful testicular tumor and a right epididymal cyst. A right epididymal tumor excision was performed successfully. Discussion: Testicular cysts are benign and represent 20-40% of benign testicular tumors. They may arise due to idiopathic, infectious, or traumatic causes with no established risk factors. Diagnosis is often incidental and involves physical examination and imaging techniques like ultrasound. Management is conservative for asymptomatic cases, while symptomatic cases may require surgical intervention that involves careful separation of the cyst from the adhered area. Conclusion: An epididymal cyst is a common pathology in males worldwide, occupying up to 40% of the masses in the testes at the time of a urological assessment. It is a collection at the testicular level of hyaline content and usually measures &lt; 2 cm. They are generally asymptomatic, but when their size exceeds 2 cm or causes symptomatology, it is important to know the therapeutic options that can be offered to patients. In the case of our patient, as it is an epididymal cyst with a diameter of 5 cm and with additional symptomatology, the ideal management was surgical resection, showing adequate evolution in the postoperative follow-up.

Cowper’s Duct Syringocele Mimicking Prostatic Obstruction: A Case Report

Introduction: Cowper’s glands, also known as bulbourethral glands, were first described by French surgeon Jean Mery in 1684 and later detailed by William Cowper in 1699. Cowper’s duct syringocele, a rare condition involving cystic dilatation of Cowper’s gland, can mimic symptoms of prostatic obstruction, posing diagnostic challenges. Common presentations include lower urinary tract symptoms (LUTS) such as urgency, weak stream, and incomplete emptying, often leading to misdiagnosis as benign prostatic hyperplasia (BPH). Accurate diagnosis involves imaging studies like transrectal ultrasound (TRUS) and magnetic resonance imaging (MRI), along with retrograde urethrography and cystourethroscopy. Management varies from conservative measures to surgical intervention, depending on symptom severity. Case Presentation: A 36-year-old male presented with urinary obstruction symptoms, reporting a poor stream and straining to urinate over three months, with exacerbation characterized by incomplete voiding. No hematuria, UTIs, or urolithiasis history was noted. Examination was largely unremarkable, except for a flat prostate on per rectal examination. Uroflowmetry indicated a maximum flow rate (Qmax) of 15 ml/sec with an interrupted pattern. MRI revealed a cystic lesion in the posterior urethra, raising suspicion for Cowper’s duct syringocele. Diagnostic cystoscopy confirmed the cystic dilatation, which was deroofed using monopolar energy. The patient’s recovery was uneventful, with follow-up uroflowmetry showing significant improvement, with a Qmax of 27 ml/sec. Discussion: This case underscores the importance of considering Cowper’s duct syringocele in the differential diagnosis of LUTS, especially in patients with atypical presentations. The diagnostic approach included uroflowmetry, MRI, and cystoscopy, which confirmed the cystic lesion. Management involved transurethral deroofing, leading to symptom resolution and improved urinary flow. Early recognition and intervention are crucial for favorable outcomes. Literature highlights the role of imaging and endoscopic techniques in diagnosing and managing this rare condition, emphasizing the need for interdisciplinary collaboration in complex urological cases. Conclusion: This case emphasizes the need for considering Cowper’s duct syringocele in patients with LUTS to avoid misdiagnosis and inappropriate management. Accurate diagnosis through a combination of uroflowmetry, imaging, and cystoscopy, followed by appropriate surgical intervention, can significantly improve patient outcomes. The case underscores the efficacy of endoscopic techniques and the importance of interdisciplinary collaboration in optimizing care for patients with rare urological conditions.

ENHANCED TRANSFORMER-BASED DEEP KERNEL FUSED SELF ATTENTION MODEL FOR LUNG NODULE SEGMENTATION AND CLASSIFICATION

Lung cancer remains a leading cause of mortality globally, with outcomes heavily dependent on the timeliness and accuracy of diagnosis. Traditional medical imaging techniques, while foundational in detecting lung nodules, often falter in distinguishing malignant from benign lesions with high precision, largely due to their inability to contextualize the complex spatial relationships within the images. Precise segmentation and classification of lung nodules is crucial for the early detection of lung cancer. This paper presents a novel deep learning model that incorporates a transformer block to improve the performance of lung cancer detection and classification. From performance evaluation, it is evident that our proposed model has an average accuracy of 93%. 05%, which is superior to the existing D3DR _ MKCA model with a mean accuracy of 91.53%. These findings are especially important for the identification of Adenocarcinoma and Small Cell Carcinoma, as improvements in the precision and recall factors have been achieved in these cases.

Implementing verifiable oncological imaging by quality assurance and optimization (i‑Violin) : Protocol for aEuropean multicenter study.

Advanced imaging techniques play apivotal role in oncology. Alarge variety of computed tomography (CT) scanners, scan protocols, and acquisition techniques have led to awide range in image quality and radiation exposure. This study aims at implementing verifiable oncological imaging by quality assurance and optimization (i-Violin) through harmonizing image quality and radiation dose across Europe. The 2‑year multicenter implementation study outlined here will focus on CT imaging of lung, stomach, and colorectal cancer and include imaging for four radiological indications: diagnosis, radiation therapy planning, staging, and follow-up. Therefore, 480 anonymized CT data sets of patients will be collected by the associated university hospitals and uploaded to arepository. Radiologists will determine key abdominopelvic structures for image quality assessment by consensus and subsequently adapt apreviously developed lung CT tool for the objective evaluation of image quality. The quality metrics will be evaluated for their correlation with perceived image quality and the standardized optimization strategy will be disseminated across Europe. The results of the outlined study will be used to obtain European reference data, to build teaching programs for the developed tools, and to create aculture of optimization in oncological CT imaging. The study protocol and rationale for i‑Violin, aEuropean approach for standardization and harmonization of image quality and optimization of CT procedures in oncological imaging, is presented. Future results will be disseminated across all EU member states, and i‑Violin is thus expected to have asustained impact on CT imaging for cancer patients across Europe.

Cerebellar Structural and N-Acetylaspartate, Choline, and Creatine Metabolic Profiles in Parkinson's Disease and Essential Tremor.

The role of the cerebellum in Parkinson's disease (PD), particularly in tremor-dominant subtypes, is increasingly recognized. Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) provide anatomical and metabolic insights, suggesting compensatory hyperactivity or degenerative changes in the cerebellum in PD. Volumetric analysis of cerebellar structures in MRI images, combined with metabolic profiles from MRS, offers possibilities for differentiating PD from essential tremor (ET). The cerebellum may be a potential therapeutic target due to its role in neurocircuitry of PD and ET. Brain structural data were obtained using MRI, and cerebellar metabolic profiles, focusing on the quantification of N-acetylaspartate (NAA), choline, and creatine peaks were obtained using MRS. This study enrolled patients with ET and PD, both with and without tremor, as well as disease controls with cerebellar atrophy (including spinocerebellar ataxia and multiple system atrophy). Volumetric analysis of cerebellar structures was performed. Differences in MRI and MRS parameters were analyzed using one-way analysis of covariance with a significance threshold of p < 0.05. From November 2018 to March 2023, 111 patients were enrolled, including 29 ET, 29 cerebellar atrophy, 12 PD without tremor, and 41 PD with tremor. No significant differences in cerebellar volume and N-acetylaspartate/creatine and choline/creatine ratios were found between ET and PD with tremor. This preliminary retrospective study suggests similarities in cerebellar structures and metabolic profiles between ET and PD, highlighting the need for advanced imaging techniques to better differentiate between these conditions. Future research should integrate clinical data, such as tremor severity and cognitive assessments, to explore the relationships with cerebellar MRI parameters.

Correlations between coagulation abnormalities and inflammatory markers in trauma-induced coagulopathy.

In multiple trauma patients, the occurrence of trauma-induced coagulopathy (TIC) is closely associated with tissue damage and coagulation function abnormalities in the pathophysiological process. This study established a multiple trauma and shock model in Sprague-Dawley (SD) rats and comprehensively utilized histological staining and radiographic imaging techniques to observe injuries in the intestine, liver, skeletal muscles, and bones. Monitoring activated partial thromboplastin time (APTT), platelet (PLT) count, respiratory rate, blood pressure, and other physiological indicators revealed time-dependent alterations in coagulation function and physiological indicators. Enzyme-linked immunosorbent assay (ELISA) measurements of inflammatory factors Tumor Necrosis Factor-alpha (TNF-α), Interleukin-6 (IL-6) and vascular endothelial injury marker (Syndecan-1) were also conducted. Experimental results demonstrated significant changes in tissue structure after multiple traumas, although widespread necrosis or hemorrhagic lesions were not observed. There were time-dependent alterations in coagulation function and physiological indicators. ELISA measurements showed a strong positive correlation between the significant decrease in PLT count and the increase in TNF-α and IL-6 concentrations. The study provides crucial information for the early diagnosis and treatment of TIC. The findings suggest that structured monitoring of coagulation and inflammatory indicators can help in understanding the pathophysiological changes and aid in the management of TIC in multiple trauma patients.

Data-driven AI for the automated classification of the isothermal heat-treated thermal barrier coatings using pulsed infrared thermography

Abstract Thermal barrier coating (TBC) is a multilayer coating applied to metallic structures exposed to high temperatures, such as aero-engine parts and gas turbine blades. These thermally insulating materials are used to extend the component life by minimizing the high-temperature exposure of structural components. As a result of the high-temperature oxidation tests, a thermally grown oxide (TGO) layer formed at the interface between the ceramic topcoat layer and the bond coat layer. The primary cause of TBC performance decline and structure failure is the growth of the oxide layer. Hence, it is crucial to regularly monitor the formation of the oxide layer and the degradation of coatings. This can be achieved by developing coating-life prediction models, which are vital for quality control, health monitoring of TBCs, maintenance decision-making, and the prevention of catastrophic failures. Existing methods for life estimation, which are dependent on empirical methods and microstructural analysis, often fail due to various material compositions and service conditions. This study proposes an automated classification of iso-thermal heat-treated TBC samples using temperature data, which helps in predicting the TBC life and monitoring the TBC degradation. TBC-coated samples are isothermal heat-treated at 1000 °C, and the initial growth of TGO is monitored using a non-destructive thermal imaging technique. Identifying distinctive features in each class corresponding to layer thickness measurement and service hours is challenging and time-consuming. So, we integrate data-driven AI models and feature extraction techniques to interpret complex thermal patterns. The performance of deep learning models and classical machine learning models demonstrates that our method can achieve maximum classification accuracy and F1-score of 89.2% and 89.0%, respectively. This automated classification framework promises a powerful tool for predictive maintenance and remaining useful lifetime estimation of hot section components reliant on TBCs.

Revisiting PD: Unraveling the brain-first and body-first perspectives

Parkinson’s disease (PD) has undergone significant advancements in diagnosis and treatment over the past century, with apparent dopaminergic cell degeneration on dopamine transporter scans and a strong response to medication being key features. However, the etiology remains complex, involving various pathogenic mechanisms beyond alpha-synuclein accumulation. The recent brain-first versus body-first hypothesis, emerging from advances in functional imaging and clinical symptom clustering, suggests distinct starting points of alpha-synuclein pathology-either in the brain or the body, with subsequent spread via neural connections. This theory, exemplified by the alpha-synuclein origin site and connectome (SOC) model, proposes that body-first PD may originate in the enteric nervous system and spread to the brain, while brain-first PD starts within the central nervous system, such as the olfactory bulb or amygdala. While the SOC model offers valuable insights into the progression of PD, it raises several controversies. Critics argue that the model may oversimplify the disease’s complexity, failing to account for overlapping symptoms and the varying progression rates observed in different subtypes. Furthermore, there are concerns about the lack of longitudinal data and the potential for reclassification of PD subtypes over time. Despite these challenges, the ongoing development of imaging techniques that reflect in-vivo pathology holds promise for resolving these controversies and advancing the selection of patients for disease-modifying therapies.

Non-invasive Imaging Techniques for the Diagnosis of Chromoblastomycosis

Non-invasive Imaging Techniques for the Diagnosis of Chromoblastomycosis

Cranioplasty Approaches for Cranial Defects: A Case Series

Abstract Cranial defects are commonly caused due to road traffic accidents, tumor, postneurosurgery, or congenital deformities. Protection of the cranial structures, maintaining cerebrospinal fluid dynamics, and esthetics are some of the prime considerations while restoration of such defects. The use of autograft or allograft materials such as bone from a self or another donor site from ribs, ilium, tibia, scapula, and fascia and procedures such as split-thickness cranioplasty were carried out in the past. However, in larger defects, alloplastic materials such as celluloids, methyl methacrylate, hydroxyapatite, polyethylene, silicone, and metals such as titanium, aluminum, and stainless steel, were used for restoration. Irrespective of the material of choice, it is desirable of the prosthetic material to demonstrate low thermal conductivity, optimal strength, low infection rate, longevity, close adaptation to the defect, and fixability with plates to adjacent bone. Before digital imaging, conventional impressions were made, and approximations were done to fabricate cranial plates. With the advent of digital technology and bone imaging techniques with alongside the development of printed and milled materials, accurate cranial prosthesis can be fabricated. We cannot disregard conventional techniques as these are still used in places where access to digital technology is limited and also for patients who cannot afford the cost incurred with digital technology. The case series presents one case, which was fabricated with a conventional method, and two cases with two different approaches using digital technology. The paper aims to present various advantages, limitations, and nuances needed while the fabrication of such a prosthesis with these three methods.

Method for Extracting Optical Element Information Using Optical Coherence Tomography.

This study examines the measurement of film thickness, curvature, and defects on the surface or inside of an optical element using a highly accurate and efficient method. This is essential to ensure their quality and performance. Existing methods are unable to simultaneously extract the three types of information: thickness, curvature, and defects. Spectral-domain optical coherence tomography (SD-OCT), a non-invasive imaging technique with imaging depths down to the millimeter scale, provides the possibility of detecting the optical element components' parameters. In this paper, we propose an error correction model for compensating delay differences in A-scan, field curvature, and aberration to improve the accuracy of system fitting measurements using SD-OCT. During data processing, we use the histogram-equalized gray stretching (IAH-GS) method to deal with strong reflections in the thin film layers inside the optics using individual A-scan averages. In addition, we propose a window threshold cutoff algorithm to accurately identify defects and boundaries in OCT images. Finally, the system is capable of rapidly detecting the thickness and curvature of film layers in optical elements with a maximum measurement depth of 4.508 mm, a diameter of 15 × 15 mm, a resolution of 5.69 microns, and a sampling rate of 70 kHz. Measurements were performed on different standard optical elements to verify the accuracy and reliability of the proposed method. To the best of our knowledge, this is the first time that thickness, curvature, and defects of an optical film have been measured simultaneously, with a thickness measurement accuracy of 1.924 µm, and with a difference between the calibrated and nominal curvature measurements consistently within 1%. We believe that this research will greatly advance the use of OCT technology in the testing of optical thin films, thereby improving productivity and product quality.

Spontaneous Renal Arteriovenous Malformation Presenting with Hematuria: A Case Report

Introduction: Rare vascular abnormalities called renal arteriovenous malformations (AVMs) can cause hematuria among other symptoms. Due to overlapping clinical and radiological symptoms, differentiating between renal AVMs and other disorders such renal cell carcinoma (RCC) can be difficult. Here, we report a case of a patient who developed hematuria and was first diagnosed with renal AVM. We go over the difficulties in diagnosing this ailment and the approaches to managing it. Case Presentation: A 34-year-old female patient, reported having hematuria with clots for one week, coupled with fever and left loin discomfort that persisted for four and one day, respectively. Her hemoglobin level was 4.5 g/dL at arrival, which required packed red cell transfusions. A left double-J stent was implanted after an emergency cystoscopy revealed bloody efflux from the left ureteric orifice. A potential arteriovenous malformation in the left kidney's upper pole area was discovered by further imaging. A cirsoid-type AV abnormality arising from the superior polar branch of the renal artery was verified by renal angiography. After therapeutic embolization, the patient's symptoms were relieved and hematuria stopped. Discussion: The case study highlights the need of taking renal AVMs into account when making a differential diagnosis for hematuria, especially if there haven't been any previous urological operations. It also emphasises how important imaging techniques like renal angiography and renal ultrasonography with Doppler are for making the right diagnosis. Distinctive diagnosis from other ailments, such as renal cell carcinoma, highlights the necessity of comprehensive assessment and monitoring to guarantee suitable treatment. Conclusion: Renal arteriovenous malformations are rare but important causes of hematuria. Prompt diagnosis and management are crucial to prevent complications and improve patient outcomes. This case report demonstrates the diagnostic challenges associated with renal AVMs and underscores the importance of a multidisciplinary approach in their evaluation and treatment.

Ostial LCx: Achilles Heel of Left Main Bifurcation Angioplasty and How We Evolved in Its Management

In-stent restenosis (ISR) within bifurcation lesions of the left main (LM) coronary artery (LMCA) is challenging due to its complex anatomy and critical function. This case series highlights 3 patients with LM bifurcation ISR (Medina 1,1,1) post-index intervention using different stent strategies as follows: Case 1: A 58-year-old male developed distal LM bifurcation stenosis after ostial left anterior descending artery (LAD) stenting. Mini-culotte bifurcation angioplasty effectively managed this. Case 2: A 62-year-old male presented with neo-atherosclerosis-induced distal LM bifurcation ISR post-provisional LM-left anterior descending artery (LAD) stenting. A single-stent crossover with a drug-coated balloon in a large side branch achieved optimal flow restoration. Case 3: A chronic total occlusion in the right coronary artery and distal LM bifurcation ISR due to stent overhang into LMCA in a 72-year-old male was resolved with a string culotte technique. These cases underscore ISR management strategies tailored to patient-specific anatomy and clinical needs, advocating advanced imaging techniques like intravascular ultrasound and optical coherence tomography for procedural precision and safety.