Noninvasive Imaging Modality Research Articles

Pericarotid Fat as a Marker of Cerebrovascular Risk.

Vascular inflammation is widely recognized as an important factor in the atherosclerotic process, particularly in terms of plaque development and progression. Conventional tests, such as measuring circulating inflammatory biomarkers, lack the precision to identify specific areas of vascular inflammation. In this context, noninvasive imaging modalities can detect perivascular fat changes, serving as a marker of vascular inflammation. This review aims to provide a comprehensive overview of the key concepts related to perivascular carotid fat and its pathophysiology. Additionally, we examine the existing literature on the association of pericarotid fat with features of plaque vulnerability and cerebrovascular events. Finally, we scrutinize the advantages and limitations of the noninvasive assessment of pericarotid fat.

Correlation and Diagnostic Agreement Between Ultrasonography and MRCP in Evaluating Obstructive Jaundice: A Prospective Study

Background: Obstructive jaundice is a clinical condition characterized by the yellow discoloration of the skin, sclera, and mucous membranes due to elevated bilirubin levels caused by bile flow obstruction. Accurate diagnosis of the obstruction's cause and site is essential for effective management. Ultrasonography (USG) is commonly used for initial screening, but it has limitations, especially in visualizing the distal common bile duct (CBD). Magnetic resonance cholangiopancreatography (MRCP) has emerged as a superior, non-invasive imaging modality with higher accuracy in evaluating biliary obstructions. Objective: To evaluate the correlation and agreement between USG and MRCP findings in patients with obstructive jaundice and to determine the diagnostic accuracy of each modality in detecting the level and cause of biliary obstruction. Methods: This prospective cohort study was conducted over six months at a tertiary care hospital in Rawalpindi. A total of 32 patients with clinical suspicion of obstructive jaundice were included. Each patient underwent both USG and MRCP. USG was performed using a GE Logiq-e machine, followed by MRCP on a Philips Achieva 1.5 Tesla MRI scanner. Data were analyzed using SPSS version 25. Pearson's correlation coefficient and kappa statistics were used to assess the correlation and agreement between the two modalities. The diagnostic accuracy of USG and MRCP was compared based on the detection of the level of obstruction and the identification of benign and malignant etiologies. Results: The mean age of the patients was 59.53 ± 13.41 years, with 65.6% being male. MRCP showed a diagnostic accuracy of 97.2% compared to 78.1% for USG. MRCP detected distal CBD calculi with 100% accuracy, while USG missed these in 11 cases. A positive correlation was found between USG and MRCP in detecting the site of obstruction (r = 0.48, p = 0.005), the porta hepatis as the site of obstruction (r = 0.47, p = 0.006), and the ampulla as the site of obstruction (r = 0.47, p = 0.006). However, the correlation for benign etiologies was weak (r = 0.094, p = 0.607), and for malignant etiologies, it was moderate (r = 0.31, p = 0.08). Conclusion: MRCP demonstrated superior diagnostic accuracy compared to USG in evaluating patients with obstructive jaundice, particularly in detecting distal CBD calculi and malignant lesions. While USG remains useful as an initial screening tool, MRCP should be considered the preferred imaging modality when detailed evaluation is required.

Canadian Medical Imaging Inventory 2022–2023: MRI

MRI is a noninvasive imaging modality that uses powerful electromagnetic and radiofrequency fields to produce cross-sectional images of the body. MRI is primarily used for neurologic exams (28%), followed by musculoskeletal (23%) and oncology exams (17%). In total, 432 MRI units in 11 jurisdictions were identified by the Canadian Medical Imaging Inventory (CMII) in its 2022 to 2023 national survey. Most sites are publicly funded hospitals located in urban centres. Canada has an average of 10.8 MRI units per million people. The greatest density of units per million people is in Yukon, Quebec, and New Brunswick. Overall, 2,214,157 publicly funded MRI examinations were performed in the 2022–2023 fiscal year. This represents a national average of 55.6 exams per 1,000 people, an increase of 4.3% since 2019– Canada is positioned in the bottom 25% of Organisation for Economic Co-operation and Development (OECD) countries in units per million population and the bottom 50% of OECD countries for average volume of publicly funded MRI exams per 1,000 population. The average age of MRI equipment in Canada is 8.4 years; 62.8% of MRI units are 10 years old or newer, 23.3% are 11 to 15 years old, and 13.9% are more than 15 years old. On average, MRI units operate 15.3 hours per day and 97.4 hours per week. Overall, 76.0% of sites reported MRI operation on weekends and 17% of sites reported operating 24 hours a day.

Imaging-Guided Metabolic Radiosensitization of Pediatric Rhabdoid Tumors.

Tumor hypoxia leads to increased resistance to radiation therapy (RT), resulting in markedly worse clinical outcomes in the treatment and management of pediatric malignant rhabdoid tumors (MRT). To alleviate hypoxia in MRT, we repurposed an FDA approved, mitochondrial oxidative phosphorylation (OXPHOS) inhibitor, Atovaquone (AVO), to inhibit oxygen consumption and thereby enhance the sensitivity of tumor cells to low dose RT in MRT by hypoxia alleviation. Additionally, to better understand the tumor response induced by AVO and optimize the combination with RT, we employed an emerging, noninvasive imaging modality, known as multispectral optoacoustic tomography (MSOT), to monitor and evaluate real-time dynamic changes in tumor hypoxia and vascular perfusion. Oxygen-Enhanced (OE)-MSOT could measure the change of tumor oxygenation in the MRT xenograft models after AVO and RT treatments, indicating its potential as a response biomarker. OE-MSOT showed that treating MRT mouse models with AVO resulted in a transient increase in oxygen saturation (ΔsO 2 ) in tumors when the mice were subjected to oxygen challenge, while RT or saline treated groups produced no change. In AVO+RT combination groups, the tumors showed an increase in ΔsO 2 after AVO administration followed by a significant decrease after RT, that correlated with a strong anti-tumor response, demarcated by complete regression of tumors, with no relapse on long-term monitoring. These observations were histologically validated. In MRT models of acquired AVO resistance, combination therapy failed to alleviate tumoral hypoxia and elicit any therapeutic benefit. Together, our data highlights the utility of repurposing anti-malarial AVO as an anticancer adjuvant for enabling low dose RT for pediatric patients.

Consensus of National Heart Center and the Saudi Arabian Cardiac Interventional Society on the Current Landscape of the Management of Intracoronary Calcification in Saudi Arabia.

We aimed to develop a streamlined algorithm for the management of intracoronary calcification that includes guidance on intracoronary imaging and the appropriate selection of atherectomy devices. National experts representing both the National Heart Center (NHC) and the Saudi Arabian Cardiac Interventional Society (SACIS) met to develop a consensus document on the assessment and management of intracoronary calcification in Saudi Arabia. The nominal group technique was utilized; a number of statements on the assessment and management of coronary artery calcification were developed based on a systematic review of the literature. The authors discussed the developed statements until a consensus was reached. Twenty statements were discussed and agreed upon. Invasive and non-invasive imaging modalities in the assessment of coronary artery calcification, and management of intracoronary calcification using calcium ablation techniques, excimer laser coronary atherectomy, ballon-based techniques, and shockwave lithotripsy; were all thoroughly discussed in light of scientific evidence and the experts' clinical practice. We present a national consensus on the assessment and the multifaceted management of intracoronary calcification in Saudi Arabia.

From images to insights: a neuroradiologist's practical guide on white matter fiber tract anatomy and DTI patterns for pre-surgical planning.

Diffusion tensor imaging (DTI) is a valuable non-invasive imaging modality for mapping white matter tracts and assessing microstructural integrity, and can be used as a "biomarker" in diagnosis, differentiation, and therapeutic monitoring. Although it has gained clinical importance as a marker of neuropathology, limitations in its interpretation underscore the need for caution. This review provides an overview of the principles and clinical applicability of DTI. We focus on major white matter fiber bundles, detailing their normal anatomy and pathological DTI patterns, with emphasis on tracts routinely requested in our neurosurgical department in the preoperative context (uncinate fasciculus, arcuate fasciculus, pyramidal pathway, optic radiation, and dentatorubrothalamic tract). We guide neuroradiologists and neurosurgeons in defining volumes of interest for mapping individual tracts and demonstrating their 3D reconstructions. The intricate trajectories of white matter tracts pose a challenge for accurate fiber orientation recording, with each bundle exhibiting specific characteristics. Tracts adjacent to brain lesions are categorized as displaced, edematous, infiltrated, or disrupted, illustrated with clinical cases of brain neoplasms. To improve structured reporting, we propose a checklist of topics for inclusion in imaging evaluations and MRI reports. DTI is emerging as a powerful tool for assessing microstructural changes in brain disorders, despite some challenges in standardization and interpretation. This review serves an educational purpose by providing guidance for fiber monitoring and interpretation of pathological patterns observed in clinical cases, highlighting the importance and potential pitfalls of DTI in neuroradiology and surgical planning.

Multiparametric simultaneous hybrid 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) incorporating intratumoral and peritumoral regions for grading of glioma.

Preoperative grading gliomas is essential for therapeutic clinical decision-making. Current non-invasive imaging modality for glioma grading were primarily focused on magnetic resonance imaging (MRI) or positron emission tomography (PET) of the tumor region. However, these methods overlook the peritumoral region (PTR) of tumor and cannot take full advantage of the biological information derived from hybrid-imaging. Therefore, we aimed to combine multiparameter from hybrid 18F-fluorodeoxyglucose (18F-FDG) PET/MRI of the solid component and PTR were combined for differentiating high-grade glioma (HGG) from low-grade glioma (LGG). A total of 76 patients with pathologically confirmed glioma (41 HGG and 35 LGG) who underwent simultaneous 18F-FDG PET, arterial spin labelling (ASL), and diffusion-weighted imaging (DWI) with hybrid PET/MRI were retrospectively enrolled. The relative maximum standardized uptake value (rSUVmax), relative cerebral blood flow (rCBF), and relative minimum apparent diffusion coefficient (rADCmin) for the solid component and PTR at different distances outside tumoral border were compared. Receiver operating characteristic (ROC) curves were applied to assess the grading performance. A nomogram for HGG prediction was constructed. HGGs displayed higher rSUVmax and rCBF but lower rADCmin in the solid component and 5 mm-adjacent PTR, lower rADCmin in 10 mm-adjacent PTR, and higher rCBF in 15- and 20-mm-adjacent PTR. rSUVmax in solid component performed best [area under the curve (AUC) =0.865] as a single parameter for grading. Combination of rSUVmax in the solid component and adjacent 20 mm performed better (AUC =0.881). Integration of all 3 indicators in the solid component and adjacent 20 mm performed the best (AUC =0.928). The nomogram including rSUVmax, rCBF, and rADCmin in the solid component and 5-mm-adjacent PTR predicted HGG with a concordance index (C-index) of 0.906. Multiparametric 18F-FDG PET/MRI from the solid component and PTR performed excellently in differentiating HGGs from LGGs. It can be used as a non-invasive and effective tool for preoperative grade stratification of patients with glioma, and can be considered in clinical practice.

Role of optical coherence tomography angiography in retinal tumors: A narrative review.

Intraocular tumors constitute a small subset of cases in ophthalmologic practice. Proper diagnosis of intraocular tumors is crucial because some pose threat to vision and life, while others may indicate underlying systemic disorders. Intraocular tumors comprise benign and malignant lesions affecting the retina, choroid, optic disc, iris, and ciliary body. Retinal tumors can be classified as vascular, neural, glial, and retinal pigment epithelial tumors. Optical coherence tomography angiography (OCTA) is a noninvasive imaging modality employed in diagnosis and management of retinal and choroidal vascular diseases, and has enhanced our knowledge in better understanding of the vascular physiology and pathology. Multiple case reports and small series evaluating the role of OCTA in retinal tumors are published in literature. OCTA helps in better understanding of the vascularity of intraocular tumors. In addition to this, OCTA has its role in clinical practice. It helps in identification of small retinal capillary hemangioblastoma (RCH), assessment of treatment response, and identification of tumor recurrence in RCH. It aids in identification of retinal astrocytic hamartoma missed on clinical examination and differentiating retinal astrocytic hamartoma and presumed solitary circumscribed retinal astrocytic proliferation. It helps in assessment of risk of tumor recurrence in retinoblastoma. It helps in differentiating tumors of retinal pigment epithelium (RPE) origin from pigmented tumors of the choroid. It also helps in detection of choroidal neovascular membrane in combined hamartoma of the retina and RPE.

Customized Vascular Repair Microenvironment: Poly(lactic acid)-Gelatin Nanofibrous Scaffold Decorated with bFGF and Ag@Fe3O4 Core-Shell Nanowires.

Vascular defects caused by trauma or vascular diseases can significantly impact normal blood circulation, resulting in serious health complications. Vascular grafts have evolved as a popular approach for vascular reconstruction with promising outcomes. However, four of the greatest challenges for successful application of small-diameter vascular grafts are (1) postoperative anti-infection, (2) preventing thrombosis formation, (3) utilizing the inflammatory response to the graft to induce tissue regeneration and repair, and (4) noninvasive monitoring of the scaffold and integration. The present study demonstrated a basic fibroblast growth factor (bFGF) and oleic acid dispersed Ag@Fe3O4 core-shell nanowires (OA-Ag@Fe3O4 CSNWs) codecorated poly(lactic acid) (PLA)/gelatin (Gel) multifunctional electrospun vascular grafts (bAPG). The Ag@Fe3O4 CSNWs have sustained Ag+ release and exceptional photothermal capabilities to effectively suppress bacterial infections both in vitro and in vivo, noninvasive magnetic resonance imaging (MRI) modality to monitor the position of the graft, and antiplatelet adhesion properties to promise long-term patency. The gradually released bFGF from the bAPG scaffold promotes the M2 macrophage polarization and enhances the recruitment of macrophages, endothelial cells (ECs) and fibroblast cells. This significant regulation of diverse cell behavior has been proven to be beneficial to vascular repair and regeneration both in vitro and in vivo. Therefore, this study supplies a method to prepare multifunctional vascular-repair materials and is expected to represent a significant guidance and reference to the development of biomaterials for vascular tissue engineering.

Fundus Autofluorescence in Diabetic Retinopathy.

Diabetic retinopathy is a leading cause of visual morbidity worldwide. Fundus autofluorescence is a rapid, non-invasive imaging modality that has gained increased popularity in recent years in the multimodal evaluation of diabetic retinopathy and, in particular, of diabetic macular oedema. Acquired using either a fundus camera or the confocal scanning laser ophthalmoscope, short-wavelength and near-infrared autofluorescence are the most used techniques in diabetic retinopathy. In diabetic macular oedema, short-wavelength autofluorescence, in its cystoid pattern, is useful for detecting cystoid macular oedema. Increased spot hyperautofluorescence in short-wavelength and granular changes in near-infrared autofluorescence correlate well with other imaging findings, indicating photoreceptor and retinal pigment epithelium damage and being associated with decreased visual acuity. While also being a marker of oxidative stress, increased short-wavelength autofluorescence in the setting of diabetic macular oedema appears to be a prognostic factor for poor visual outcome, even after the resolution of the intraretinal fluid. Autofluorescence also helps in the assessment of diabetic retinal pigment epitheliopathy and choroidopathy. Fundus autofluorescence is an evolving technology that will assist in gaining further insight into the pathophysiology of diabetic retinopathy and allow for a more comprehensive evaluation of these patients.

A Case Report of Aberrant Origin of the Right Coronary Artery from thePulmonary Artery in an Adult Male: The Role of Multi-modality Imaging

Background: The normal anatomy of the coronary arteries consists of the right coronary artery and the left main coronary artery, which originate from the right and left sinuses of Valsalva in the aortic root separately. In general, congenital anomalies of the coronary artery are uncommon in adults. The ectopic origin of a coronary artery from the pulmonary trunk is part of a group of infrequent coronary artery anomalies. The Anomalous origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA) is thought to be an extremely rare congenital coronary artery anomaly. Most of our knowledge and experience about this congenital coronary malformation is derived from published case reports and series. Case Presentation: We have, herein, reported the case of a 68-year-old male who was discovered to have ARCAPA after he presented to our center with chest pain. The patient underwent multiple invasive and non-invasive diagnostic imaging modalities, including an echocardiogram, a coronary angiogram, a multislice-gated coronary computed tomographic angiogram, and stress perfusion cardiovascular magnetic resonance imaging. The clinical decision was to continue with conservative non-surgical management along with close follow-up. Conclusion: The ARCAPA anomaly is considered to be one of the rare congenital coronary artery variances that can be discovered in late adulthood as a patient may remain asymptomatic for many decades.

Diagnostic ability of [18F]FDG PET/CT for distinguishing benign from malignant spleen lesions.

[18F]Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a non-invasive imaging modality used in the differential diagnosis of splenic lesions, although ideal parameters and thresholds remain unclear. The present study evaluated the ability of [18F]FDG PET/CT, including its visual and quantitative parameters, to differentiate between benign and malignant splenic lesions. Patients who underwent [18F]FDG PET/CT following the detection of splenic lesions on contrast-enhanced CT were retrospectively analysed. Visual parameters assessed on [18F]FDG PET/CT included whole spleen uptake intensity, lesion multiplicity, and lesion uptake, and quantitative parameters included maximum standardised uptake value (SUVmax), lesion-to-background ratio (LBR), metabolic tumour volume (MTV), total lesion glycolysis (TLG), and lesion size. Parameters differentiating between benign and malignant lesions were evaluated by Pearson's chi-square test, Mann-Whitney U-test, and receiver operating characteristics (ROC) curve analysis. Splenic lesion uptake (p = 0.001) was the only visual parameter significantly distinguishing between benign and malignant lesions. ROC curve analysis demonstrated that SUVmax had the largest area under the ROC, 0.91 (p < 0.001), with an optimal cut-off > 5.3 having a sensitivity of 90.3% and a specificity of 80.6%. Subgroup analysis of malignant lesions showed that SUVmax (p = 0.013), LBR (p = 0.012), and TLG (p = 0.034) were significantly higher in splenic lymphomas than in splenic metastases. Of the [18F]FDG PET/CT parameters investigated, SUVmax had the highest accuracy in diagnosing malignant splenic lesions and was significantly higher in splenic lymphomas than in splenic metastases. Visual determination of [18F]FDG uptake by splenic lesions may be an easily evaluated parameter. SUVmax and visual grade of [18F]FDG PET/CT help to differentiate spleen lesions. [18F]FDG PET/CT is useful for discriminating between benign and malignant spleen lesions. Many splenic lesions are difficult to diagnose on anatomical imaging, with histopathologic analyses are required. SUVmax of PET/CT provided the diagnostic ability to differentiate between benign and malignant splenic lesions. More than normal spleen uptake can be a convenient parameter to diagnose malignant spleen lesions.

Multi-phase CT-Angiography outperforms angiographic careggi collateral score and predicts functional outcome in acute ischemic stroke.

Collaterals are a strong determinant of clinical outcome in acute ischemic stroke (AIS) patients undergoing Endovascular Treatment (EVT). Careggi Collateral Score (CCS) is an angiographic score that demonstrated to be superior to the widely suggested ASITN/SIR score. Multi-phase CT-Angiography (mCTA) could be alternatively adopted for collateral assessment. We investigated whether mCTA had an equivalent predictive performance for functional outcome compared to CCS. Consecutive AIS patients undergoing EVT for large vessel occlusion within 24h from onset were analyzed. Receiver operating characteristic curves and multivariable logistic regression were investigated to evaluate the predictive performance of mCTA collateral score (range 0-5) and CCS (range 0-4) for good functional outcome (three-months modified Rankin Scale 0-2). We included 201 subjects (59.7% females, mean age 75), of whom 96 (47.7%) had good outcome at three-months. Both CCS (OR = 14.4, 95% CI = 6.3-33.8) and mCTA (OR = 23.8, 95% CI = 10.1-56.4) collateral scores were independent predictors of outcome. The AUC of CCS was 0.80 (95% CI 0.73-0.86) and the best cut-off was ≥ 3 (87% sensitivity, 71% specificity), while the AUC of mCTA collateral score was 0.84 (95% CI 0.78-0.90) with an optimal cut-off of ≥ 4 (85% sensitivity, 87% specificity). Patients with good mCTA collaterals experienced smaller (16.6 vs. 63.7 mL, p < 0.001) infarct lesion as compared to those with mCTA poor collaterals. mCTA discriminative ability for three-months 0-2 mRS was found to be comparable to CCS. mCTA appears a valid, non-invasive imaging modality for evaluating collaterals of AIS patients potentially eligible for EVT.

Role of Multi-Detector Computed Tomography (MDCT) in Assessment of Biliary Neoplasms

Abstract Background Biliary neoplasms are commonly encountered in the day-to-day radiological practice and can be benign or malignant. Multidetector CT (MDCT) is a noninvasive imaging modality for evaluation of patients with biliary obstruction, to localize the cause of obstruction, detect the presence of mass lesion, and define its extension and identify remote metastasis. Objective To find out the role of MDCT scan in the evaluation of biliary neoplasms with respect to nature, cause and level of obstruction. Methods During the period from January 2022 to August 2022, the present study included 30 patients with clinically suspected biliary obstruction and previously radiological or laboratory diagnosed cases of biliary malignancy after fulfilling the inclusion and exclusion criteria and taking written /verbal informed consent. 16 patients were males and 14 were females, their ages ranged between 36– 85 years with mean age of 64years old. Results The mean age of participants was 63.73±11.11 years old; and slight male predominance (53.3%). in correlation to histopathological findings, MDCT was 95.2% sensitive in detection of cholangiocarcinoma (20/21*100). It was 100% sensitive in detection of combined cholangiocarcinoma &amp; HCC (1/1*100). Also it was 85.75 sensitive in detection of gall bladder carcinoma (6/7*100). While it was false positive in detection a case of HCC. The sensitivity of MDCT to detect biliary neoplasm is 96.4% (27/28*100) with specificity of 0% (0/2*100), the positive predictive value is 93.1% (27/29*100) while the negative predictive value is 0% (0/1%). We found significant association between MDCT Final outcome with resectability (P-value 0.002) and between resectability and TNM Staging (P-value &amp;lt;0.0001) Conclusion Multidetector computed tomography MDCT can be considered a noninvasive fast with high sensitivity imaging tool in the assessment of patients with biliary neoplasms. The MDCT is satisfactory for staging of biliary neoplasms and for accurate preoperative assessment of the tumor extent.

Diagnostic accuracy of carotid plaque instability by noninvasive imaging: a systematic review and meta-analysis.

There is increasing evidence that plaque instability in the extracranial carotid artery may lead to an increased stroke risk independently of the degree of stenosis. We aimed to determine diagnostic accuracy of vulnerable and stable plaque using noninvasive imaging modalities when compared to histology in patients with symptomatic and asymptomatic carotid atherosclerosis. Medline Ovid, Embase, Cochrane Library, and Web of Science were searched for diagnostic accuracy of noninvasive imaging modalities (CT, MRI, US) in the detection of 1) vulnerable/stable plaque, and 2) vulnerable/stable plaque characteristics, compared to histology. The quality of included studies was assessed by QUADAS-2 and univariate and bivariate random-effect meta-analyses were performed. We included 36 vulnerable and 5 stable plaque studies in the meta-analysis, and out of 211 plaque characteristics from remaining studies, we classified 169 as vulnerable and 42 as stable characteristics (28 CT, 120 MRI, 104 US characteristics). We found that MRI had high accuracy [90% (95% CI: 82-95%)] in the detection of vulnerable plaque, similar to CT [86% (95% CI: 76-92%); P > 0.05], whereas US showed less accuracy [80% (95% CI: 75-84%); P = 0.013]. CT showed high diagnostic accuracy in visualizing characteristics of vulnerable or stable plaques (89% and 90%) similar to MRI (86% and 89%; P > 0.05); however, US had lower accuracy (77%, P < 0.001 and 82%, P > 0.05). CT and MRI have a similar, high performance in detecting vulnerable carotid plaques, whereas US showed significantly less diagnostic accuracy. Moreover, MRI visualized all vulnerable plaque characteristics allowing for a better stroke risk assessment. PROSPERO ID CRD42022329690.

Positron Emission Tomography Imaging-based Analysis of Biological Functions

Positron emission tomography (PET) refers to a noninvasive imaging modality that enables ultrahigh-sensitivity quantitative evaluation of the spatiotemporal dynamics of targeted molecules within living organisms from outside the body. In this review, we explain the principles of PET imaging technology and the basic properties of ultrahigh sensitivity and quantifiability. Furthermore, we have outlined PET imaging-based integrated approaches to elucidate the fundamental neurobiological mechanisms underlying neuropsychiatric activity, as well as the usefulness of PET imaging in pharmacokinetic analysis and theranostics during drug development.

Clinical issues and challenges in imaging of gastrointestinal diseases: A minireview and our experience.

Imaging techniques play a crucial role in the modern era of medicine, particularly in gastroenterology. Nowadays, various non-invasive and invasive imaging modalities are being routinely employed to evaluate different gastrointestinal (GI) diseases. However, many instrumental as well as clinical issues are arising in the area of modern GI imaging. This minireview article aims to briefly overview the clinical issues and challenges encountered in imaging GI diseases while highlighting our experience in the field. We also summarize the advances in clinically available diagnostic methods for evaluating different diseases of the GI tract and demonstrate our experience in the area. In conclusion, almost all imaging techniques used in imaging GI diseases can also raise many challenges that necessitate careful consideration and profound expertise in this field.

An Update on Non-Invasive Skin Imaging Techniques in Actinic Keratosis-A Narrative Review.

Nonmelanocytic skin cancers (NMSCs) are currently the most common group of human cancers and include all tumors that are not melanomas. Increased exposure to sunlight over the past few years, the lack of regular and proper use of sunscreen, the aging of the population, and better screening techniques are the reasons for the escalation in their diagnosis. Squamous cell carcinoma (SCC) comprises nearly 37% of the tumors in this group and can originate from actinic keratosis (AK), which usually presents as pink, often scaly plaques, usually located on the face or scalp. Advances in dermatoscopy, as well as the development of other non-invasive skin imaging modalities such as high-frequency ultrasound (HFUS), reflectance confocal microscopy (RCM), and optical coherence tomography (OCT), have allowed for greatly increased sensitivity in diagnosing these lesions and monitoring their treatment. Since AK therapy is usually local, and SCCs must be removed surgically, non-invasive imaging methods enable to correctly qualify difficult lesions. This is especially important given that they are very often located on the face, and achieving an appropriate cosmetic result after treatments in this area is very important for the patients. In this review, the authors describe the use of non-invasive skin imaging methods in the diagnosis of actinic keratosis.

DIAGNOSTIC ACCURACY AND SAFETY OF ULTRASONOGRAPHY FOR INTESTINAL MALROTATION IN THE PEDIATRIC POPULATION

Intestinal malrotation is a critical condition in pediatric patients that requires accurate and timely diagnosis. Ultrasonography is a non-invasive imaging modality frequently used to diagnose this condition. Objective: To evaluate ultrasonography's diagnostic accuracy and safety for detecting intestinal malrotation in pediatric patients. Methods: This retrospective study was conducted at Lahore General Hospital from January 2023 to January 2024. The study included children who underwent ultrasound for suspected malrotation during this period. Ultrasounds were performed by pediatric sonographers and interpreted by radiologists. The ultrasound examination was deemed indeterminate if normal anatomy was not delineated or the diagnosis was not confirmed. Data were analyzed to determine the sensitivity and specificity of ultrasonography in diagnosing intestinal malrotation. Results: Ultrasound examinations were performed on 230 patients for suspected malrotation. The mean age of the participants was 1.4 years. Among these, 61.7% (142) were neonates, with 36% (51/142) presenting on the first day of life. 218 (94.7%) patients had normal ultrasound findings, with no false-negative results reported. Malrotation was diagnosed through ultrasound in 7 (3%) patients, two of whom had associated malrotation. Five out of these seven patients were neonates. No false-positive results were reported after surgical confirmation. Additionally, 5 (2.17%) patients had indeterminate ultrasound findings. The sensitivity and specificity of ultrasonography for diagnosing intestinal malrotation were 100%. Conclusion: The study concludes that ultrasonography is a safe, accurate, and effective diagnostic tool for intestinal malrotation in pediatric patients. It is a feasible option for clinical practice due to its high diagnostic accuracy and non-invasive nature.

This Is What Metabolic Dysfunction-Associated Steatotic Liver Disease Looks Like: Potential of a Multiparametric MRI Protocol.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent condition with a broad spectrum defined by liver biopsy. This gold standard method evaluates three features: steatosis, activity (ballooning and lobular inflammation), and fibrosis, attributing them to certain grades or stages using a semiquantitative scoring system. However, liver biopsy is subject to numerous restrictions, creating an unmet need for a reliable and reproducible method for MASLD assessment, grading, and staging. Noninvasive imaging modalities, such as magnetic resonance imaging (MRI), offer the potential to assess quantitative liver parameters. This review aims to provide an overview of the available MRI techniques for the three criteria evaluated individually by liver histology. Here, we discuss the possibility of combining multiple MRI parameters to replace liver biopsy with a holistic, multiparametric MRI protocol. In conclusion, the development and implementation of such an approach could significantly improve the diagnosis and management of MASLD, reducing the need for invasive procedures and paving the way for more personalized treatment strategies.