Noninvasive Imaging Research Articles

Gender differences in the use of coronary computed tomography angiography, functional testing, coronary angiography, revascularization, and outcomes - a 10-year Danish, nationwide, registry-based foll

Abstract Background and aims Coronary computed tomography angiography (CCTA) serves as a noninvasive imaging modality, that guides downstream preventive and invasive treatment. However, differences in its use in relation to gender has not been investigated. Methods This nationwide register-based cohort study investigated all residents in Denmark between 2008 and 2018, consisting of individuals aged 50-80 years without coronary artery disease (CAD). The study population was stratified into male and female cohorts (n = 1469724). The outcomes included CCTA, functional testing, invasive coronary angiography (ICA), myocardial infarction (MI), revascularization, and major adverse cardiovascular and cerebrovascular events (MACCE). Results Among individuals who underwent CCTA, a slightly higher use was observed among females (absolute risk [AR] 4.2% individuals aged ≥50-59 years, AR 4.1% individuals aged ≥60-69 years, and AR 2.3% individuals aged ≥70-80 years) compared to males (absolute risk [AR] 4.0% individuals aged ≥50-59 years, AR 3.6% individuals aged ≥60-69 years, and AR 2.3% individuals aged ≥70-80 years). Conversely, the use of functional testing, were lower among females (AR 4.5% individuals aged ≥50-59 years, AR 5.2% individuals aged ≥60-69 years, and AR 4.3% individuals aged ≥70-80 years) compared to males (AR 6.2% individuals aged ≥50-59 years, AR 7.1% individuals aged ≥60-69 years, and AR 6.3% individuals aged ≥70-80 years), similar differences were observed for ICA, revascularization, MI risks, and MACCE. Conclusion Men were less likely to undergo CCTA compared to women. Conversely, use of functional testing, ICA, and revascularization along with an increased risk of MI or MACCE were higher in men.Figure 1

Predictive value of plaque characteristics assessed by coronary computed tomography angiography and optical coherence tomography for identification of lesions causing ischemia

Abstract Background In patients with intermediate coronary stenosis, the functional assessment with fractional flow reserve (FFR) and the anatomical assessment with optical coherence tomography (OCT) have been widely used in clinical practice. Additionally, coronary computed tomography angiography (CTA) is commonly used non-invasive imaging technique for evaluating suspected coronary artery disease before being referred for angiography. Objectives This study sought to investigate the association between FFR and plaque characteristics assessed by coronary CTA and OCT in intermediate coronary stenosis. Methods Based on the prospective multicentre registry, a total of 159 patients including 339 coronary lesions with intermediate stenosis were included. All patients underwent coronary CTA before being referred for coronary angiography and both FFR measurement and OCT examination were performed during angiography. The stenotic lesion with FFR ≤0.80 was considered diagnostic of lesion causing ischemia. The predictive value of plaque characteristics assessed by coronary CTA and OCT for identifying lesions causing ischemia was analyzed. Results Stenosis severity and plaque characteristics on coronary CTA and OCT were different between the lesions causing ischemia versus not causing ischemia. On multivariate analysis, low attenuation plaque on coronary CTA (odds ratio [OR]= 2.78; P=0.038) and thrombus (OR=5.13; 0.042), plaque rupture (OR=3.25; P=0.017), and intimal vasculature on OCT (OR=2.57; P=0.012) were independent predictors for the lesions causing ischemia. Increasing number of these plaque characteristics offered incremental improvement in predicting the lesions causing ischemia. Conclusions Comprehensive anatomical evaluation of coronary stenosis may be able to provide additional supportive information for predicting the lesions causing ischemia.

Multiple Arterial Aneurysms Revealing a New Case of Ehlers-Danlos Syndrome

Ehlers-Danlos syndrome (EDS) is a rare genetic disorder transmitted in an autosomal dominant mode. Its progression in young adults is marked by vascular, digestive, and obstetric complications. We report the case of a 24-year-old woman presenting with a mass in the right femoral triangle. Non-invasive imaging revealed multiple staged arterial aneurysms in the lower limbs. The diagnosis of vascular Ehlers-Danlos syndrome was established based on facial dysmorphia, acrogeria, and a history of right humeral aneurysm surgery. The patient underwent surgery for the right femoral aneurysm due to its significant size and risk of rupture, with simple monitoring for the other arterial aneurysms that were discovered incidentally. The postoperative course was uneventful with a favorable outcome.

Echo triaging works. How to use international guidelines

Abstract Introduction Transthoracic echocardiography (TTE) is the first-choice non-invasive imaging modality for the assessment of cardiac structure and function due to its wide availability, speed, cost-effectiveness and reproducibility. Therefore, there is exponential increase in demand in TTE across all specialties in medicine and surgery. Hence, it is important to carefully triage patients according to current international guidelines. Purpose To reduce inappropriate TTE scans by using guideline driven indications in triaging echo scans in the UK tertiary hospital. Methods Strict list of guidelines driven indications adapted to local practice was used for triaging echo requests which included both inpatient and outpatient TTEs. The 4 objectives: appropriateness, completeness of requests as well as impact of performed studies on the follow-up and patient management plan were assessed before and after implementation of new triaging tool. To ensure similar working and staff environment was sustained we studied the pattern of referrals in the same month of the year- September. The triage process was conducted by accredited physiologists. The same month was chosen to reflect true change of practice. Change in patient management and follow up were evaluated for a minimum duration of 6-months. Results Overall there were 1112 TTEs performed in September 2022 and 1081 - in September 2023. Prospective TTE referral triaging began in March 2023. We have studied and analyzed above criteria retrospectively. In 2022 there were 18% inappropriate requests; 37% of requests lacked sufficient clinical information and 10% of studies did not lead to change in management plan according to clinical letters. There was also high proportion of inappropriate requests for inpatients (9%). Within 6 months of implementation there was a significant improvement in the appropriateness (82% vs. 99%, p<0.001), with increase in supply of adequate clinical information (63.4% vs. 86.1%, p<0.001). However, there was no significant change using TTE study results in changing patient management (10%). All inpatients had 100% appropriate requests. Conclusion The implementation of triage criteria resulted in a significant improvement in TTE referrals: both in appropriateness and completeness of requests. However, some clinicians did not use echo in patient management plan. Future research on lack of use of TTE results in clinical practice might help to utilize the limited echo capacity to full.

Low-Field Magnetic Resonance Imaging for the Detection of Medial Meniscal Lesions in Cranial Cruciate-Deficient Stifle Joints in Dogs

Background: The aim of this study was to substantiate the ability of noninvasive low-field magnetic resonance imaging (lfMRI) to accurately depict meniscal lesions, thereby establishing lfMRI as a viable option for the diagnosis of meniscal pathology. Study Design: This was a prospective, controlled study. Materials and Methods: In each of 57 stifle joints, 5 predefined lfMRI sequences using a 0.25 T lfMRI were used. The scans were evaluated by an experienced surgeon (DECVS) and through external assessment by a radiologist (DECVDI). The patients were divided into two groups depending on their meniscal status after lfMRI. Dogs (Group 1; n = 33) without lfMRI evidence of medial meniscal pathology underwent TPLO, whereas concurrent craniomedial mini-arthrotomy was performed in patients with suspected meniscal lesions (Group 2; n = 24). Gait assessment was performed 6 weeks later and 6 months postoperatively. Results: Cohen’s kappa value of 0.8571 corresponds to a high level of agreement between the observers. A significant correlation was found between preoperative lameness severity and intraoperative meniscal damage (p < 0.04). The results showed a highly significant correlation between meniscal injuries on MRI and intraoperative findings (p < 0.0001). Conclusions: LfMRI appears to be a noninvasive, reliable imaging tool for the detection of medial meniscal lesions in cranial cruciate-deficient stifle joints, aiming to avoid (minimally) invasive diagnostics in healthy menisci.

Reproducibility of Thermography for Measuring Skin Temperature of Upper Limbs in Breast Cancer Survivors

Background/Objectives: Breast cancer-related lymphedema (BCRL) is a chronic condition that has early diagnosis as a critical component for proper treatment. Thermography, a non-invasive imaging method, is considered a promising complementary tool for the diagnosis and monitoring of BCRL, especially in subclinical stages. The present study aimed to evaluate the intra- and inter-examiner reproducibility of thermography for measuring the skin temperature of the upper limbs (UL) of women with and without BCRL. Methods: This study, conducted with women who underwent a unilateral mastectomy, assessed BCRL using indirect volumetry. Maximum, minimum, and mean skin temperatures were measured in five regions of interest (ROI) of each UL (C1, C2, C3, C4, and Cup) in four different postures. Reproducibility measures were assessed using an intraclass correlation coefficient, 95% confidence interval, and coefficient of variation. Results: The sample comprised 30 women; 14 were diagnosed with BCRL. A total of 120 thermograms were recorded in different postures, and 3600 ROI were analyzed in the UL with and without BRCL. The intraclass correlation coefficient of the analyses indicated intra- and inter-examiner reproducibility from good to excellent (0.82 to 1.00) for all skin temperatures evaluated (maximum, minimum, and mean). The coefficient of variation for all measures was below 10%, indicating low variability. Conclusions: Our findings demonstrate that thermography shows good-to-excellent reproducibility across multiple postures and regions of interest, reinforcing its potential as a non-invasive and reliable method for assessing lymphedema in breast cancer survivors. This study establishes a foundation for incorporating thermography into clinical practice for early BCRL detection, particularly in subclinical stages, thus improving patient management and outcomes.

18F-FDG PET/CT impact in grade 3B follicular lymphoma.

[18F]-fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a non-invasive imaging tool that has a fundamental role in the management of FDG-avid lymphoma (also FL) in different settings, especially in the evaluation of treatment response and prognostication. The report by Barraclough etal. demonstrated that the treatment response evaluation by 18F-FDG PET/CT was a strong predictor of prognosis in grade 3B follicular lymphoma (G3BFL). Moreover, among semiquantitative baseline PET features, standardized uptake value (SUV) and TGL showed to be useful in predicting progression-free survival (PFS). Commentary on: Barraclough etal. The value of semiquantitative PET features and end-of-therapy PET in grade 3B follicular lymphoma. Br J Haematol 2024 (Online ahead of print). doi: 10.1111/bjh.19823.

Deep Learning With Optical Coherence Tomography for Melanoma Identification and Risk Prediction.

Malignant melanoma is the most severe skin cancer with a rising incidence rate. Several noninvasive image techniques and computer-aided diagnosis systems have been developed to help find melanoma in its early stages. However, most previous research utilized dermoscopic images to build a diagnosis model, and only a few used prospective datasets. This study develops and evaluates a convolutional neural network (CNN) for melanoma identification and risk prediction using optical coherence tomography (OCT) imaging of mice skin. Longitudinal tests are performed on four animal models: melanoma mice, dysplastic nevus mice, and their respective controls. The CNN classifies melanoma and healthy tissues with high sensitivity (0.99) and specificity (0.98) and also assigns a risk score to each image based on the probability of melanoma presence, which may facilitate early diagnosis and management of melanoma in clinical settings.

Successful non-invasive imaging of the coronary artery IMT in pediatric patients with Kawasaki disease using high-resolution echocardiography

Kawasaki Disease (KD) is a multisystemic vasculitis of medium- and small-sized arteries. Abnormal intimal thickening may develop in the involved arterial area after regression of coronary artery aneurysm (CAA). Intimal dysfunction may induce local stenosis or arteriosclerosis in the future. In this case–control study, we investigated 29 consecutive KD patients [20 male, median current age, 7.9 years; median follow-up duration, 5.7 years] and a group of 29 healthy matched controls (CON) [19 male, median current age, 10.8 years]. They were assesed and compared for CAA, LVFS, GCS, GLS, coronary artery (CA) Z scores, carotid intima-media thickness (IMT) and coronary artery IMT by high-resolution transthoracic echocardiography (hrTTE). Coronary artery IMT (caIMT) was significantly higher in patients with a maximal CA Z score > 2.5 in acute KD than in CON: KD caIMT: 0.62 mm [IQR, 0.57–0.72 mm] vs. 0.53 mm [0.51–0.60 mm], p = 0.043. CAAs were found in 15 (51.7%) patients with acute KD. The maximal median LCA Z score in acute KD was 2.57z [IQR, 1.93—3.2z] and in follow-up −0.39z [IQR, −1.25 to −0.36z]. There was no significant difference in carotid IMT between KD patients and CON. Signs of CA intima-media thickening were detected by hrTTE in patients with a maximal CA Z score > 2.5 in acute KD. These data indicate that these patients may be at risk for cardiovascular sequale even in the absence of permanent CA luminal abnormalities. Therefore long-term follow-up of this group of KD patients may be required.

A Novel Cyanine-Based Fluorescent Dye for Targeted Mitochondrial Imaging in Neurotoxic Conditions and In Vivo Brain Studies.

Mitochondrial dysfunction is a key feature of neurodegenerative diseases, often preceding symptoms and influencing disease progression. However, real-time in vivo imaging of mitochondria in the brain is limited by existing dyes like MitoTrackers, which struggle with poor tissue penetration, phototoxicity, and inability to cross the blood-brain barrier (BBB). This study introduces Cy5-PEG4, a novel mitochondrial-targeting dye that overcomes these limitations, enabling high-resolution, non-invasive imaging of mitochondrial dynamics. Cy5-PEG4 effectively labels mitochondria in primary neuronal cells exposed to the SARS-CoV-2 RNYIAQVD peptide, revealing dose-dependent alterations in mitochondrial function that may contribute to COVID-19-related neurodegeneration. Importantly, Cy5-PEG4 crosses the BBB without causing neuroinflammation or toxicity, making it a safe tool for in vivo brain imaging and detailed studies of mitochondrial responses. In 3D cultured cells, Cy5-PEG4 captures dynamic changes in mitochondrial distribution and morphology as cell structures mature, highlighting its potential in neurobiological research, diagnostics, and therapeutic development. These findings support Cy5-PEG4 as a powerful tool for studying disease progression, identifying early biomarkers, and evaluating therapeutic strategies in neurodegenerative disorders and COVID-19.

Non-Invasive Imaging Including Line-Field Confocal Optical Coherence Tomography (LC-OCT) for Diagnosis of Cutaneous Lymphomas

Background/Objectives: Primary cutaneous lymphomas (PCL) are a heterogeneous group of non-Hodgkin lymphomas arising from malignant T (CTCL) or B (CBCL) cells, often mimicking other skin conditions. Recently, non-invasive diagnostic imaging modalities, including dermoscopy, Reflectance Confocal Microscopy (RCM), and Line-field Optical Coherence Tomography (LC-OCT), have become increasingly important, supporting clinicians in clinical practice. Hence, our study aimed to describe dermoscopic, RCM, and LC-OCT features of PCL and to explore their role in PCL management. Methods: Between December 2022 and January 2024, 40 lesions of 25 patients with PCL were retrospectively analyzed at the Dermatologic Unit of the University of Siena, Italy. Predefined dermoscopic, LC-OCT, and RCM criteria were assessed and their frequencies were calculated. Results: At dermoscopy, CTCL lesions were characterized by pinkish structureless areas (58,6%) and homogeneous distributed dotted vessels (35,7%), whereas 57.1% of CBCL presented with orange-yellow structureless areas. Considering CTCL, lymphocytes in the epidermis, dermal-epidermal junction, and dermis were detected by LC-OCT in 73.1%, 66.7%, and 51.9% and by RCM in 72.2%, 55.6%, and 61.1% of cases, respectively. The detection of lymphocytes was more precise using RCM than LC-OCT in CTCL (p < 0.001). Dermal infiltration of medium-reflective cells was visible in 80% and 40% of CBCL cases by LC-OCT and RCM, respectively. Conclusions: Non-invasive imaging techniques may support clinicians in managing PCL; however, further studies are mandatory in this field.

Different Pathways of Skin Aging: Objective Instrumental Evaluation

Background/Objectives: Hypertrophic and atrophic skin aging represent two distinct phenotypes: hypertrophic aging is marked by deep wrinkles and a leathery texture, whereas atrophic aging is characterized by overall skin thinning, increased vascularity, and a higher risk of non-melanoma skin cancers. This study aims to elucidate the characteristics and differences between hypertrophic and atrophic facial aging subtypes using two non-invasive imaging devices: VISIA® and dynamic optical coherence tomography (D-OCT). Methods: We retrospectively evaluated patients who had presented to the outpatient dermatological clinic at Policlinico Umberto I hospital in Rome, Italy for a non-invasive facial imaging check-up. We included 40 patients aged 60–75 who were imaged with VISIA® and dynamic optical coherence tomography (D-OCT). Based on the number of UV spots and amount of red found on VISIA®, subjects were grouped into four subgroups (PIGM, RED, CONTROL, PIGM + RED), and trends among them were analyzed. Results: We found a strong correlation between VISIA® red area scores and D-OCT vascular density at 300 µm depth, confirming VISIA®’s effectiveness for assessing facial vascularity. Wrinkle count was highest in areas with UV spots, particularly in the PIGM and PIGM + RED groups. Conversely, low attenuation coefficients and dermal density were observed in regions with low UV spots but high red areas. Intermediate subgroups (CONTROL and PIGM + RED) displayed varying parameters. Conclusions: Non-invasive imaging devices are effective in evaluating facial aging and distinguishing between aging subtypes. This study identified two intermediate aging types in addition to the hypertrophic and atrophic subtypes.

Sensing and Imaging Agents for Cyclooxygenase Enzyme.

In this concept, we present a comprehensive study on the development and application of COX-2-specific fluorescent probes for cancer imaging and diagnosis. Targetting cancer cells and measuring cancer-related activities in specific organelles quickly and accurately are crucial factors for early diagnosis and research on cancer pathology and treatment. This concept explores a variety of probes which include BDIMC1-2, TPI-IMC, YZP1, IQ-1, ANQ-IMC-6, Niblue-C6-IMC, AZB-IMC2, CMP, CF3-Fluorocoxib, IBPC1, CoxFluor, etc. and each one demonstrates unique mechanisms and high selectivity towards COX-2 enzymes. These probes were designed to enhance fluorescence upon binding to COX-2 which enable precise visualization of tumor and inflamed tissues. The research emphasizes the importance of COX-2 as a biomarker in cancer diagnostics, particularly in identifying cancer stem cells and inflamed tissues. This concept highlights the potentiality of these probes in non-invasive imaging techniques which offering significant advancements in cancer diagnosis and monitoring. The in vivo and in vitro experiments, including applications in mouse models and human tissue samples, confirm the efficacy of these probes in providing detailed imaging for clinical and research applications.

Skin Cancer Image Classification Using Artificial Intelligence Strategies: A Systematic Review

The increasing incidence of and resulting deaths associated with malignant skin tumors are a public health problem that can be minimized if detection strategies are improved. Currently, diagnosis is heavily based on physicians’ judgment and experience, which can occasionally lead to the worsening of the lesion or needless biopsies. Several non-invasive imaging modalities, e.g., confocal scanning laser microscopy or multiphoton laser scanning microscopy, have been explored for skin cancer assessment, which have been aligned with different artificial intelligence (AI) strategies to assist in the diagnostic task, based on several image features, thus making the process more reliable and faster. This systematic review concerns the implementation of AI methods for skin tumor classification with different imaging modalities, following the PRISMA guidelines. In total, 206 records were retrieved and qualitatively analyzed. Diagnostic potential was found for several techniques, particularly for dermoscopy images, with strategies yielding classification results close to perfection. Learning approaches based on support vector machines and artificial neural networks seem to be preferred, with a recent focus on convolutional neural networks. Still, detailed descriptions of training/testing conditions are lacking in some reports, hampering reproduction. The use of AI methods in skin cancer diagnosis is an expanding field, with future work aiming to construct optimal learning approaches and strategies. Ultimately, early detection could be optimized, improving patient outcomes, even in areas where healthcare is scarce.

The Role of Endoscopic Ultrasound-Guided Shear Wave Elastography in Pancreatic Diseases.

Elastography is a non-invasive imaging modality that has been developed for the evaluation of the stiffness of various organs. It is categorized into two main types: strain elastography and shear wave elastography. While strain elastography offers valuable information on the mechanical properties of the organ being studied, it is limited by the qualitative nature of its measurements and its reliance on operator skills. On the other hand, shear wave elastography overcomes these limitations as it provides a quantitative assessment of tissue stiffness, offers more reproducibility, and is less operator-dependent. Endoscopic ultrasound-guided shear wave elastography (EUS-SWE) is an emerging technique that overcomes the limitations of transabdominal ultrasound in the evaluation of the pancreas. A growing body of literature has demonstrated its safety and feasibility in the evaluation of pancreatic parenchyma. This article provides a comprehensive review of the current state of the literature on EUS-SWE, including its technical aspects, clinical applications in the evaluation of various pancreatic conditions, technological limitations, and future directions.

Combined strategy of upfront CTCA and optimal treatment for stable chest pain: rationale and design of the CLEAR-CAD trial.

Patients with stable chest pain suspected of coronary artery disease (CAD) usually undergo multiple diagnostic tests to confirm or rule out obstructive CAD. Some tests may not effectively assess the presence of CAD, precluding optimal treatment. Adiagnostic strategy of upfront computed tomography coronary angiography (CTCA) combined with optimal medical therapy (OMT) tailored to the extent of CAD may be superior to standard care in preventing major adverse cardiac events. The CLEAR-CAD trial is aprospective, open-label, multicentre, randomised, superiority trial of an upfront CTCA-guided strategy in 6444 patients presenting in an outpatient setting with suspected CAD compared with standard care, in approximately 30participating centres in the Netherlands. The upfront CTCA-guided strategy consists of an initial CTCA which is assessed using the Coronary Artery Disease-Reporting and Data System (CAD-RADS2.0). In patients without CAD (CAD-RADS0) no specific cardiac medication is mandated. Patients with non-obstructive CAD (CAD-RADS 1-2) are treated with preventive OMT. Patients with obstructive CAD (CAD-RADS ≥ 3) are treated with preventive and anti-anginal OMT; in the presence of pharmacologically refractory symptoms patients undergo selective revascularisation after non-invasive functional imaging for myocardial ischaemia (≥ 10%). Patients with significant left main or proximal left anterior descending coronary artery stenosis on CTCA undergo direct invasive coronary angiography and subsequent revascularisation. The primary endpoint is the composite of all-cause death and myocardial infarction. The CLEAR-CAD trial is the first randomised study to investigate the efficacy of acombined upfront CTCA-guided medical and selective revascularisation strategy in an outpatient setting with suspected CAD compared with standard care.

Which is the best imaging modality to diagnose a manica flexoria tear?

SummaryThe manica flexoria (MF) is an extension of the medial and lateral borders of the superficial digital flexor tendon (SDFT) that forms a sleeve around the deep digital flexor tendon (DDFT), within the digital flexor tendon sheath (DFTS), just proximal to the metacarpo/metatarsophalangeal joint. Tears of the MF have been described associated with cases of nonseptic tenosynovitis presenting with lameness, with ponies and cobs being over‐represented. Ultrasonography and contrast tenography are the predominant imaging modalities used to diagnose tears of the MF, with tenoscopic evaluation still serving as the gold standard. However, the sensitivity and specificity of additional techniques such as contrast computed tomographic tenography and MRI are now being investigated as other modalities that could be of value to identify MF tears. Additional techniques have been described to combine with traditional ultrasonography, with the aim to improve the sensitivity of identifying MF tears, such as dynamic extension/flexion techniques and saline injections of the DFTS. The overall aim of this paper was to review current evidence to determine the best noninvasive diagnostic imaging modality, with a high sensitivity and specificity, to more accurately diagnose MF tears and aid more thorough surgical planning.

Gallbladder Polyps: A Literature Review of Basic Concepts, Diagnosis and Treatment Options

Gallbladder polyps (GP) are projections of the mucosa toward the light, most of them are benign caused by cholesterol deposits, focal adenomatosis, or hyperplastic lesions secondary to a local infection. It has an estimated prevalence of 5% of the world population. Cholesterol polyps are usually formed by an asymptomatic process, rarely obstructive jaundice or cholangitis due to the blockage of distal bile ducts by detached fragments of polyps. A small number of patients may be symptomatic; cholesterolosis and adenomatosis can also cause chronic dyspeptic abdominal pain, nausea, and vomiting. Ultrasound is the main imaging modality to diagnose polyps of the gallbladder, endoscopic ultrasonography can be a useful tool in patients with clinical pictures suggestive of vesicular pathology and non-invasive imaging studies, and inconclusive. In a patient aged less than 50 years with GP, the likelihood of malignancy is minimal and does not require cholecystectomy. However, those with a size greater than or equal to 10 mm should be resected by cholecystectomy for high risk of malignancy, and those with a size less than 10 mm should be submitted to ultrasound monitoring, observing the risk characteristics during follow-up, to provide timely treatment.

Advancements and challenges in Shear-Wave Elastography of tendons: a comprehensive review.

Shear-Wave Elastography (SWE) has emerged as a promising non-invasive imaging technique for assessing the mechanical properties of tendons, particularly larger and more superficially located tendons of the body. Despite its potential, significant variability in SWE measurements exists due to differences in protocols, positioning, and equipment. Standardizing these factors, enhancing operator training, and reporting reliability metrics are crucial to improve the consistency and comparability of SWE data. This review aims to synthesize current knowledge and report on the existing practices in tendon SWE. By addressing the current challenges and variability, SWE has the potential to become a reliable tool for diagnosing and monitoring tendon pathologies, ultimately enhancing patient care and outcomes.

Improved Localization of Insulinomas Using 68Ga-NODAGA-Exendin-4 PET/CT.

Precise anatomic localization of insulinomas is crucial for surgical treatment. Current routine noninvasive imaging techniques, including CT, MRI, and 68Ga-DOTA-somatostatin analog (DOTA-SSA) PET/CT, have limited sensitivity. Endoscopic ultrasound is highly sensitive but invasive. In this prospective multicenter study, we compared the diagnostic accuracy of 68Ga-NODAGA-exendin-4 (exendin) PET/CT with all routine imaging procedures for the localization of insulinomas. Methods: Sixty-nine adults with biochemically proven adult endogenous hyperinsulinemic hypoglycemia underwent exendin PET/CT and current routine imaging. Images were evaluated in a clinical reading and in an expert reading. Image quality was determined by quantitative analysis. Results: Based on clinical readings, the accuracy of exendin PET/CT (94.4%; 95% CI, 84.6%-98.8%) was greater than that of DOTA-SSA PET/CT (64.8%; 95% CI, 50.6%-77.3%), contrast-enhanced CT/contrast-enhanced diffusion-weighted imaging-MRI (83.3%; 95% CI, 70.7%-92.1%), and endoscopic ultrasound (82.8%; 95% CI, 64.1%-94.1%). In 13% of patients, a correct diagnosis was only reached after exendin PET/CT. Interobserver agreement between readings was higher for exendin PET/CT than for DOTA-SSA PET/CT and contrast-enhanced CT/contrast-enhanced diffusion-weighted imaging-MRI (Cohen κ, 1.0 vs. 0.5 and 0.55). Exendin PET/CT provided a higher insulinoma-to-background ratio (15.3 ± 6.7 vs. 5.2 ± 3.0) and contrast-to-noise ratio (22.6 ± 11.1 vs. 5.1 ± 3.7) than did DOTA-SSA PET/CT. Conclusion: This study demonstrates the superiority of exendin PET/CT in a unique prospective comparison to all current routine imaging modalities for preoperative localization of benign insulinomas, providing the level of evidence needed for clinical implementation.