Preoperative Imaging Evaluation Research Articles

Innovative 3-Dimensional Imaging in Preoperative Evaluation for Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer—A Pilot Study

ObjectiveThe efficacy of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer remains controversial, necessitating meticulous preoperative planning. While three-dimensional (3D) imaging has transformed surgical approaches in various disciplines, its application in gynaecologic oncology is nascent. This study introduces a novel investigation employing preoperative 3D modelling in SCS preparation. MethodsA retrospective analysis was undertaken at a university-affiliated tertiary medical centre, examining patients who underwent SCS for recurrent ovarian cancer between 2017 and 2022. Patients were stratified into 2 cohorts: those with preoperative CT-based 3D imaging (group A) and those without (group B). Demographic profiles, clinical data, and surgical outcomes were compared between the groups. ResultsAmong the 76 identified patients, 18 were deemed suitable for surgery, with 7 in group A undergoing preoperative 3D modelling. Demographics encompassing age and performance status were consistent across both groups, while Serous histology was more prominent in group B. Although operative metrics and collaborative endeavours exhibited no statistically significant variance, the attainment of optimal debulking with no residual disease (R0) was substantially higher in group A (100%) compared to group B (54%), with a significance level of P = 0.05. ConclusionCT-based 3D modelling in the preoperative phase of SCS for ovarian cancer shows potential for enhancing surgical planning. While this pioneering research highlights the potential benefits of integrating 3D imaging into gynaecologic oncology, the limitations of this retrospective study imply that these findings are primarily hypothesis-generating. Further prospective studies are necessary to validate the impact.

Prevalence and characteristics of facial nerve bifurcation in the mastoid segment: a retrospective analysis using temporal bone CT scans.

To investigate the prevalence and characteristics of bifurcation of the facial nerve (FN) in the mastoid segment using temporal bone CT scans. A total of 970 cases (1931 ears) of temporal bone CT scans were reviewed, including 463 females and 498 males, aged 1 to 95years (interquartile range: 20-69years). CT imaging with multiplanar reconstruction (MPR) was used to identify and evaluate the bifurcation of the FN. Cases showing branching were confirmed by consensus among three physicians. We identified 10 cases (10 ears) with facial nerve branching in the vertical segment, yielding an incidence rate of 0.52% (10/1931 ears). Every cases were unilateral, predominantly on the left side. Age analysis revealed 1 case (0.22%) in individuals under 20years and 9 cases (0.61%) in those over 20years. Bifurcation generally occurred near the middle to lower vertical segment, with the closest proximity to the second genu observed in a 15-year-old patient. Bifurcation of the FN in the mastoid segment, though rare, can be encountered in otologic surgery. Detailed preoperative imaging evaluations are crucial for surgical planning to minimize the risk of nerve damage. Our findings emphasize the importance of recognizing anatomical variations in the FN for improving surgical outcomes and patient safety.

Transarterial embolization for anterior cranial fossa dural arteriovenous fistula based on multi-modal three-dimensional imaging.

Dural arteriovenous fistula (DAVF) in the anterior cranial fossa (ACF) is known to show a high risk of intracranial hemorrhage. Recently, multi-modal fusion imaging with computed tomography angiography, computed tomography venography, and three-dimensional (3D) rotation angiography have been used preoperatively to ensure anatomical safety. We report on endovascular treatment as a first-line approach for ACFDAVF based on the understanding of vascular anatomy obtained from multi-modal fusion imaging. All patients with ACF-DAVF treated endovascularly as a first-line approach were included in this study. Analyses took into account complications (particularly visual function), immediate angiographic outcomes, and follow-up findings in consecutive patients with ACF-DAVF treated with interventional treatment based on multi-modal fusion imaging. Five patients with ACF-DAVF underwent six sessions of transarterial embolization (TAE) in our institution. The five male patients (mean age, 74.5 years; range, 60-84 years) were treated with liquid embolic agents (Onyx, four procedures; n-butyl 2-cyanoacrylate, two procedures). No difference was seen between preoperative image evaluation and image evaluation during the endovascular procedure, and in all cases, a microcatheter was navigated into a target artery assumed from preoperative multi-modal imaging, allowing treatment completion in a single procedure. In all cases, the shunt disappeared completely and visual function after procedure was maintained. At the last follow-up, all patients showed a modified Rankin scale score of 0 or 1 with no recurrences. Multi-modal fusion imaging facilitates a 3D understanding of the vascular anatomy, allowing TAE as the first-line treatment for ACF-DAVF.

Clinical Outcome of Patients with Epithelioid Glioblastoma Harboring BRAFV600E Mutation; A Single Institution Experience

Purpose Epithelioid glioblastoma (GBM) is a rare variant of GBM. The study aimed to look into clinicopathological details and outcomes of patients with epithelioid GBM harboring BRAFV600E mutation from a single institution. Methods Ten cases of epithelioid GBM diagnosed over the past 5 years were reviewed. All patients underwent surgical resection followed by adjuvant treatment as per protocol after initial diagnosis. Of these, seven patients were planned to redo surgery, reradiation, BRAF with MEK inhibitors, and bevacizumab based on clinical condition, magnetic resonance imaging findings, and progression-free survival after their recurrence. Four recurrent patients had received dabrafenib and trametinib. Results All tumor locations were supratentorial. The median follow-up was 2.3 years and the median time to recurrence was 19 months from the diagnosis (range 4–36 months). Four recurrent patients received BRAF + MEK inhibitors. One patient who started dabrafenib and trametinib experienced local progression after 33 months, followed by lung and bone metastasis. One patient died due to multiple subacute hemorrhages, who was a known case of congenital vascular malformations, and two patients remained disease-free after a year and 2 years. Conclusion Epithelioid GBM is a very rare, but well-documented entity. Therefore, careful preoperative imaging and detailed evaluation of genetic studies including BRAF V600E mutation are necessary for accurate diagnosis and appropriate selection of treatment for epithelioid GBM. Dabrafenib plus trametinib showed clinically meaningful activity in patients with BRAF V600E mutation-positive recurrent high-grade glioma.

Assessing the Histological Malignancy Grade of Olfactory Neuroblastoma Using the Apparent Diffusion Coefficient Histogram Analysis.

Introduction Olfactory neuroblastoma (ONB) is a rare malignant tumor of the upper nasal cavity. The Hyams classification is an important histological grading system for diagnosing recurrence and predicting survival in ONB. This study aimed to evaluate the utility of apparent diffusion coefficient (ADC) histogram analysis in distinguishing between high-grade and low-grade ONB based on the Hyams classification system. Methods This retrospective study included 17 patients (11 males, six females; mean age 54 years, range 29-84) diagnosed with ONB who underwent pretreatment magnetic resonance imaging (MRI) including diffusion-weighted imaging between December 2017 and September 2022. Two board-certified radiologists outlined the regions of interest on ADC maps of the tumors. Mean, minimum, maximum ADC, standard deviation, skewness, kurtosis, and entropy were calculated from the ADC histograms. Patients were divided into low-grade (Hyams I-II) and high-grade (Hyams III-IV) groups based on histopathological evaluation by a board-certified pathologist. ADC histogram parameters were compared between the two groups using Mann-Whitney U tests. Two-sided p-values of < 0.05 were considered statistically significant. Results The study included 10 low-grade (two grade I, eight grade II) and seven high-grade (five grade III, one grade III/IV, one grade IV) ONB cases. Comparison between the low-grade and high-grade groups showed no statistically significant differences in any of the ADC histogram parameters analyzed: mean ADC (median 1.02 vs 0.95; p = 0.591), minimum ADC (0.84 vs 0.78; p = 0.494), maximum ADC (1.06 vs 1.19; p = 0.625), standard deviation (0.09 vs 0.14; p = 0.433), skewness (-0.48 vs -0.75; p = 0.133), kurtosis (2.79 vs 3.12; p = 0.161), and entropy (4.69 vs 5.06; p = 0.315). Conclusion This study demonstrated that ADC histogram analysis was unable to differentiate between high-grade and low-grade ONB based on the Hyams classification. The findings suggest that preoperative grading of ONB malignancy using ADC histogram parameters is challenging. Thus, grading based on preoperative imaging evaluation is difficult.

Pulmonary artery aneurysm: computed tomography (CT) imaging findings and diagnosis.

Pulmonary artery aneurysm (PAA) is a rare pulmonary vascular disease with nonspecific symptoms and various etiologies. As the disease progresses, in addition to the dilation of the pulmonary arteries, it may be accompanied by remodeling of the cardiac structure and changes in the morphology of the aorta. Recognizing the cause of PAA is therefore a clinically challenging task. In this review article, we provide an overview of various causes of PAA with the support of corresponding imaging findings on computed tomography pulmonary angiography (CTPA) examination. Firstly, from the perspective of hemodynamics, a logical diagnosis is provided according to whether the main pulmonary artery (MPA) is dilated, and whether the PA is dilated locally or diffusely. Secondly, for the imaging examination of vascular wall lesions, due to the limitations of ultrasound examination and interventional procedures, the irreplaceability of dual-phase CTPA examination in disease assessment is especially emphasized. Finally, for highly suspected disorders, it is necessary to comprehensively check with the patient whether there is a family history or past medical history. For patients with PAA, especially those with Marfan syndrome (MFS) or arteritis, adequate preoperative imaging evaluation, regular postoperative radiographic follow-up, and concurrent treatment of the underlying disease (if necessary) are crucial, which are related to the prognosis and long-term quality of life of such patients. Despite the nonspecific features of PAA presentation, a thorough examination of the patient's clinical history and imaging characteristics will play an important role in diagnosing PAA and planning patient management strategies.

Does neoadjuvant chemotherapy reduce surgical complexity in patients with advanced-stage epithelial ovarian cancer?

BackgroundThis study aimed to determine the effect of neoadjuvant chemotherapy (NACT) on the complex surgical procedures required in addition to staging surgery for the need to achieve a residual tumor 1 cm or less in a population of stage IIIC–IV epithelial ovarian cancer patients.MethodsPatients were referred for NACT if preoperative imaging and/or intraoperative evaluation confirmed that it was not possible to achieve a residual tumor size of 1 cm or less with cytoreductive surgery or if the patient had a poor performance status and a high American Society of Anesthesiologists (ASA) score. Surgical complexity was defined as complex or non-complex.ResultsOne hundred and twenty-six patients with stage IIIC–IV ovarian cancer were included in the study. Primary cytoreductive surgery was performed in 67 patients, and interval cytoreductive surgery was performed in 59 patients after NACT. At least one complex surgery was performed in 74.6% of the patients in the primary cytoreductive surgery group and in 61% of the patients in the NACT group, with no statistically significant difference between the groups. However, the NACT group showed significantly decreased rates of low-rectal resection, diaphragmatic peritoneal stripping, and peritonectomy.ConclusionsThe analyses showed no reduction in the requirement for at least one complex surgical procedure in the group of patients who underwent NACT. Nevertheless, this group exhibited a significant decrease in low-rectal resection, diaphragmatic peritoneal stripping, and peritonectomy due to their effectiveness in reducing peritoneal disease.

The Condition of the Meniscus and Cartilage of the Injured Knee on Preoperative Magnetic Resonance Imaging Is a Prognostic Factor Affecting Postoperative Outcomes Following Knee Cartilage Restoration Surgery

PurposeTo evaluate the relationship between preoperative whole-joint imaging evaluation of the knee with patient reported outcome measures after cartilage restoration surgery (mosaicplasty, osteochondral allograft transplantation (OCA), matrix autologous chondrocyte implantation (MACI)). MethodsWe retrospectively evaluated patients who underwent knee articular cartilage restoration at our institution from 2014 to 2020. The patients’ knee MRI was evaluated with the whole joint magnetic resonance imaging score (WORMS) and semi-quantitative synovial inflammation imaging biomarkers of the preoperative MRI. To assess patient-reported outcome (PRO) score, Lysholm score and Knee Osteoarthritis and Injury Outcome Score (KOOS) were completed at minimum 2 years follow-up. Statistical analysis was performed using Spearman rank test to obtain correlation values for WORMS score and PRO score for each survey. ResultsThere were 40 patients who were enrolled in this study. The average age at baseline was 34.5 years. The average BMI was 28.2 kg/m2 and 26 of 40 were men (range, 20-58 years). The maximum preoperative WORMS score was significantly correlated with the post-operative Lysholm score (r = -0.52, p=0.0013). The WORMS Meniscus and Cartilage sub-scales were significantly correlated with the Lysholm score (r = -0.36, p=0.024 and r = -0.37, p=0.021 respectively). The maximum WORMS score was significantly correlated with the KOOS Daily living and Sports/rec sub-scores (r= -0.47, p=0.0023 and r = -0.42, p=0.0077, respectively). Semi-quantitative synovial inflammation imaging biomarkers were not significantly correlated with PRO scores. ConclusionIncreasing preoperative degenerative change in the knee, as evidenced by a higher WORMS on preoperative MRI, was associated with inferior patient-reported outcomes at a minimum of 2 years after cartilage restoration surgery (mosaicplasty, OCA, MACI). Semi-quantitative scoring of the whole joint on preoperative MRI may allow for improved counseling regarding expected benefit for patients after cartilage restoration surgery.

Is Staged Surgery Always Necessary for Schatzker Type IV-VI Tibial Plateau Fractures? A Comparison Study.

This study aims to compare the outcomes of immediate (followed by closed-incision negative-pressure therapy use) versus delayed ORIF in patients with Schatzker type IV-VI TPFs. A prospective study of patients undergoing ORIF between January 2018 and December 2019 was performed. The inclusion criteria were patients (>18 years) with a closed fracture sent to the emergency room (ER) within 24 h of injury. All the patients underwent preoperative image evaluation. Two senior orthopedic trauma surgeons evaluated the soft tissue condition in the ER by 5P's of the compartment syndrome, judging the timing of the operation of definitive ORIF. Group 1 (n = 16) received delayed ORIF. Group 2 (n = 16) received immediate ORIF and ciNPT use. Patient follow-up occurred after 2 and 6 weeks and 3, 6, and 12 months after surgery. The assessments included the time to definitive fixation, the length of hospital stay, the time to bone union, surgical site complications, and reoperation within 12 months. A universal goniometer was used to measure the postoperative 3 m, 6 m, and 12 m ROM. The patient demographics were similar between the groups (p > 0.05). Group 2 displayed significantly a shorter time to definitive fixation (5.94 ± 2.02 vs. 0.61 ± 0.28, p < 0.0001) and hospital stay (14.90 ± 8/78 vs. 10.30 ± 6.78, p = 0.0016). No significant difference was observed in the time to bone union, surgical site complication incidence, and reoperation rates (p > 0.05). Flexion and flexion-extension knee ROM were demonstrated to be significantly improved in Group 2, 3, 6, and 12 months postoperatively (p < 0.0001). In this study, early ORIF and ciNPT use resulted in a shorter hospital length of stay, a reduced time to early active motion of the knee, and improved knee ROM. These results suggest that early ORIF with ciNPT for Schatzker type IV-VI TPFs is safe and effective in some patients. However, further research to confirm these findings across larger and more diverse populations is needed.

Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part I. Initial Management of Differentiated Thyroid Cancers - Chapter 1. Preoperative Imaging and Diagnostic Evaluation in Thyroid Cancer 2024

Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part I. Initial Management of Differentiated Thyroid Cancers - Chapter 1. Preoperative Imaging and Diagnostic Evaluation in Thyroid Cancer 2024

Surgery for Pineal Region Tumors: Concept and Technical Aspects of Occipital Transtentorial Approach

This article describes the concept and technical aspects of the occipital transtentorial approach(OTA)for tumor extraction in the pineal region, based on the author's experience and literature review. Awareness of the successful completion of each surgical step is essential. Preoperative preparation and imaging evaluations, with particular attention to the veins and venous sinuses, are especially important. It is also helpful to perform a complete dura incision and inversion up to the edge of confluence, superior sagittal sinus, and transverse sinus. Subsequently, it is necessary to understand the usefulness of adequate dissection in the vicinity of the corpus callosum and internal occipital vein(IOV)so that the occipital lobe can be moved without difficulty. Furthermore, development of the IOV with adequate tentoriotomy facilitates contralateral work. Finally, complete understanding of each step during the bilateral, ambient cistern and cerebellomesencephalic fissure dissection process, where the cerebellar vermis can be moved without difficulty, is necessary for a safe OTA to pineal region tumor extraction.

Impact of Surgical Margin Status on Survival and Recurrence After Pancreaticoduodenectomy for Distal Cholangiocarcinoma: Is Microscopic Residual Tumor (R1) Associated with Higher Rates of Local Recurrence?

Patients undergoing macroscopically curative resection for distal cholangiocarcinoma (DCC) have high recurrence rates and poor prognoses. This study aimed to investigate the impact of surgical margin status on survival and recurrence after resection of DCC, specifically focusing on microscopic residual tumor (R1) and its relationship to local recurrence. This was a retrospective analysis of patients who had undergone pancreaticoduodenectomy (PD) for DCC between 2005 and 2021. Surgical margin was classified as R0, R1cis (positive bile duct margin with carcinoma in situ), and R1inv (positive bile duct margin with an invasive subepithelial component and/or positive radial margin). In total, 29 of 133 patients (21.8%) had R1cis and 23 (17.3%) R1inv. The 5-year overall survival (OS) for R0 (55.7%) did not differ significantly from that for R1cis/R1inv (47.4%/33.6%, respectively). The 5-year recurrence-free survival (RFS) for R0 was significantly longer than that for R1inv (50.1% vs. 17.4%, p = 0.003), whereas RFS did not differ significantly between those with R0 and R1cis. R1cis/R1inv status was not an independent predictor of OS and RFS in multivariate analysis. Cumulative incidence of isolated distant recurrence was significantly higher for R1cis/R1inv than for R0 (p = 0.0343/p = 0.0226, respectively), whereas surgical margin status was not significantly associated with rates of local or local plus distant recurrence. Surgical margin status does not significantly impact OS and RFS in patients undergoing PD for DCC following precise preoperative imaging evaluation. Additionally, R1 status is significantly linked to higher isolated distant recurrence rather than local recurrence, highlighting the importance of multidisciplinary therapy.

Impact of postoperative cerebral complications in acute infective endocarditis: a retrospective single-center study

BackgroundThe treatment of patients with infective endocarditis (IE) who have preoperative cerebral complications remains less understood. Therefore, this study aimed to retrospectively evaluate the clinical outcomes of patients with acute IE based on preoperative intracranial findings.MethodsOf 32 patients with acute IE treated at our hospital between August 2015 and March 2022, 31 patients of whom preoperative intracranial imaging evaluation was available were included in our analysis and compared with those with and without intracranial findings. We controlled the mean arterial blood pressure and activated clotting time (ACT) to prevent abnormally high perfusion pressures and ACTs during cardiopulmonary bypass (CPB). The preoperative background, and postoperative courses focusing on postoperative brain complications were reviewed.ResultsAmong the 31 patients, 20 (65%) had preoperative imaging findings. The group with intracranial findings was significantly older, with more embolisms in other organs, positive intraoperative pathology findings, and longer CPB times. A new cerebral hemorrhage developed postoperatively in one patient without intracranial findings. There were no early deaths; two patients had recurrent infections in each group, and one died because of sepsis in the late phase in the group with intracranial findings.ConclusionsPositive intracranial findings indicated significantly active infectious conditions preoperatively but did not affect the postoperative course. Patients without preoperative cerebral complications can develop serious cerebral hemorrhage. Although meticulous examination of preoperative cerebral complications in all patients with IE is essential, a strategy should be adopted to prevent cerebral hemorrhage, even in patients without intracranial findings.

Evaluation of clinical examination and preoperative imaging in patients with right iliac fossa pain and a medium or high risk score for appendicitis (RIFT-2)

Introduction: Clinical risk models can be used to safely stratify UK patients with suspected appendicitis with low scores to ambulatory pathways, preventing admissions and unnecessary surgery. This study aimed to examine the diagnostic pathways in patients with medium or high risk scores.&#x0D; Methods: This prospective cohort study included patients admitted with suspected appendicitis in the UK. Patients aged ≥16 years were included if they had a medium or high risk score for appendicitis (Appendicitis Inflammatory Response score &gt;2 in men, Adult Appendicitis Score &gt;8 in women). The primary outcome measure was the normal appendicectomy rate (NAR). The AIRS and AAS risk prediction models were validated against pre-determined criteria.&#x0D; Results: This UK study included 2,231 women and 1,958 men. Overall, 57.7% of patients underwent surgery. The NAR was 18.4% in women aged 16-45 years, 9.5% in men aged 16-45 years, 4.5% in women aged ≥46 years, and 2.1% in men aged ≥46 years. Risk prediction models did not achieve the pre-determined threshold to be used to identify patients with appendicitis. Ultrasound was the most common imaging modality in women aged 16-45 years, whereas CT was most common in the other subgroups. CT was performed in 12.8% women aged 16-45 years, 21.1% in men aged 16-45 years, 69.3% in women aged ≥46 years, and 74.5% in men aged ≥46 years. The overall NAR in patients who had CT imaging alone (3.6%) was lower than in patients who had no imaging (12.4%) or ultrasound imaging alone (19.0%).&#x0D; Conclusion: Patients with right iliac fossa pain should be risk scored, with low-risk patients triaged to ambulatory management and medium and high-risk patients routinely CT scanned. Normal appendicectomy should become a specific therapeutic option rather than a chance finding.

Preoperative rapid growth of inferior vena cava tumor thrombus in renal cell carcinoma

IntroductionWe present the case of a rapidly growing inferior vena cava tumor thrombus in renal cell carcinoma.Case presentationWe present a case of a 66‐year‐old woman with right renal cell carcinoma with a tumor thrombus extending 2 cm into the inferior vena cava on an initial Imaging. Radical surgery was performed 6 weeks after the first visit. Intraoperatively, the tumor thrombus was confirmed to have grown near the diaphragm. The tumor was resected using an inferior vena cava clamping just below the diaphragm. The tumor thrombus and renal cell carcinoma were completely removed. There was no recurrence 6 months postoperatively.ConclusionInferior vena cava tumor thrombus in renal cell carcinoma can grow in a short period, suggesting that preoperative imaging evaluation at the appropriate time is important. Once inferior vena cava tumor thrombus of renal cell carcinoma occurs, surgery should not be delayed unless there is an urgent reason.

Study on the diagnostic value of MDCT extramural vascular invasion in preoperative N staging of gastric cancer patients

BackgroundTo explore the diagnostic value of multidetector computed tomography (MDCT) extramural vascular invasion (EMVI) in preoperative N Staging of gastric cancer patients.MethodsAccording to the MR-defined EMVI scoring standard of rectal cancer, we developed a 5-point scale scoring system to evaluate the status of CT-detected extramural vascular invasion(ctEMVI), 0–2 points were ctEMVI-negative status, and 3–4 points were positive status for ctEMVI. Patients were divided into ctEMVI positive group and ctEMVI negative group. The correlation between ctEMVI and clinical features was analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of ctEMVI for pathological metastatic lymph nodes and N staging, The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of pathological N staging using ctEMVI and short-axis diameter were generated and compared.ResultsThe occurrence rate of lymphovascular invasion (LVI) and proportion of tumors with a greatest diameter > 6 cm in the ctEMVI positive group was higher than that in the ctEMVI negative group (P < 0.05). Spearman correlation analysis showed a positive correlation between ctEMVI and LVI, N stage, and tumor size (P < 0.05). For ctEMVI scores ≥ 3,The AUC of ctEMVI for diagnosing lymph node metastasis, N stage ≥ N2, and N3 stage were 0.857, 0.802, and 0.758, respectively. The sensitivity, NPV and accuracy of ctEMVI for diagnosing N stage ≥ N2 were superior to those of short-axis diameter (P < 0.05), while sensitivity, specificity, PPV, NPV, and accuracy of ctEMVI for diagnosing N3 stage were superior to those of short-axis diameter (P < 0.05).ConclusionctEMVI has important value in diagnosing metastatic lymph nodes and advanced N staging. As an important imaging marker, ctEMVI can be included in the preoperative imaging evaluation of patients, providing important assistance for clinical guidance and treatment.

Preoperative bimodal imaging evaluation in finding histological correlations of in situ, superficial spreading and nodular melanoma.

The aim of this study is to correlate the diagnostic criteria described in dermoscopy, ultrasonography (US), and histology of the most common types of cutaneous melanoma (CM). We conducted a prospective study including 40 CM cases, which were analyzed by dermoscopy using the Delta 30 dermatoscope and Vidix 4.0 videodermoscope, by ultrasound (US) using a high-resolution 20 MHz linear probe, along with histopathological analysis. The study involved 40 patients with histopathologically confirmed CM, comprising 10 nodular melanomas (NM), 21 superficial spreading melanomas (SSM), and nine in situ melanomas (MIS). US measurements of tumor thickness exhibited strong correlations with the histopathological Breslow index (BI), particularly in the NM and SSM groups. A notable correlation was observed between the presence of ulceration in histopathology and ultrasonography. Dermoscopic analysis revealed significant associations between specific features and CM types. For instance, the presence of an atypical network, irregular globules, irregular dots, prominent skin margins, angulated lines/polygons, dotted and short linear vessels, and negative network correlated with a median BI ≤ 0.5 mm. Conversely, the presence of blue-white veil, atypical vessels, blue-black color, and milky red color were associated with a median BI ≥ 2.3 mm. Furthermore, regression observed in histopathology correlated with regression identified in dermoscopy, we also found statistical correlations between the presence of vascularization at US with the high Clark level, and the presence of prominent skin markings at dermoscopy. The presence of histopathological regression was more frequently associated with tumors that had precise margins, absent vascularization and with those that did not have ulceration on US. The high mitotic rate was associated with tumors that presented imprecise margins, increased vascularization and US detectable ulceration. Innovative CM diagnosis using non-invasive methods like dermoscopy and ultrasound may enhance accuracy and treatment guidance by assessing lesion characteristics.

Pre-operative imaging evaluation of renal cell carcinoma.

Pre-operative imaging evaluation of renal cell carcinoma.

Challenges and predictive radiological findings in the diagnosis of neuroendocrine tumors in patients with acute appendicitis.

Acute appendicitis is one of the most common surgical emergencies. With antibiotic-first treatment strategies gaining importance, the risk of an appendiceal tumor as an incidental finding or as the cause of appendicitis presents an obstacle to a conservative approach. Neuroendocrine tumors, the most frequent type of appendiceal tumors, are difficult to diagnose preopera-tively due to their small size. This study aims to identify predictive factors for neuroendocrine tumors in patients undergoing surgery for acute appendicitis by analyzing imaging and clinical characteristics, thereby enhancing preoperative diagnostic accuracy and guiding surgical interventions. This retrospective observational study included 1,298 patients who underwent appendectomy from January 2014 to May 2024. After excluding 59 patients with normal pathology results, 40 with variable pathologies, and 49 with inaccessible computed tomography (CT) images, 1,150 patients remained (1,135 with acute appendicitis and 15 with neuroendocrine tumors). Abdominal CT scans were evaluated for appendiceal diameter, wall thickness, cecal wall thickness, periappendiceal fat stranding, fluid collection, lymphadenopathy, intraluminal and free periappendiceal air, mucosal hyperenhancement, the presence of appendicolith, mural calcification, and mural nodules. The presence of a mural nodule protruding into the lumen was significantly higher in neuroendocrine tumor patients compared to those with acute appendicitis, with a sensitivity of 53.3%, specificity of 95.8%, positive predictive value (PPV) of 31.9%, negative predictive value (NPV) of 99.4%, and accuracy of 97.9%. Intraluminal air was also more frequent in neuroendocrine tumor patients, with a sensitivity of 53.3%, specificity of 76.7%, PPV of 2.9%, NPV of 99.2%, and accuracy of 76.4%. Other imaging parameters did not show significant differences between the two groups. This study identifies mural nodules and intraluminal air as significant predictors of neuroendocrine tumors in patients with acute appendicitis, emphasizing the importance of meticulous preoperative imaging evaluations. Incorporating these predictors into diagnostic protocols could improve the preoperative identification of neuroendocrine tumors, enabling more appropriate surgical interventions. Future research should validate these findings through prospective studies and explore advanced imaging techniques to further enhance the detection of appendiceal neoplasms, ultimately improving patient outcomes and reducing overlooked malignancies.

Endoscopic endonasal surgery of Rathke’s cleft cysts-- preoperative imaging evaluation, personalized removal and multilevel sellar floor reconstruction

ObjectivesThe purpose of this study was to evaluate the effectiveness of endoscopic endonasal surgery (EES) for Rathke's cleft cysts (RCCs) and the advantages of detailed preoperative imaging evaluation, intraoperative personalized removal and multilevel sellar floor reconstruction. MethodsThe clinical data of 43 patients with RCCs who were treated by EES in the neurosurgery department of affiliated hospital of Jiangnan University and Wuxi No.2 People’s Hospital from January 2018 to January 2023 were retrospectively analyzed. The effectiveness of EES for RCCs was analyzed by imaging information, surgical procedures, symptom improvement and complications. ResultsAll 43 RCCs were completely removed by EES, and all clinical symptoms improved to varying degrees. Postoperative relief of headache was achieved in 23 out of 26 patients (88.5 %); there was improvement in 10 out of 13 patients with visual field disorders (76.9 %) and in 8 out of 10 patients with endocrine abnormalities (80 %). New hormonal deficiency was discovered in 7 of all the patients postoperatively. There were 8 patients with postoperative diabetes insipidus and 1 patient with cerebrospinal fluid leakage. The incidence of new hormonal dysfunction and postoperative DI in expanded EES (33.3 %, 33.3 %) was higher than it in conventional EES (4 %, 8 %) (P < 0.05). The average follow-up time was 29.1 ± 14.8 months, and there were no deaths or infections. Three patients presented with cyst recurrence on MRI. ConclusionsThe clinical manifestations and imaging characteristics of RCCs are variable, and a detailed preoperative review of the imaging is helpful for the development of surgical plans. RCCs can be treated more safely and thoroughly with less trauma and complications by intraoperative personalized removal and multilevel sellar floor reconstruction. The high incidence of new hormonal dysfunction and postoperative DI may be related to the disturbance of the pituitary stalk. EES has unique advantages and high clinical application value for the treatment of RCCs.