Radiological Assessment Research Articles

Detecting Tumor-Associated Intracranial Hemorrhage Using Proton Magnetic Resonance Spectroscopy

Intracranial hemorrhage associated with primary or metastatic brain tumors is a critical condition that requires urgent intervention, often through open surgery. Nevertheless, surgical interventions may not always be feasible due to two main reasons: (1) extensive hemorrhage can obscure the underlying tumor mass, limiting radiological assessment; and (2) intracranial hemorrhage may occasionally present as the first symptom of a brain tumor without prior knowledge of its existence. The current review of case studies suggests that advanced radiological imaging techniques can improve diagnostic power for tumoral hemorrhage. Adding proton magnetic resonance spectroscopy (1H-MRS), which profiles biochemical composition of mass lesions could be valuable: it provides unique information about tumor states distinct from hemorrhagic lesions bypassing the structural obliteration caused by the hemorrhage. Recent advances in 1H-MRS techniques may enhance the modality’s reliability in clinical practice. This perspective proposes that 1H-MRS can be utilized in clinical settings to enhance diagnostic power in identifying tumors underlying intracranial hemorrhage.

Radiological assessment of extremity bone involvement in Erdheim-Chester disease: a systematic review of case reports.

To describe the clinical presentations and radiological manifestations of Erdheim-Chester disease (ECD) in the extremities, with particular emphasis on radiologic findings, as radiographs are typically the initial imaging modality used in clinical practice. Following the PRISMA guidelines, a comprehensive systematic search was performed across Scopus, PubMed, Web of Science, and Embase databases, covering case reports from inception until August 1, 2024. Included were studies with pathologically confirmed ECD (CD68 positive and CD1a negative) that were evaluated with at least one imaging modality and provided detailed descriptions of radiological findings. Out of 401 identified articles, 20 articles comprising 20 histologically confirmed cases of ECD met the inclusion criteria following screening and full-text review. Pathological reports were assessed for the presence of lipid-laden cells and Touton giant cells, which were identified in 84.2% and 75% of cases, respectively. Upper extremities were affected in 65% of cases and lower extremities in all cases. Symmetric involvement was observed in 84.6% of upper extremity cases and 84.2% of lower extremity cases. Radiological findings were categorized as pure sclerosis (53.3%) and cortical thickening (42.8%) identified as the most common findings. Clinical manifestations were assessed, with pain and swelling in the extremities being the most common symptoms, occurring in 70% of cases. The hallmark of ECD is bilateral, symmetric diaphyseal and/or metaphyseal osteosclerosis in the long tubular bones of the lower extremities. Epiphyseal sparing is observed in more than half of the patients.

Characteristics of HCC patients with portal vein thrombosis: albumin and survival.

Presence of macroscopic portal vein thrombosis (PVT) in patients with hepatocellular carcinoma (HCC) has been found to be a major poor prognosis characteristic. To examine patients with PVT for their clinical characteristics and factors related to both PVT and to survival. A large HCC database containing 1094 patients with PVT and 2513 patients without PVT was examined. Patients had routine baseline serum liver parameters and alpha-fetoprotein (AFP) levels measured; radiological assessment of maximum tumor diameter (MTD), tumor number, presence of macroscopic portal vein thrombosis, plus survival. The percent of patients with PVT increased with increase in both MTD and serum AFP levels and liver parameter levels were worse in patients with PVT than without it. A logistic regression model showed that the combination of MTD>5cm plus AFP >100 IU/mL plus albumin <3.5 g/dL had an odds ratio of 10.988 for the presence of PVT. Normal serum albumin levels significantly reduced the hazard ratio for death in a Cox proportional hazard model and were associated with decreased liver failure. Logistic regression showed the significance of MTD, AFP and albumin on presence of PVT and the Cox model highlighted the importance of albumin levels in decreasing death.

Trabecular metal collars in endoprosthetic replacements: do they osseointegrate?

Limb salvage surgery (LSS) is the primary treatment option for primary bone malignancy. It involves the removal of bone and tissue, followed by reconstruction with endoprosthetic replacements (EPRs) to prevent amputation. Trabecular metal (TM) collars have been developed to encourage bone ingrowth (osseointegration (OI)) into EPRs. The primary aim of this study was to assess whether OI occurs when TM collars are used in EPRs for tumour. A total of 124 patients from July 2010 to August 2021 who underwent an EPR for tumour under the West of Scotland orthopaedic oncology team were identified. Overall, 81 patients (65%) met the inclusion criteria, and two consultants independently analyzed radiographs at three and 12 months, as well as the last radiograph, using a modified version of the Stanford Radiological Assessment System. OI of the TM collar occurred in approximately 65% of patients at last radiograph. The percentage of patients with OI at three months (65.4%) reflected the 12-month (65%) and long-term (64.4%) follow-up. The median amount of OI across all radiographs was one at all three timepoints, with only five cases (11.1%) showing OI in all four zones at last radiograph. Radiolucency at the bone:collar junction was present in 23 cases (28.4%) at three months, but only four (6.7%) showed progression of this at 12 months. The interobserver reliability was found to be highly reliable in all parameters (p < 0.001). OI occurs in approximately 65% of TM collars, and is similar at three months, 12 months, and last radiograph. The extent of OI at the bone:collar junction was found to have decreased at longer-term follow-up. Furthermore, radiolucency at the bone-collar impact junction does occur in some patients but only a low number will show radiolucency progression at longer-term follow-up.

Radiological Assessment of Exposure to Background Ionizing Radiation in Ogbomoso South Local Government, Oyo State, Nigeria

The radiological evaluation of rural areas in developing countries is frequently overlooked due to the assumption of minimal radiation risk and low levels of industrialization. This research aims to fill this gap by assessing the background radiation level in Ogbomoso South Local Government, Oyo State, Nigeria, and estimating the radiological risks. One thousand sampling locations were randomly selected across the ten administrative wards of the study area, and the radiation level was examined using a dosimeter. The recorded dose rates varied between 0.09 and 0.17 μSvh-1, with an overall mean of 0.13 μSvh-1. This average is 48.2% lower than the global mean of 0.27 µSvh-1. The estimated annual effective dose equivalent ranged from 0.15 to 0.30 mSvy-1, with an average of 0.23 mSvy-1, which is 23.1% below the acceptable limit of 1 mSvy-1. The study shows that the current levels of radiation exposure do not present a significant radiological threat. It recommends establishing a regular monitoring program to observe changes over time, with this data serving as a baseline for Ogbomoso South Local Government.

Optimizing acromioclavicular joint management: A case series on minimally invasive TightRope with double endobutton fixation

Acromioclavicular (AC) joint dislocation constitutes 40% of shoulder injuries, impacting patients across diverse activities. The Rockwood Staging System guides assessment, prompting exploration of the novel TightRope with double endobutton fixation technique to restore AC joint function. This study aims to evaluate the outcomes of the TightRope with double endobutton fixation technique in 20 cases of AC joint dislocation, emphasizing its potential advantages over conventional methods. A case series involving 20 AC joint dislocation cases underwent comprehensive evaluation, including follow-ups and radiological assessments. Surgical interventions were performed using the TightRope with double endobutton fixation technique. The average age was 44.5 years, with a notable prevalence of severe dislocations (Classes V and VI). Surgical interventions demonstrated efficiency, with a brief hospital stay. The innovative technique yielded excellent outcomes, with 90% achieving high Constant–Murley scores. TightRope with double endobutton fixation emerges as a promising, minimally invasive strategy for AC joint dislocation, exhibiting potential in minimizing post-operative complications and expediting recovery. The study advocates for individualized interventions and emphasizes the need for further exploration of long-term implications.

A young patient complaining of left scrotal pain diagnosed with testicular ischemia: a potentially fatal consequence of epididymitis

Rare complications of acute epididymitis include ischemia and infarction of the testicles. Both clinically and radiologically, it is challenging to distinguish testicular torsion. In this article we have tried to expand the library of digital images of radiological diagnostic methods used for fast and accurate differential diagnostics. This case emphasizes the significance of a comprehensive radiological assessment and how a multidisciplinary approach is necessary to guarantee an accurate diagnosis. A 24-year-old man experienced severe left testicular pain and came to the hospital 2 weeks later. At the radiology department, he reported that he had for some time painful ejaculations, pain during intercourse (dyspareunia), scrotal redness/swelling, genital inflammation, chills, swollen inguinal lymph nodes, dysuria, and scrotal pain. All diagnostic procedures were performed, first ultrasonography and then magnetic resonance imaging, as required by the urologist. The imaging studies revealed left testicular ischemia, and based on the referred clinical history, a chronic orchid-epididymitis was suspected. Thus, the condition was resolved, not with a left orchidectomy but with medical therapy because the ischemia area was not too large. The patient also had a left varicocele. Images acquired with different magnetic resonance imaging sequences were carefully examined. A rare instance of epididymal orchitis is described as a potentially dangerous complication of epididymitis and must be considered if sudden, severe scrotal pain is experienced to avoid severe consequences. This case can help with optimal patient management and prevent unnecessary interventions.

Radiological assessment of pulmonary vascular changes and gastrointestinal changes in patients with COVID-19 referred to a tertiary health care center in Chennai, India: a prospective cross-sectional study

BACKGROUND: The coronavirus disease pandemic (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has led to significant morbidity and mortality worldwide since its emergence in 2019. Although primarily a respiratory illness, COVID-19 can also affect other organ systems, including the vascular and gastrointestinal systems. COVID-19 is linked to both venous and arterial thrombosis, and numerous studies have indicated a heightened risk of pulmonary embolism. Autopsies have revealed pulmonary vasculature thrombosis and bowel ischemia in patients with COVID-19. AIM: To assess radiological pulmonary vascular changes, specifically pulmonary embolism, and gastrointestinal changes in patients with COVID-19 referred to a tertiary healthcare center in Chennai, India. MATERIALS AND METHODS: Computed tomography pulmonary angiography and contrast-enhanced computed tomography of the abdomen were conducted in 100 patients with COVID-19 who met the selection criteria. A radiologist with 5 years of experience evaluated pulmonary vascular and bowel changes. Subsequently, statistical analysis was performed to determine the significance of the relationship between patients with COVID-19 and the occurrence of pulmonary vascular and bowel changes. RESULTS: In this study, 11 patients exhibited pulmonary thromboembolism, and 7 showed significant bowel changes such as bowel wall thickening, mesenteric ischemia, and omental infarction, indicative of potential gastrointestinal involvement of patients with COVID-19. A positive correlation was found between pulmonary embolism prevalence in patients with COVID-19. Pulmonary embolism was diagnosed at a mean of 11 days from disease onset. Of the 24 patients with severe acute respiratory illness, 7 showed pulmonary embolism, detected by computed tomography pulmonary angiography. In addition, of the 10 patients on mechanical ventilation, pulmonary embolism was found in 7. Among the seven patients with bowel changes, four had pulmonary embolism, as detected by computed tomography pulmonary angiography, indicating a significant association between the two concomitant complications. The observed bowel changes were attributed to intravascular thrombosis. CONCLUSIONS: Based on our findings, pulmonary emboli and bowel changes often occur in patients with COVID-19. Multivariate analyses also revealed a connection between invasive mechanical ventilation and pulmonary embolism. The results indicate that patients with severe COVID-19 may also experience concurrent acute pulmonary embolism. Thus, for these patients, the use of contrast-enhanced computed tomography instead of standard non-contrast computed tomography may aid in treatment decision-making.

The sinus surgery completeness score: a radiological assessment of the extent of endoscopic sinus surgery.

Chronic rhinosinusitis (CRS) often requires endoscopic sinus surgery (ESS) for symptom control. However, there is currently a high reported revision rate. The introduction of biologics offers an alternative treatment, but patient criteria are ambiguous, particularly regarding the definition of "previous ESS." This study aims to introduce the Sinus Surgery Completeness Score (SSCS) to help evaluate the extent of ESS as well as evaluate the extent of sinus surgery in the study cohort. The SSCS was developed by expert rhinologists and anterior skull base surgeons and applied to computed tomography (CT) sinus scans of 41 CRS patients who underwent previous ESS. Inter-rater reliability was assessed, and statistical analysis was performed to correlate SSCS scores with Lund-Mackay (LM) and Sinonasal Outcome Test-22 (SNOT-22) scores. The SSCS demonstrated strong inter-rater reliability (Fleiss Kappa score 0.857). The mean time to complete the SCSS was 2.7min. Most patients had incomplete surgery with a mean SCSS of 7.40 (total 24) with no patients achieving a maximum score. The maxillary sinus was the most dissected subunit, with frontal and sphenoid sinuses being the least. Weak negative correlations were observed between the SSCS and LM and SNOT-22 scores. The SSCS is a useful tool for assessing the completeness of sinus surgery, offering a standardized approach to evaluating surgical outcomes. While further research is needed to elucidate the relationship between surgical completeness and patient outcomes, the SSCS holds promise in guiding patient management including informing decisions regarding eligibility for biologic therapy.

Hepatic arterial infusion chemotherapy plus regorafenib compared with regorafenib alone as second-line therapy for advanced hepatocellular carcinoma: a randomised controlled trial protocol

IntroductionThe exact role of hepatic arterial infusion chemotherapy (HAIC) in advanced hepatocellular carcinoma (aHCC) is still unknown. The combination of HAIC and sorafenib has been proven to be more effective...

Comparative Analysis of Large Language Models and Spine Surgeons in Surgical Decision-Making and Radiological Assessment for Spine Pathologies

AimThis study aimed to investigate the accuracy of large language models (LLMs), specifically ChatGPT and Claude, in surgical decision-making and radiological assessment for spine pathologies compared to experienced spine surgeons. MethodsThe study employed a comparative analysis between the LLMs and a panel of attending spine surgeons. Five written clinical scenarios encompassing various spine pathologies were presented to the LLMs and surgeons, who provided recommended surgical treatment plans. Additionally, MRI images depicting spine pathologies were analyzed by the LLMs and surgeons to assess their radiological interpretation abilities. Spino-pelvic parameters were estimated from a scoliosis radiograph by the LLMs. ResultsQualitative content analysis revealed limitations in the LLMs' consideration of patient-specific factors and the breadth of treatment options. Both ChatGPT and Claude provided detailed descriptions of MRI findings but differed from the surgeons in terms of specific levels and severity of pathologies. The LLMs acknowledged the limitations of accurately measuring spino-pelvic parameters without specialized tools. The accuracy of surgical decision-making for the LLMs (20%) was lower than that of the attending surgeons (100%). Statistical analysis showed no significant differences in accuracy between the groups. ConclusionThe study highlights the potential of LLMs in assisting with radiological interpretation and surgical decision-making in spine surgery. However, the current limitations, such as the lack of consideration for patient-specific factors and inaccuracies in treatment recommendations, emphasize the need for further refinement and validation of these AI models. Continued collaboration between AI researchers and clinical experts is crucial to address these challenges and realize the full potential of AI in spine surgery.

Radiological risk assessment and characteristics of gross alpha and beta activities in vegetables, tubers, and fruits in Hanoi, Vietnam

ABSTRACT In this paper, the radiological risk and activity baseline data of the popular vegetables, tubers, and fruits in Vietnam were studied. In the summer of 2020, the selected samples were classified into three categories, including 29 vegetables of flowers, buds, stems, and leaves (C1); 10 tubers of bulbs, roots, and tubers (C2), and 15 fruits of seeds, fruits, and pods (C3). The activities varied over a wide range from 0.45 ± 0.30 to 63 ± 33 Bq.kg−1 wet and 8.2 ± 5 Bq.kg–1 wet on average for gross alpha and from 20 ± 3 to 250 ± 29 Bq.kg−1 wet and 90 ± 10 Bq.kg−1 wet on average for the gross beta. The average gross alpha is far lower than gross beta activity and in order of C1< C3 < C2, with values of 7.0 ± 5.0, 9.1 ± 5.0, and 10.5 ± 6.0 Bq.kg−1 wet, respectively. In contrast, the gross beta activity values decrease with trending C1 > C2 > C3, and values of 98 ± 11, 85 ± 10, and 77 ± 9 Bq.kg−1wet, respectively. The average annual effective dose (AED) of C1, C2, and C3 categories could be up to 0.108, 1.83, and 1.93 mSv.year−1, respectively. The two values exceed the recommended level of 1 mSv.year−1 (WHO). However, those AEDs can be significantly reduced, as there was the dominance of gross beta with gross beta/alpha ratio greater than 10:1 and a high correlation between total beta and AED compared to total alpha. The excess lifetime cancer risks (ELCR) were calculated with values of 0.38 × 10−3 and 6.39 × 10−3 for gross alpha and beta activities, respectively.

Clinical, biochemical, and genetic study of TACE/TNF-α/ACE signaling pathway in pediatric COVID-19 infection.

: Pediatric patients infected with coronavirus disease 2019 (COVID-19) have unique clinical characteri-stics. Tumor necrosis factor (TNF) is a proinflammatory cytokine that greatly contributes to tumor pathogenesis. : To describe the presenting characteristics of COVID-19 infection among pediatric patients, and investi-gate the possible role of the TNF-α signaling pathway. : This prospective case-control study included 50 Egyptian pediatric patients with COVID-19 and 50 healthy controls. Clinical, laboratory, and radiological as-sessments were performed. Serum TNF-alpha (TNF-α), TNF-α-converting enzyme (TACE), and angiotensin-con-verting enzyme 2 (ACE2) were measured using enzyme-linked immunosorbent assay. ACE (I/D) (rs4646994), ACE2 rs2285666, and TNF-α-308G/A single nucleotide poly-morphisms (SNPs) were performed using conventional polymerase chain reaction techniques with or without restriction fragment length polymorphism. : The median age was 1 year (interquartile range [IQR], 0.31-2.50 years) in the case group and 1.45 years (IQR, 1.00-3.00) in the control group. The main presenting symptoms were fever (92%), dry cough (74%), and dyspnea (72%). The lymphocytic count was normal in 14 patients (28%), decreased in 16 patients (32%), and in creased in 20 patients (40%) of the case group. Positive chest com-puted tomography finding of COVID-19 infection were demonstrated among 40% of patients using COVID-19 Re-porting and Data System categories (ground-glass op-acity with or without consolidations in the lungs). There were significant increased serum TACE and TNF-α with decreased ACE2 levels among cases versus controls (P< 0.001). The GG genotype and G allele of the TNF-α-308G/A SNP were significantly higher in patients than in controls (P<0.05 for both), with insignificant differences in genotype and allelic frequencies in the ACE (I/D) (rs4646994) and ACE2 rs2285666 SNPs. : The TNF signaling pathway was significantly activated in pediatric COVID-19 infection. Only the TNF-α-308G/A SNP was significantly associated with pediatric COVID-19 infection.

Changes in clinical presentation, management, and survival outcomes in patients affected by colorectal cancer following COVID-19 pandemic.

As an extended analysis of the COVID-DELAY study, we aimed to assess the impact of the COVID-19 pandemic on diagnosis, staging, and survival outcomes among patients with colorectal cancer (CRC) diagnosis performed from 2019 to 2022. All consecutive newly diagnosed CRC patients referred to 11 Italian Oncology Departments between March and December 2019, 2020, 2021, and 2022 were enrolled. Access rate, demographics, diagnostic-therapeutic temporal intervals, and first-line progression-free survival (PFS) and OS among metastatic patients were assessed. Compared to 2019 (n = 690), an initial global reduction in new CRC cases in 2020 (n = 564, -18.3%) was observed, followed by a progressive increase in new CRC diagnoses in 2021 (n = 748, + 8.4%) and 2022 (n = 756, + 9.6%); a higher rate of TNM stage IV tumors was diagnosed in 2020 (35.4%) and 2021 (31.0%) compared to 2019 (29.6%), with normalization in 2022 (26.4%) (P < .001). Not clinically relevant differences between histological diagnosis and first oncological examination, cytohistological diagnosis and systemic treatment start, first oncological appointment and systemic treatment start, treatment start and first radiological assessment between 2020 and 2021-2022 years were found. After propensity score matching according to the year of diagnosis, median OS was significantly worse in 2020, 2021, and 2022 compared to 2019 (27.6 vs 24.8 vs not reached vs 38.9 months, respectively) (P < .001). Concordantly, the median PFS was significantly worse with each passing year: 13.0 vs 11.1 vs 9.2 vs 7.2 months in 2019, 2020, 2021, and 2022, respectively (P = .00027). A progressive normalization in the rate of new CRC diagnosis as well as TNM stages at diagnosis, in 2021 and 2022 compared to 2020 and 2019, was found. The increase in new CRC cases might have affected some diagnostic-therapeutic time intervals in 2021-2022 years compared to 2020. Significantly, compared to the pre-pandemic phase, pandemic years were independently associated with worse PFS and OS outcomes in patients affected by metastatic disease.

Pulmonary lymphangiomatosis: insights into an ultra-rare disease

BackgroundPulmonary lymphangiomatosis (PL) is an ultrarare disease characterized by diffuse infiltration of the lung, pleura and/or mediastinum by abnormal lymphatic proliferation. Consented diagnostic or treatment approaches are not established. We therefore aimed to collect data on diagnostics and treatments in a cohort of patients with PL from a tertiary center for rare lung diseases.MethodsClinical, radiological and outcome data from PL patients were collected retrospectively.Results12 patients were diagnosed between 1996 and 2022 in our center. PL was diagnosed more commonly in female (58%), never smokers (75%) and younger patients (mean age 42 years). Main clinical symptoms comprised haem- and chyloptysis (58%) and dyspnea on exertion (83%). Pulmonary function was mostly restrictive (mean VC 59%) with impaired DLCO (mean 65%). Radiological assessment mainly showed mediastinal involvement (83%), and pleural effusion (67%), pleural thickening (67%) and bronchial wall thickening (67%) while interstitial changes were rare. Diagnosis was confirmed by surgical or transbronchial cryobiopsy. 8 patients were treated with sirolimus, 3 of these combined with a surgical intervention and in one case surgical intervention was necessary 9 months after initiation of sirolimus. Clinical and radiological improvement was demonstrated for all patients treated with sirolimus. 1 patient received a lung transplant due disease progression. Survival rates were 90% after a mean follow up of at least 3 months.ConclusionThis case series illustrates the variability of the clinical presentation of PL. Among our patients, those treated with sirolimus showed significant clinical, functional and radiological improvement. However, further investigation is needed to understand the pathogenesis of lymphangiomatosis in order to establish therapeutic approaches.

A Rare Presentation of IgG4-Related Disease with Gastric Outlet Obstruction and Lymphadenopathy: A Case Report.

Background. IgG4-related disease (IgG4-RD) is a systemic immune-mediated condition characterized by fibro-inflammatory infiltration. It is a rare disease that can affect any organ, with the involvement of the stomach being particularly uncommon. The clinical manifestations of IgG4-RD are highly variable depending on the type and number of organs involved and mirror the symptoms of other conditions. Case presentation. We report a 61-year-old man who presented with symptoms of gastric outlet obstruction and was subsequently diagnosed with IgG4-RD. The patient experienced recurrent vomiting, early satiety, and substantial weight loss. Imaging studies revealed luminal narrowing in the pyloric region, prompting further endoscopic evaluation. Initial endoscopic biopsies were nondiagnostic. Because the patient's clinical symptoms and previous investigations were highly indicative of malignancy, he underwent distal gastrectomy with Roux en Y anastomosis. However, final histopathology revealed lymphoplasmacytic infiltration and dense fibrosis, confirming the diagnosis of IgG4-RD; no malignant cells were noted. The surgery resulted in symptom improvement. Conclusion. This presentation highlights the diagnostic challenges of IgG4-RD with gastric outlet obstruction, emphasizing the significance of a multidisciplinary approach involving clinical, radiological, and histopathological assessments to achieve an accurate diagnosis and develop tailored management strategies.

Rare complication of varicella-zoster virus infection: a case report of vernet syndrome in clinical and radiological evidence.

Vernet syndrome is a neurological disorder rarely seen in association with varicella-zoster virus (VZV) infection in ear. This report presents a 61-year-old man demonstrating neuropathy of cranial nerve XI, X, and XI. Subsequent serological and radiological examinations revealed Vernet syndrome due to VZV infection, a rare complication of a common infection. Notably, the current report features in the resolutions of inflammatory processes around the right jugular foramen evidenced by serial magnetic resonance (MR) images. This report highlights the potential values of radiological assessment in VZV-induced Vernet syndrome regarding the diagnosis and clinical follow-up. In addition, prompt clinical intervention can lead to favorable outcomes in VZV-induced Vernet syndrome.

Assessing potential factors leading to perioperative peri-implant fracture in femoral pertrochanteric fracture osteosynthesis using the proximal femoral nail antirotation 2: A retrospective study

BackgroundPerioperative peri-implant fractures (PPIFs) pose infrequent yet significant challenges in orthopedic surgery, particularly in the context of femoral pertrochanteric fractures (FPF) treated with proximal femoral nail antirotation 2 (PFNA-2) nails. PPIFs can lead to prolonged recovery and may necessitate re-osteosynthesis in severe cases. Despite the effectiveness of PFNA-2 in the management of FPFs, our understanding of PPIFs in this specific context remains limited. This study aimed to elucidate the factors contributing to PPIFs in patients with PFNA-2-treated FPF.MethodsIn this retrospective analysis spanning from 2019 to 2022, patients with FPF treated with PFNA-2 nails were examined. Demographic data, fracture characteristics, and radiological parameters were collected, along with details of the PPIF management strategies and rehabilitation protocols. Radiological assessments included femoral morphology measurements and reduction and fixation quality evaluation. The area under the curve (AUC) was analyzed in this specific group.ResultsAmong 157 patients, 3.2% experienced acute PPIFs managed conservatively with successful union without secondary surgical intervention. Younger age and increased femoral isthmus diameter (DI) emerged as significant predictors of PPIFs in the univariate regression analyses (P = 0.01). The AUCs for age (65.5 years) and DI (1.4 cm) were 0.78 and 0.79, respectively, indicating moderate accuracy.ConclusionsAlthough PFNA-2 nails are reliable in managing FPFs, the persistence of PPIFs emphasizes their complex causes. This study highlights that younger age and increased femoral DI are crucial factors for PPIF occurrence in patients with PFNA-2-treated FPF. Conservative treatment with delayed weight-bearing ambulation may be effective in treating these fractures.

Assessment of spinopelvic relationship among Turkish orthopedic surgeons in total joint replacement: a survey.

This study aims to investigate the preferences of orthopedics and traumatology specialists in evaluating the spinopelvic relationship in primary total hip arthroplasty (THA) in Türkiye. Members of the Turkish Orthopedics and Traumatology Association (n=2485) were invited to fill out the questionnaire. The survey was created using Google Forms and distributed to participants via WhatsApp and Gmail by sharing the link. A total of 205 orthopedic surgeons responded and completed the questionnaire. The survey included 13 questions about the duration of their experience, the number of THA and spinal instrumentation procedures they performed, the dislocation rates they encountered after surgery, and the radiological assessments they performed for the spinopelvic relationship. Sixty-three percent of the participants evaluated spinopelvic parameters in patients undergoing THA. Forty-seven percent of surgeons state that in their daily practice, they determine the angle of the acetabular component according to whether the spinal deformity is rigid, flexible, balanced, or unstable. While 88% of the participants stated the rate of encountering dislocation after primary THA as less than 2%, 12% of the participants stated it as more than 2%. It was observed that 40% of the surgeons with a prosthetic dislocation rate of more than 2% evaluated the spinopelvic relationship, while 67% of the surgeons with a dislocation rate of less than 2% evaluated the spinopelvic relationship. Approximately half of the orthopedic surgeons in Türkiye plan component placement in primary THA cases by considering the spinopelvic relationship. In order to increase awareness about the spinopelvic relationship, it would be beneficial to give more space to this subject in training programs and conferences. N/A.

Radiomics Analysis for the Identification of Invasive Pulmonary Subsolid Nodules From Longitudinal Presurgical CT Scans.

Effective identification of malignant part-solid lung nodules is crucial to eliminate risks due to therapeutic intervention or lack thereof. We aimed to develop delta radiomics and volumetric signatures, characterize changes in nodule properties over three presurgical time points, and assess the accuracy of nodule invasiveness identification when combined with immediate presurgical time point radiomics signature and clinical biomarkers. Cohort included 156 part-solid lung nodules with immediate presurgical CT scans and a subset of 122 nodules with scans at 3 presurgical time points. Region of interest segmentation was performed using ITK-SNAP, and feature extraction using CaPTk. Image parameter heterogeneity was mitigated at each time point using nested ComBat harmonization. For 122 nodules, delta radiomics features (ΔRAB= (RB-RA)/RA) and delta volumes (ΔVAB= (VB-VA)/VA) were computed between the time points. Principal Component Analysis was performed to construct immediate presurgical radiomics (Rs1) and delta radiomics signatures (ΔRs31+ ΔRs21+ ΔRs32). Identification of nodule pathology was performed using logistic regression on delta radiomics and immediate presurgical time point signatures, delta volumes (ΔV31+ ΔV21+ ΔV32), and clinical variable (smoking status, BMI) models (train test split (2:1)). In delta radiomics analysis (n= 122 nodules), the best-performing model combined immediate pre-surgical time point and delta radiomics signatures, delta volumes, and clinical factors (classification accuracy [AUC]): (77.5% [0.73]) (train); (71.6% [0.69]) (test). Delta radiomics and volumes can detect changes in nodule properties over time, which are predictive of nodule invasiveness. These tools could improve conventional radiologic assessment, allow for earlier intervention for aggressive nodules, and decrease unnecessary intervention-related morbidity.