Radiological Methods Research Articles

Case report: Primary intraosseous meningioma: a radiological study of two cases confirmed pathologically

IntroductionPrimary intraosseous meningioma (PIM) is a rare lesion often misidentified preoperatively due to its ambiguous benign or malignant characteristics. In this report, we introduce two novel cases of PIM and explore the potential correlation between pathological classification and imaging features. Our aim is to enhance our understanding of PIM and improve its preoperative diagnosis.Case presentationThe first case is a 68-year-old female patient presenting with a brain mass located in the temporal region. Computed tomography (CT) imaging demonstrated the destruction of adjacent bone structures. A right frontal temporal craniectomy was subsequently performed and histological examination pathologically confirmed the lesion was the chordoid variant of PIM. The second case is a 56-year-old male patient who exhibited an irregular soft-tissue mass in the right sphenoid as visualized on brain CT. The patient underwent a surgical intervention for a skull base neoplasm. Postoperative pathological analysis confirmed the presence of the meningothelial variant of PIM. Upon pathological examination, the two cases were respectively classified as atypical meningioma (Grade II) and benign meningioma (Grade I).ConclusionsWhile pathological examination remains indispensable for the definitive confirmation of PIM, the early identification of PIM is critically dependent on radiological imaging methods. The imaging characteristics of PIM exhibit variability across different pathological grades, a factor that can significantly aid in both the diagnostic process and the formulation of appropriate treatment strategies.

Infective Native Aortic and Iliac Artery Aneurysms: Clinical Profiles and Short-Term Outcomes from a Single-Center Cohort.

Infective native aortic and iliac artery aneurysms, although rare, have high mortality rates of 21%-44%. Diagnosis is often delayed owing to nonspecific symptoms. Treatment includes surgical intervention and antimicrobial therapy. This study aimed to describe the clinical characteristics and short-term outcomes of 32 patients with infective aneurysms at a single center. This retrospective study, conducted at the Saitama International Medical Center from January 2011 to December 2020, included patients diagnosed with infective native aortic and iliac artery aneurysms. The patients' clinical data, microbiological and radiological findings, treatment methods, and outcomes were collected and analyzed. Of the 32 patients, 56.3% presented with fever (≥37.5 °C) and 87.5% exhibited nonspecific symptoms, such as pain and loss of appetite. Blood cultures were positive in 18 patients (58.1%), with Staphylococcus aureus being the predominant pathogen, isolated in 11 patients. Pathogens in 5 of the 11 cases (45%) were resistant to methicillin. Surgery was performed in 75% of patients, with 20 undergoing open surgical repair (OSR) and 4 undergoing endovascular treatment (EVT). The 1-year mortality rates of the patients who underwent OSR and EVT were 23.5% (4/17) and 0% (0/4), respectively. Postoperative infection-related complications occurred in 25% of patients who underwent OSR. For nonsurgical patients, the 30-day and 1-year mortality rates were 25% (2/8) and 85.7% (6/7), respectively. The findings of this study highlight the high mortality rates associated with infective aneurysms. S. aureus was the predominant pathogen, differing from trends observed in other Asian regions.

A RARE CAUSE OF TENSION PNEUMOTHORAX ECHINOCOCCUS GRANULOSUS

Hydatid cyst (HH) is a zoonotic parasitic disease caused by Echinococcus. The most common site of localization is the liver and the second most common site is the lungs. The most common complication of pulmonary hydatid cyst is rupture of the cyst into the bronchus. Tension pneumothorax is a very rare complication. The diagnosis of hydatid cyst of the lung is based on clinical and radiologic imaging methods and serologic tests. Treatment is primarily surgical. In this case, we aimed to present a case of an adult patient who presented with tension pneumothorax, in which the diagnosis of hydatid cyst was made with clinical and radiologic imaging, and the treatment was organized with surgery and medical treatment immediately afterwards, since he presented with a very rare complication.

Gamma knife radiosurgery for cavernous malformations: a comprehensive study on symptom relief, hemorrhage rates, and histopathological changes

This study aims to demonstrate the effect of gamma knife radiosurgery (GKRS) on symptoms, hemorrhage rates, and histopathological changes in patients with cavernous malformations (CMs), regardless of whether the symptomatic lesions are hemorrhagic. This single-center retrospective study evaluated symptomatic patients with single CMs treated with GKRS between 2016 and 2023. The patients’ demographic data, presenting symptoms, GKRS radiation dose, complications developed during follow-up (hemorrhage, radiotoxicity), the rate of symptom improvement, and histopathological changes of surgically removed CMs were recorded. Our study included 134 symptomatic patients, of whom 55 were male (41%) and 79 were female (59%). Among the patients, 80 (59.7%) had CMs in the lobar region, 23 (17.1%) in the cerebellum, 16 (12%) in the brainstem, and 15 (11.2%) in the basal nuclei/thalamus. The mean target volume was 0.64 ± 1.23 cm3, and the mean tumor margin dose was 14.89 ± 1.90 Gy. Symptoms were completely recovered in 95 patients (70.9%), while 18 (13.4%) experienced partial recovery. The annual hemorrhage rate (AHR) reduced from 6.26 to 1.01 following GKRS. Adverse radiation effects (ARE) were encountered in ten patients (7.46%) of cases, with only three patients (2.2%) being permanent. The mean follow-up period was 35.57 ± 23.54 months (2–83 months). Two patients without hemorrhage underwent surgical removal of CM due to symptomatic deterioration after GKRS. Histopathological examination demonstrated numerous vascular structures with luminal narrowing due to hyalinization and fibrinoid necrosis caused after GKRS. Our findings suggest that GKRS may help reduce hemorrhage rates and potentially relieve symptoms in patients with symptomatic CMs, although further long-term studies are necessary to confirm these observations and to fully assess potential risks. Since there is no radiological method to evaluate the impact of GKRS on CMs, our study examines the histopathological changes that occurred following the GKRS. The histopathological changes prove that GKRS alters the morphology of the CMs and thus can relieve symptoms and reduce hemorrhage rates associated with CMs.

Non-enhanced abbreviated MRI as a periodic surveillance protocol for colorectal liver metastases compared with contrast-enhanced CT: a prospective observational study.

Adopting appropriate noninvasive radiological method is crucial for periodic surveillance of liver metastases in colorectal cancer (CRC) patients after surgery, which is closely related to clinical management and prognosis. This study aimed to prospectively enroll stage II-III CRC patients for the surveillance of liver metastases, and compare the diagnostic performance of contrast-enhanced CT (CE-CT) and non-enhanced abbreviated MRI (NE-AMRI) during this process. 587 CRC patients undergoing radical resection of the primary tumor were evaluated by 1 to 3 rounds of surveillance tests, consisting of abdominal CE-CT and contrast-enhanced MRI (CE-MRI) within 7days at 6-month intervals. Subsequently, images of NE-AMRI were extracted from the CE-MRI examination, paired CE-CT and NE-AMRI analysis were performed. The lesion-based detection rates between two protocols were compared and a subgroup analysis was performed in lesions with the size of ≤ 10mm. The patient-based sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and the areas under the curves (AUCs) of CE-CT and NE-AMRI in each round were evaluated. Finally, the relationship between the diagnostic accuracy of two protocols and characteristics of patients was explored. The lesion-based detection rates of NE-AMRI in three rounds were all significantly higher than that of CE-CT (p < 0.001, p < 0.001, p=0.003, respectively). In the subgroup analysis of lesions ≤ 10mm, NE-AMRI also performed better than CE-CT (p < 0.001, p=0.002, p=0.005, respectively). The patient-based sensitivities, specificities, NPVs, PPVs of NE-AMRI were higher than those of CE-CT in three rounds of surveillance. The AUCs for NE-AMRI were all significantly better than that for CE-CT in each round (p=0.015, p=0.045, p=0.009, respectively). Furthermore, patient BMI and fatty liver disease had impacts on the diagnostic accuracy of CE-CT protocol, but not on NE-AMRI protocol. NE-AMRI may be a promising periodic surveillance tool for CRC patients after surgery to increase diagnostic accuracy of liver metastases, developing personalized clinical management and improving prognosis, simultaneously avoiding side-effects associated with ionizing radiation and contrast agents.

P0409 Clinical and serological characteristic of Crohn’s Disease patients with gastrointestinal strictures

Abstract Background Processes of inflammation and fibrogenesis in Crohn’s Disease (CD) contribute to development of strictures and subsequent complications, constituting a significant medical issue. The primary objective of the study was to identify clinical parameters associated with the occurrence of gastrointestinal stenosis, as well as to determine the clinical utility of promising biomarkers of fibrosis in a cohort of patients with CD. Methods A single-center cohort study was performed on 78 adults diagnosed with different phenotypes of CD. The study cohort included 36 subjects (46.2%) with gastrointestinal strictures identified by endoscopic or radiological methods, while the control group comprised 42 individuals (53.8%) without stenosis. The assessment of clinical factors, like gender, age of disease onset, disease duration, comorbidities, disease location, extra-intestinal symptoms was undertaken to explore potential associations with the presence of gastrointestinal strictures. Serum levels of candidate biomarkers of fibrosis, including granulocyte-macrophage colony stimulating factor antibodies (GM-CSF Ab), hepatocyte growth factor activator (HGFA), fibronectin isoform ED-A and cartilage oligomeric matrix protein (COMP) were measured using ELISA test. Results The overall cohort consisted of 47.44% females (n=37) and 52.56% males (n=41). The median age of disease onset was similar between the stenosis group (25.00 years, IQR: 19.00–37.00) and the non-stenosis group (26.00 years, IQR: 21.00–33.00). A proportion of 44.44% of the stenosis group required surgical or endoscopic treatment due to strictures. The most common sites of stenosis comprised the large intestine (52.78%) and the ileocecal valve region (50%), ranking ileocecal valve involvement as a significant predictor for stricture formation, with OR=3.65 (95% CI: 1.11–13.43, p=0.039). Fibronectin ED-A, with a cut-off of ≤14.52 ng/mL, was significantly associated with strictures occurrence, with OR=0.96 (95% CI: 0.92–1.00, p=0.036). Some trends in GM-CSF Ab levels were observed in patients with ileocecal involvement (median 1.75 ng/mL) compared to those without (median 1.37 ng/mL), nearing statistical significance (p=0.061). Conclusion The performed study provided some significant data about stricturing course of CD, with ileocecal valve involvement as a marker of stricture formation among CD patients. Evaluated serum biomarkers, especially fibronectin isoform ED-A, seem to be a promising diagnostic tool, however obtained data are inconsistent and demand further trials.

Comparative role of radiologic diagnostic methods in patients with prostate cancer biochemical recurrence

Biochemical recurrence occurs approximately in 25-50% of patients with prostate cancer after treatment. However, the prognosis and course of the disease vary substantially and depend on the wide range of factors. Biochemical recurrence may be caused either by local recurrence or by metastatic dissemination. Approaches to the diagnostics and treatment of patients with prostate cancer biochemical recurrence underwent radical changes over the last years due to the implementation of the new diagnostic methods in clinical practice. The article represents literature review of the current possibilities of diagnostic methods in the detection of local recurrence and metastatic spread in patients with prostate cancer biochemical recurrence.

P0393 Radiological healing in perianal fistulising Crohn’s disease: MRI predictors and disease course

Abstract Background Perianal fistulising Crohn’s disease (CD) is a disabling condition affecting up to 30% of patients. Studies suggest that greater fibrosis in the fistula tract is linked to improved clinical outcomes. This study aims to describe the natural history of perianal fistulising CD, including MRI parameters, and to identify clinical and radiological predictors of relapse and radiological healing Methods Pelvic MRIs for perianal fistula performed at CHU Liège, Belgium, from 2018 to 2023 were collected. MRI protocols used 1.5T [Siemens Aera/Sola] or 3T [Siemens Vida] machines, with sequences including T2 TSE, T2 TSE FS, and T1 TSE FS before and after gadolinium injection. The MAGNIFI-CD and modified Van Assche (VA) indices were assessed for each patient. Two blinded radiologists evaluated fistula tract fibrosis. For patients with perianal flare, only the first MRI was analysed (MRI 1). For others, the first and last MRI (MRI 2) within the study period were assessed. Perianal flare was defined as abscess drainage or stoma creation for active perianal CD, and radiological healing as ≥80% fistula fibrosis or a MAGNIFI-CD score of 0. Results A total of 102 pelvic MRIs from 84 patients were included. The median patient age was 39 years (31–51), with 40% female. The median duration of perianal CD was 52 months (2–144); 26% had a seton at MRI 1, 7% had a stoma, and 41% were on anti-TNF therapy. During follow-up, 22% required abscess drainage. No clinical factors were associated with perianal flare. Univariate analysis identified several MRI 1 radiologic predictors of flare: fibrosis percentage (OR=0.72, p=0.033), VA hyperintensity T2 (OR=3.22, p=0.028), VA rectal involvement (OR=1.75, p=0.040), VA inflammatory mass (OR=1.42, p=0.022), VA T1 post-contrast hyperintensity (OR=3.68, p=0.045), MAGNIFI-CD score (OR=1.13, p=0.022), MAGNIFI T1 post-contrast hyperintensity (OR=1.77, p=0.031), and MAGNIFI inflammatory mass (OR=1.40, p=0.033). In multivariate analysis, only MAGNIFI T1 post-contrast hyperintensity remained significant (OR=1.77, p=0.031). Radiological healing was achieved in 30% at MRI 1 (25/84) and 44% at MRI 2 (8/18). No factors at MRI 1 predicted healing at MRI 2, though T1 post-contrast hyperintensity at MRI 1 showed a trend towards predicting lack of healing (OR=0.11, p=0.071). Conclusion One-fifth of patients experienced perianal flare during follow-up. Clinical and therapeutic factors did not predict outcomes; only persistent MRI inflammation and low fistula fibrosis were linked to future abscess drainage. Specific MRI features may serve as therapeutic targets in perianal CD management, pending validation in a prospective cohort.

More Complex Investigations Improved Diagnoses of Community-Acquired Pneumonia in Children With Different Vaccination Histories.

Community-acquired pneumonia (CAP) significantly contributes to high infant mortality in Kazakhstan and developing effective treatment methods is critical. The aim of this study was to explore the microbiological and immunological characteristics of CAP in vaccinated and unvaccinated paediatric patients. The study was carried out in the Regional Children's Clinical Hospital and the research centre of Karaganda Medical University, Republic of Kazakhstan. It comprised 85 children aged 2 months to 3 years who had been diagnosed with CAP and had received inpatient treatment from 2017 to 2019. Of these, 45 had complete pneumococcal vaccinations and 40 had not. Their CAP diagnoses were confirmed by microscopic, bacteriological and radiological methods and vaccination status. General clinical examinations were conducted. The study showed the diagnostic and prognostic value of the level of cytokines, depending on the severity of the children's CAP. The level of monocytic chemoattractant protein-1 was 2.1 pg/mL in the vaccinated children with mild CAP and 3.4 pg/mL in those with impaired immunisation. Pneumococcal vaccination affected the aetiological structure of CAP in early childhood. More complex clinical and immunological diagnostic methods increased the efficiency of diagnosing CAP in children with different vaccination histories.

Clinicopathological and microbiological study of fungal rhinosinusitis treated with endoscopic surgery.

The objective of this study was to analyse the aetiology, clinical presentations, histopathology and microbiological aspects of fungal rhinosinusitis (FRS) in patients undergoing endoscopic surgery. The descriptive study was carried out over a 4-year period in two Serbian ENT Clinics and included patients with sinonasal pathology who underwent endoscopic surgery. The study included 26 patients. The most common forms of FRS treated by endoscopic sinus surgery was allergic FRS (AFRS). The fungus identification rate varied between entities, and was 72.2% in AFRS and 33.3% in fungal ball specimens. The common species seen in AFRS isolates were Cladosporium spp. (38.5% of isolated) and dematiaceous molds in the same percentage, while the remainder of the cultures were hyaline moulds. CT scan can be very helpful in diagnosing FRS and sometimes even in differentiating between different entities. Treatment of FRS should be tailored for each entity. Postoperative medical treatment in AFRS should consider potential advancements described in the literature. This study emphasises the need to combine all types of clinical, radiology, pathohistological and microbiological methods to obtain the best diagnostic and treatment strategies and should be the basis for further research.

The Deep Structure of the Kimberlite Pipe Volchya in the Arkhangelsk Diamond Province and Controlling Faults Based on Passive Seismic and Radiological Methods (Northwest Russia)

The successful prospecting of kimberlite pipes is dependent upon a comprehensive understanding of the deep structures of the pipes and the host geological formation. This is a challenging task, given the complex nature of diamond deposits, the small size of pipes in the plan, the absence of stable features in potential fields, etc. As a consequence, the allocation of control structures is practically not used in exploration work. In this regard, the Arkhangelsk diamond province (NW Russia) is distinguished by the considerable overburden thickness, which presents a significant challenge for the application of geophysical methods. It is thus imperative to devise novel methodologies for conducting investigations. In order to achieve this, a set of methods was employed, including microseismic sounding, passive seismic interferometry, and radon emanation mapping. This set of methods has previously been tested only on a few pipes and has not previously been employed in the Griba deposit. The Volchya pipe was selected as the test object due to its proximity to the Griba pipe. The findings revealed that the pipe displayed a more complex configuration than was previously postulated. The controlling faults were found to be oriented in a southwesterly to northwesterly direction and to exhibit a contrasting narrow vertical structure at depths greater than 400 m. Further identification of control structures by the proposed set of methods can increase the efficiency of diamond prospecting.

Evaluation of external and radiological landmark methods for optimizing ultrasound-guided right internal jugular venous catheterization depth in cardiac surgery

The formula-based estimation of the right internal jugular venous (IJV) catheterization depth can be inaccurate when using ultrasound guidance. External landmark-based and radiological landmark-based methods have been proposed as alternatives to estimate the insertion depth. This study aimed to evaluate these methods using transesophageal echocardiography (TEE)-guided insertion depth as the reference. Ninety-seven adult cardiac surgery patients underwent real-time ultrasound-guided right IJV catheterization, with placement at the superior vena cava-right atrium (SVC-RA) junction under TEE guidance. The primary outcome compared the accuracy of external-landmark and radiological-landmark methods in estimating optimal catheter position (2 cm above to 1 cm below the SVC-RA junction), while secondary outcomes assessed their reliability and agreement with TEE. The external-landmark method proved more accurate than the radiological-landmark method (91.8% vs. 68%, p < 0.001) and had a higher correlation with TEE (r = 0.83 vs. 0.67). Bland–Altman analysis showed a mean difference of 0.08 cm between external-landmark and TEE methods (limits of agreement: -1.75 to 1.90 cm) and 0.43 cm for radiological-landmark (limits of agreement: -2.63 to 3.49 cm). Overall, the external-landmark method is a reliable and simple technique for estimating right IJV catheter depth and is more useful in cardiac surgery compared to the radiological-landmark method.Trial registration Thai Clinical Trials Registry (TCTR20200410012). Date registered April 9, 2020.

Lymphadenopathies: A Retrospective Study of Epidemiology, Characteristics, Diagnosis and Treatment Outcomes of Patients in a Tertiary Hospital in Mogadishu-Somalia.

Lymphadenopathies, which can be caused by infections, malignant diseases, autoimmune disorders, and many other diseases, pose a challenge to clinicians in sub-Saharan Africa, as well as all over the world. The purpose of this research was to identify the clinical and diagnostic characteristics of Somalian patients suffering from swollen lymph nodes. Under the purview of this study, the diagnoses, patient clinical courses, and treatment outcomes were ascertained retrospectively by analyzing the biochemical, microbiological, radiological, and pathological data of the cases in all age groups who underwent therapy for lymphadenitis at Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital between January 2016 and September 2023. During the study period, 317 patients were followed up, with 53.3% of the patients as female, 46.7% as male, 28.1% as pediatric, 63.1% as adult, and 8.8% were elderly patients. With 58.7% of diagnoses, tuberculous lymphadenitis was the most common, pursued by malignant causes (21.8%). The most commonly affected lymph node was the cervical region, the symptom detected was lymph node swelling, the radiological method used was ultrasonography, and the biopsy method was fine needle aspiration biopsy. It was determined that benign conditions, including tuberculosis were more common in pediatric group and younger adults (p<0.001), and weight loss was a significant in terms of malignancy and tuberculosis (p<0.001). White blood cell value (p<0.001), erythrocyte sedimentation rate (p<0.001), and C-reactive protein (p:0.001) revealed differences across the diagnostic groups. Almost two-thirds of patients were diagnosed with tuberculosis lymphadenitis. Our finding revealed tuberculosis as the commonest cause of lymphadenopathy followed by malignant causes. Therefore, before screening for malignant causes, tuberculosis should be the first diagnosis considered in Somalia, particularly in a patient presenting with weight loss and swelling of the lymph nodes.

THE USING OF VIRTOPSIA IN FORENSIC MEDICAL EXAMINATION OF HANGING (literature review)

Background. For the third decade in a row, forensic medical expertise in the world has been introducing and developing the use of virtopsia as a virtual alternative to traditional examination of corpse. It is believed that the combination of postmortem computed tomography (PMCT), postmortem magnetic resonance imaging (PMRI) 3D surface scanning and postmortem angiography is sufficient to replace the traditional autopsy with a virtual one. Yjwever, the practical experience of using virtopsia has revealed both its positive aspects and disadvantages that should be taken into account when using in practice. Aim: To study the peculiarities of the use of virtopsia in forensic medical examinations of corpses in general and in cases where the cause of death was mechanical asphyxia due to hanging. Material and methods: systematic review of electronic databases of medical and biological publications, bibliographic, analytical. Results. Virtopsia can be useful in cases of identification by dental status, in case of damage of the bones of the skull and in the diagnosis of craniocerebral injuries. Analysis of the role of PMCT in trauma and diagnostic features showed that the presumed cause of death as a result of trauma was proven in approximately 30% of cases. The properties of PMCT make it possible to use it in cases of drawing, in the examination of gunshot injuries to detect skeletal injuries in high-energy trauma and it can be used as a tool for selecting individual parts of the body for further detailed autopsy and reconstruction of the cause of events and finding the cause of death. In addition, it is advisable to use postmortem PMRI for the radiological assessment of gunshot wounds. Postmortem CT angiography is particularly useful for identifying vascular involvement and coronary death. During virtopsia signs of mechanical asphyxia, fractures of the hyoid bone, larynx or thyroid cartilage and intramuscular hemorrhages were revealed which can be used as an adjunct to the autopsy. A combined approach with radiological methods demonstrates the utility of a multidisciplinary approach to significantly reduce the number of unidentified injuries. Conclusion. Analysis of the literature suggests that both postmortem PMCT and PMRI have become widely used, but forensic medical examination of corpse is the gold standard for diagnosing injuries and determining of the cause of death yet. In cases of mechanical asphyxia due to hanging, it is advisable to use PMCT to detect injuries to the hyoid bone and cartilage of the larynx, and using PMRI to detect hemorrhages in the soft tissues of the neck. Detection of specific signs of perpetuity of neck tissue injury during mechanical asphyxia with the help of PMCT allows to improve the diagnosis of hanging by applying innovative technologies and using a multidisciplinary approach.

Evolution of management strategies for unstable pelvic ring injuries over the past 40 years: a systematic review

BackgroundHemodynamically unstable pelvic ring fractures from high-energy trauma are critical injuries in trauma care, requiring urgent intervention and precise diagnostics. With ongoing advancements in trauma management, treatment strategies have evolved, with some techniques becoming obsolete as new ones emerge. This study aimed to evaluate changes and trends in treatment algorithms for these injuries over approximately 40 years.MethodsA systematic review of PubMed and EMBASE was conducted to include articles published over roughly four decades that presented visual treatment algorithms or workflows for managing unstable pelvic ring fractures. Identified algorithms were categorized by publication period and analyzed by initial assessment, diagnostic methods, pelvic stabilization, and hemorrhage control interventions.ResultsThe search identified 5,434 publications, of which 32 met the inclusion criteria. 75% of these studies were published between 2011 and 2022, reflecting a growing focus on standardization, particularly in Europe, North America, and Asia. Physiological assessment remains essential in the initial management of hemodynamically unstable pelvic ring fractures, guiding resuscitation and influencing the selection of intervention and imaging. The use of pelvic binders or sheets has risen steadily, highlighting their role in hemorrhage control and temporary stabilization. CT scans and angiography have largely replaced pelvic X-rays in diagnostic protocols, becoming preferred radiological methods alongside focused assessment with sonography for trauma (FAST). Pelvic stabilization remains critical, with external fixation being the most commonly used technique, showing an upward trend in recent years. Laparotomy, pelvic packing, and angioembolization continue to play vital roles in hemorrhage management. Emerging techniques, such as resuscitative endovascular balloon occlusion of the aorta (REBOA), anterior subcutaneous internal fixation (INFIX), and rescue screws, are increasingly included in treatment algorithms, while diagnostic peritoneal lavage (DPL) has become obsolete and is no longer listed in these algorithms.ConclusionsThis review provides foundational insights toward the standardization of initial treatment for hemodynamically unstable pelvic ring fractures and holds significant importance in enhancing the consistency and efficiency of treatment. Future research should focus on accumulating higher-quality evidence to evaluate the effectiveness of standardized protocols and explore the applicability of new treatment methods.

The Efficiency of MRI in the Diagnostic of Esophageal Cancer in Comparison with CT and Endoscopic Ultrasound

Relevance: Esophageal cancer is the eighth most common cancer in the world. Improving the algorithm for visualization of esophageal cancer through the use of modern magnetic resonance imaging (MRI) techniques along with traditionally used methods of radiological diagnostic methods (endoussis, MSCT, PET/CT), is an important purpose of choosing the optimal way of treatment for various categories of patients.Purpose: To determine the possibilities of MRI in comparison with other methods (CT and Endoscopic Ultrasound) in the diagnosis of esophageal cancer.Material and methods: 125 people with suspected esophageal cancer were examined. All patients underwent MRI, 121 (96.8 %) of which also underwent esophageal CT, and 82 (65.6 %) EUS. All cases were histologically verified.Statistics: Categorial data processing was carried out using statistical techniques: frequency tables, conjugacy tables, χ2 criteria or Fisher’s exact criteria (in the case of a small sample number). The differences were considered statistically significant at values of p &lt; 0.05.The results: Mostly the use of an optimized MRI protocol in the diagnosis of esophageal tumors demonstrated predominantly high sensitivity, specificity and accuracy in determining T and N criteria (72.8 %, 89.3 % and 85.7 % for the T-criterion, 70.4 %, 87.3 % and 83.9 % for the N-criterion, respectively) in comparison with CT methods (57.0 %, 83.7 % and 77 % for the T-test, and 73.6 %, 88.7 % and 85.6 % for the N-test, respectively) and endo-ultrasound (75.6 %, 83.3 % and 85.2 % for the T-test, 67.1 %, 86.7 % and 81.1 % for the N-test, respectively).Conclusion: The use of an optimized MRI protocol in determining the T and N criteria for esophageal cancer when compared with other modalities of radiation diagnosis showed: significant advantages of MRI in determining the T and N criteria compared with CT, moderate compared with endo-ultrasound for the T criterion, and comparable for the N criterion. The data obtained indicate the prospects for in-depth study and implementation of MR esophageal examination in clinical practice.

Retrospective study of the frequency of diagnosing diffuse changes in the liver parenchyma according to the results of radiological studies

Background. The prevalence of chronic liver pathology is high and increasing in most countries of the world. Objective: to evaluate the incidence rate of structural diffuse changes in the liver using radiological methods in different sex-age groups of the adult population. Materials and methods. 65,570 unique protocols of ultrasound examination and 1,212 magnetic resonance imaging (MRI) of the hepatobiliary system were studied in patients aged 18 years and older. During the statistical analysis of quantitative features, the distribution of indicators for normality was checked according to the Shapiro-Wilk test. The chi-square test was used to compare frequencies. To determine the relationship between the risk of diffuse liver changes and factor characteristics, we used the method of building logistic regression models. To assess the relationship between the factor traits and the resulting trait, the odds ratio (OR) and 95% confidence interval (CI) were calculated. To assess the quality of the model’s prediction, the area under the curve (AUC) and 95% CI were calculated. The level of statistical significance was chosen at 5 % (p = 0.05). The study was approved by the local ethics committee. Results. The frequency of diagnosing diffuse changes in the liver parenchyma during B-mode ultrasound examination in the total sample was 12.5 % (in women — 8.7 %, in men — 18.2 %). A statistically significant increase (p &lt; 0.01) in the risk of developing diffuse changes in the liver was found (OR = 1.01 (95% CI 1.01–1.02 %) with increasing age for each year. In the univariate logistic regression model, men had a 2.3 times higher chances of developing diffuse liver changes than wo­men (p &lt; 0.01), AUC = 0.604 (95% CI 0.598–0.61 %). In the gene­ral sample of patients who underwent MRI of the hepatobiliary system, the frequency of diagnosing fatty infiltration of the liver was 37 % (95% CI 34.3–39.8 %). In particular, among 700 women, the frequency of incidents was 34.1 % (95% CI 30.7–37.7 %), among 512 men — 41.0 % (95% CI 36.8–45.3 %). Conclusions. The prevalence of diffuse liver changes is high (12.5 % according to ultrasound and 37 % according to MRI) and increases with age among the adult population of working age. Given the variety of factors contributing to the progression of chronic liver diseases and the importance of identifying patients at high risk of developing liver cirrhosis, there is a need for widespread implementation of non-invasive diagnostic tests and technical upgrading of specialized healthcare facilities. The data obtained can serve as landmarks for calculating the needs for secondary care and improving clinical pathways for patients.

Radioembolization for Hepatocellular Carcinoma: a Comparison on Dual-phase Cone-beam CT, Contrast-enhanced CT (CECT)and 99mTc-macroaggregated albumin-SPECT/CT in predicting final distribution volumes and dosimetry of the post-embolization 90Y PET/CT.

Personalized treatment schemes are being systematically applied to ensure best treatment outcome in oncologic patients. This is true also for personalized dosimetry in transarterial radioembolization (TARE) in hepatocellular carcinoma (HCC) patients. Precise and detailed volumetric and functional data derived from radiological and nuclear imaging methods are essential for personalized dosimetry. We sought to evaluate accuracy of dual-phase cone-beam CT (CBCT) in comparison to pre-treatment contrast-enhanced CT (CECT), and 99mTc-macroaggregated albumin-SPECT/CT ([99mTc]MAA SPECT/CT) to predict and assess the efficacy of TARE based on post-treatment 90Y PET/CT. Thirty consecutive patients with HCC treated with TARE were included. Intraprocedural dual-phase CBCT acquisition protocol was developed to distinguish tumor volume in the early arterial phase and perfused volume of non-affected liver in the late arterial phase. Volumetric data obtained from pre-treatment CECT, dual-phase CBCT and [99mTc]MAA SPECT/CT were compared to post-treatment 90Y PET/CT considered the standard reference. Treatment simulations for final calculated dose from the different imaging derived volumes were then compared to post-treatment 90Y PET/CT. CBCT resulted as the most accurate method in predicting tumor- (R2 0.88) and perfused volumes (R2 0.82). Dosimetry prediction planning performed on derived volumes from the different methods did not show significant difference (p < 0.05), yet highest concordance with 90Y PET/CT data was observed with dual-phase CBCT. Our study shows that dual-phase CBCT acquisition is a novel alternative method for correctly and safely administering more accurate and defined doses during TARE. gov ID: NCT03981497.

A Rare Cause of Inguinal Herniation: Bladder Herniation

Herniation of the bladder into the inguinal canal is a rare condition. It is mostly asymptomatic but symptoms such as dysuria, sudden and severe urge to urinate, nocturia and haematuria may also be observed. Early diagnosis of inguinal bladder hernia is important to minimize potential complications and those that may arise during treatment. In male patients over the age of fifty with unilateral inguinal swelling, possible bladder herniation should be considered, and when necessary, computed tomography and other radiological imaging methods should be used in addition to ultrasonography. We aimed to present our case of bladder herniation accompanying inguinal hernia, supported by the literature.

Surgical treatment of double-level spondylolysis of the L4 and L5 vertebrae using custom-made implant

Background: Spondylolysis is a frequent cause of pain in the lumbar spine in adolescents and young adults, especially those who practice sports. Spondylolysis most commonly occurs at the L5 vertebrae, and less commonly at the L4 vertebrae. Multilevel spondylolysis is extremely rare. The low frequency of occurrence and, as a consequence, difficulties in diagnosing multilevel spondylolysis are the reason for the lack of a unified approach to the treatment of this pathology. In most cases, conservative measures are sufficient, but if they are ineffective, surgical intervention is indicated. Options of surgical treatment are mainly characterised by the focus on restoring the integrity of the arch and, if possible, preserving motion in the vertebral-motor segment. This article describes the experience of using custom-made implants for surgical treatment of double-level spondylolysis and a brief review of the literature. Clinical case description: A clinical case of a 16-year-old patient with bilateral spondylolysis of the L4 and L5 vertebrae is presented. The anamnesis, clinical manifestations, and diagnostic features, including radiological methods of examination, are described. The peculiarities of preoperative planning and modelling of individual implants, surgery and immediate results are presented. A brief literature review describes the main options for surgical treatment of multilevel spondylolysis and demonstrates the validity of the use of individual implants in the surgical treatment of this pathology. Conclusion: Surgical treatment of double-level bilateral spondylolysis with indirect restoration of the integrity of the vertebral arch with preservation of movements in the vertebral-motor segments can be successfully performed using custom-made implants manufactured using additive technologies. A number of advantages of such implants, such as the ability to design the position and shape of implants considering the individual anatomy of patients, as well as the prevention of contact between the elements of the metal structure during movement, make it possible to improve the results of surgical treatment of double-level spondylolysis.