Radiological Examination Research Articles

Femoral Head Reduction Osteotomy for the Treatment of Severe Femoral Head Deformities and Articular Incongruity in Children with Perthes Disease

Background. Lack of adequate treatment for children with Perthes disease leads to the formation of severe femoral head deformity with articular surfaces incongruity, followed by the development of femoroacetabular impingement and early hip osteoarthritis. To date, femoral head reduction osteotomy is the most effective treatment option for such patients. However, the results of its performance have been discussed in only a few case-control studies with small sample sizes in both international and domestic literature. The aim of the study was to evaluate the effectiveness and safety of femoral head reduction osteotomy and to analyze the further development of the hip joint in children operated for severe femoral head deformity due to Perthes disease. Methods. We have analyzed preoperative and postoperative results of clinical and radiological examination of 20 patients (20 hip joints) aged 8 to 12 years with deformed Perthes femoral head and articular surfaces incongruity. Femoral head reduction osteotomy was performed in all patients. Results. A radical proximal femoral reconstruction has led to significant improvement in the shape of the proximal femur with improved head sphericity and restoration of articular congruence. However, at the 6- to 12-month follow-up, some patients, primarily those with progressive lateral acetabular rim deformity, exhibited a decrease in the intraoperatively achieved Wiberg angle, an increase in the percentage of femoral head extrusion from the acetabulum, and varying degrees of Shenton line disruption. Conclusions. Performing femoral head reduction osteotomy with correct surgical technique is an effective reconstructive technique for the treatment of children with a severe saddle-shaped deformity of the femoral head and articular surfaces incongruity. In patients with Tönnis and Sharp angles exceeding the upper limit of the physiological norm, due to the formation of secondary subluxation, it is advisable to simultaneously perform femoral head reduction osteotomy and triple/periacetabular pelvic osteotomy. This treatment option should be chosen only after a critical analysis of potential risks.

Enhancing Large Language Models with Retrieval-augmented Generation: A Radiology-specific Approach.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Retrieval-augmented generation (RAG) is a strategy to improve performance of large language models (LLMs) by providing the LLM with an updated corpus of knowledge that can be used for answer generation in real-time. RAG may improve LLM performance and clinical applicability in radiology by providing citable, up-to-date information without requiring model fine-tuning. In this retrospective study, a radiology-specific RAG was developed using a vector database of 3,689 RadioGraphics articles published from January 1999 to December 2023. Performance of 5 LLMs with and without RAG on a 192-question radiology examination was compared. RAG significantly improved examination scores for GPT-4 (81.2% versus 75.5%, P = .04) and Command R+ (70.3% versus 62.0%, P = .02), but not for Claude Opus, Mixtral, or Gemini 1.5 Pro. RAG-System performed significantly better than pure LLMs on a 24-question subset directly sourced from RadioGraphics (85% versus 76%, P = .03). The RAG-System retrieved 21/24 (87.5%, P < .001) relevant RadioGraphics references cited in the examination's answer explanations and successfully cited them in 18/21 (85.7%, P < .001) outputs. The results suggest that RAG is a promising approach to enhance LLM capabilities for radiology knowledge tasks, providing transparent, domain-specific information retrieval. ©RSNA, 2025.

Effective Management of Panfacial Fractures in a Craniofacial Trauma Center: A Retrospective Study.

Panfacial fractures are caused by high-impact trauma and represent the most severe injuries to the face. The combination of these fractures determines the treatment strategy. The objective of this study was to analyze the treatment protocol for panfacial fractures at the Centro Médico ISSEMYM, to describe a new proposed protocol for the management of panfacial fractures and analyze the complication rate associated with this protocol. Eighteen patients with panfacial fractures were treated between January 2014 and June 2024. After clinical and radiological examination, patients with panfacial fractures defined as: fractures of at least 2 of the 3 facial thirds: upper facial third, middle facial third, and lower facial third were included in this study. The authors reviewed in-hospital medical records to collect data on the medical history, cause of injury, fracture location, treatment sequence, postoperative complications, duration of hospital stay, and computed tomography scans. The average age of patients was 45 years. The etiology of trauma was predominantly traffic accidents. A total of 108 fractures were recorded in 18 patients. Eight patients (44%) had frontal fractures (7%), 13 patients (72%) had mandibular fractures (18%), and all patients had fractures of midface in different combinations. Postoperatively, buccal occlusion was satisfactory. Computed tomography scans were taken to assess the adequacy of fracture reduction and fixation. The sequence used in the authors' center is safe, reliable and has shown adequate results, and also allows for adequate correction for this type of trauma in a single surgical procedure.

Breaking barriers: The impact of telemedicine on improving soft tissue and bone tumor management in Armenia.

Breaking barriers: The impact of telemedicine on improving soft tissue and bone tumor management in Armenia.

Hepatobiliary and Pancreatic Neoplasms: Essential Predictive Imaging Features for Personalized Therapy.

Tumor biologic characteristics encompassing histopathologic, immune microenvironmental, genetic, and molecular aspects are becoming indispensable factors to be considered in treatment strategies for patients with cancer. Innovations in oncologic treatment have broadened the range of therapeutic approaches and now hold promise for treatments personalized according to tumor biologic characteristics. Particularly for hepatobiliary and pancreatic neoplasms, the advent of cytostatic agents such as molecularly targeted agents and immune checkpoint inhibitors, which differ markedly from conventional cytotoxic agents, has contributed to advances in clinical practice. These cytostatic agents increase the potential for curative-intent treatment of unresectable cancers by reducing tumor volume. Radiologic examinations are of more interest than ever to noninvasively obtain information about tumor biologic features. Radiomics represents an invaluable research method for elucidating associations between tumor biologic characteristics and radiologic imaging findings, but their applicability in daily clinical practice remains challenging. Various radiologic predictive findings for tumor biologic characteristics have already been proposed for hepatobiliary and pancreatic neoplasms. Radiologists must gain familiarity with these findings and the roles they have in predicting the clinical prognosis and treatment efficacy. In addition, radiologists should explore the potential applications of these imaging findings to current treatment strategies for the coming era of personalized medicine. The authors describe predictive findings using CT and MRI for diagnosis of hepatocellular carcinoma, colorectal liver metastases, intrahepatic cholangiocarcinoma, and pancreatic adenocarcinoma, with correlations to pathologic, immunologic, molecular, and genetic background factors. ©RSNA, 2025 Supplemental material is available for this article. See the invited commentary by Ronot in this issue.

Unveiling distinct clinical manifestations of primary familial brain calcifications in Asian and European patients: A study based on 10-year individual-level data.

Unveiling distinct clinical manifestations of primary familial brain calcifications in Asian and European patients: A study based on 10-year individual-level data.

Association between price transparency and patient decision to complete outpatient imaging.

Association between price transparency and patient decision to complete outpatient imaging.

Horseshoe appendix: A case report and literature review.

Horseshoe appendix is 1 of the rarest types of duplex appendix characterized by 1 appendix having 2 openings at the cecum. Clinically, it is extremely rare and is detected incidentally at surgery. Therefore, accurate and timely diagnosis is important for enhanced prognosis, treatment planning, and optimizing patient outcomes. This case report presents the first case of horseshoe appendix in France. A French 15-year-old boy, presented to the emergency department with pain in the right iliac fossa that had been worsening for 4 days. Considering his symptoms, abdominal ultrasound, radiological examination, and computed tomography (CT) scan results, an acute appendix was suspected. Acute appendicitis (AA) with "horseshoe" type appendix. Surgical intervention with exploratory laparoscopy was performed immediately. We found a heterogeneous image, partially fluid in the right iliac fossa, measuring approximately 16 × 9 mm, with inflammatory remodeling of the fat upon contact. The radiological examination concluded that complicated AA was suspected. Finally, the pathological report revealed acute suppurative appendicitis with peritoneal reaction. Horseshoe appendix is rare. Considering his symptoms, radiological examination, ultrasound, and CT scan results, an acute appendix was suspected. The patient was successfully treated using emergency surgery and antibiotics treatment thanks to further diagnosis via exploratory laparoscopy and pus microbial analysis.

Application of multimodal medical image fusion in temporomandibular joint disease

With the rapid development of modern technology, the deep integration of computer science and medicine has greatly propelled the field of the dental diagnostics field. Multimodal medical image registration refers to the fusion of information from various modalities of medical imaging. In other words, with the assistance of computer technology, the image data acquired from various radiological examinations undergo spatial registration and are merged to create a comprehensive new image, serving the purpose of computer-aided diagnosis. The temporomandibular joint (TMJ) has complex anatomical structures, so there is a wide range of diseases associated with it. Traditional single-modal imaging methods can only provide partial anatomical information, which limits the comprehensive assessment and subsequently hinders the diagnosis and treatment of TMJ disease. Multimodal medical image registration techniques, owing to their ability to provide comprehensive information, have been widely applied in the field of dentistry. This has greatly enhanced the efficiency of diagnosing and treating TMJ disease. The article discusses the advancements in the application of multimodal medical image registration in the context of temporomandibular joint disease.

The Results of Management of Distal End Radius Fractures by Various Modalities

Background: Distal end radius fractures constitute 16%-20% of all fractures. Extra-articular fractures are managed with closed reduction and casting, while intraarticular fractures require more invasive treatment due to instability and conservative treatment complications. Despite extensive research, the optimal treatment for distal end radius fractures remains unclear, prompting ongoing comparative studies. Methods: 40 patients were treated and followed up for 3 to 14 months. Each patient underwent detailed clinical and radiological examinations of the affected wrist using AO classification. Radiographs were routinely taken to evaluate extra-articular deformities and articularincongruences.Treatmentdecisions‒plating,externalfixation,orconservativemanagement‒werebasedonfracturetypeand patient physiology. Follow-ups occurred at various intervals, with assessments including hand grip strength comparison, radiographic measurements, and clinical evaluation of fracture union using Green and O’Brien scoring and Sarmiento radiological criteria. Results: 40 patients with distal end radius fractures, averaging 40.62 years old, were included in the study. Treatment distribution was eight patients with reduction cast/slab, 18 with external fixators, and 14 with plating. Plating showed 57.28% excellent, 28.57% good, and 14.28% fair outcomes. External fixators had 33.33% excellent, 33.33% good, 16.67% fair, and 16.67% poor outcomes. Conservative management had 25% excellent, 37.5% good, 25% fair, and 12.5% poor outcomes. Conclusion: Conservative management with a reduction pop slab/cast is suitable for extra-articular fractures in elderly patients. External fixation is effective for osteoporotic or comminuted fractures. Plating is recommended for intra-articular fractures in young patients.

Atypical Epithelioid Schwannoma in a Young Female- A Dilemma Set by Morphology; Resolved by Immunohistochemistry-A Rare Case Report

Abstract Epithelioid morphology spawns myriad of benign and malignant tumors into differential diagnoses, which include epithelioid sarcoma, malignant melanoma, epithelioid malignant peripheral nerves sheath tumor, epithelioid hemangioendothelioma, myoepithelioma, etc. Epithelioid schwannoma (ES), especially the atypical variant has not received much attention in literature. Conclusive diagnosis, important for accurate management is, however, challenging. We describe a case of atypical ES in a 24-year-old female. On clinical and radiological examination, a provisional diagnosis of vascular malformation was made. Atypical epithelioid ESs are rare, but it is important to be aware of this variant to avoid misdiagnosis with other malignant epithelioid tumors. Apart from clinical and morphological features, immunohistochemistry aids in arriving at a decisive diagnosis. Perineurium-like capsule, circumscription, oblong shape of the lesion, and hyalinized blood vessels are pointers toward shwannomatous differentiation of this tumor.

An overlooked connection: oral health status in patients with chronic diseases

BackgroundOral and systemic health are closely linked. Chronic diseases like diabetes mellitus, cardiovascular diseases, and hypertension increase the risk of dental caries, periodontal disease and tooth loss. Moreover, poor oral health can worsen the status of systemic diseases. Despite this, oral health is often overlooked in chronic disease management. This study aimed to evaluate the oral health status of patients with chronic diseases (PWCD) compared to healthy controls using DIMF-T and DMF-S indices.MethodsThis retrospective study included 205 participants (106 PWCD and 99 healthy controls) attending the Oral Diagnosis & Radiology outpatient clinic at Bahçeşehir University Dental Hospital. Comprehensive intraoral and radiological examinations assessed caries lesions, missing teeth, filled teeth, periodontal disease, denture usage, and the prevalence of apical osteitis, soft tissue lesions, and intraosseous lesions. Oral health status was quantified using DIMF-T and DMF-S indices. Statistical analyses were conducted to identify differences between groups.ResultsThe study group (PWCD) exhibited significantly higher median values for missing teeth (MT), decayed surfaces (DS), missing surfaces (MS), DIMF-T, and DMF-S indices compared to the control group (p < 0.001). Chronic periodontitis was more prevalent in PWCD (76.42%) than in controls (45.45%), while gingivitis was more common in the control group (52.53%, p < 0.001). Medication use for systemic diseases was strongly associated with poor oral health outcomes (p < 0.001). However, no significant differences were observed between the groups for decayed teeth (DT), hopeless teeth (IT), or filled teeth (FT).ConclusionsPWCD demonstrated worse oral health outcomes compared to healthy controls, highlighting the need for integrated oral and systemic healthcare strategies. Dental professionals should be careful in identifying oral conditions that may signal underlying systemic diseases. Future research should explore the integration of oral health evaluations into routine medical screenings and examine the global practices of oral health management in PWCD.

An Unexpected Journey of Pediatric Hodgkin's Lymphoma Diagnosed via Pericardial Cytology: An Educational Case Report.

Hodgkin's lymphoma (HL) is a recognized hematological malignancy that typically appears in two specific age groups: the first peak occurs between 15 and 40 years of age, while the second peak arises in individuals aged over 60. While typically presenting as a mediastinal mass, rarer initial presentations include cardiac tamponade. In this case, we report a pediatric patient with HL presenting with massive pericardial effusion in the emergency department. We emphasize how a simple cytology test can facilitate diagnosis in such cases and discuss the role of cytological evaluation in guiding management. A 13-year-old male presented to our institution with fever and breathlessness. Radiological examinations indicated a mediastinal mass lesion. An emergency echocardiogram revealed pericardial effusion, which was subsequently drained and sent for cytological evaluation. Cytology revealed large atypical cells characterized by abundant cytoplasm, large nuclei, and prominent nucleoli, corresponding to Reed-Sternberg cells. Immunocytochemistry (ICC) on the cell block further confirmed the diagnosis of HL. Treatment commenced following biopsy confirmation, yielding favorable prognostic results from the patient's perspective. The primary goal of presenting this case is to underscore the unusual early presentation of HL and to illustrate how a simple test, combined with comprehensive diagnostic reasoning, can enable early diagnosis and enhance prognostic outcomes. Furthermore, we highlight the crucial role of ICC in the timely identification of this condition.

Pre-Prosthetic Intrusion of Maxillary Molars by Clear Aligners: A Case Report.

Insufficient vertical space is often a great challenge for prosthodontic treatment of patients with teeth overeruption. This case report describes a simple technique using clear aligners to intrude over-erupted molars. A 27-year-old woman was diagnosed with left mandibular dentition defect, yet the left third molar was presented in lower arch. However, the prosthetic rehabilitation was limited by the opposing over-erupted molars. Clear aligners therapy (CAT) was used to regain the necessary interocclusal space. After initial molar distalization, subsequent 2.14 mm and 1.3mm intrusion for left maxillary first and second molar was designed to solve the door-wedge effect dilemma. Without mini-screws, considerable intrusion (1.9 mm and 0.9 mm for left maxillary first and second molar, respectively) was achieved within 6 months with minimal discomfort. Radiological and clinical examinations revealed a favorable occlusal relationship and improved alignment for both arches. Outcomes in the case revealed that intruding over-erupted molars via CAT may be an effective approach.

Temporal dynamics of ICP, CPP, PRx, and CPPopt in relation to outcome in spontaneous intracerebral hemorrhage.

There is a paucity of studies on the optimal thresholds for neurointensive care (NIC) targets such as intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in spontaneous intracerebral hemorrhage (sICH). There is also a need to clarify the role of cerebral pressure autoregulatory disturbances (pressure reactivity index [PRx]) and to determine if the autoregulatory CPP target (optimal CPP [CPPopt]) is superior to traditional fixed CPP targets in sICH. In this study, the authors aimed to explore the role of ICP, PRx, CPP, and CPPopt insults in sICH patients treated in the NIC unit. In this observational study, 184 adults with sICH with intracerebral hemorrhage (ICH) volume above 10 ml who received > 12 hours of ICP monitoring during the first 7 days at the authors' NIC unit, Uppsala University Hospital, Sweden, between 2010 and 2019 (10 years) were included. Demographic characteristics, admission status, radiological examination, and clinical outcome were evaluated. Favorable outcome was defined as conscious at discharge, while unfavorable outcome as unconscious or deceased. ICP, CPP, PRx, and CPPopt during the first 7 days were analyzed in relation to outcome. In total, 138 (75%) patients recovered favorably at discharge. Lower percentage of good monitoring time with ICP above 25 mm Hg was independently associated with favorable outcome. CPP above 80 mm Hg was frequent and independently associated with favorable outcome. Median PRx did not differ between the outcome groups, but there was a trend toward worse outcome when PRx exceeded +0.5. Furthermore, when PRx was analyzed together with the concurrent ICP and CPP values, higher values increased the ICP and CPP interval associated with unfavorable outcome. Lastly, there was no independent correlation between CPP deviation from CPPopt and outcome. Avoiding ICP elevations above 20 to 25 mm Hg and maintaining CPP above 80 mm Hg may be beneficial in sICH patients with large bleeding volume who require NIC. PRx was not independently associated with outcome, but higher values appeared to narrow the safe zones of ICP and CPP.

Optimized interaction with Large Language Models : A practical guide to Prompt Engineering and Retrieval-Augmented Generation

Given the increasing number of radiological examinations, large language models (LLMs) offer promising support in radiology. Optimized interaction is essential to ensure reliable results. This article provides an overview of interaction techniques such as prompt engineering, zero-shot learning, and retrieval-augmented generation (RAG) and gives practical tips for their application in radiology. Demonstration of interaction techniques based on practical examples with concrete recommendations for their application in routine radiological practice. Advanced interaction techniques allow task-specific adaptation of LLMs without the need for retraining. The creation of precise prompts and the use of zero-shot and few-shot learning can significantly improve response quality. RAG enables the integration of current and domain-specific information into LLM tools, increasing the accuracy and relevance of the generated content. The use of prompt engineering, zero-shot and few-shot learning, and RAG can optimize interaction with LLMs in radiology. Through these targeted strategies, radiologists can efficiently integrate general chatbots into routine practice to improve patient care.

An inflammatory myofibroblastic tumor of the soft tissue of the neck: a case report and literature review.

Inflammatory myofibroblastic tumor (IMT) of the soft tissues of the neck is a rare pathological entity. We present the case of a 32-year-old patient who had a painful, slowly enlarging mass in the neck's soft tissues. Radiological examination revealed a well-defined, dense lesion. The mass was surgically removed through local excision. Immunohistological analysis confirmed the diagnosis of IMT. After nearly 2 years of follow-up, there was no evidence of recurrence or distant metastases. In conclusion, although IMT of the soft tissues of the neck is uncommon, it should be considered in the differential diagnosis of neck tumors. Further research is necessary to understand the pathogenetic mechanisms of IMT, which could lead to the development of more effective treatments for this tumor.

A simple and efficient method of preparing patients with gastric cancer for abdominal MRI examination.

This study aims to evaluate the advantages of administering 200ml of 5% dextrose water in improving pre-examination training efficiency, examination efficiency, success rate, and image quality of MRI scans in patients with gastric cancer. This study included 122 gastric cancer patients who underwent upper abdominal MRI from March 2022 to March 2024. These patients were divided into two groups: a study group of which patients had 200ml of 5% dextrose water before MRI scan (n = 59) and a control group with only routine preparations (n = 63). Group differences in the pre-examination training efficiency, examination efficiency, examination success rate and image quality of MRI scan were performed using chi-square test and T-test. We found there were statistically significant group differences in the success rate of MRI examination (96.6% in the study group and 85.7% in the control group, P = 0.036), the average time of pre-examination training before MRI examination (7.73 ± 6.35min in the study group and 12.03 ± 5.39min in the control group, P = 0.001), the average completion time of MRI examination (45.22 ± 5.85min in the study group and 50.25 ± 8.45min in the control group, P = 0.001), the rate of excellent image quality (66.1% in the study group and 44.4% in the control group, P = 0.038), the scores of image quality (3.92 ± 0.96 in the study group and 3.13 ± 1.33 in the control group, P = 0.0006). Our findings demonstrated that administering 200ml of 5% glucose water before MRI examination in gastric cancer patients improved the pre-examination training efficiency, the efficiency and success rate of MRI examination and image quality, highlighting its potential to optimize the patient care in radiological examinations.

A marker for acute cholecystitis severity: thiol-disulfide balance and ischemia-modified albumin.

According to the Tokyo 2018 guidelines, white blood cells (WBCs) are the only markers used in the staging of acute cholecystitis. We aimed to investigate the role of thiol-disulfide and ischemia-modified albumin (IMA), which are used in the diagnosis of inflammatory diseases, in the diagnosis, and severity of acute cholecystitis. A total of 108 patients hospitalized with acute cholecystitis and 42 healthy volunteers were included in the study. Plasma total thiol (TT), native thiol (NT), and disulfide levels were measured and IMA was calculated using disulfide/native, disulfide/total, and native/TT ratios. Significant differences were found in both inflammatory and antioxidant markers, age, and symptom duration between disease stages (Stages I, II, and III) and control group (p < 0.001). Age and symptom duration were negatively correlated with antioxidant parameters (albumin, NT, and TT) (r = -0.321, p < 0.00). C-reactive protein and WBC correlated negatively with albumin and antioxidant parameters and positively with disulfide (r = 0.776, p < 0.001; r = 0.358, p < 0.001). The oxidative stress markers in our study can be used to assist radiologic examinations in determining the severity of acute cholecystitis.

Development of GLCM Method in Calculate Entropy Value for Digital Visualization in Identifying Childhood Pneumonia Based on Chest X-Ray Images

Pneumonia can affect people of all ages, especially children. One way to identify pneumonia is by using medical equipment through radiological examinations such as chest X-rays. This study proposes the development of an entropy formula found in the gray level co-occurrence matrix (GLCM) texture extraction method to automatically detect pediatric chest X-ray results in identifying pneumonia. The pre-processing stage is tested with several steps, including converting RGB to grayscale, adaptive histogram equalization (AHE), filtering, Otsu thresholding, image inversion, and automatic image cropping. After preprocessing is the segmentation stage that conducted by processing the image from the cropping results. The testing process in the segmentation stage includes contrast enhancement, Otsu multi-thresholding, border clearing, and image segmentation. The results from the segmentation process are then followed by the extraction stage. The extraction stage focuses on developing the entropy value found in GLCM, referred to as the entropy value algorithm with gray level co-occurrence matrix (EVAGLCM). The key contributions of this study lie in the advancement of digital image processing methods for the accurate identification of childhood pneumonia through improved texture feature extraction. This study compares the developed entropy value with several previous studies. The development of this entropy value is then followed by the classification stage using a support vector machine (SVM). The accuracy achieved in this study was 97.5%, meaning it was able to accurately detect 390 images out of 400 images. This indicates that the entropy value calculation using the EVA-GLCM formula and classification using SVM can provide more accurate output with a higher accuracy rate.