Radiology Pathology Research Articles

Artificial Intelligence in Detection, Management, and Prognosis of Bone Metastasis: A Systematic Review.

Metastasis commonly occur in the bone tissue. Artificial intelligence (AI) has become increasingly prevalent in the medical sector as support in decision-making, diagnosis, and treatment processes. The objective of this systematic review was to assess the reliability of AI systems in clinical, radiological, and pathological aspects of bone metastases. We included studies that evaluated the use of AI applications in patients affected by bone metastases. Two reviewers performed a digital search on 31 December 2023 on PubMed, Scopus, and Cochrane library and extracted authors, AI method, interest area, main modalities used, and main objectives from the included studies. We included 59 studies that analyzed the contribution of computational intelligence in diagnosing or forecasting outcomes in patients with bone metastasis. Six studies were specific for spine metastasis. The study involved nuclear medicine (44.1%), clinical research (28.8%), radiology (20.4%), or molecular biology (6.8%). When a primary tumor was reported, prostate cancer was the most common, followed by lung, breast, and kidney. Appropriately trained AI models may be very useful in merging information to achieve an overall improved diagnostic accuracy and treatment for metastasis in the bone. Nevertheless, there are still concerns with the use of AI systems in medical settings. Ethical considerations and legal issues must be addressed to facilitate the safe and regulated adoption of AI technologies. The limitations of the study comprise a stronger emphasis on early detection rather than tumor management and prognosis as well as a high heterogeneity for type of tumor, AI technology and radiological techniques, pathology, or laboratory samples involved.

The Added Value of Prostate Magnetic Resonance Imaging to Patient Selection.

There has been a rapid increase in the utilization of magnetic resonance imaging (MRI) for prostate cancer detection. The objective of this study was to measure the increase in utilization of MRI before prostate biopsy and the effects on the distribution of Prostate Imaging Reporting and Data System (PI-RAD) scores and Gleason grades over a 5-year interval in an integrated health system. The authors conducted a retrospective analysis of prostate MRI studies prior to biopsy in the calendar years of 2017 and 2022. Peak PI-RADS score, peak Gleason grade of suspected prostatic lesions, and the number of biopsy cores were collected from radiology reports and pathology reports from patients' electronic health records, respectively. All statistical tests were 2-tailed with a significance level set at p < 0.05. Categorical data analyses were performed using Mann-Whitney tests. Continuous data analyses were performed using t-tests. The total number of prostate MRIs and the number of MRIs with subsequent biopsy respectively increased by 178% and 215% over a 5-year interval (2017-2022). There was a higher proportion of MRI studies with an associated biopsy given a PI-RADS score of ≥ 3 (91%) and a Gleason grade of ≥ 7 (61%) in 2022 than in 2017 (PI-RADS: 75%; Gleason: 28%). Increased utilization of prostate MRI has been associated with a higher proportion of biopsies with high PI-RADS and Gleason scores consistent with improved patient selection in this integrated health system.

Italian research on anterior cruciate ligament: a bibliometric analysis.

This study analysed thetrend of publications on anterior cruciate ligament(ACL) in Italy. It was hypothesised that publications on this topic have quickly increased in recent years due to increased knowledge of both clinical and radiological pathology. PubMed and Scopus were accessed on 29/11/2023. This retrieved 838 articles from PubMed and 1050 from Scopus. We analysed the top 10 authors, and journals in publication numbers, citation numbers, and citations per year. We have also looked at the top 10 institutions publishing on anterior cruciate ligament from Scopus as PubMed does not give this information in the output. Data mining was performed using the Orange software, Mac version 3.32.0 ( https://orangedatamining.com/ ) from the titles of all articles. A word cloud analysis of titles, authors, journals and universities was performed. The peak of citations was in 2017 with 1529, whilst the peak of publications was in 2019 with 59 articles published. Analysing the number of publications and citations for the journal, the most impacted journal is Knee Surgery, Sports Traumatology, Arthroscopy with 5472 citations and 183 articles, followed by The American Journal of Sports Medicine, with 2722 citations and 56 articles and Arthroscopy with 1990 citations and 62 articles. Considering also international collaborations, the most cited author is Della Villa F. in 2020 with 43.67 citationsper year.The Italian author with the major number of publications is Zaffagnini S. with 39 articles, whilst the author with the higher number of citations is Aglietti P. with 1612 citations. ACL reconstruction has gained growing interest amongst the scientific community. Publications and citations presented a rising trend, the majority of the highly cited papers were contributed by few centres, and clinical trials were the most cited study designs. The long-term outcomes of ACL lesions have attracted interest. The authors hypothesised that shortly there will be an increase in articles analysing the results of ACL revisions, the use of lateral extra-articular tenodesis, and meniscus transplants. Cross-Sectional Study.

Explanation of the personality factor with the Enneagram in the selection of the specialty branch of the intern doctors

IntroductionPersonality characteristics have an important place in the choices of interns who are at the stage of deciding how their profession will be shaped in the future. While the Big 5 personality model has been widely used in evaluating the personality traits factor in career planning, the Enneagram has increased in popularity in recent years. In this study, it was aimed to investigate how senior medical students evaluate their professional future between these choices and the students’ personality types.Objectives Forms and scales were presented to 221 interns who agreed to participate in our study and were studying in their final year in the 2022-2023 period at three different faculties, two state universities and one private university in the Marmara Region in Turkey.MethodsThe sociodemographic data form, Enneagram Personality Types and Subtypes Inventory, and Positive Future Expectation Scale, prepared by the researchers and containing questions about the factors that may be effective in choosing medical specialization, obtained through a face-to-face pilot interview with ten students and literature review, were applied to the participants. Participants answered the forms and scales via ‘Google forms’.Results211 out of 221 participants, who did not constitute outliers, were included in the analysis. The mean age of the participants was 24.43 (S.E= 0.11)In terms of Enneagram typologies, Type 2 (39.3%) exhibited the highest prevalence, followed by Type 1 (13.3%), Type 6 (11.8%), and Type 7 (8.5%).Furthermore, a statistically significant relationship was found between specialization area and Enneagram types (Fisher exact &lt;.001, p&lt; .001). Post-hoc examinations highlighted specific associations, such as the relationship between Type 3 and Cardiovascular Surgery, Orthopedics and Traumatology; Type 4 and Pneumology, Psychiatry; Type 5 and PRC, Type 6 and Infectious Diseases, Neurology, Medical Microbiology; Type 7 and Cardiology; Type 8 and Pediatrics, Medical Biochemistry; and Type 9 and Family Medicine, Radiology, Psychiatry, Medical Pathology.ConclusionsWhen the results are evaluated, the highest rate of type 2 and type 1 of the Enneagram typology in senior medical faculty students supports the fact that the medical profession consists of responsible and principled people who love helping others. It is compatible with the character traits of people with type 9 who avoid stress and conflict, preferring the department to have a low workload, and turning to family medicine, radiology, psychiatry and medical pathology departments, which are estimated to have relatively fewer working hours and emergency applications.Our study suggests that this scale be used more widely, as the Enneagram typology, which is used in many professional and career choices, shows results compatible with the participants’ preferences in choosing a medical specialty.Disclosure of InterestNone Declared

Abstract 1002: The historically black colleges and universities cancer trial consortium: A way forward to diversifying cancer clinical trials

Abstract The National Comprehensive Cancer Center Network cancer guidelines state that the best management for a cancer patient is on a clinical trial. However, the demographics of 74 registration trials for oral cancer therapies from 2009 - 2019 show only 2.5% of participating patients were Black. Similarly, of the 3,593 patients enrolled in all registration trials for new cancer drugs approved by the FDA in 2019, only 4% were Black patients. A third analysis showed that between 2008 and 2018, only 3.1% of cancer trial patients were Black. The underrepresentation of Black patients in cancer clinical trials is a complex issue that requires a multifaceted solution. Complicated, interdependent causes include, but are not limited to system, provider, and patient bias. Increasing globalization of clinical trials also contributes to a widening gap in Black patient enrollment. Achieving diversity among clinical trial participants requires intention in study design regarding accrual sites and outreach, and involvement of a diverse trial workforce. The ideal clinical trial system would minimize system, provider, and patient biases. Such a system already exists in the Historically Black Colleges and Universities (HBCU) system. HBCUs represent 3% of institutions of higher education in the USA, yet they enroll 16% of Black students and confer 24% of all baccalaureate degrees earned by Black students. 40% of Black engineers, 50% of Black lawyers, 70% of Black physicians, and a staggering 80% of Black judges attended an HBCU. HBCUs are exceptional at impacting communities of Color and have been doing so for centuries. The HBCU Cancer Trials Consortium (HBCU CTC) is a network of HBCUs and Ally institutions that aims to bring innovative cancer clinical trials to historically underserved communities and honor the legacy of HBCUs, which have consistently and successfully served underserved communities for over a century. The HBCU CTC will oversee and conduct cancer clinical trials at member institutions. We envision founding flagship members to include HBCUs that provide graduate medical education and training, such as Howard, Meharry, Charles Drew, and Morehouse. Non-HBCUs committed to the mission are invited to join the consortium as Ally institutions (eg. MSIs). Membership is not exclusive of membership in other cancer consortia. The HBCU CTC will provide shared resource services for member institutions that lack expertise or funding to conduct services locally (eg. data management, DSMB, biostatistics, a cancer focused IRB, central radiology, and central pathology). The Consortium will also work to develop local infrastructure support for the conduct of cancer clinical trials at member institutions. Citation Format: Sheldon L. Holder, Robert A. Winn, Wafik S. El-Deiry. The historically black colleges and universities cancer trial consortium: A way forward to diversifying cancer clinical trials [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1002.

RAPHIA: A deep learning pipeline for the registration of MRI and whole-mount histopathology images of the prostate

Image registration can map the ground truth extent of prostate cancer from histopathology images onto MRI, facilitating the development of machine learning methods for early prostate cancer detection. Here, we present RAdiology PatHology Image Alignment (RAPHIA), an end-to-end pipeline for efficient and accurate registration of MRI and histopathology images. RAPHIA automates several time-consuming manual steps in existing approaches including prostate segmentation, estimation of the rotation angle and horizontal flipping in histopathology images, and estimation of MRI-histopathology slice correspondences. By utilizing deep learning registration networks, RAPHIA substantially reduces computational time. Furthermore, RAPHIA obviates the need for a multimodal image similarity metric by transferring histopathology image representations to MRI image representations and vice versa. With the assistance of RAPHIA, novice users achieved expert-level performance, and their mean error in estimating histopathology rotation angle was reduced by 51% (12 degrees vs 8 degrees), their mean accuracy of estimating histopathology flipping was increased by 5% (95.3% vs 100%), and their mean error in estimating MRI-histopathology slice correspondences was reduced by 45% (1.12 slices vs 0.62 slices). When compared to a recent conventional registration approach and a deep learning registration approach, RAPHIA achieved better mapping of histopathology cancer labels, with an improved mean Dice coefficient of cancer regions outlined on MRI and the deformed histopathology (0.44 vs 0.48 vs 0.50), and a reduced mean per-case processing time (51 vs 11 vs 4.5 min). The improved performance by RAPHIA allows efficient processing of large datasets for the development of machine learning models for prostate cancer detection on MRI. Our code is publicly available at: https://github.com/pimed/RAPHIA.

Rad Path in a Flash: Creation of the First AMSER Sponsored Digital Flashcard Deck and a Review of Digital Flashcard Use among? Medical Students

Digital flashcards are an increasingly popular study method for medical students today. The purpose of this study is to assess students' opinions on digital flashcards and to evaluate the need for radiology-focused digital flashcards. We created the first official Radiology-Pathology (Rad-Path) Correlation course digital flashcard deck sponsored by the Alliance of Medical Student Educators in Radiology (AMSER), and evaluated its effectiveness in increasing medical students' confidence levels of understanding Rad-Path concepts. A 16-question survey was developed and publicly shared with medical students to assess the need for a high-quality radiology deck. In addition, students who trialed the AMSER Rad-Path Anki deck were assessed on their confidence of radiology pathology concepts prior to and after using these digital flashcards. 185 survey responses were received for the first survey about digital flashcard use. Overall, 87.6% of medical student respondents had used digital flashcards during medical school, and 33.5% had used digital flashcards to study radiology topics specifically. 67.6% of respondents stated they would use a digital flashcard deck if sponsored by an academic radiology society. Regarding the survey of the students who used the AMSER Rad-Path flashcards, 31 responses were received in the pre- and follow-up survey. Mean confidence in understanding the radiology pathology learning objectives increased when the Rad-Path Anki deck was utilized, and students rated the flashcards favorably. Students reported a high use of digital flashcards for studying topics in medical school. We identified a perceived need in students for a series of high-quality digital flashcards covering radiology topics. We created the first deck of AMSER Rad-Path flashcards which was well received by the medical students.

Abstract A012: The Spanish Familial Pancreatic Cancer Registry (PANGENFAM): Genetic testing and follow-up of high risk individuals

Abstract Introduction: The Spanish familial pancreatic cancer registry (PANGENFAM) was established in 2009, with the main objective to study the genetic and phenotypic characteristics of familial pancreatic cancer families and offer screening of high-risk individuals for early detection. Methods: Targeted panel and exome sequencing of 52 FPC and 33 sporadic PDAC cases was performed to identify genes and novel variants related to PDAC risk. Healthy high-risk relatives of FPC cases enter into a screening that consists of an annual MRI, echo-endoscopy and routine blood tests, which is followed by a biopsy if a suspicious lesion is identified. Results: The registry and associated biobank is maintained thanks to a stable collaboration between the departments of Medical Oncology, Gastroenterology, Radiology General Surgery and Pathology. The registry currently includes over 150 families and 350 individuals, including PDAC cases and high risk individuals. Targeted sequencing analysis of DNA repair genes involved in familial cancer identified pathogenic variants in 7.5% of FPC cases in the MLH1 and CDKN2A genes, likely pathogenic variants were found in 5.7% of cases in the genes MUTYH, TERT and ATM. Likely pathogenic variants were found in 9.4% of sporadic cases in the genes POLQ, CHEK2 and FANCM and no pathogenic variants were identified. By exome sequencing, missense variants with a damaging effect were found in 11 FPC cases, including stop gain, stop loss or frameshift variants in 5 FPC cases (45.45%), affecting WWOX, C2orf83, CYP3A5 and TANGO2. KRAS somatic mutations in codon 12 and 13 were more frequently detected in sporadic PDAC cases (70%) compared to familial cases (16%) via the liquid biopsy. Interestingly, the median overall survival for sporadic and familial PDAC cases in our cohort was 10.2 vs. 21.7 months (p⇒0.01), respectively, even when adjusted for stage at diagnosis and first line adjuvant therapy. From all the families included in the registry, 185 were offered the high-risk screening program for early detection. Currently 129 individuals are actively participating in the screening program, of which, 72% of these individuals have a non-normal looking pancreas via MRI or EUS. The most commonly detected lesions were cysts and IPMN found in 32% and 12% individuals, respectively. Screening has successfully detected and treated solid lesions in 4 high-risk individuals, including 3 early PDAC and 1 neuroendocrine tumor. An additional 11 individuals with lesions with worrisome features are under close follow-up. Conclusions: Panel sequencing has identified pathogenic variants in known familial cancer genes that are also associated with FPC risk. Exome sequencing in panel negative FPC cases has identified novel risk associated genes. The molecular and clinical profile of FPC and sporadic cases are distinct which should be taken into account in the clinic. Citation Format: Emma Melian, Ana García García de Paredes, Mercedes Rodríguez, Jorge Villalón López, María Muñoz, Javier Blaquez, Ignacio Ruz, Alfonso Sanjuanbenito, Eduardo Lobo, Victoria Lopéz, Carmen Guillen Ponce, José Ramón Foruny Olcina, Sergio López Durán, Alfredo Carrato, Julie Earl. The Spanish Familial Pancreatic Cancer Registry (PANGENFAM): Genetic testing and follow-up of high risk individuals [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr A012.

Diagnostic accuracy of the breast MRI Kaiser score in suspected architectural distortions and its comparison with mammography

Suspicious architectural distortion is an elusive finding in breast cancer diagnosis. This study aimed to evaluate the diagnostic accuracy of the Kaiser score for suspicious architectural distortions observed on mammography and compare it with the BI-RADS score of the lesion. Mammograms performed between January 2013 and March 2023 were retrospectively analyzed for the presence of suspicious architectural distortion. Forty-one patients, who had at least 1 year of radiological follow-up or pathology results, and underwent breast MRI, were included in the study. Mammography findings and the BI-RADS category of the lesion were assessed. MRI findings were evaluated and Kaiser scoring was performed according to the tree flowchart. Ninety-one percent of the enhanced lesions had a Kaiser score of 5 and above. In the diagnosis of malignancy, the Kaiser score yielded an accuracy of 75.61% (AUC 0.833). A statistically significant correlation was observed indicating that a malignant diagnosis was more prevalent in patients with a Kaiser score of 5 and above (p < 0.05). Additionally statistically significant relationship was also observed between the BI-RADS category of architectural distortions on mammography and the Kaiser score (p = 0.007). The combined utilization of mammography findings and the evidence-based Kaiser score in suspected architectural distortions provides more accurate results in the differential diagnosis of breast cancer.

Post-COVID-19 pulmonary fibrosis with prognostic risk factors: A study in the hilly state of North India

Context: Coronavirus disease 19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). As it is a novel coronavirus infection, its acute as well as long-term pulmonary alterations in terms of radiological imaging and pathology need to be explored. Aim: To analyze the risk factors associated with the development of pulmonary fibrosis in post-COVID-19 patients. Settings and Design: A retrospective study in a tertiary center in a hilly state of North India. Methods and Material: A retrospective study was carried out in a hilly state of North India during the second wave of the COVID-19 pandemic. A baseline computed tomography (CT) within 1 month and a follow-up CT within 3–6 months of the onset of patients’ symptoms was done. The patients were assigned two groups based on the presence of fibrosis [reticular pattern (inter/intralobular septal thickening), parenchymal bands, bronchiectasis, and/ or honeycombing] on follow-up CT. The patients’ demographic profiles, clinical records, blood laboratory findings, treatment given, baseline CT, and follow-up CT findings were compared between the fibrosis and non-fibrosis groups. Statistical analysis used: The data entry was done in the Microsoft EXCEL spreadsheet, and the final analysis was done with the use of Statistical Package for Social Sciences (SPSS) software, IBM manufacturer, Chicago, USA, ver 25.0. Results: Of the total 72 patients, two had no abnormality on baseline CT. Forty (57.14%) out of 70 patients already had fibrosis on baseline CT, which increased to involve 47 (67.14%) patients on follow-up CT. It was analyzed that old age, smoking, comorbid status, low SpO2, longer hospitalization, lymphopenia, and increased severity of COVID-19 disease were independent risk factors for the development of pulmonary fibrosis in post-COVID-19 pneumonia. Conclusions: A better understanding of the underlying mechanism and pathogenesis can help in filling up of gaps in risk stratification of COVID-19.

Improving prediction of treatment response and prognosis in colorectal cancer with AI-based medical image analysis

&lt;p&gt;The heterogeneous response and prognosis of patients with colorectal cancer (CRC) to standard treatment regimens remains a challenge for clinical management. Individually weak prognostic markers, defined by gene mutations and protein expression, are difficult to apply in routine clinical practice because of their high acquisition cost and mediocre prediction accuracy. Visual evaluation of medical images, including radiology and digital pathology images, is an important part of CRC management. With the rapid development of artificial intelligence (AI), high-dimensional imaging features other than visual information are increasingly being used to develop imaging markers. At different stages of treatment, accurate predictions of treatment response and prognosis may help in selecting patients and tailoring their treatment. Here, we review the current state of AI applied to the medical imaging of CRC and describe its recent progress in short-term response and long-term survival prediction. In addition, we illustrate how these AI-based approaches may affect clinical decision-making. Although few approaches have been applied in routine clinical practice, their results are promising. Finally, we discuss the challenges in applying AI in clinical practice and possible future solutions from three perspectives: model interpretability, model generalizability, and patient privacy protection. This comprehensive assessment underscores the transformative potential of AI in CRC management and emphasizes the need for further exploration and integration into routine clinical workflows.&lt;/p&gt;

Demographic and clinicopathological features and long-term results of pediatric cases diagnosed with pilomatrixoma

Objectives: In this study, we present our experience with pilomatrixoma in pediatric patients. Patients and methods: Between January 2013 and January 2023, a total of 86 children (29 males, 57 females; mean age: 10.8±4.2 years; range, 1 to 18 years) who were diagnosed with pilomatrixoma based on histopathological examination of excisional biopsies were included. Demographic characteristics of the patients, symptoms, location of lesions, radiological imaging results and pathology reports were obtained from the medical records. Results: The number of patients under the age of 10 diagnosed with pilomatrixoma was 29 (33.7%), while there were 57 (66.2%) patients between 10 and 18 years of age. Eighty-three (88.3%) of our cases were in the form of a single nodule, and three (11.6%) were in the form of multiple nodules. In terms of tumor localization, 38 (42.6%) were located in the head and neck region, 29 (32.5%) in the upper extremities, 14 (15.7%) in the trunk and eight (8.9%) in the lower extremities. One patient (1.1%) was reoperated due to recurrence during postoperative follow-up. Conclusion: Pilomatrixoma should be surgically excised, as it can be confused with other subcutaneous tumors usually seen in children and adolescents. Its ability to show malignant transformation over time should not be overlooked.

REASON(S) FOR REFUSAL OF SURGERY IN PATIENTS WITH ESTABLISHED DEGENERATIVE LUMBAR PATHOLOGY

Low back pain is the single most common cause for disability in individuals aged 45 years or younger, it carries tremendous weight in socioeconomic considerations. Degenerative aging of the structural components of the spine can be associated with genetic aspects, lifetime of tissue exposure to mechanical stress &amp; loads and environmental factors. Mechanical consequences of the disc degenerative include loss of disc height, segment instability and increase the load on facets joints. All these can lead to degenerative changes and osteophytes that can narrow the spinal canal. Surgery is indicated in patients with spinal stenosis who have intractable pain, altered quality of life, substantially diminished functional capacity, failed non-surgical treatment and are not candidates for non-surgical treatment. The aim was to determine the reasons for refusal of surgery in patients with established degenerative lumber spine pathology eligible for surgery.All patients meeting the study criteria, patients older than 18 years, patients with both clinical and radiological established symptomatic degenerative lumbar spine pathology and patients eligible for surgery but refusing it were recruited. Questionnaire used to investigate reasons why they are refusing surgery.Results 59 were recruited, fifty-one (86.4 %) females and eight (13.6 %) males. Twenty (33.8 %) were between the age of 51 and 60 years, followed by nineteen (32.2 %) between 61 and 70 years, and fourteen (23.7 %) between 71 and 80 years. 43 (72 %) patients had lumber spondylosis complicated by lumber spine stenosis, followed by nine (15.2 %) with lumbar spine spondylolisthesis and four (6.7 %) had adjacent level disease. 28 (47.4 %) were scared of surgery, fifteen (25.4 %) claimed that they are too old for surgery and nine (15.2 %) were not ready.Findings from this study outlined that patients lack information about the spinal surgery. Patients education about spine surgery is needed.

Conventional Magnetic Resonance Imaging (MRI) and histopathology agreement for the diagnosis of intracranial meningioma at Dr. Soetomo General Hospital, Surabaya, January 2016–December 2021: a single center study

Link of Video Abstract: https://youtu.be/OG7qXwNHzHQ Background: Meningioma, a prevalent intracranial neoplasm, ranks among the most frequently encountered tumors within the cranial cavity. The utilization of Magnetic Resonance Imaging (MRI) in the diagnostic process of meningioma has proven to be highly valuable. This study aims to evaluate the Conventional-MRI and histopathology agreement for the diagnosis of intracranial meningioma at Dr. Soetomo General Hospital, Surabaya. Methods: This study presents a diagnostic test and retrospective case-control analysis to evaluate the precision of head MRI in diagnosing intracranial meningioma, as confirmed by histopathological examination. The research was conducted at Dr. Soetomo Surabaya General Hospital from January 2016 to December 2021. Sample size calculations were performed on a cohort of patients diagnosed with intracranial meningioma who underwent head magnetic resonance imaging (MRI) scans and histopathological examinations at the Radiology and Anatomical Pathology Installation of Dr. Soetomo General Hospital. Only patients who satisfied the predetermined inclusion and exclusion criteria were included in the study. Data were analyzed using SPSS version 25.0 for Windows. Results: At the time of diagnosis, it was observed that the average diameter of grade II/III meningioma was 6.6 ± 1.5 cm, which was found to be greater than the average diameter of grade I meningioma, measuring 4 ± 1.92 cm. The prevalence of grade I meningioma was higher in the skull base region higher in the skull base region, accounting for approximately 36% of cases. Conversely, grade II/III meningioma was found more frequently in the non-skull base area, constituting approximately 76% of cases. In our investigation, it was observed that there exists a higher occurrence of irregular border shape in grade II/III meningioma, accounting for approximately 75% of cases, as compared to grade I meningioma, which only accounts for 14.2% of cases. The presence of contrast enhancement in meningiomas can provide valuable insights into their histological grade. Grade II/III meningiomas exhibit a higher degree of contrast enhancement, which is observed to be heterogeneously distributed in approximately 75% of cases. Conclusion: This study highlights the potential of MRI as a valuable tool in assessing the grade of meningioma while emphasizing the importance of considering other diagnostic modalities and clinical factors to ensure accurate diagnosis and treatment decisions.

Overview of radiological and anatomical pathology of meningioma disease: a 3-year retrospective study

Overview of radiological and anatomical pathology of meningioma disease: a 3-year retrospective study

The impact of over-distraction on adjacent segment pathology and cage subsidence in anterior cervical discectomy and fusion

Over-distraction has been shown to be a risk factor for cage subsidence and postoperative neck pain after anterior cervical discectomy and fusion (ACDF). Biomechanical studies have demonstrated increased adjacent segment intradiscal pressure after ACDF. The purpose of this study is to determine if over-distraction of the index disc has an effect on adjacent segment pathology. A consecutive series of 145 patients who received primary ACDF for cervical degenerative pathologies from January 2010 to December 2017 were retrospectively reviewed. The patients were divided into: (1) Over-distraction group (postoperative–preoperative index disc height ≥ 2 mm), and (2) No-distraction group (postoperative–preoperative index disc height < 2 mm). Outcome measures included radiographic parameters, Japanese Orthopaedic Association (JOA) score, and incidences of cage subsidence, radiological and clinical adjacent segment pathologies (RASP and CASP) were compared between the two groups preoperatively, postoperatively, and at the final follow-up. The two groups were comparable with respect to age, follow-up length, JOA score, incidence of CASP, and radiographic parameters. The Over-distraction group (83 patients; 115 levels) had smaller preoperative index disc height (4.5 vs. 5.2 mm, p < 0.001), but taller postoperative index disc height (7.7 vs. 6.6 mm, p < 0.001) than No-distraction group (62 patients; 90 levels) Furthermore, significantly higher incidences of cage subsidence (47% vs. 31%, p = 0.04) and RASP (any progression: 48% vs. 15%, p < 0.001; progress ≥ 2 grades: 25% vs. 7%, p = 0.001) were observed in the Over-distraction group. The multivariate analysis indicated that over-distraction and multilevel fusion were independent risk factors for RASP. There were no clinical outcome differences between the Over-distraction group and the No-distraction group in ACDF. Over-distraction of the index level of ≥ 2 mm should be avoided because it significantly increases the incidences of RASP and cage subsidence.

PD-L1 Expression in Pituitary Neuroendocrine Tumors/Pituitary Adenomas.

About a third of Pituitary Neuroendocrine Tumors (PitNETs) may show aggressive behavior. Many efforts have been performed for identifying possible predictive factors to early determine the future behavior of PitNETs. Programmed cell death ligand 1 (PD-L1) expression was associated with a more aggressive biology in different solid tumors, but its role in PitNET is not well-established yet. Our study aims to analyze PD-L1 expression in a surgical cohort of PitNETs to determine its association with radiological invasion and pathology findings, as well as with long-term recurrence rates. We performed a retrospective analysis in a series of 86 PitNETs. Clinical presentation and radiological features of the preoperative period were collected, as well as pathological data and follow-up data. The rate of PD-L1 expression was immunohistochemically evaluated and expressed as a tumor proportion score (TPS). We assessed its relationship with cavernous sinus invasion and Trouillas' classification as primary outcomes. Secondary outcomes included the TPS' relationship with histopathological markers of proliferation, hormonal expression, tumor size and long-term recurrence rates. We calculated the optimal cut-point for the primary outcomes while maximizing the product of the sensitivity and specificity and then we evaluated the significance of secondary outcomes with logistic regression analysis. Eighty-six patients were included in the analysis; 50 cases were non-functional PitNETs. The TPS for PD-L1 showed a highly right-skewed distribution in our sample, as 30.2% of patients scored 0. Using Trouillas' classification, we found that "proliferative" cases have a significantly higher probability to express PD-L1 in more than 30% of tumor cells (OR: 5.78; CI 95%: 1.80-18.4). This same cut-point was also associated with p53 expression. A positive association was found between PD-L1 expression and GH expression (p = 0.001; OR: 5.44; CI 95%: 1.98-14.98), while an inverse relationship was found with FSH/LH expression (p = 0.014; OR = 0.27, CI 95%: 0.10-0.76). No association was found with CS invasion, tumor size, bone erosion or dura invasion. We could not find any association between PD-L1 expression and recurrence. PD-L1 expression was associated with proliferative grades of Trouillas' classification and p53 expression. We also confirmed a higher expression of PD-L1 in somatotroph tumors. Larger studies are necessary to investigate the relationship between PD-L1 expression and aggressive behaviors.

The Introduction of a Protocol for Esophageal Screening in Videofluoroscopic Swallowing Studies: Exploring Clinical Impacts and Barriers.

Esophageal screening is a valuable inclusion in videofluoroscopic swallowing studies (VFSSs). However, routine standardized esophageal screening does not always occur in clinical practice. This study introduced and evaluated an esophageal screening protocol at one Australian hospital. Radiology, gastroenterology, and speech-language pathology endorsed an esophageal screening protocol, which followed a timed 20-ml International Dysphagia Diet Standardisation Initiative Level 0 bolus from mouth to stomach in an upright anterior-posterior position. Measures exploring clinical impacts and barriers were recorded. Participants were compared with 100 consecutive VFSS patients prior to the introduction of the esophageal screening protocol. During the esophageal screening protocol trial, 163 VFSSs were conducted with recruited patients. Aspiration risk (29%, n = 47/163) and positioning limitation (3%, n = 5/163) were barriers to esophageal screening. Rates of esophageal screening significantly increased with the esophageal screening protocol (χ2 = 63.462, p < .001). There was no difference in radiation dose for patients who had esophageal screening and those who did not in the esophageal screening protocol group (U = 1689.000, p = .237). The VFSS team breached the esophageal screening protocol for some patients, when evaluating esophageal transit time (n = 28) and recommending gastroenterology referral (n = 6). There was no difference between groups for rates of gastroenterology consults (χ2 = 1.805, p = .188) or dysphagia procedures (χ2 = 1.951, p = .209). This study confirms that routine esophageal screening provides additional clinical information to assist holistic dysphagia management without adverse operational impacts. Further research with the multidisciplinary dysphagia team has commenced to continue to optimize and refine esophageal screening practice.

The potential of 3D models and augmented reality in teaching cross-sectional radiology

What was the educational challenge? The complexity and variability of cross-sectional imaging present a significant challenge in imparting knowledge of radiologic anatomy to medical students. What was the solution? Recent advancements in three-dimensional (3D) segmentation and augmented reality (AR) technology provide a promising solution. These advances allow for the creation of interactive, patient-specific 3D/AR models which incorporate multiple imaging modalities including MRI, CT, and 3D rotational angiography can help trainees understand cross-sectional imaging. How was the solution implemented? To create the model, DICOM files of patient scans with slice thicknesses of 1 mm or less are exported to a computer and imported to 3D Slicer for registration. Once registered, the files are segmented with Vitrea software utilizing thresholding, region growing, and edge detection. After the creation of the models, they are then imported to a web-based interactive viewing platform and/or AR application. What lessons were learned that are relevant to a wider global audience? Low-resource 3D/AR models offer an accessible and intuitive tool to teach radiologic anatomy and pathology. Our novel method of creating these models leverages recent advances in 3D/AR technology to create a better experience than traditional high and low-resource 3D/AR modeling techniques. This will allow trainees to better understand cross-sectional imaging. What are the next steps? The interactive and intuitive nature of 3D and AR models has the potential to significantly improve the teaching and presentation of radiologic anatomy and pathology to a medical student audience. We encourage educators to incorporate 3D segmentation models and AR in their teaching strategies.

A Comprehensive Analysis of the Radiation Exposure and the Diagnostic Benefit of PanCT in Pediatric Cases with Multiple Trauma.

Background and Objectives: The primary objective of this study was to obtain quantitative data, taking into account the amount of radiation exposure, about the clinical and diagnostic benefit obtained from panCT in pediatric trauma cases. Thus, we aim to create greater awareness in all physicians and primarily emergency medicine physicians regarding correct selection in terms of the patient group where this effective radiological method is to be applied, and to protect children from the adverse effects of radiation. Materials and Methods: The computed tomography (CT) images were retrieved from the hospital radiological archive system (PACS). The effective dose (Ed) was calculated using the standardized method including the tissue weighted parameters. The radiological pathologies determined as a result of CT imaging of the cases were categorized according to clinical significance in accordance with the Modified CT Colonography Reporting and Data System (C-RADS). Results: The data for a total of 268 patients were analyzed, comprising 89 (33.2%) females and 179 (66.8%) males with a mean age of 8.81 ± 5.21 years. The mean Ed was determined to be 18.14 ± 10.44 mSv. The Ed was determined to be statistically significantly higher in the 1-5 years age group than in the 15-18 years age group (p = 0.024). A statistically significant difference was determined between the age groups in terms of the pathologies determined (p = 0.028). Conclusions: In order to prevent performing unnecessary CT imaging, trauma teams in Emergency Departments (ED) should work in harmony and individual decision-making should be based on the severity of the trauma mechanism, the severity of the predicted injury, and the clinical status of the injured child.