Mapping wrist motion: 3D CT analysis after scapholunate ligament transection.

The injury of the scapholunate (SL) ligament is common in wrist traumas leading to pain and reduced wrist function. The wrist's unique joint design and possible underlying theories as the carpal row theory were subject to earlier investigations studying wrist kinematics. Nevertheless, a comprehensive understanding of how SL ligament injuries affect wrist biomechanics is still lacking. Through a quantitative analysis of carpal bone motion patterns, we evaluated the impact on wrist kinematics occurring after SL ligament injury. We conducted a study using computer tomography imaging to analyse wrist kinematics after SL ligament transection in 21 fresh-frozen anatomical specimens. The collected data were then transformed into 3D models, employing both standardized global and object coordinate systems. The study encompassed the evaluation of rotation and translation for each individual carpal bone, as well as the ulna, and all metacarpal bones in reference to the radius. The study showed a significant increase in rotation towards palmar (p < 0.01), particularly notable for the scaphoid, following transection of the SL ligament during palmar flexion. Ulnar deviation did not significantly affect rotation or translation, and radial deviation also showed no significant changes in rotation or translation. The study highlights the significance of the SL ligament in wrist kinematics, revealing that SL ligament tears lead to changes in wrist motion. While we observed significant rotational changes for the scaphoid, other carpal bones showed less pronounced alterations, emphasizing the complexity of wrist biomechanics.

Imaging of glenohumeral osteoarthritis: Reliability and reproducibility of radiological classifications.

BACKGROUND: Glenohumeral degenerative joint disease may affect up to 20% of the population. There are several classification systems of this disease in the scientific literature. OBJECTIVE: The aim of this study is to determine the reliability and reproducibility of glenohumeral osteoarthritis classification systems. METHODS: We assessed glenohumeral plain radiographs performed in a University Hospital. These radiographs were graded into nine radiological classification systems by two observers on two evaluations. Patients who have performed CT/MRI scan were staged according to the Walch classification. The intra-observer and inter-observer reliability of the classification schemes were determined by using Cohen's weighted kappa coefficient. RESULTS: A total of 752 patients were included in the study (52.4% females and 47.6% males), mean aged 66.2 ± 16.3 years. The intra-observer and inter-observer reliabilities were 0.543 (observer 1), 0.630 (observer 2), and 0.760 (inter-observer) for the Weinstein grading system; 0.661, 0.706, and 0.761 for the Guyette grading system; 0.575, 0.679 and 0.704 for the Kellgren and Lawrence classification; 0.817, 0.816 e 0.871 for the Samilson and Prieto classification; 0.791, 0.811 and 0.847 for the Allain modification; 0.797, 0.842 and 0.860 for the Gerber modification; 0.773, 0.827 and 0.828 for the Buscayret modification; 0.584, 0.648 and 0.755 for the Hawkins and Angelo classification; 0.661, 0.749 and 0.764 for the Rosenberg classification. Intra-observer reliability for MRI was 0.757 (observer 1) and 0.675 (observer 2), while intra-observer reliability for CT was 0.811 (observer 1) and 0.653 (observer 2). Inter-observer reliabilities were 0.790 for MRI and 0.673 for CT. CONCLUSION: The classification systems according to Weinstein, Guyette, Hawkins and Angelo, Rosenberg and the modifications of the Samilson and Prieto classification according to Allain, Gerber and Buscayret showed a comparable reliability with the commonly used glenohumeral osteoarthritis grading systems, Samilson and Prieto and Kellgren and Lawrence. Thus, they are recommended for clinical and especially scientific purposes.

Relationship between stone volume, average CT value and operation time and efficiency before ureteral soft lens laser lithotripsy.

BACKGROUND: Soft ureteroscopic holmium laser lithotripsy is becoming increasingly popular as the preferred method for treating mid-to-lower ureteral stones. Studies have indicated that the size, composition, hardness, and fragility of the stones can impact the treatment's effectiveness. OBJECTIVE: To explore the relationship between stone volume, average CT value and operation time and efficiency before ureteral soft lens laser lithotripsy. METHODS: Our study on 126 patients undergoing ureteroscopic holmium laser lithotripsy for ureteral calculi from May 2020 to January 2022 categorized them into groups based on stone volume and CT value. We compared surgical outcomes and analyzed correlations between stone characteristics, operation parameters, and stone clearance rate to identify independent risk factors influencing treatment efficacy. RESULTS: Group A demonstrated significantly shorter operation durations and lower blood loss compared to Group B, along with higher single stone clearance rates and fewer postoperative complications. Similarly, Group C exhibited shorter operation times, reduced blood loss, higher stone clearance rates, and lower complication rates than Group D. Preoperative stone volume and CT value correlated positively with operation time and stone clearance rate, with both factors identified as independent risk factors affecting ureteral stone clearance following holmium laser lithotripsy. CONCLUSION: The stone volume and average CT value before ureteral soft lens laser lithotripsy show a positive correlation with operation time and efficiency, indicating that larger stone volumes and higher CT values lead to slower lithotripsy speeds and reduced operation efficiency. Furthermore, preoperative stone volume and average CT value are identified as independent risk factors for residual stones.

Clinical Performance Comparison of a Long Versus a Short Axial Field-of-View PET/CT Using EARL-Compliant Reconstructions.

PURPOSE: To ensure comparable PET/CT image quality between or within centres, clinical inter-system performance comparisons following European Association of Nuclear Medicine Research Ltd. (EARL) guidelines is required. In this work the performance of the long axial field-of-view Biograph Vision Quadra is compared to its predecessor, the short axial field-of-view Biograph Vision. PROCEDURES: To this aim, patients with suspected tumour lesions received a single weight-based (3 MBq/kg) 2-deoxy-2-[18F]fluoro-D-glucose injection and underwent routine clinical ( ∼ 15 min) scans on the Vision and 3-min scans on the Quadra in listmode in balanced order. Image quality (IQ), image noise (IN), and tumour demarcation (TD) were assessed visually by four nuclear medicine physicians using a 5-point Likert scale and semiquantitative analysis was performed using standardised uptake values (SUVs). Inter-reader agreement was tested using Wilcoxon's signed rank test and the SUVs were statistically compared using a paired t-test. RESULTS: Twenty patients (mean age, 60 years ± 8.8 [standard deviation], 16 male) were enrolled. Inter-reader agreement ranged from good to very good for IQ and IN (0.62 ≤ W ≤ 0.81), and fair for TD (0.29 ≤ W ≤ 0.39). Furthermore, a significant difference was found for TD (p = 0.015) between the systems, showing improved TD for the Quadra. CONCLUSION: This study demonstrates that the Quadra can be used in routine clinical practice with multiple PET/CT systems or in multicentre studies. This system provides comparable diagnostic image quality and semiquantitative accuracy, improved TD, and has the advantage of shorter scan durations.

Protein Corona-Directed Cellular Recognition and Uptake of Polyethylene Nanoplastics by Macrophages.

The widespread use of plastic products in daily life has raised concerns about the health hazards associated with nanoplastics (NPs). When exposed, NPs are likely to infiltrate the bloodstream, interact with plasma proteins, and trigger macrophage recognition and clearance. In this study, we focused on establishing a correlation between the unique protein coronal signatures of high-density (HDPE) and low-density (LDPE) polyethylene (PE) NPs with their ultimate impact on macrophage recognition and cytotoxicity. We observed that low-density and high-density lipoprotein receptors (LDLR and SR-B1), facilitated by apolipoproteins, played an essential role in PE-NP recognition. Consequently, PE-NPs activated the caspase-3/GSDME pathway and ultimately led to pyroptosis. Advanced imaging techniques, including label-free scattered light confocal imaging and cryo-soft X-ray transmission microscopy with 3D-tomographic reconstruction (nano-CT), provided powerful insights into visualizing NPs-cell interactions. These findings underscore the potential risks of NPs to macrophages and introduce analytical methods for studying the behavior of NPs in biological systems.

CBCT-based synthetic CT image generation using a diffusion model for CBCT-guided lung radiotherapy.

BACKGROUND: Although cone beam computed tomography (CBCT) has lower resolution compared to planning CTs (pCT), its lower dose, higher high-contrast resolution, and shorter scanning time support its widespread use in clinical applications, especially in ensuring accurate patient positioning during the image-guided radiation therapy (IGRT) process. PURPOSE: While CBCT is critical to IGRT, CBCT image quality can be compromised by severe stripe and scattering artifacts. Tumor movement secondary to respiratory motion also decreases CBCT resolution. In order to improve the image quality of CBCT, we propose a Lung Diffusion Model (L-DM) framework. METHODS: Our proposed algorithm is based on a conditional diffusion model trained on pCT and deformed CBCT (dCBCT) image pairs to synthesize lung CT images from dCBCT images and benefit CBCT-based radiotherapy. dCBCT images were used as the constraint for the L-DM. The image quality and Hounsfield unit (HU) values of the synthetic CTs (sCT) images generated by the proposed L-DM were compared to three selected mainstream generation models. RESULTS: We verified our model in both an institutional lung cancer dataset and a selected public dataset. Our L-DM showed significant improvement in the four metrics of mean absolute error (MAE), peak signal-to-noise ratio (PSNR), normalized cross-correlation (NCC), and structural similarity index measure (SSIM). In our institutional dataset, our proposed L-DM decreased the MAE from 101.47 to 37.87 HU and increased the PSNR from 24.97 to 29.89 dB, the NCC from 0.81 to 0.97, and the SSIM from 0.80 to 0.93. In the public dataset, our proposed L-DM decreased the MAE from 173.65 to 58.95 HU, while increasing the PSNR, NCC, and SSIM from 13.07 to 24.05 dB, 0.68 to 0.94, and 0.41 to 0.88, respectively. CONCLUSIONS: The proposed L-DM significantly improved sCT image quality compared to the pre-correction CBCT and three mainstream generative models. Our model can benefit CBCT-based IGRT and other potential clinical applications as it increases the HU accuracy and decreases the artifacts from input CBCT images.

Phase-contrast visualization of human tissues using superimposed wavefront imaging of diffraction-enhanced x-rays.

BACKGROUND: Phase-contrast computed tomography (CT) using high-brilliance, synchrotron-generated x-rays enable three-dimensional (3D) visualization of microanatomical structures within biological specimens, offering exceptionally high-contrast images of soft tissues. Traditional methods for phase-contrast CT; however, necessitate a gap between the subject and the x-ray camera, compromising spatial resolution due to penumbral blurring. Our newly developed technique, Superimposed Wavefront Imaging of Diffraction-enhanced x-rays (SWIDeX), leverages a Laue-case Si angle analyzer affixed to a scintillator to convert x-rays to visible light, capturing second-order differential phase contrast images and effectively eliminating the distance to the x-ray camera. This innovation achieves superior spatial resolution over conventional methods. PURPOSE: In this paper, the imaging principle and CT reconstruction algorithm based on SWIDeX are presented in detail and compared with conventional analyzer-based imaging (ABI). It also shows the physical setup of SWIDeX that provides the resolution preserving second-order differential images for reconstruction. We compare the spatial resolution and the sensitivity of SWIDeX to conventional ABI. METHODS: To demonstrate high-spatial resolution achievable by SWIDeX, the internal structures of four human tissues-ductal carcinoma in situ, normal stomach, normal pancreas, and intraductal papillary mucinous neoplasm of the pancreas-were visualized using an imaging system configured at the Photon Factory's BL14B beamline under the High Energy Accelerator Research Organization (KEK). Each tissue was thinly sliced after imaging, stained with hematoxylin and eosin (H&E) for conventional microscope-based pathology. RESULTS: A comparison of SWIDeX-CT and pathological images visually demonstrates the effectiveness of SWIDeX-CT for biological tissue imaging. SWIDeX could generate clearer 3D images than existing analyzer-based phase-contrast methods and accurately delineate tissue structures, as validated against histopathological images. CONCLUSIONS: SWIDeX can visualize important 3D structures in biological soft tissue with high spatial resolution and can be an important tool for providing information between the disparate scales of clinical and pathological imaging.

Evolving trends in CT colonography: A 10-year analysis of use and associated factors.

PURPOSE: Computed tomographic colonography (CTC) is a non-invasive screening test for colorectal cancer (CRC) with high sensitivity and low risk of complications. We used a nationally representative sample of screening-eligible adults to examine trends in and factors associated with CTC use. METHODS: We examined CTC use among 58,058 adults in the National Health Interview Survey in 2010, 2015, 2018, 2019, and 2021. For each survey year, we estimated CTC use by sociodemographic and health factors. We used multivariable logistic regression to identify factors associated with CTC use. RESULTS: A total of 1.7 % adults reported receiving CTC across all survey years. CTC use was similar in 2010 (1.3 %), 2015 (0.8 %), 2018 (1.4 %), and 2019 (1.4 %) but increased in 2021 (3.5 %, p < 0.05). In multivariable analysis, survey year 2021 [vs. 2010, odds ratio (OR) 2.51, 95 % confidence interval (CI) 1.83-3.43], Hispanic (OR 1.73, 95 % CI 1.34-2.23), non-Hispanic Black (OR 2.07, 95 % CI 1.67-2.57), and household income <200 % federal poverty level (vs. >400 %, OR 1.25, 95 % CI 1.01-1.57) was associated with CTC use. Further, adults with a history of diabetes (OR 1.20, 95 % CI 1.01-1.45), chronic obstructive pulmonary disease (OR 1.58, 95 % CI 1.25-1.99), cancer (OR 1.29, 95 % CI 1.05-1.58), or past-year hospital admissions (OR 1.44, 95 % CI 1.18-1.78) were more likely to receive CTC. CONCLUSION: CTC use remained low from 2010 to 2019 but increased in 2021. CTC use was more frequent among adults with chronic health conditions, minorities, and adults with lower income, and may help reduce disparities in CRC screening.

International Benchmark for Total Metabolic Tumor Volume Measurement in Baseline 18F-FDG PET/CT of Lymphoma Patients: A Milestone Toward Clinical Implementation.

Total metabolic tumor volume (TMTV) is prognostic in lymphoma. However, cutoff values for risk stratification vary markedly, according to the tumor delineation method used. We aimed to create a standardized TMTV benchmark dataset allowing TMTV to be tested and applied as a reproducible biomarker. Methods: Sixty baseline 18F-FDG PET/CT scans were identified with a range of disease distributions (20 follicular, 20 Hodgkin, and 20 diffuse large B-cell lymphoma). TMTV was measured by 12 nuclear medicine experts, each analyzing 20 cases split across subtypes, with each case processed by 3-4 readers. LIFEx or ACCURATE software was chosen according to reader preference. Analysis was performed stepwise: TMTV1 with automated preselection of lesions using an SUV of at least 4 and a volume of at least 3 cm3 with single-click removal of physiologic uptake; TMTV2 with additional removal of reactive bone marrow and spleen with single clicks; TMTV3 with manual editing to remove other physiologic uptake, if required; and TMTV4 with optional addition of lesions using mouse clicks with an SUV of at least 4 (no volume threshold). Results: The final TMTV (TMTV4) ranged from 8 to 2,288 cm3, showing excellent agreement among all readers in 87% of cases (52/60) with a difference of less than 10% or less than 10 cm3 In 70% of the cases, TMTV4 equaled TMTV1, requiring no additional reader interaction. Differences in the TMTV4 were exclusively related to reader interpretation of lesion inclusion or physiologic high-uptake region removal, not to the choice of software. For 5 cases, large TMTV differences (>25%) were due to disagreement about inclusion of diffuse splenic uptake. Conclusion: The proposed segmentation method enabled highly reproducible TMTV measurements, with minimal reader interaction in 70% of the patients. The inclusion or exclusion of diffuse splenic uptake requires definition of specific criteria according to lymphoma subtype. The publicly available proposed benchmark allows comparison of study results and could serve as a reference to test improvements using other segmentation approaches.

18F-DCFPyL PSMA PET/CT Tracheobronchial Uptake in Patients with Prostate Cancer: Incidence and Etiology.

We evaluated the incidence and potential etiology of tracheobronchial uptake in patients being evaluated by 18F-DCFPyL PET/CT for prostate cancer (PCa). Methods: The study included a consecutive 100 PCa patients referred for 18F-DCFPyL PET/CT. The PET/CT scans were retrospectively reviewed. The presence or absence of physiologic tracheobronchial uptake on PET/CT was recorded. To further evaluate tracheal prostate-specific membrane antigen (PSMA) expression, immunohistochemistry was performed on tracheal samples taken from 2 men who had surgical resection of lung cancer. Results: Tracheal uptake was present in 31 of 100 patients (31%). When tracheal uptake was present, the SUVmax was significantly higher in the left main bronchus (mean, 2.7) than in the right (mean, 2.3) (P < 0.001). Histopathologic testing of tracheobronchial samples showed PSMA expression in bronchial submucosal glands. Conclusion: In PCa patients undergoing 18F-DCFPyL PET/CT, tracheobronchial uptake occurred in 31% of patients. This is attributed to normal physiologic PSMA expression in bronchial submucosal glands.

Utility of 64Cu-Sarcophagine-Bombesin PET/CT in Men with Biochemically Recurrent Prostate Cancer and Negative or Equivocal Findings on 68Ga-PSMA-11 PET/CT.

Despite a high detection rate of 68Ga-prostate-specific membrane antigen (PSMA) PET/CT in biochemical recurrence (BCR) of prostate cancer, a significant proportion of men have negative 68Ga-PSMA-11 PET/CT results. Gastrin-releasing peptide receptor, targeted by the copper-chelated bombesin analog 64Cu-sarcophagine-bombesin (SAR-BBN) PET/CT, is also overexpressed in prostate cancer. In this prospective imaging study, we investigate the detection rate of 64Cu-SAR-BBN PET/CT in patients with BCR and negative or equivocal 68Ga-PSMA-11 PET/CT results. Methods: Men with confirmed adenocarcinoma of the prostate, prior definitive therapy, and BCR (defined as a prostate-specific antigen [PSA] level > 0.2 ng/mL) with negative or equivocal 68Ga-PSMA-11 PET/CT results within 3 mo were eligible for enrollment. 64Cu-SAR-BBN PET/CT scans were acquired at 1 and 3 h after administration of 200 MBq of 64Cu-SAR-BBN, with further delayed imaging undertaken optionally at 24 h. PSA (ng/mL) was determined at baseline. All PET (PSMA and bombesin) scans were assessed visually. Images were read with masking of the clinical results by 2 experienced nuclear medicine specialists, with a third reader in cases of discordance. Accuracy was defined using a standard of truth that included biopsy confirmation, confirmatory imaging, or response to targeted treatment. Results: Twenty-five patients were enrolled. Prior definitive therapy was radical prostatectomy (n = 24, 96%) or radiotherapy (n = 1, 4%). The median time since definitive therapy was 7 y (interquartile range [IQR], 4-11 y), and the Gleason score was 7 or less (n = 15, 60%), 8 (n = 3, 12%), or 9 (n = 7, 28%). The median PSA was 0.69 ng/mL (IQR, 0.28-2.45 ng/mL). Baseline PSMA PET scans were negative in 19 patients (76%) and equivocal in 6 (24%). 64Cu-SAR-BBN PET-avid disease was identified in 44% (11/25): 12% (3/25) with local recurrence, 20% (5/25) with pelvic node metastases, and 12% (3/25) with distant metastases. The κ-score between readers was 0.49 (95% CI, 0.16-0.82). Patients were followed up for a median of 10 mo (IQR, 9-12 mo). Bombesin PET/CT results were true-positive in 5 of 25 patients (20%), false-positive in 2 of 25 (8%), false-negative in 7 of 25 (28%), and unverified in 11 of 25 (44%). Conclusion: 64Cu-SAR-BBN PET/CT demonstrated sites of disease recurrence in 44% of BCR cases with negative or equivocal 68Ga-PSMA-11 PET/CT results. Further evaluation to confirm diagnostic benefit is warranted.

Comparative Evaluation of Supplementary Cleaning Techniques for Removal of Bio-C Sealer and AH-Plus from Oval Root Canals: A Micro-CT Analysis.

Introduction: This study aimed to compare the effectiveness of two endodontic cleaning techniques, passive ultrasonic irrigation (PUI) and the XP-endo Finisher R (XPR) system, in removing residual filling material during endodontic retreatment procedures. Materials and Methods: Forty mandibular premolars with oval canals were divided into four groups based on the sealer used (AH-Plus or Bio-C Sealer) and the cleaning technique employed (PUI or XPR). To ensure uniformity of canal volume among groups, initial micro-CT scans were conducted. The canals were instrumented, filled, and then re-instrumented before undergoing either PUI or XPR cleaning techniques. Residual filling material volumes were assessed through micro-CT scans, and statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney U tests. Results: Following instrumentation, there was no significant difference in residual filling material volumes between AH-Plus and Bio-C Sealer groups (1.35 mm3and 1.02 mm3, respectively; P>0.05). However, after supplementary cleaning techniques, XPR-cleaned specimens exhibited significantly less residual material compared to PUI-cleaned specimens (0.01 mm3 and 0.29 mm3 for Bio-C Sealer, and 0.07 mm3 and. 0.30 mm3 for AH-Plus, P<0.05). Conclusion: The XPR system was found to be more effective than PUI in removing residual filling material from Bio-C Sealer-filled root canals. This highlights its potential as a useful supplementary cleaning technique in endodontic retreatment procedures.

Effect of Matrix Size and Acquisition Mode on Image Quality and Radiation Dose of Ultra-High-Resolution CT of the Temporal Bone: An Anatomical Study.

Purpose: To compare image quality and radiation exposure between super- and ultra-high-resolution helical and super-high-resolution volumetric CT of the temporal bone. Methods: Six cadaveric temporal bone specimens were used to evaluate key temporal bone structures using the following CT reconstruction and acquisition modes: helical and single-volume acquisition modes in super-high resolution (0.25-mm slice thickness, 10242 matrix), and helical mode in ultra-high resolution (0.25-mm slice thickness, 20482 matrix). Two observers performed 5 previously described preoperative measurements, measured noise and signal-to-noise ratios for air, and noise for bone, and rated the visualization of 5 anatomical structures on a 4-point scale, for each reconstruction mode. Radiation dose exposure was recorded for each examination. Results: There was no significant difference between any of the quantitative or qualitative measurements in any of the reconstruction and acquisition modes. There was a slight increase in noise and a decrease in signal-to-noise ratio in the air using the single-volume mode (115 ± 13.1 HU and 8.37 ± 0.91, respectively) compared to the helicoidal super-high-resolution (92.4 ± 11.8 HU and 10.8 ± 1.26, respectively) and helicoidal ultra-high-resolution (91.1 ± 10.7 HU and 10.9 ± 1.39, respectively) modes (P < .002). The volumic CT dose index was 50.9 mGy with helical acquisition and 29.8 mGy with single-volume acquisition mode (P < .0001). Conclusion: The single-volume super-high-resolution acquisition mode allows a reduction in radiation dose exposure without compromising image quality compared to helical scanning, but with a slightly lower signal-to-noise ratio in air with the single-volume mode, while there was no difference in image quality between the helical super- and ultra-high-resolution modes.

The treatment effect across ASPECTS in acute ischemic stroke: Analysis from the AcT Trial.

BACKGROUND: Early ischemic changes on baseline imaging are commonly evaluated for acute stroke decision-making and prognostication. AIMS: We assess the association of early ischemic changes on clinical outcomes and whether it differs between intravenous tenecteplase versus Alteplase. METHODS: Data are from the phase 3, Alteplase compared to Tenecteplase (AcT) trial. Subjects with anterior circulation stroke were included. Early ischemic changes were assessed using the Alberta Stroke Program Early CT score (ASPECTS). Efficacy outcomes included modified Rankin scale (mRS) 0-1, mRS 0-2, and ordinal mRS at 90 days. Safety outcomes included 24-hour symptomatic intracerebral hemorrhage (sICH), any hemorrhage on follow-up scan, and 90-day mortality rate. Mixed effects logistic regression was used to assess the association of ASPECTS [continuous and categorical (0-4 vs. 5-7 vs. 8-10)] with outcomes and if these associations were modified by thrombolytic type after adjusting for age, sex, and baseline stroke severity. RESULTS: Of the 1577 patients in the trial, 901 patients (56.3%) (median age 75 years [IQR 65-84], 50.8% females, median NIHSS 14 [IQR 17-19]) with anterior circulation stroke were included. mRS 0-1 at 90d was achieved in 1/14 (0.3%), 43/160 (14.7%) and 252/726 (85.1%) in the ASPECTS 0-4, 5-7 and 8-10 groups respectively. Every 1-point decrease in ASPECTS was associated with 2.7% and 1.9% decrease in chances of mRS 0-1 and mRS 0-2 at 90 days, respectively, and 1.9% chances of increase in mortality at 90 days. Subgroup analysis in EVT treated population showed similar results. Thrombolytic type did not modify this association between ASPECTS and 90-day mRS 0-1 (P interaction 0.75). There was no significant interaction by thrombolytic type with any other outcome. CONCLUSIONS: Similar to prior studies, we found that every one-point decrease in ASPECTS was associated with poorer clinical and safety outcomes. This effect did not differ between alteplase and tenecteplase.

Evaluation of the pit and fissure system in primary and permanent molars with micro-computed tomography and 3D printing.

This study aimed to characterize the anatomical and physiological features of pits and fissures in primary and permanent molars by microtomographic (micro-CT) examination and three-dimensional (3D) printing. The occlusal surfaces of 84 primary molars and 60 permanent third molars were examined. The samples were scanned with micro-CT and the occlusal surface separated. The areas of the crown, its occlusal part, and fissures and pits were calculated. Digital impression of the occlusal surface was created and 3D printed. The frequency of different fissure types was determined by direct observation. Data were subjected to statistical analysis using Mann-Whitney U Test and chi-square test (p < 0.05). There was statistically significant difference between the ratio of occlusal surface and the crown area for the molars in primary and permanent dentitions (24.78% and 28.85% respectively, p < 0.05). In terms of the percentage ratio of the fissure area to the occlusal surface (24.24% and 22.30%) and the fissure area to the crown (6.02% and 6.52%), no significant difference was observed (p > 0.05). V-shaped fissures were predominant in both primary and permanent teeth, with a higher occurrence in primary dentition (59.48%, p < 0.05). Permanent molars exhibited a higher prevalence of I-type and U-type fissure configurations compared to primary molars (p < 0.05), with I-type fissures being the least common in primary molars. In both dentitions there was no statistically significant difference in the prevalence of IK-configuration (p > 0.05). The fissure depth was significantly greater in permanent molars than primary molars (p < 0.05). In conclusion, this study revealed remarkable diversity in fissure morphology among primary and permanent molars.

Postpartum obstetric complications: a guide for radiologists.

The puerperium refers to the 6-8 weeks following delivery, and is a dynamic period in which maternal anatomy and physiology are restored to their prepregnant state. Postpartum complications can be divided into non-obstetric and obstetric. The latter are the topic of this article and can be further classified as infectious, thrombotic, hemorrhagic or cesarean-related. Transvaginal US is often the initial modality in the evaluation of puerperal disorders. CT is probably the most valuable imaging technique when life-threatening conditions are suspected. Pelvic MRI is being increasingly used in cases of inconclusive findings or if further characterization is needed, especially in the setting of postsurgical complications or placental disorders. Diagnostic and interventional radiologists play a pivotal role in the evaluation and management of a variety of puerperal complications. Many of these conditions pose a diagnostic challenge, as imaging findings often overlap with normal postpartum changes, so keeping in mind the patient's clinical information is key.

The association of quantitative PSMA PET parameters with pathologic ISUP grade: an international multicenter analysis.

PURPOSE: To assess if PSMA PET quantitative parameters are associated with pathologic ISUP grade group (GG) and upgrading/downgrading. METHODS: PCa patients undergoing radical prostatectomy with or without pelvic lymph node dissection staged with preoperative PSMA PET at seven referral centres worldwide were evaluated. PSMA PET parameters which included SUVmax, PSMAvolume, and total PSMA accumulation (PSMAtotal) were collected. Multivariable logistic regression evaluated the association between PSMA PET quantified parameters and surgical ISUP GG. Decision-tree analysis was performed to identify discriminative thresholds for all three parameters related to the five ISUP GGs The ROC-derived AUC was used to determine whether the inclusion of PSMA quantified parameters improved the ability of multivariable models to predict ISUP GG ≥ 4. RESULTS: A total of 605 patients were included. Overall, 2%, 37%, 37%, 10% and 13% patients had pathologic ISUP GG1, 2, 3, 4, and 5, respectively. At multivariable analyses, all three parameters SUVmax, PSMAvolume and PSMAtotal were associated with GG ≥ 4 at surgical pathology after accounting for PSA and clinical T stage based on DRE, hospital and radioligand (all p < 0.05). Addition of all three parameters significantly improved the discrimination of clinical models in predicting GG ≥ 4 from 68% (95%CI 63 - 74) to 74% (95%CI 69 - 79) for SUVmax, 72% (95%CI 67 - 76) for PSMAvolume, 74% (70 - 79) for PSMAtotal and 75% (95%CI 71 - 80) when all parameters were included (all p < 0.05). Decision-tree analysis resulted in thresholds that discriminate between GG (SUVmax 0-6.5, 6.5-15, 15-28, > 28, PSMAvol 0-2, 2-9, 9-20 and > 20 and PSMAtotal 0-12, 12-98 and > 98). PSMAvolume was significantly associated with GG upgrading (OR 1.03 95%CI 1.01 - 1.05). In patients with biopsy GG1-3, PSMAvolume ≥ 2 was significantly associated with higher odds for upgrading to ISUP GG ≥ 4, compared to PSMAvolume < 2 (OR 6.36, 95%CI 1.47 - 27.6). CONCLUSION: Quantitative PSMA PET parameters are associated with surgical ISUP GG and upgrading. We propose clinically relevant thresholds of these parameters which can improve in PCa risk stratification in daily clinical practice.

Revolutionizing Aneurysm detection: The role of artificial intelligence in reducing rupture rates.

Cerebral aneurysms, affecting 2-5% of the global population, are often asymptomatic and commonly located within the Circle of Willis. A recent study in Neurosurgical Review highlights a significant reduction in the annual rupture rates of unruptured cerebral aneurysms (UCAs) in Japan from 2003 to 2018. By analyzing age-adjusted mortality rates of subarachnoid hemorrhage (SAH) and the number of treated ruptured cerebral aneurysms (RCAs), researchers found a substantial decrease in rupture rates-from 1.44 to 0.87% and from 0.92 to 0.76%, respectively (p < 0.001). This 88% reduction was largely attributed to improved hypertension management. Recent advancements in artificial intelligence (AI) and machine learning (ML) further support these findings. The RAPID Aneurysm software demonstrated high accuracy in detecting cerebral aneurysms on CT Angiography (CTA), while ML algorithms showed promise in predicting aneurysm rupture risk. A meta-analysis indicated that ML models could achieve 83% sensitivity and specificity in rupture prediction. Additionally, deep learning techniques, such as the PointNet + + architecture, achieved an AUC of 0.85 in rupture risk prediction. These technological advancements in AI and ML are poised to enhance early detection and risk management, potentially contributing to the observed reduction in UCA rupture rates and improving patient outcomes.

Application value of adrenal venous sampling in the surgical treatment of primary aldosteronism.

The diagnosis of primary aldosteronism (PA) is critical for determining treatment strategies. The aim of the present study was to investigate the clinical value of preoperative adrenal venous sampling (AVS) for determining the benefit of PA surgery. Patients diagnosed with PA at Liaocheng People's Hospital (Liaocheng, China) between January 2015 and December 2020 were selected and divided into two groups: Group A underwent adrenal computed tomography (CT) only, whereas Group B underwent adrenal CT and successful AVS. Subsequently, the improvement rate of adrenal CT and adrenal CT + AVS in the treatment of PA was compared. A total of 164 patients were included, with an average age of 46.69±13.64 years. There were 62 patients in Group A and 102 in Group B. Among the patients diagnosed with unilateral lesions on adrenal CT scan, 82.61% of patients in group A and 87.72% in group B showed improvement; however, the difference was not significant (χ2=0.534, P=0.465). Among the patients diagnosed with bilateral lesions on adrenal CT images, 62.50% of patients in Group A and 91.11% of patients in Group B showed improvement (P=0.019). In conclusion, unilateral adrenal lesions detected by CT did not benefit significantly from surgical decision-making after AVS. AVS should be advised for all patients with bilateral adrenal PA who are willing to undergo adrenal surgery, which is conducive to correct lateral segmentation and improve treatment choices.