Tomography

Acute traumatic aortic injury (ATAI) is a rare but life-threatening consequence of blunt trauma that requires prompt diagnosis and accurate imaging assessment. This review presents an imaging-based approach to ATAI, with emphasis on computed tomography angiography (CTA) as the first-line modality for diagnosis, grading, treatment planning, and follow-up. CTA enables the detection of both direct and indirect signs while also allowing for the assessment of lesion severity, extent, and associated findings that may influence management. Familiarity with common mimics and anatomic variants improves diagnostic confidence and helps avoid false positive interpretations. Careful protocol optimization, including multiphasic acquisition, bolus timing, and postprocessing reconstructions, can further enhance image quality and diagnostic performance. Recognition of patient-related and technical CTA artifacts, along with strategies to reduce them, including the selective use of ECG-gated CTA, may further decrease diagnostic uncertainty. We also discuss the complementary roles of emerging CT technologies and magnetic resonance angiography in selected patients. Finally, we review current classification systems, imaging-guided management, post-treatment surveillance, and potential complications. Awareness of ATAI imaging findings, protocol optimization, and diagnostic pitfalls is essential for accurate interpretation and effective multidisciplinary care. Full article

Background/Objectives: We aim to evaluate whether digital imaging and communications in medicine (DICOM)-level deep learning-based iodine-boosting applied to dual-source dual-energy computed tomography (DECT) source DICOM improves image quality in low-iodine-dose abdominal DECT in adults undergoing post-procedure follow-up computed tomography (CT). Methods: This retrospective study included 43 adults (April–September 2025) who underwent dynamic dual-source DECT using a low-iodine protocol. Three CT reconstructions were compared: mixed images, conventional 50-keV virtual monoenergetic images (VMIs), and 50-keV VMIs generated after applying DICOM-based deep learning iodine-boosting/denoising to the tube-specific dual-energy source DICOM series prior to VMI/iodine-map reconstruction (deep learning-based reconstruction [DLR]-VMI). Iodine material density (IMD) images were compared between the conventional and DLR-processed datasets. Quantitative attenuation and signal-to-noise ratio (SNR) were assessed using paired and repeated-measures tests. Image quality was scored by two readers using a five-point Likert scale. Results: Attenuation varied across CT reconstructions for all regions of interest in both phases (all overall p < 0.001). Liver attenuation increased from 94.9 ± 22.0 Hounsfield units (HU) (VMI) to 114.5 ± 34.6 HU (DLR-VMI) during the arterial phase and from 127.6 ± 25.6 HU to 166.6 ± 39.9 HU during the portal venous phase (both p < 0.001). Liver SNR improved with DLR-VMI compared to VMI (arterial: 9.11 ± 3.62 vs. 6.06 ± 1.90; portal: 12.74 ± 3.56 vs. 7.90 ± 1.82; both p < 0.001). On IMD images, DLR increased HU-equivalent values and liver SNR (arterial: 5.20 ± 2.89 vs. 2.61 ± 1.39; portal: 9.22 ± 2.81 vs. 4.48 ± 1.28; both p < 0.001). Qualitatively, DLR-VMI yielded the highest overall image-quality scores for both reviewers in both phases (Reviewer 1, arterial/portal: 4 (4–5)/5 (4–5); Reviewer 2, arterial/portal: 4 (3–4)/4 (4–4)). DLR also improved the overall image quality of IMD images for both reviewers (all p < 0.001). Conclusions: Raw DICOM-level iodine-boosting DLR applied to dual-source DECT-source DICOM enabled enhanced image quality and improved quantitative and qualitative metrics in low-iodine-dose abdominal DECT. Full article

Background: The fat attenuation index (FAI) derived from coronary computed tomography angiography (CTA) is an emerging imaging biomarker of perivascular inflammation. Coronary flow reserve (CFR), assessed by phase-contrast (PC) cine cardiac magnetic resonance (CMR) of the coronary sinus, reflects coronary microvascular function. Although FAI has been linked to adverse outcomes in coronary artery disease (CAD), its relationship with CFR across different CAD stages is not well defined. Methods: We retrospectively evaluated 241 patients (mean age 73.4 ± 10.8 years; 149 men [61.8%]) who underwent both coronary CTA and CMR (122 with known CAD and 119 with suspected CAD). FAI was measured in the proximal left anterior descending (LAD), left circumflex (LCX), and right coronary (RCA) arteries. Impaired CFR was defined as <2.0. Univariable and multivariable logistic regression analyses were performed to identify factors associated with impaired CFR. Results: Impaired CFR was observed in 38 of 122 patients (31.1%) with known CAD and 26 of 119 (21.8%) with suspected CAD. Higher LAD-FAI was associated with impaired CFR in both groups: OR 1.06 (95% CI 1.01–1.11; p = 0.018) in known CAD and OR 1.08 (95% CI 1.02–1.15; p = 0.017) in suspected CAD. Correlation analysis also demonstrated an inverse relationship between LAD-FAI and CFR (p < 0.001), and the strength of association was comparable between the two groups. Conclusions: LAD-FAI was associated with impaired CFR in both suspected and known CAD, with comparable strength of association across the two groups. These findings indicate that perivascular inflammation, reflected by FAI, may relate to coronary microvascular dysfunction in different stages of CAD. Full article

Background/Objectives: Young women with breast cancer (aged ≤ 40 years) have distinct prognostic characteristics, yet little is known about how modifiable body composition factors influence outcomes in this age group. This study examined whether CT-derived body composition measures could identify thresholds that predict overall survival (OS). Methods: This was a single-center, 10-year, matched case–control study nested within a cohort, utilizing retrospectively collected data. Using an institutional database (2009–2018) and the initial cohort of 112 patients, we performed a subset analysis of patients with stage I–III breast cancer at diagnosis who had available pretreatment CT scans to estimate associations with body composition metrics and OS. The final analytic dataset included 89 individuals (49 survivors and 40 deceased). CT scans at the L3 level were analyzed using Slice-O-Matic software to quantify visceral (VAT), subcutaneous (SAT), intermuscular (IMAT), total adipose tissue (TAT), skeletal muscle density (SMD), skeletal muscle gauge (SMG), and skeletal muscle index (SMI). Cox proportional hazard models determined optimal cutpoints for OS. Multivariable models included adjustments for disease stage and hormone receptor status. Results: The median age was 35 (IQR, 32–38); 47% were White and 37% were Black. The majority (78%) were not Hispanic or Latina. Most (67%) were overweight/obese. Specific thresholds for IMAT index (>2.57), VAT (>31.38), and SMG (<2419.89) were associated with worse survival (all p < 0.05), while no cutpoints were identified for other variables. Conclusions: These findings show that muscle fat infiltration and reduced muscle quality have important prognostic value in young women with breast cancer. Exploratory cutpoints derived from routine staging CT scans may help inform risk stratification and generate hypotheses for targeted nutritional or exercise interventions, but require validation in larger, independent cohorts before clinical application. Full article

Background: Epidural procedures benefit from a pre-procedural informed estimation of epidural depth, as anticipating the approximate distance can support safer needle placement and reduce technical difficulties during analgesia or anesthesia procedures. The influence of ethnicity has been established across different populations worldwide; however, there is a lack of Saudi-specific MRI data on epidural depth among the adult population. Aim of this Study: To measure the skin to epidural space distance (SED) at the lumbar interspaces L3–L4 and L4–L5 in the Saudi adult population using magnetic resonance imaging (MRI) and to examine its correlations with age, sex, height, weight, and body mass index (BMI). Methods: In this retrospective cross-sectional study, sagittal T1-weighted lumbar MRI images of the spine of 169 adult Saudi patients were studied. The age group ranged from 20 to 70 years, with an equal distribution of males and females. The skin to epidural space distance (SED) was measured at the L3–L4 and L4–L5 interspaces, and its correlations with age, sex, height, weight, and BMI were analyzed. Results: The average measurement of skin to epidural space distance (SED) was 59.08 mm in L3–L4, and 63.21 in L4–L5. BMI and weight showed strong positive correlations with SED across both levels. Female sex was associated with longer SED values at L4–L5. There was no significant correlation between SED and age or height of the patients. Conclusions: MRI-based assessment of SED revealed strong correlations with weight and BMI, but no correlation with height, age, and sex. These findings support the individualized estimation of epidural depth and needle length selection to enhance procedural safety and reduce complications. Full article

Background and Objectives: The association between spinal and pelvic alignment significantly impacts sagittal balance in adults. This study, that is retrospective, aims to investigate sagittal alignment anatomy of the pelvis and spine in juvenile idiopathic scoliosis (JIS) and adolescent idiopathic scoliosis (AIS) patients. Materials and Methods: We evaluated nine sagittal parameters from lateral radiographs of 100 JIS and AIS patients, including thoracic kyphosis (TKA), lumbar lordosis (LLA), pelvic tilt (PTA), pelvic incidence (PIA), spinosacral (SSA), sacral slope (SSLA), C7 tilt angles (C7-TA), sagittal vertical axis length (SVAL), and odontoid process hip axis angle (OPHAA) using the ImageJ program. Participants were classified based on their coronal curve group. Analysis of variance compared parameters between curve groups, and Pearson coefficients assessed the relationship between all parameters (p < 0.05). Results: Female participants had an average age of 13.4, and male participants had an average age of 13.0. Female participants had an average scoliosis degree of 19.3, while male participants had 15.2. PIA, PTA, SSLA, and SSA values were significantly higher in women participants than in men participants (p < 0.05). Additionally, PIA, PTA, SSLA, SSA, and OPHAA values were significantly lower in participants with a lower scoliosis degree (p < 0.05). We observed a moderately positive association between LLA and TKA, PIA, SSA, and C7-TA. There was also a moderate positive association between spinopelvic alignment parameters and the degree of scoliosis in participants. Conclusions: Easily measured values such as PIA, PTA, SSLA, SSA, and OPHAA may be related to severity of vertebral column deformities in patients, making them valuable for monitoring scoliosis patients. Full article

Background: This study aims to evaluate the prevalence, spectrum, and coexistence of anatomical variations in the major branches of the abdominal aorta using Multidetector Computed Tomography (MDCT) angiography, with a specific emphasis on analyzing sex-related differences in a large-scale cohort. Methods: A retrospective analysis was conducted on 1174 patients (63.8% male, 36.2% female; mean age 60.54) who underwent abdominal CT angiography between January 2023 and June 2024. Images were acquired using a 128-slice MDCT scanner and reconstructed for detailed vascular assessment. Statistical comparisons between genders were performed using Chi-square and Fisher–Freeman–Halton tests, with p < 0.05 considered significant. Results: The celiac trunk (93.3%), superior mesenteric artery (SMA) (97.1%), and inferior mesenteric artery (IMA) (98.5%) predominantly showed classical patterns. However, significant sex-related differences were identified. Females exhibited significantly higher rates of classical patterns for the celiac trunk (96.2% vs. 91.7%), IMA (99.1% vs. 98.1%), right hepatic artery (RHA) (91.5% vs. 82.6%), and left hepatic artery (LHA) (95.8% vs. 85.4%). Conversely, males showed a higher prevalence of complex variations, including replaced/accessory hepatic arteries and the absence of the common hepatic artery. The number of right and left renal arteries was similar between sexes and did not show a significant difference, while horseshoe kidney was detected only in males. Conclusions: Abdominal vascular structures adhere to classical anatomy more frequently in females, while males exhibit greater morphological variability. These findings emphasize the necessity of gender-specific preoperative vascular mapping to optimize surgical outcomes and reduce morbidity. Full article

Objectives: The objective of this study is to investigate the clinical potential of generating artificial bone scintigraphy (aBS), defined here as a deep learning-generated bone scintigraphy image that simulates delayed-phase bone scintigraphy (dBS) characteristics, from early-phase bone scintigraphy (eBS) obtained with a short waiting time using an unpaired image-to-image translation method in patients with breast cancer (BC). Methods: In this single-center prospective study involving 245 patients with BC (195 for training and 50 for testing), eBS and dBS were performed. Using the contrastive unpaired translation (CUT) model, we trained with anterior and posterior images of the eBS and dBS from the training group. We then generated aBS images targeting dBS by inputting eBS from the test group for both anterior and posterior views. We conducted quantitative, qualitative, and visual assessments to evaluate aBS. Results: The points of the anterior and posterior images of aBS on the qualitative four-point and five-point rating scales were significantly higher than those of eBS (p < 0.0001). Three nuclear medicine physicians performed visual assessments, demonstrating consistent findings on the presence of bone metastases in both aBS and dBS. Their visual evaluations indicated that the bone-to-soft tissue contrast in aBS was superior to that in eBS. The quantitative metrics of aBS were superior to those of eBS. However, aBS was inferior to the targeted dBS in terms of qualitative and visual assessments. Conclusions: The aBS generated through CUT was superior to eBS in quantitative, qualitative, and visual assessments and preserved lesion-related information comparable to dBS. Although these findings do not support replacement of dBS for definitive diagnosis, they support the feasibility of aBS as an assistive delayed-phase-like image generation approach from earlier-acquired bone scintigraphy. Full article

Background/Objectives: Modern tomographic reconstruction methods—including physics-informed and AI-based approaches—can produce very high fidelity images. In this regime, widely used global image quality metrics often approach saturation, making it harder to distinguish residual differences between methods and identify remaining performance gaps. This study introduces a physically grounded and standardized evaluation framework designed to retain sensitivity beyond conventional global metrics and support both comparison and systematic improvement in tomographic reconstruction methods. Methods: The proposed framework defines standardized reference images—“Source”, “Detector”, “Ideal”, and “Realistic”—using Monte Carlo simulations, with the Ideal Image serving as a physically grounded benchmark. Reconstruction performance is evaluated using pixel-wise difference and ${\chi }^2$ maps, Region-of-Interest analysis, intensity (gray-value) histogram comparisons, and the Structure and Contrast Index (SCI), computed on difference maps. Demonstrations use simulated SPECT data reconstructed with ART, MLEM, and RISE-1. Results: Across case studies, SCI and ${\chi }^2$-based diagnostics reveal structured residuals and localized deficiencies not evident from global similarity metrics such as SSIM or NMSE. Comparative analyses show that methods with similar global scores can exhibit distinct residual structures and region-specific performance variations, while improved agreement in the sinogram domain does not necessarily translate into improved image fidelity. Histogram-based diagnostics provide complementary information on intensity redistribution not captured by pixel-domain summaries. Conclusions: The framework provides a reproducible, physically meaningful, and sensitive approach for evaluating tomographic reconstruction performance in the high-fidelity regime. By combining standardized reference images with multi-domain and multi-metric analysis, it enables robust benchmarking and supports physically consistent interpretation of reconstruction quality. Full article

Background/Objectives: Radiofrequency (RF) wire energy can be used for tissue ablation across many conditions. Adjusting RF generator parameters allows RF energy to puncture tissue with minimal adjacent damage. When RF energy is applied to tissue, however, microbubbles are produced, obstructing intravascular ultrasound (IVUS). Mitigation of RF-generated microbubbles has been studied for ablation but not for puncture. Methods: This paper describes an in vitro bench study using ex vivo bovine live tissue. A model was created with bovine liver tissue and an IVUS catheter submerged in a saline bath. Tissue was punctured with an RF guidewire to recreate microbubbles. Following the puncture, various methods were applied: altering the mechanical index of the IVUS, applying a VF10-5 Linear probe (Siemens), and applying a L12-3 Linear probe (Philips). Regions of interest (ROIs) were selected to track pixel brightness as a proxy for microbubbles. Results: The control increased ROI brightness by 1.5%. Altering the mechanical index of IVUS reduced ROI brightness by 1.2%. VF10-5 probe application increased ROI brightness by 1.2%. L12-3 probe application reduced ROI brightness by 33.0% (p = 0.046, n = 3, one-sample t-test). Brightness reduction was most pronounced at the site of initial RF wire puncture, where microbubbles accumulated. Tip visualization improved, allowing for more precise wire trajectory adjustments. Conclusions: External US with an L12-3 probe was able to dissipate microbubbles effectively to improve IVUS guidance following RF wire puncture in an in vitro exploratory bench model. Full article

Objective: This study aimed to investigate the associations between intratumoral and peritumoral apparent diffusion coefficient (ADC) measurements and multiparametric biological markers in invasive breast cancer using a novel peritumoral analysis approach. Materials and Methods: In this retrospective study, 68 patients underwent 1.5 T breast magnetic resonance imaging. Following volumetric tumor segmentation, the peritumoral environment was analyzed using a segmentation-based, improved multilayered concentric shell model at distances of 0–2, 2–5, and 5–10 mm. The ADC values were normalized to contralateral parenchyma (rADC), and the intratumoral-to-peritumoral ADC ratios were calculated. Parameters were correlated with molecular subtypes, axillary metastasis, lymphovascular invasion (LVI), histologic grade, and Ki-67 index. Results: Lower intratumoral ADC and lower intratumoral-to-peritumoral ADC ratios were significantly associated with higher histologic grade, increased Ki-67, and axillary metastasis (p < 0.05). The 0–2 mm shell, representing the immediate invasion front, demonstrated the strongest associations with lymphovascular invasion and nodal involvement, while distance-dependent attenuation of effect sizes was observed across more distal peritumoral layers. Conclusions: The segmentation-based and improved multilayered shell model effectively captures the distance-dependent biological gradient of the peritumoral microenvironment. The intratumoral-to-peritumoral ADC ratios within the immediate 2 mm zone may provide complementary information regarding imaging markers of tumor aggressiveness when interpreted alongside absolute measurements. These findings suggest a potential role for these parameters as complementary imaging markers in preoperative risk stratification within a multiparametric framework. Full article

Background/Objectives: Liver fibrosis, if left untreated, can lead to cirrhosis and cancer. The current standard liver biopsy for fibrosis staging is invasive and prone to risks of complication. The objective of this study was to develop a new noninvasive method to quantify fibrosis using diamagnetic susceptibility sources generated from multi-echo gradient echo (mGRE) data with both magnitude decay R2* modeling and phase QSM modeling. Methods: mGRE data of ex vivo liver explants was processed with fat–water separation and then susceptibility source separation. Negative susceptibility was used to measure diamagnetic fibrosis. In 20 formalin-fixed liver explant sections, negative susceptibility maps were compared with other MRI parameters against pathology for fibrosis staging. Results: The correlation between the negative susceptibility sources and the fibrosis stages was evaluated with Spearman coefficients. Negative susceptibility differentiated (i) no or mild fibrosis (stages F0 to F1) from moderate-to-advanced fibrosis (stages F2 to F3; p = 0.0025), (ii) stages F2 to F3 from cirrhosis (stage F4; p = 0.021), and (iii) no-to-moderate fibrosis (stages F0 to F2) from advanced fibrosis or cirrhosis (stages F3 to F4) with a sensitivity of 90%, a specificity of 90%, and a 0.88 Receiver Operating Characteristic Area Under the Curve (AUC) (p = 0.0017). Conclusions: For staging fibrosis, negative susceptibility was superior to other MRI parameters, including R2*, QSM, and PDFF. Negative susceptibility sources were positively correlated with the fibrosis stage (r = 0.60). Negative susceptibility could be valuable for MRI staging in liver fibrosis. Full article

Background/Objectives: Breast cancer screening such as mammography supports earlier detection, but variability in interpretation can still lead to missed cancers and avoidable follow-up testing. We evaluated ChatGPT-5.2 Thinking (OpenAI) as a stand-alone model for examination-level malignancy classification on standard bilateral mammography views in a biopsy-referred cohort, compared with breast radiologists, and assessed laterality performance. Methods: We conducted a retrospective, multicenter diagnostic-accuracy study across breast imaging centers in Saudi Arabia. From an upstream screened cohort (n = 1225), we constructed a biopsy-referred test set of 100 mammography examinations (four 2D views per exam: bilateral CC and MLO; 400 images), including 61 biopsy-confirmed malignancies and 39 biopsy-negative controls, with pathology as the reference standard. Radiologists were blinded to pathology and AI outputs and assigned BI-RADS (0–5) and suspected laterality. ChatGPT-5.2 interpreted the same de-identified views using a BI-RADS-guided prompt to generate BI-RADS and laterality. The sensitivity, specificity, accuracy, and laterality concordance were then estimated. Results: ChatGPT-5.2 had higher sensitivity than radiologists (95.08% vs. 81.97%) but markedly lower specificity (10.26% vs. 56.41%), resulting in lower overall accuracy (62.00% vs. 72.00%). The AI produced 58 true positives, 35 false positives, and 3 false negatives, while radiologists produced 50 true positives, 17 false positives, and 11 false negatives. Laterality accuracy among malignant examinations was 60.66%. Conclusions: In this pathology-anchored, biopsy-referred evaluation, ChatGPT-5.2 identified more cancers but generated substantially more false-positive classifications and showed only moderate breast-side localization. These findings support use as a concurrent aid or prioritization tool rather than a stand-alone reader and motivate efforts to improve specificity and laterality before prospective validation. Full article

Background: The Magnetic Resonance Imaging (MRI)-based tumor segmentation remains a challenging problem in medical imaging due to tumor heterogeneity, unpredictable morphological features, and the high complexity of calculations needed to implement it in clinical practice, putting it out of the scope of real-time applications. Although neural networks have significantly improved segmentation performance, they still struggle to capture morphological tumor features while maintaining computational efficiency. This work introduces Hybrid Adaptive Attention U-Net (HAAU-Net) framework, combining context-aware morphologically stable features and spatial channel attention to achieve high-quality tumor segmentation with less computational cost. Methods: The proposed HAAU-Net framework integrates multi-scale Adaptive Attention Blocks (AAB), Context-Aware Morphological Feature Module (CAMFM) and Spatial-Channel Hybrid Attention Mechanism (SCHAM). CAMFM is used to maintain the stability of morphological features by hierarchical aggregation and dynamic normalization of features. SCHAM enhances feature representation by modelling channels and spatial regions where the strongest feature are determined to use in segmentation. On the BRaTS 2022/2023 data, the proposed HAAU-Net is evaluated using four modalities including T1, T1GD, T2 and T2-FLAIR sequences. Results: The proposed model able to obtain 96.8% segmentation accuracy with a Dice coefficient of 0.89 on the entire tumor region, outperforming the alternative U-Net (0.83) and conventional CNN methods of segmentation (0.81). The proposed HAAU-Net architecture cuts the computational complexity of the standard deep learning models by 43% and still achieve real-time inference (28 FPS on a regular GPU). The hybrid model used to predict survival has a C-Index of 0.91 which is higher than the traditional SVM-based methods (0.72). Conclusions: Spatial-channel attention, combined with morphologically stable features, can be combined to allow clinically significant interpretability in attention maps. The proposed framework significantly improves segmentation performance while maintaining computational effeciency. This broad system has a serious potential of AI-enabled clinical decision support system and early prognostic diagnosis in neuro-oncology with practical deployment capability. Full article

Background/Objectives: Radiological assessment has become indispensable for modern clinical decision-making. Image quality plays a critical role in the reliability of radiological interpretation. Unlike most previous studies, this study investigated the effect of monitor type on diagnostic accuracy and ease of diagnosis under physical conditions outside the radiology unit. Methods: Three image sets were prepared for the study, consisting of emergency radiological images, each containing 50 computed tomography, magnetic resonance imaging, and digital radiography images. The image sets were examined by five emergency specialists, who were blinded to each other’s work, under emergency service conditions on a standard monitor (SM), medical monitor (MM), and advanced monitor (AM). The accuracy and ease of diagnosis were analyzed statistically according to the type of monitor used. Results: Overall diagnostic accuracy rates were 98.7% for SM, 100% for AM, and 100% for MM. Cochran’s Q test demonstrated a statistically significant difference between monitor types (p = 0.002), with significant pairwise differences for SM–AM and SM–MM comparisons. The absolute risk difference between SM and AM/MM was 1.3%, corresponding to a relative risk of 1.013 and a number needed to benefit (NNB) of 77. Ease of diagnosis scores increased progressively across monitor types (SM: 7.6 [IQR 7–8], AM: 9.4 [IQR 9–9.8], MM: 9.8 [IQR 9.6–10]; p < 0.001), with a large overall effect size (Kendall’s W = 0.81). Multilevel modeling confirmed that these associations persisted after adjustment for clustering effects. Conclusions: In situations where medical monitors cannot be used due to cost and operational constraints, opting for advanced monitors instead of standard monitors may modestly improve diagnostic accuracy while substantially enhancing perceived ease of diagnosis. Full article

Background/Objectives: To comprehensively evaluate longitudinal retinal and choroidal vascular changes after phacoemulsification using automated optical coherence tomography angiography (OCTA) analysis and to investigate clinical factors influencing these changes. Methods: This retrospective study included 26 subjects (31 eyes) who underwent uncomplicated phacoemulsification. OCTA was performed at baseline and at 1 day, 1 week, 1 month, and 2 months postoperatively. Automated quantitative analysis was applied to assess vessel density- and structure-related parameters in the superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris, and Haller layer. Longitudinal changes were analyzed using repeated-measures analysis of variance, with time × clinical factor interactions evaluated for diabetes mellitus, anesthesia method, and sex. Inter-layer associations were assessed using Spearman correlation analysis. Results: Significant longitudinal changes were observed in retinal layers. In the SCP, vessel density increased from 42.59 ± 1.46 at baseline to 44.10 ± 1.44 at 2 months (p = 0.002), accompanied by increases in vessel length and node counts (all p < 0.001). In the DCP, vessel density increased from 34.66 ± 5.98 to 38.65 ± 4.83 (p < 0.001). In contrast, choriocapillaris-related parameters showed no significant overall time effect. In the Haller layer, mean vessel diameter decreased significantly over time (p < 0.001), while density-related metrics remained unchanged. ΔVAD demonstrated positive correlations between adjacent layers (SCP–DCP and DCP–choriocapillaris) and a negative correlation between choriocapillaris and Haller layers. Diabetes mellitus showed no significant longitudinal effect, whereas retrobulbar anesthesia and sex significantly modified selected choroidal trajectories. Conclusions: Automated and integrated OCTA analysis revealed layer-dependent retinal and choroidal vascular responses after phacoemulsification, with coordinated changes confined mainly to anatomically adjacent layers and selective modulation by clinical factors. Full article

Background/Objectives: This article develops theory and methods for 3D tomographic imaging of absorption coefficient distributions using axial scanning with EUV microscopes at 46× and 345× magnification. Unlike conventional CT that requires sample rotation, axial scanning moves cells through the microscope focus. The aim is tomographic reconstruction of living cell fine structure without the organelle staining used in optical fluorescence microscopy or ultra-thin cell slicing as in electron microscopy. Methods: By generalizing the geometric-optical approximation for small absorption coefficient inhomogeneities in absorbing media, we derived a new explicit tomography equation and solution algorithm validated through numerical simulation. The approach was applied to Convallaria cell analysis using the ×46 microscope. For the ×345 microscope, we developed an alternative method where the kernel of the tomography integral equation was determined experimentally using gold nanospheres with known absorption coefficient, shape, and position. This method was tested through modeling and applied to diagnostics of Convallaria and mouse cerebellar granule cells. Results: The developed methods resolve subcellular features down to 140 nm using the ×46 microscope and 50 nm using the ×345 microscope. Thin low-contrast intracellular structures and individual 50–100 nm organelles were detected. Conclusions: Methods for retrieving absorption coefficient distributions in cone-beam geometry based on geometric-optical theory generalization and on calibration by gold nanoparticles have been developed and validated through numerical simulation and cell analysis. These methods demonstrate for the first time the effectiveness of axial nanotomography using multilayer mirror microscopes for cell diagnostics. Full article

Background: Although magnetic resonance imaging (MRI) provides excellent soft-tissue contrast for most spinal evaluations, computed tomography (CT) is still always required for preoperative planning to assess osseous anatomy and determine surgical device size, increasing the radiation exposure and workflow complexity. CT-like images enable visualization of precise bone morphology without ionizing radiation. In addition, these images often provide CT myelography-like contrasts, allowing the simultaneous depiction of the spinal canal area (SCA). This study aimed to evaluate whether CT-like images provide measurement accuracy equivalent to conventional CT and MRI for pedicle screw planning and spinal canal area assessment. Methods: We retrospectively analyzed paired lumbar CT and MRI datasets obtained within ≤1 month in 51 patients. Pedicle width and length were measured on CT and CT-like images, whereas SCA was measured on T2 weighed-images and CT-like images. A total of 224 vertebrae were analyzed. Annotated images were independently evaluated by two readers in a randomized order. Inter-modality agreement was assessed using intraclass correlation coefficients (ICCs) and a Bland–Altman analysis. Results: CT-like images demonstrated an excellent agreement with CT for pedicle measurements (ICCs: 0.968–0.985 for width; 0.922–0.966 for length). Mean differences were ≤0.1 mm for pedicle width and approximately 1 mm for pedicle length, which are unlikely to affect screw selection. The agreement with T2WI for SCA was good to excellent (ICCs: 0.766–0.945). Conclusions: CT-like images provide comparable performance for quantitative pedicle assessment and show high agreement for SCA evaluation, supporting comprehensive preoperative assessment with a single MRI examination. Full article

Background/Objectives: Post-cholecystectomy syndrome (PCS) remains diagnostically challenging due to overlapping biliary and non-biliary causes. This study aimed to evaluate whether common bile duct (CBD) diameter measured by MRCP can serve as a practical triage parameter in symptomatic PCS patients and to define a data-supported threshold for predicting clinically relevant biliary pathology. Secondary objectives included assessing correlations between MRCP findings and upper endoscopic features. Methods: In this retrospective single-center study, symptomatic adults undergoing upper endoscopy and MRCP were analyzed. Demographic, clinical, biochemical, radiologic, and endoscopic variables were recorded. Diagnostic performance was assessed using ROC analysis, and independent predictors of biliary dilatation were evaluated with multivariable logistic regression. Results: We analyzed 141 symptomatic post-cholecystectomy patients (mean age 58.2 ± 16.3 years; 67.4% female; median time since surgery 18 [9–36] months). Major symptoms: abdominal pain 84.9%, dyspepsia/bloating 47.5%, nausea/vomiting 22.3%, diarrhea 15.1%. CBD diameter measurements were available in the MRCP subgroup (n = 45); ERCP was performed selectively (n = 12). MRCP findings: CBD ≥ 7 mm 31.9%, biliary dilatation 14.9%, stricture 2.8%, suspected Oddi dysfunction 11.3%, postoperative complications 39.7%. Endoscopy: mucosal inflammation 91.5%; normal 8.5%. Significant correlations included CBD diameter vs. mucosal inflammation (r = 0.32, p = 0.001), dilatation vs. bile reflux (r = 0.28, p = 0.004), and Oddi dysfunction vs. papillary edema (r = 0.41, p = 0.001). CBD diameter showed the best diagnostic performance (AUC 0.82, 95% CI 0.74–0.90; cut-off ≥ 8.0 mm; sensitivity 78.3%; specificity 81.5%; p < 0.001). In multivariable analysis, age independently predicted biliary dilatation (OR 1.05 per year; 95% CI 1.01–1.09; p = 0.007). Conclusions: In symptomatic post-cholecystectomy patients, MRCP-measured CBD diameter provides a useful metric for risk stratification, with a threshold of ≥8 mm identifying patients more likely to harbor biliary pathology. These findings support a structured diagnostic approach that prioritizes noninvasive imaging while reserving ERCP for selected cases. Further prospective validation is warranted. Full article