Search Results (817)

Background/Objectives: Liver metastasis after surgery for adrenocortical carcinoma (ACC) is a critical factor affecting patient prognosis; however, relevant ultrasound imaging features remain poorly characterized. This retrospective study aims to systematically describe the conventional ultrasound and contrast-enhanced ultrasound (CEUS) features of post-surgical hepatic metastases from ACC and to evaluate the clinical utility of ultrasonography in the diagnosis and follow-up. Methods: A total of 10 patients with post-surgical ACC liver metastases via ultrasound-guided liver biopsy between January 2000 and June 2026 at West China Hospital of Sichuan University were retrospectively enrolled. All patients underwent conventional ultrasound (B-mode and color Doppler flow imaging, CDFI) and CEUS. Given the small sample size, only descriptive statistics were performed, and all findings should be interpreted as exploratory. Results: All 10 patients were female (age range: 38–56 years), 70% had multiple lesions. On B-mode ultrasound, 80% of lesions appeared hypoechoic, 100% exhibited heterogeneous internal echotexture, 80% had irregular shapes, and 60% displayed well-defined margins. CDFI detected internal or perilesional blood flow signals in 90% of lesions, predominantly perilesional (50%). CEUS demonstrated arterial-phase hyperenhancement in all cases (50% heterogeneous hyperenhancement, 30% peripheral-dominant enhancement, and 20% ring-like nodular hyperenhancement), followed by rapid wash-out during the portal venous or delayed phases, with 100% of lesions showing hypoenhancement at 180 s. Conclusions: These exploratory findings suggest that post-surgical ACC liver metastases typically manifest on conventional ultrasound as hypoechoic, heterogeneous solid masses with variable margins and predominant perilesional blood flow. CEUS reveals a characteristic “fast-in, fast-out” malignant enhancement pattern. CEUS may serve as a useful adjunct to conventional imaging within a multimodal surveillance strategy, but larger prospective studies are needed to confirm its diagnostic value. Full article

Cardiovascular ultrasound is a cornerstone of noninvasive cardiac and vascular assessment, yet conventional interpretation remains operator-dependent, variable, and limited in sensitivity for subclinical disease. Artificial intelligence (AI), particularly machine learning (ML), deep learning (DL), and, most recently, vision–language and foundation models, offers tools to automate, standardize, and extend ultrasound analysis. This narrative review examines the role of AI-enhanced cardiovascular ultrasound in the transition from descriptive imaging toward predictive and personalized medicine. We conducted a structured literature search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar (January 2016–May 2026), combining Medical Subject Headings and free-text terms related to AI and cardiovascular ultrasound. Original studies, meta-analyses, reviews, consensus documents, and seminal works were considered. AI now spans the entire echocardiographic workflow, acquisition guidance, view classification, segmentation (Dice ≈ 0.92–0.94 on public datasets), and automated quantification of ejection fraction and global longitudinal strain, achieving expert-level accuracy and improved reproducibility. Across clinical domains, AI supports ischemia detection on stress echocardiography, heart-failure phenogrouping, Doppler-independent aortic stenosis detection, and carotid plaque characterization for stroke-risk stratification. Emerging vision–language and multitask foundation models (e.g., EchoCLIP, EchoPrime, and PanEcho) point toward general-purpose interpretation, and a growing number of tools (Caption Guidance, Us2.ai, and Ultromics EchoGo) have obtained FDA clearance and/or CE marking. Increasingly, AI-derived imaging biomarkers feed multimodal models that enable individualized risk prediction and therapy selection. AI-enhanced cardiovascular ultrasound is poised to become a central tool of precision cardiology. Realizing its potential will require prospective multicenter validation, cross-vendor standardization, attention to generalizability, interpretability, and reproducibility, and evolving regulatory and ethical frameworks. Full article

Background/Objectives: Temporomandibular joint (TMJ) abnormalities are a common finding in the general adult population, but they have been rarely investigated in people receiving chronic dialysis. The TMJ is a unique synovial joint that can be altered by either inflammatory or degenerative processes, both of which are amenable to ultrasound (US) assessment. The aim of this study was to describe the pattern of TMJ involvement in a cohort of hemodialysis patients using TMJ ultrasound (TMJ US). Methods: This cross-sectional, single-center study evaluated the clinical utility of TMJ US to detect inflammatory and degenerative changes in patients undergoing chronic hemodialysis and was carried out between June and December 2025. Demographic data, dialysis vintage, the Controlling Nutritional Status (CONUT) score and the Charlson Comorbidity Index (CCI) were collected and related to TMJ US findings and to bone-metabolism biomarkers (calcium, phosphate, parathyroid hormone). Results: 100 hemodialysis patients were included (65 male, 65%; mean age 71.6 ± 13.1 years). Comorbidity and undernutrition were frequent findings (CCI ≥ 4 in 63%; CONUT ≥ 3 in 68%). TMJ US revealed that degenerative indicators were more common than inflammatory ones: calcifications (36%), condylar irregularities (33%) and enthesophytes (25%) were the most prevalent degenerative findings, whereas joint effusion (16%), synovial hypertrophy (15%) and cartilage changes (15%) were the leading inflammatory findings; a positive power Doppler signal was rare (1%). Cortical/condylar irregularity was significantly more prevalent in patients with a dialysis vintage of less than 30 months (43.8% vs. 23.1%, p = 0.034), who also had lower serum calcium levels. No other TMJ US finding showed a significant association with age, sex, comorbidity burden, nutritional status, or bone-metabolism parameters on univariate. Conclusions: TMJ US demonstrated a substantial burden of subclinical degenerative and, to a lesser extent, inflammatory TMJ findings in this cohort of hemodialysis patients; none of these abnormalities were spontaneously reported as symptomatic, and their prevalence was independent of age, dialysis vintage, comorbidity, nutritional status and classical bone-metabolism parameters. These findings cannot be directly attributed to the dialysis/uremic environment rather than to age-related degeneration; they support the concept that the TMJ warrants further investigation as a potentially under-recognized target within the broader systemic metabolic derangement of end-stage kidney disease, and suggest that TMJ US is a feasible, accessible technique for detecting subclinical TMJ involvement in this population, pending confirmation of clinical utility in controlled studies. Full article

Background/Objectives: Gestational diabetes mellitus (GDM) is one of the most common metabolic complications of pregnancy and is associated with adverse maternal and neonatal outcomes. Current screening strategies are generally performed during the end of the second trimester, limiting opportunities for early intervention. Increasing evidence suggests that placental and fetal ultrasound markers detectable in early pregnancy may reflect the pathophysiological changes preceding the clinical diagnosis of GDM. This narrative review aims to summarize the current evidence regarding first- and second-trimester placental and fetal ultrasound markers associated with the subsequent development of GDM. Methods: A narrative review of the literature was conducted focusing on studies evaluating ultrasound markers of placental morphology, placental vascularization and function, uterine artery Doppler indices, placental volume, placental thickness, and fetal biometric and functional parameters in relation to later GDM diagnosis. Twenty-two studies were identified and analyzed to assess their clinical utility and predictive value. Results: Increasing evidence suggests that placental and fetal ultrasound markers detectable in early pregnancy may reflect pathophysiological changes preceding the clinical diagnosis of GDM. Three-dimensional power Doppler, particularly the vascularization–flow index, has demonstrated reduced placental vascularization in pregnancies subsequently complicated by GDM. Placental elastography and artificial intelligence-based radiomic analysis also show promising predictive potential. Uterine artery Doppler has demonstrated limited and inconsistent value. Fetal findings suggest that conventional biometry has limited predictive utility, whereas fetal growth velocity and markers of adiposity, including anterior abdominal wall thickness and abdominal overgrowth, more consistently identify early adaptations associated with later GDM. However, substantial methodological heterogeneity limits interpretation. Conclusions: Early placental and fetal ultrasound markers represent promising non-invasive tools for the early identification of pregnancies at risk for GDM. Further large-scale prospective studies are required to validate their predictive performance and establish standardized assessment protocols. Integrating maternal clinical characteristics and biochemical parameters may enhance future screening strategies for GDM. Full article

Background: Combined bone and soft-tissue loss of the lower extremity requires complex reconstructive pathways. While acute post-traumatic infected defects and chronic osteomyelitis differ clinically, both present reconstructive challenges that demand radical debridement, infection-directed therapy, and radiology-guided soft-tissue coverage. Objective: To evaluate treatment options and functional recovery using a standardized orthoplastic workflow supported by radiological planning in patients with lower-extremity combined bone and soft-tissue loss of acute traumatic infectious etiology and chronic osteomyelitis. Methods: In this retrospective case series, 27 patients treated between May 2021 and December 2023 were included and divided into two groups: (A) acute post-traumatic bone and soft-tissue loss (n = 17) and (B) chronic osteomyelitis with fistula and soft-tissue loss (n = 10). Patients received multidisciplinary orthoplastic management with local and/or free flaps selected according to defect characteristics and radiology-guided vascular assessment (CT/MRI and angiographic CT; Doppler ultrasound for regional flap planning). Empirical broad-spectrum antibiotics were started after intraoperative biopsy sampling and later tailored to microbiological results. Healing was defined by bone union, infection/inflammation resolution, and flap healing. Functional outcomes were assessed using the Lower Limb Functional Index (LLFI). Due to baseline differences and a small sample size, within-group pre- vs. post-treatment changes in LLFI were analyzed separately. Results: Both groups demonstrated clinically relevant improvements in LLFI after treatment when assessed within each group. Flap selection and antibiotic strategy were implemented according to predefined multidisciplinary endpoints, achieving the study healing criteria in the included patients. Conclusions: A standardized orthoplastic reconstruction strategy supported by radiology-guided planning appears feasible in distinct clinical contexts of acute infected traumatic defects and chronic osteomyelitis, with improvement in lower-limb function assessed within groups. Full article

Thoracopagus conjoined twins are the most common type of conjoined twinning and are frequently associated with shared cardiac anatomy, the principal determinant of prognosis and postnatal survival. Early prenatal diagnosis is essential for accurate counseling and timely pregnancy management. We report the diagnosis of thoracopagus conjoined twins with a shared cardiac structure in a 35-year-old primigravid woman at 8 weeks and 3 days of gestation. High-resolution transvaginal ultrasound demonstrated persistent thoracic fusion, fixed relative fetal position, a single yolk sac, a single umbilical cord, and absence of an intertwin membrane. Color Doppler confirmed a single sonographically detectable cardiac complex, while three-dimensional ultrasound enhanced spatial visualization and facilitated parental counseling. Differential diagnoses, including monochorionic twins with close apposition, TRAP sequence, body stalk anomaly, and other forms of conjoined twinning, were systematically excluded. Early first-trimester recognition of thoracopagus conjoined twins with shared cardiac anatomy is feasible using dynamic ultrasound and Doppler imaging. Establishing the diagnosis before the end of the first trimester enables accurate prognostic assessment, timely multidisciplinary counseling, and informed parental decision-making for this condition associated with an extremely poor prognosis. Full article

Background/Objectives: A surface feature first noticed after aesthetic treatment may be misclassified as treatment-created. This single-patient observation examined a stable medial tear-trough contour noticed after midface volumization. The aims were to map its clinically continuous course across anatomical layers and assess whether a superficial orbicularis oculi (OOc)-related component could modify its visibility. Methods: Clinical examination, palpation-guided surface marking, retrospective photography, cone-beam computed tomography (CBCT), thin-section computed tomography (CT), high-frequency ultrasound, and qualitative color Doppler were correlated using the marked course as a common spatial reference. Results: Diffuse fullness decreased after clinically indicated hyaluronidase treatment, whereas a narrower palpable line persisted; retrospective photographs showed similar earlier topography. CT/CBCT identified a bilateral asymmetric osseous correlate confined to the superior medial segment. Ultrasound identified a superficial band-like structure along the medial and inferior border of OOc with sonographic features compatible with an OOc-related muscular component; it was more superficial on the left and separated from the levator labii superioris alaeque nasi/levator labii superioris (LLSAN/LLS) field by adipose tissue. Qualitative color Doppler localized a deeper angular venous pathway and a superficial tributary passing beneath the band. The clinical course was continuous, but its correlates changed by segment and plane. Conclusions: In this patient, the contour was best understood as a layered boundary rather than a single substrate. Changes in surrounding volume may have increased its visibility, while the OOc-related band may have sharpened the edge adjacent to the tear-trough hollow. Layer-specific classification may be useful before corrective treatment is considered. Full article

Background/Objectives: Fetal hepatosplenomegaly is an uncommon but clinically significant prenatal finding associated with a wide range of heterogeneous conditions, including congenital infections, fetal anemia, genetic syndromes, metabolic disorders, and other, less common abnormalities. Because of its nonspecific presentation and diverse etiologies, it represents a diagnostic challenge that requires a structured, multidisciplinary approach. This review aims to present a practical, clinically oriented, stepwise approach to the prenatal evaluation of fetal hepatosplenomegaly, integrating current evidence to facilitate differential diagnosis and guide prenatal management. Methods: A comprehensive literature review was performed, focusing on ultrasound diagnosis, differential diagnosis, genetic evaluation, and prenatal management strategies in fetuses with hepatosplenomegaly. Results: The prenatal detection of hepatosplenomegaly should prompt a detailed ultrasound assessment, including the confirmation of organ enlargement, evaluation of associated structural abnormalities, Doppler studies, and screening for signs of fetal anemia, infection, hydrops fetalis, or cardiac dysfunction. The diagnostic workup should begin with targeted maternal and fetal investigations directed toward the most common causes. In unresolved cases, genetic testing—including chromosomal microarray analysis and next-generation sequencing—may help establish the diagnosis. The preservation of biological material obtained during invasive procedures should be considered to allow future molecular analyses if new clinical findings emerge. The management depends on the underlying etiology and may include fetal therapy, maternal treatment, or specific interventions in selected genetic and metabolic conditions. Conclusions: Fetal hepatosplenomegaly requires a systematic diagnostic strategy that integrates ultrasound, laboratory, and genetic assessment. A structured approach may improve diagnostic accuracy, optimize prenatal counseling, and facilitate the timely management of potentially treatable conditions. Full article

Popliteal artery aneurysms (PAA) lose their pulsatility once thrombosed and may therefore be mistaken for a Baker cyst or a soft-tissue tumor. A 58-year-old male presented with a 6-month history of progressive right popliteal swelling and pain, accompanied by right foot paresthesia and diminished distal pulses for two months. The presence of accompanying neurovascular deficits shifted the diagnostic consideration from a benign soft-tissue lesion to a vascular disorder. In this patient, non-contrast imaging protocol integrating grayscale ultrasound, power Doppler, and magnetic resonance imaging (MRI) successfully identified a chronically thrombosed popliteal artery aneurysm, supporting a vascular rather than neoplastic etiology. While ultrasound cannot replace contrast-enhanced MRI for definitive tissue characterization, its real-time capability established a vascular etiology and guided subsequent diagnostic digital subtraction angiography with urgent endovascular stent-graft reconstruction. Furthermore, serial ultrasonographic surveillance at three and 18 months confirmed long-term stent-graft patency and favorable aneurysmal sac remodeling. Neurovascular deficits accompanying a popliteal mass should redirect the workup toward vascular imaging. This case underscores a critical diagnostic pitfall, demonstrating that a stepwise strategy combining real-time ultrasound and non-contrast MRI ensures rapid definitive management for complex popliteal masses while preserving the unique role of sonography in non-invasive follow-up. Full article

Rheumatoid arthritis (RA) frequently involves the wrist joints, where early inflammation may induce subtle changes in carpal spatial architecture. This study investigated whether baseline (BL) ultrasound inflammation is associated with longitudinal changes in AI-derived compactness metrics and whether these metrics provide information complementary to conventional wrist radiographic scores. This study included 159 patients with early RA who underwent BL and follow-up (FU) bilateral wrist radiography and BL wrist ultrasound. Four AI-derived centroid-based compactness metrics—root-mean-square-radius (RMSR), mean pairwise distance (MPD), median radius (R50), and 90th-percentile-radius (R90)—were calculated, and their annualized changes were evaluated in relation to conventional wrist SvdH scores and BL ultrasound inflammation, including gray-scale (GS), power Doppler (PD), GS+PD, and vascularity percentage (VS%). Associations were assessed using correlation and subgroup analyses. AI-derived compactness metrics at BL and FU, as well as their annualized changes, were not significantly associated with conventional wrist radiographic scores. In contrast, BL ultrasound inflammation was significantly associated with subsequent increases in compactness metrics. BL GS, PD, and GS+PD scores showed significant positive correlations with annualized changes in RMSR, MPD, R50, and R90 (r = 0.18–0.25, p < 0.05). Subgroup analyses similarly demonstrated greater increases in compactness metrics in patients with positive GS or PD activity. Annualized changes in AI-derived compactness metrics were associated with baseline ultrasound inflammation but not with changes in conventional wrist radiographic scores. These findings suggest that AI-derived compactness metrics may provide complementary quantitative information on global carpal spatial architecture in early RA. Full article

The increasing detection of small, non-palpable testicular lesions has challenged the traditional paradigm that every solid intratesticular mass should be managed by radical orchiectomy. Many incidental lesions, particularly in infertile men and in patients with negative tumour markers, are benign or non-neoplastic, making overtreatment a clinically relevant concern. In this setting, ultrasound has become central to a more conservative and individualised diagnostic strategy. By combining high-resolution grey-scale imaging with Doppler, microvascular imaging, CEUS and elastography, multiparametric ultrasound provides complementary information on lesion morphology, vascularity, stiffness and interval change. When integrated with clinical presentation, tumour markers, fertility status, syndromic background and patient history, these features can help characterise lesions and estimate the likelihood of malignancy in the appropriate clinical context. Although imaging cannot replace histology, it can refine pre-test probability, support active surveillance in selected low-risk lesions, guide testis-sparing surgery, and improve assessment of the operated testis. This review examines the role of multiparametric ultrasound in characterisation of focal testicular lesions across different clinical settings, including incidentalomas, acute scrotal pain, trauma, bilateral disease, heterogeneous parenchyma, genetic and endocrine syndromes, and the postoperative testis. A structured, context-sensitive imaging approach may help reduce unnecessary orchiectomy while preserving timely detection of malignant, persistent, recurrent or metachronous disease. Full article

Background: Assessment of inflammatory activity in Crohn’s disease (CD) remains challenging. Bowel wall vascularization is an established marker of transmural inflammation and is typically evaluated using semiquantitative ultrasound scoring systems. In contrast, quantitative vascularization analysis is not yet widely used in clinical practice. To compare these approaches, this study evaluated semiquantitative and quantitative methods in the same patient cohort. Methods: This prospective single-center study included 50 patients with CD and sonographically detectable bowel wall thickening. Bowel wall vascularization was assessed using power Doppler (PD), color-coded superb microvascular imaging (cSMI) and monochrome mode superb microvascular imaging (mSMI). Video sequences were independently evaluated by three blinded readers using the Limberg classification. Quantitative vascularization was assessed using a vendor-derived vascular index and retrospective ImageJ analysis. Crohn’s Disease Activity Index (CDAI) and laboratory parameters were documented. Results: Interobserver agreement differed between imaging modalities. Krippendorff’s α values were 0.735 (PD), 0.655 (cSMI) and 0.527 (mSMI), indicating higher reliability for PD than for the SMI techniques. According to Fleiss’ κ (0.480 (PD), 0.376 (cSMI) and 0.367 (mSMI)), agreement was moderate for PD and fair for both SMI techniques. Complete concordance among all three readers was observed in 24 (PD), 18 (cSMI), and 22 (mSMI) patients, respectively. SMI-based techniques consistently resulted in higher Limberg grades compared to PD. Exploratory analyses showed strong correlations between different quantitative vascularization parameters (ρ up to 0.898, p < 0.001), but only moderate correlations with fecal calprotectin (FC) (ρ up to 0.389 with p = 0.017). Significant negative correlations were observed between vascular indices and body mass index (BMI) and skin-to-bowel distance (ρ up to −0.614, p < 0.001). The same trend was observed in the semiquantitative Limberg classification. Conclusions: Semiquantitative assessment of bowel wall vascularization seems to be limited by interobserver variability and Doppler technique, with SMI yielding higher Limberg grades than conventional Doppler. Standardized quantitative approaches may improve objectivity, but their reproducibility requires further validation. Patient-related factors should be considered when interpreting vascularization findings. Full article

Background: Ultrasound-guided radiofrequency ablation (RFA) has become an established minimally invasive treatment for selected benign and autonomously functioning thyroid nodules. Although clinical outcomes are well documented, the biological mechanisms underlying tissue remodeling after ablation remain incompletely characterized. The integration of imaging, molecular, and histopathological data may provide a more comprehensive understanding of treatment response. Methods: We conducted a prospective monocentric observational translational cohort study including 60 patients undergoing ultrasound-guided RFA for benign or autonomously functioning thyroid nodules between November 2024 and December 2025. Patients underwent standardized pre-procedural assessment including high-resolution ultrasound with volumetric evaluation, three-dimensional reconstruction, and collection of peripheral blood samples for exploratory extracellular vesicle (EV)-derived microRNA (miRNA) profiling. Clinical outcomes, volumetric changes, vascular remodeling, and procedural complications were assessed during scheduled follow-up visits (mean follow-up duration: 11 months; range: 5–17 months). A subgroup of patients who subsequently required surgery because of insufficient volumetric response underwent thyroidectomy, allowing histopathological evaluation of post-ablation tissue changes. Clinical, imaging, molecular, and pathological data were integrated within a multimodal translational framework. Results: RFA resulted in a mean nodule volume reduction of 56% at early follow-up, with progressive volumetric reduction observed during longitudinal ultrasound evaluation. A clinically relevant improvement in compressive symptoms was observed, with a 44% reduction in symptom burden. Doppler ultrasound demonstrated progressive changes in vascular patterns consistent with post-ablation devascularization and tissue remodeling. Ten patients underwent thyroidectomy after RFA because of insufficient volumetric response, providing histological validation of treatment-induced tissue alterations, including coagulative necrosis, fibrosis, inflammatory changes, and architectural remodeling. Exploratory EV-derived miRNA profiling was incorporated into the translational workflow to investigate potential molecular correlates of treatment response; however, molecular findings require further validation in larger cohorts. Conclusions: This study provides a multimodal translational characterization of tissue response after thyroid RFA by integrating clinical outcomes, ultrasound imaging, histopathology, and exploratory EV-derived miRNA analysis. The proposed framework may contribute to a deeper understanding of biological changes following thermal ablation and support future investigations aimed at identifying reliable biomarkers of treatment response. Full article

Subclinical atherosclerosis (SCA) has been associated with lung function in many populations. Accordingly, those factors involved in respiratory health may contribute to the mechanisms linking pulmonary and cardiovascular disorders. Since the airway microbiome plays a key role in respiratory pathophysiology, microbial abundance and diversity in the upper airway may be associated with SCA risk. This study aimed to assess the association of upper airway microbiome abundance and diversity with SCA risk. A nested case–control study was carried out among adults from the Southern Caribbean. SCA was defined by carotid Doppler ultrasound as a carotid intima-media thickness ≥ 0.8 mm or the presence of carotid plaque. Oropharyngeal mucosal samples were collected under fasting conditions, and the V3-V4 region of the 16SRNA gene was sequenced. Differences in genus-level abundance were assessed using Microbiome Multivariable Association with Linear Models 2 (MaAsLin2). Alpha-diversity indices were compared through Wilcoxon tests. Principal coordinates analysis (PCoA) and Permutational Multivariate Analysis of Variance (PERMANOVA), adjusted for age, body mass index, and smoking status, were performed to assess associations between Bray–Curtis distances and SCA. MaAsLin2 was also applied to determine predicted metabolic pathway enrichment. A total of 40 cases and 40 controls were analyzed. The oropharyngeal microbiomes composition was dominated by three genera: Prevotella (cases: 26.0%; controls: 29.8%), Veillonella (cases: 16.3%; controls: 13.7%) and Fusobacterium (cases: 7.5%; controls: 8.0%). Significant differences in relative abundance were found for Streptococcus, Aureimonas, Mogibaecterium, Candidatus Saccharimonas, Pseudomonas, Segatella, Stomatobaculum, Oribacterium and Lachnoanaerobaculum, with lower abundance in cases for all these genera. Alpha-diversity was lower in cases than in controls, as reflected by the Shannon index (cases: 5.95 IQR [4.87; 6.35] vs. controls: 6.49 IQR [6.29; 6.75], p < 0.001), Simpson index (cases: 0.994, IQR [0.989; 0.996] vs. controls: 0.997 IQR [0.997; 0.998], p < 0.001) and Chao1 richness (cases: 1076.2 IQR [345.2; 1473.4] vs. controls: 1136.1, IQR [841.1; 1635.3], p = 0.04) were compared. In adjusted-PERMANOVA, 8.2% of microbiome variations were associated with SCA (pseudo-F = 7.49, R² = 0.082, p < 0.001), although this finding may have been influenced by intra-group dispersion among cases (PERMDISP: pseudo-F = 5.62, p = 0.018; Tukey’s HSD test: mean difference = −0.071, 95% CI [−0.118, −0.025], p = 0.003) Predicted enrichment of phenylalanine metabolism and indole alkaloid biosynthesis was higher in cases. In conclusion, these exploratory analyses suggest that reduced oropharyngeal microbiome diversity is associated with SCA. Further studies are warranted to clarify the role of the airway microbiome on cardiovascular outcomes. Full article

Background: Polymyalgia rheumatica (PMR) is a clinically heterogeneous inflammatory disorder in which conventional acute-phase reactants may inadequately reflect the complexity and biological variability of disease activity. Precision medicine approaches integrating multidimensional clinical and laboratory data may offer a more comprehensive characterization of inflammatory phenotypes. This study investigated whether the combined assessment of cytokine profiles, routine laboratory biomarkers, ultrasound findings, and clinical variables could improve disease activity stratification in PMR. Methods: A total of 103 consecutive patients with PMR were retrospectively analyzed. Disease activity was assessed using the PMR Activity Score (PMR-AS) and, for exploratory purposes, dichotomized according to the cohort median (≥11 vs. <11). Group differences were evaluated using non-parametric statistical methods. The multidimensional structure of the dataset was explored through Spearman correlation analysis, principal component analysis (PCA), and unsupervised clustering. Predictive models, including logistic regression, random forest, and gradient boosting, were developed to evaluate the potential contribution of integrated analytical approaches to patient stratification. Results: The study cohort included 103 patients (63.1% female), with a median age of 76 years (IQR 71–81); 57 patients (55.3%) presented PMR-AS ≥11. Patients with higher disease activity exhibited significantly increased levels of CRP, fibrinogen, platelet count, IL-6, serum amyloid A (SAA), and myeloid-related protein (MRP), together with a higher prevalence of joint effusion and Power Doppler positivity. Among the evaluated biomarkers, SAA demonstrated the strongest correlation with disease activity (Spearman ρ = 0.878; p < 0.001). Multivariate predictive modeling showed high discriminative performance, with random forest achieving the highest cross-validated AUC (0.934), whereas gradient boosting demonstrated the best overall accuracy (0.883). Unsupervised clustering analysis identified a subgroup characterized by a more pronounced inflammatory signature associated with higher PMR-AS values. Conclusions: These findings support the concept that disease activity in PMR may be more effectively represented through an integrated multidimensional inflammatory profile rather than isolated biomarkers. The combined evaluation of routine laboratory parameters, cytokines, and imaging features may contribute to more refined patient stratification within a precision medicine framework. Although exploratory, these results highlight the potential value of advanced data integration strategies for supporting biologically informed disease characterization in PMR, while underscoring the need for external validation before translation into clinical practice. Full article