Search Results (11,272)

Pancreatic pseudocysts (PPs) and walled-off necrosis (WON) are two distinct sequelae of acute and chronic pancreatitis, requiring accurate differentiation to guide appropriate management. Computed tomography (CT) and magnetic resonance imaging (MRI) remain essential for distinguishing PPs from WON, assessing their content, and identifying potential complications. Endoscopic ultrasound (EUS) has emerged as a key modality for both diagnosis and drainage planning, offering high-resolution imaging and the possibility of real-time aspiration. Management strategies have evolved significantly, shifting from surgical to minimally invasive approaches. Endoscopic drainage, including EUS-guided transmural drainage with double-pigtail or lumen-apposing metal stents (LAMS), has become the preferred strategy for symptomatic or infected collections. Endoscopic necrosectomy is increasingly performed for WON, providing a less invasive alternative to surgical debridement. However, patient selection and procedural techniques remain topics of ongoing debate. The aim of this review is to provide a comprehensive synthesis of current evidence regarding the diagnosis and management of pancreatic pseudocyst and walled-off necrosis. We will synthesize current evidence on diagnostic criteria, imaging modalities, and therapeutic algorithms for PPs and WON. We will discuss technical aspects, success rates, and complications associated with drainage modalities, comparing endoscopic, percutaneous, and surgical approaches. Special attention will be given to recent advancements in interventional endoscopy and their impact on patient outcomes. By integrating clinical insights with the latest literature, this review aims to provide an up-to-date reference for clinicians managing pancreatic fluid collections. A literature search was performed using PubMed, Scopus, Web of Science, and MEDLINE databases to identify relevant studies on diagnostic criteria, imaging techniques, and management strategies. Full article

Prostate cancer is one of the leading causes of cancer-related morbidity and mortality worldwide, and imaging plays a critical role in its detection, localization, staging, treatment, and management. The advent of artificial intelligence (AI) has introduced transformative possibilities in prostate imaging, offering enhanced accuracy, efficiency, and consistency. This review explores the integration of AI in prostate cancer diagnostics across key imaging modalities, including multiparametric MRI (mpMRI), PSMA PET/CT, and transrectal ultrasound (TRUS). Advanced AI technologies, such as machine learning, deep learning, and radiomics, are being applied for lesion detection, risk stratification, segmentation, biopsy targeting, and treatment planning. AI-augmented systems have demonstrated the ability to support PI-RADS scoring, automate prostate and tumor segmentation, guide targeted biopsies, and optimize radiation therapy. Despite promising performance, challenges persist regarding data heterogeneity, algorithm generalizability, ethical considerations, and clinical implementation. Looking ahead, multimodal AI models integrating imaging, genomics, and clinical data hold promise for advancing precision medicine in prostate cancer care and assisting clinicians, particularly in underserved regions with limited access to specialists. Continued multidisciplinary collaboration will be essential to translate these innovations into evidence-based practice. This article explores current AI applications and future directions that are transforming prostate imaging and patient care. Full article

Background: Desmoid tumors (DTs) are rare, locally aggressive soft-tissue neoplasms that often affect women of reproductive age. Pregnancy and prior abdominal surgery or trauma have been associated with tumor development and growth, while imaging frequently overlaps with abdominal-wall endometriosis. We present the case of a 39-year-old woman with an abdominal-wall DT and provide a narrative review of the literature focused on pregnancy/postpartum patterns, differential diagnosis, and management. Methods: A narrative review of PubMed/MEDLINE and Web of Science (January 1982–December 2024) was conducted. We included English-language case reports/series, narrative/descriptive reviews, and consensus statements relevant to DTs in pregnancy or reproductive-age women, emphasizing abdominal-wall disease. Results: The patient’s right abdominal-wall mass enlarged during pregnancy and further post-partum imaging repeatedly suggested endometriosis. En bloc resection revealed desmoid-type fibromatosis composed of bland spindle cells in a collagenous stroma, with nuclear β-catenin and lymphoid enhancer–binding factor 1 (LEF1) positivity on immunohistochemistry. Magnetic resonance imaging (MRI) at 12 months showed no recurrence. Across included studies, pregnancy and post-partum enlargement is common, abdominal-wall DTs frequently mimic scar endometriosis, and pre-operative ultrasound has limited specificity. Current practice supports watch-and-wait for stable, asymptomatic lesions and function-preserving surgery for symptomatic progression, while systemic options (anti-estrogens, low-dose chemotherapy, and tyrosine kinase inhibitors) are reserved for progressive or unresectable disease. Recurrence risk relates to age, size, site, and β-catenin status; future pregnancy is not contraindicated. Conclusions: Abdominal-wall DTs, although rare, should be considered in the differential diagnosis of reproductive-age women presenting with abdominal-wall masses, particularly during or after pregnancy. Full article

Primary bone tumors encompass a heterogeneous spectrum ranging from benign entities to highly aggressive sarcomas. This review aims to summarize the current role and future perspectives of nuclear medicine in the diagnosis, staging, and management of primary bone tumors. Accurate diagnosis and staging are critical yet challenging due to histologic heterogeneity and overlapping imaging features. While radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) remain essential, nuclear medicine provides a complementary functional perspective by assessing bone turnover, vascularity, and glucose metabolism. Bone scintigraphy is highly sensitive for skeletal lesions and useful for detecting skip lesions or multifocal disease, although its specificity is limited. Hybrid single-photon emission computed tomography (SPECT)/CT enhances diagnostic confidence through precise anatomic localization and quantitation. [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG) positron emission tomography (PET)/CT, by directly visualizing tumor metabolism, has become a cornerstone in osteosarcoma and Ewing sarcoma management, demonstrating superiority over bone scintigraphy for detecting skeletal metastases. In chondrosarcoma, [¹⁸F]FDG uptake correlates with histologic grade, although overlap with benign cartilage tumors complicates interpretation. Future directions include the integration of quantitative SPECT, artificial intelligence, and novel tracers such as [¹⁸F]sodium fluoride and [⁶⁸Ga]Ga-fibroblast activation protein inhibitor (FAPI). Collectively, nuclear medicine imaging is becoming a key element in musculoskeletal oncology, offering unique biological insights that complement anatomic imaging and contribute to improved patient management. Full article

Background: Tuberous sclerosis complex (TSC) is a rare genetic disorder characterized by the growth of benign tumors in various organ systems, with particularly significant effects on the kidneys. Renal manifestations of TSC include angiomyolipomas (AMLs), renal cysts, and a higher risk of renal cell carcinoma (RCC). Nephrological monitoring is crucial for the early detection of kidney changes, the management of hypertension, and the assessment of the risk of developing chronic kidney disease. Ultrasound is typically the initial imaging choice for diagnosis and monitoring, with magnetic resonance imaging (MRI) being a preferred imaging modality for long-term surveillance. Patients with TSC have an increased risk of arterial hypertension, renal artery stenosis, and urolithiasis. In some patients, the co-occurrence of TSC and autosomal dominant polycystic kidney disease (ADPKD) is caused by the TSC2/PKD1 contiguous gene syndrome (CGS). The primary medical treatment for TSC is a mammalian target of rapamycin kinase inhibitors (mTOR), as they effectively shrink tumors, often reducing or eliminating the need for surgical intervention. Methods: This article aims to review the most recent literature on the diagnosis and management of renal lesions in tuberous sclerosis complex (TSC), with a particular focus on the role of various imaging techniques. Conclusions: Given the multifactorial nature of this disease, this review emphasizes the importance of a multidisciplinary approach, including various imaging methods, to improve the care and treatment outcomes of children with tuberous sclerosis complex. Full article

Background: Shoulder soft tissue disorders, such as rotator cuff tears and subacromial impingement, are among the most common causes of musculoskeletal disability. Both physical examination tests and imaging techniques are routinely used in clinical settings; however, their respective contributions to patient outcomes and their potential complementarity remain underexplored. Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Controlled clinical studies comparing pre- and post-intervention outcomes in adults with suspected or confirmed shoulder soft tissue pathology were included. Two groups were analyzed: studies using musculoskeletal imaging (ultrasound or MRI) and studies applying orthopedic physical examination tests (e.g., Neer, Hawkins, and Jobe). Functional outcomes were converted into standardized mean differences (SMDs) and synthesized using a random-effects model. Heterogeneity was quantified using the I² statistic. Results: In total, 11 studies met the inclusion criteria (n = 6 imaging, n = 5 orthopedic tests). Imaging-based studies showed a pooled SMD of 4.85 (95% CI: 2.77–6.93), indicating substantial clinical improvement. Orthopedic test-based studies yielded a pooled SMD of 2.34 (95% CI: 1.27–3.41). Heterogeneity was high across both groups (I² > 90%). Conclusions: Imaging was associated with a larger overall clinical effect, while orthopedic tests provided functional insight valuable for screening and monitoring. These findings support the complementary use of both strategies to enhance diagnostic accuracy and treatment planning in shoulder care. Full article

Neuroradiology and neuro-oncology are rapidly emerging fields in the diagnosis and treatment of central nervous system (CNS) diseases, including brain tumors. This review presents a comprehensive look at the current imaging techniques, clinical applications, and therapeutic strategies, with a focus on gliomas, metastases, and functional brain mapping. Conventional modalities such as CT and MRI, as well as sophisticated approaches including functional MRI (fMRI), diffusion tensor imaging (DTI), MR spectroscopy, PET, and hybrid techniques, are discussed. On the therapeutic front, high-precision radiotherapy modalities such as stereotactic radiosurgery (SRS), stereotactic radiotherapy (SRT), and proton therapy are discussed, with a focus on radiation biology, dose planning, and the impact on neurocognitive outcomes. The interlink between neuroradiology and radiotherapy is highlighted through advanced image-guided treatment planning. Full article

Background: Advances in stereotactic neurosurgery rely on precise brain mapping, which allows the identification of functional regions for safer and more effective surgical interventions. The aim of this systematic review was to assess the effectiveness, challenges, and clinical applicability of algorithms used for multimodal data integration. Methodology: Databases were searched for studies published in the last 13 years. Studies that integrate fMRI and EEG data for brain mapping, quantitatively assess the performance of algorithms, and have potential applications in stereotactic neurosurgery were included. Heterogeneity among studies was assessed using the I² statistic, and the results were analyzed by thematic synthesis and meta-analysis. Results: The average accuracy of the algorithms was 90.2% (±5.0%). Key challenges include computational requirements, susceptibility to artifacts, and limited clinical applicability. Heterogeneity analysis showed significant methodological variability (I² = 71.90%), with greater heterogeneity among highly relevant algorithms (I² = 79.64%). Conclusions: Advanced algorithms offer significant potential to improve precision, safety, and applicability in stereotactic neurosurgery. Key recommendations include standardization of protocols, expansion of clinical validation, and optimization of algorithms for real-time application. Full article

Introduction: The rates of pediatric ischemic stroke incidence have more than doubled over the past 3–4 decades; however, pediatric posterior circulation strokes are even more uncommon. These rising incidence rates have led to increasing awareness of pediatric strokes and the development of institutional guidelines regarding these patients to optimize outcomes when possible. Case Report: We describe a rare case of acute ischemic posterior circulation stroke in a 14-year-old previously healthy adolescent boy who presented with right-sided facial droop, dysarthria, and right-sided hemiplegia. An MRI of the brain demonstrated an acute infarct in the brainstem, and an echocardiogram demonstrated a patent foramen ovale (PFO). We also discuss how to localize brainstem lesions to a specific location within the brainstem and associated blood supply using symptomatology. Conclusions: All stroke patients require evaluation for possible etiologies of stroke and possible underlying risk factors. Nearly half of patients who suffer from cryptogenic stroke are found to have a PFO, and adult studies have shown that PFO closure is associated with reduced recurrent cryptogenic strokes, although pediatric-specific data is lacking. If a posterior stroke is suspected, specifically in the brainstem, then the Brainstem Rules of Four may be utilized to localize these lesions and identify blood supply using simplified knowledge of the brainstem anatomy. Full article

Microcephaly with early-onset, intractable seizures, and developmental delay (MCSZ) is a rare inherited neurological disorder caused by biallelic loss-of-function variants in the polynucleotide kinase/phosphatase (PNKP) gene, which encodes an enzyme critical for DNA repair. Here, we describe the clinical history of two novel patients presenting with microcephaly, epilepsy, growth deficiency, language impairment, and severe intellectual disability. Brain MRI in both cases revealed complex cerebral malformations, including lissencephaly, ventriculomegaly, dysmorphic hippocampi, and cerebellar atrophy. Next-generation sequencing (NGS) analyses identified compound heterozygous PNKP variants in both patients. In case #1, we detected the missense variant p.Gln50Glu (c.148C>G) in exon 2 (rs756746191) and a novel nonsense variant, p.Gln248Ter (c.742C>T), leading to a premature stop codon in exon 7. In case #2, we identified the frameshift variant p.Thr424GlyfsTer49, caused by a 17-nucleotide duplication (c.1253_1269dupGGGTCGCCATCGACAAC) in exon 14 (rs587784365), along with a 15-nucleotide deletion (c.1386+49_1387-33delCCTCCTCCCCTGACCCC) in intron 15 (rs752902474). Over long-term follow-up (20 and 36 years for case #1 and case #2, respectively), seizures persisted in the first patient, while full control was achieved in the second case with combined therapy of valproate and clobazam. Along with a review of the literature, these two novel cases confirm the broad phenotypic spectrum of PNKP-associated disorders and underscore the importance of including PNKP in the genetic screening of patients presenting with developmental and epileptic encephalopathy (DEE) and microcephaly. Full article

Background and objective: Heterotopic ossification (HO) of the plantar fascia is an exceptionally rare condition, with only a few cases mentioned in the literature. In comparison, calcification of the fascia occurs more frequently, especially in cases of chronic plantar fasciitis. Tenex™, a percutaneous ultrasonic tenotomy system initially designed for tendinopathy treatment, may offer a minimally invasive alternative to conventional surgery in selected cases of HO. So, the aim of this case report was to assess the improvement in the pain and in the foot function after a percutaneous ultrasonic debridement. Case presentation: We present the case of an 82-year-old male with a history of hypertension and hyperuricemia, who reported a two-year history of mechanical-type plantar pain described as “walking on a stone.” Radiographs and MRI confirmed heterotopic ossification at the central component of the plantar fascia. Pain and function were assessed with the Foot Function Index (FFI). Under ultrasound and fluoroscopic guidance, percutaneous ultrasonic debridement with Tenex™ was performed following tibial and sural nerve block and conscious sedation. The procedure was completed in 6 min and 29 s of cutting time. After surgery, the patient wore a protective shoe for 3 weeks, followed a relative rest protocol, and received NSAIDs for 5 days. At 48–72 h, the patient reported noticeable pain relief, with significant functional improvement after 1 month. Conclusions: This case shows how Tenex™ effectively treats plantar fascia HO. It led to quick symptom relief and functional recovery. The ultrasonic percutaneous debridement with Tenex™ was a safe and effective option compared to open surgery for this patient. However, more research is needed to set standardized treatment protocols and assess long-term results. Full article

Background/Objectives: Glioblastoma (GBM) is an aggressive primary brain tumor marked by diffuse infiltration into surrounding brain tissue. The peritumoral zone often appears normal on imaging yet harbors microscopic invasion. While perfusion-based studies, such as arterial spin labeling (ASL), have profiled this region, longitudinal radiomic monitoring remains limited. This study investigates delta radiomics using multiparametric MRI (mpMRI) in a GBM mouse model to track subtle peritumoral changes over time. Methods: A G7 GBM xenograft model was established in nine nude mice, imaged at 9- and 12 weeks post-implantation using MRI (T1W, T2W, T2 mapping, DWI-ADC, FA, and ASL) and co-registered histopathology (H&E, HLA staining). Tumor and peritumoral regions were manually segmented, and 107 radiomic features (shape, first-order, texture) were extracted per sequence and histology. The delta features were calculated and compared between timepoints. Results: The robust T2W texture and T2 map first-order features demonstrated the greatest sensitivity and reproducibility in capturing temporal peritumoral brain zone changes, distinguishing between time points used by K-mean. Conclusions: Delta radiomics offers added value over static analysis for early monitoring of peritumoral brain zone changes. The first-order and texture features of radiomics could serve as robust biomarkers of peritumoral invasion. These findings highlight the potential of longitudinal MRI-based radiomics to characterize glioblastoma progression and inform translational research. Full article

Background: Radiation necrosis (RN) is a delayed and potentially debilitating complication of radiotherapy for central nervous system (CNS) tumors. It presents significant diagnostic and therapeutic challenges due to the variable clinical manifestations and overlap with tumor recurrence. Although advances in radiotherapy have improved tumor control, RN remains incompletely understood and inadequately addressed. This narrative review synthesizes current evidence on RN pathophysiology, risk factors, diagnostic strategies, and management approaches. Methods: A literature search was conducted for English-language literature published between January 1990 and December 2024. Studies were included if they addressed RN incidence, diagnosis, treatment, or novel preventive strategies in CNS tumor populations. Relevant findings were synthesized to produce a narrative review summarizing pathophysiology, diagnostic challenges, and treatment strategies. Results: RN results from radiation-induced neurovascular injury, inflammation, and vessel permeability, with incidence ranging from 3 to 26% depending on tumor type, location, and treatment parameters. Risk is influenced by dose, fractionation, cumulative exposure, re-irradiation, and adjuvant therapies. Advanced modalities such as SRS, HFSRT, brachytherapy, proton therapy, and IORT reduce but do not eliminate RN risk. Diagnosis remains challenging despite advanced MRI and PET techniques, with histopathology as the gold standard. Management includes corticosteroids, bevacizumab, surgery, LITT, and experimental therapies. Connectomics-based planning shows promise in minimizing RN by sparing critical brain networks. Conclusions: RN is a clinically significant and multifactorial complication of CNS radiotherapy. Precision treatment modalities and advanced imaging have improved prevention and detection, but diagnostic uncertainty and recurrence risk persist. Integration of connectomics into treatment planning may offer future promise of a reduction in RN-related morbidity by preserving structural and functional network integrity. Full article

This study discusses the challenges encountered in implementing a detailed protocol for upper abdominal imaging using magnetic resonance imaging (MRI), ranging from patient preparation and sequence selection to clinical applications. MRI is a valuable non-invasive imaging modality employed both in the early detection of diseases and as a complementary tool for the detailed characterization of various pathologies. Nevertheless, performing an abdominal MRI examination can be challenging; therefore, the understanding of sequences is particularly important, as changing the parameters can not only influence the quality of the images but also optimize scanning time improve patient experience during the examination. The methodology illustrates the purpose of each sequence and the critical role of appropriate patient preparation. Results highlighted the significance of these factors in the evaluation of hepatic lesions, showing that the proper choice of sequences and parameters is essential for distinguishing benign from malignant findings and for achieving an accurate diagnosis. It was also shown that MRI plays an important role as a complementary technique in investigation of upper abdominal pathologies in order to avoid overexposure to radiation. Full article

In recent years, several randomized controlled trials have been published regarding cervical cancer therapy and significantly changed the treatment landscape. Recent advances have improved the treatment options and allow personalized treatment concepts with escalation of treatment in high-risk disease and de-escalation with reduction in morbidity in selected low-risk patients. This review aims to provide a comprehensive analysis of the latest landmark studies that are poised to significantly influence clinical practice. Personalized treatment concepts with careful patient selection allow de-escalation in the surgical treatment of cervical cancer. In low-risk cervical cancer patients (lesions of ≤2 cm with limited stromal invasion), simple hysterectomy (SH) was non-inferior to radical hysterectomy in terms of 3-year incidence of pelvic recurrence and was associated with a lower risk of urinary incontinence or retention and improved sexual health and quality of life. Furthermore, sentinel lymphadenectomy is constantly replacing systematic pelvic lymphadenectomy in patients with low-risk cervical cancer. In addition, further studies are necessary to clarify the role of postoperative therapy for patients with intermediate-risk cervical cancer. Starting in 2008, the EMBRACE studies assess the role of Image guided adaptive brachytherapy (IGABT) in LACC in addition to modern external beam radiotherapy concurrent to chemotherapy. The publication of the results of the EMBRACE I prospective study established MRI guided IGABT as state-of-the-art brachytherapy for LACC. EMBRACE II and additional prospective studies emerging from this consortium will address important questions in modern radiotherapy for LACC. Immune checkpoint inhibitors (CPIs) have been evaluated across various clinical settings and are expected to be utilized in numerous scenarios due to several positive randomized trials. Particularly, the combination of platinum-based chemotherapy and pembrolizumab, with or without bevacizumab, has been established as the new standard treatment for primary metastatic or recurrent PD-L1 positive high-risk cervical cancer. In locally advanced cervical cancer, two new treatment escalation regimens—neoadjuvant chemotherapy and adjuvant CPI therapy—have been evaluated in addition to chemoradiation. Furthermore, antibody-drug conjugates, such as tisotumab-vedotin, represent a promising future therapeutic option for recurrent cervical cancer. Full article