Search Results (25,336)

Artificial intelligence (AI) is increasingly reshaping musculoskeletal (MSK) imaging across the entire imaging pathway. This narrative review summarizes current AI applications in MSK radiology across four domains: acquisition and reconstruction, detection and triage, characterization and quantification, and prognosis and decision support. AI-based reconstruction has enabled faster MRI acquisitions, improved denoising and artifact reduction, and supported low-dose CT imaging while preserving diagnostic quality. Fracture detection and triage currently represent the most mature clinical applications, particularly in emergency settings. AI is also promoting a shift from qualitative interpretation to quantitative imaging phenotyping through automated assessment of body composition, cartilage, bone density, degenerative spine disease, skeletal maturity, and lesion heterogeneity. Emerging applications in prognostic modeling, implant evaluation, and multimodal risk stratification remain promising but less mature. Broader clinical implementation is still limited by restricted interpretability, dataset bias, insufficient prospective validation, regulatory complexity, and unresolved medico-legal issues. Overall, AI should be viewed as a tool to augment, not replace, radiological expertise. Full article

Sarcopenia is increasingly invoked as a determinant of treatment-related toxicity, perioperative morbidity, treatment intolerance, and survival in oncology; however, contemporary international consensus frameworks define sarcopenia as a multidimensional neuromuscular syndrome centered on impaired muscle strength, physical performance, and muscle quality, whereas most oncologic studies operationalize sarcopenia using computed tomography (CT)-derived skeletal muscle mass alone. In this context, muscle quantity is effectively employed as a diagnostic surrogate for a function-centered syndrome. CT-defined skeletal muscle depletion—more precisely described as myopenia—remains a reproducible and clinically informative structural biomarker, yet defining sarcopenia by muscle mass alone aggregates biologically heterogeneous phenotypes, including neuromuscular dysfunction, inflammation-driven cachexia, and substrate-related malnutrition. Such surrogate-based definitions contribute to variable prevalence estimates, inconsistent prognostic associations, and interpretive instability across studies. Clinically, reliance on CT-based muscle mass as a surrogate for sarcopenia may influence chemotherapy dosing, perioperative risk stratification, and supportive care allocation without direct assessment of neuromuscular function; in research settings, mass-based definitions may dilute treatment effects in exercise or nutritional trials and complicate meta-analytic synthesis by conflating structural and functional constructs. This analysis does not question the value of radiologic muscle assessment but argues that CT-derived muscle mass should be recognized as a structural biomarker within a multidimensional framework rather than as a standalone diagnostic surrogate for sarcopenia. A tiered, oncology-adapted approach integrating functional assessment, muscle quality, and relevant metabolic context may enhance risk discrimination, improve trial design, and strengthen translational precision in supportive oncology. Full article

Purpose: This study aimed to assess MRI-related claustrophobia severity and patient-reported experiences among Saudi patients to examine their associations with selected demographic variables. Methodology: A cross-sectional study was conducted using a structured questionnaire administered to 200 Saudi patients who had previously undergone MRI examinations. The questionnaire comprised five sections covering demographic data, phobia severity and patient-reported experiences before, during and after MRI examinations. Statistical analysis was performed using SPSS statistical package (IBM SPSS Statistics version 26, IBM Corp., Armonk, NY, USA), applying chi-square tests to examine associations between demographic variables and questionnaire responses. Results: A significant majority of participants, 76.5%, reported a positive MRI experience, whereas only 6.5% reported a negative experience. Shortness of breath during the MRI examination was the most frequently reported source of discomfort (75%). Significant associations were identified between demographic characteristics and phobia severity. Age and gender were significantly correlated with sudden fear responses, while educational level was strongly associated with receiving adequate pre-scan information and overall examination experience. Conclusions: Despite the high percentage of positive experiences, a notable proportion of participants reported anxiety-related distress during MRI examinations. The observed associations between demographic variables and claustrophobia-related responses suggest the potential value of patient-centred approaches, particularly improved pre-scan education, to improve the MRI-related patient experience and reduce anxiety-related distress. Full article

Idiopathic root resorption is diagnosed when external root resorption occurs in the absence of an identifiable etiological factor. Two main forms are described in the literature: apical and cervical. Owing to the rarity of this condition and the limited number of published reports, evidence-based recommendations for orthodontic management are currently lacking. The aim of this study was to provide a narrative overview of published case reports describing orthodontic procedures performed in patients with idiopathic root resorption and to supplement the available literature with a detailed clinical case. A case of a 7-year-7-month-old female patient presenting with generalized idiopathic root resorption and a concomitant skeletal Class III malocclusion is described. In this patient, skeletal anchorage was used to support maxillary protraction in an attempt to obtain an orthopedic effect. The literature review had a narrative character and was based on a structured search of the PubMed, Scopus, and Web of Science databases covering the period from January 2010 to December 2025. Only English-language case reports meeting strict eligibility criteria were considered. Of 47 records initially identified, two fulfilled the inclusion criteria; an additional two case reports were retrieved through manual searching. Conclusions: Given that the available evidence is limited to isolated case reports and a single clinical observation, the present findings do not allow for reliable conclusions regarding the safety, effectiveness, or general applicability of orthodontic treatment in patients with idiopathic root resorption. Clinical management should therefore be individualized, with careful documentation and close radiological follow-up. Further well-documented clinical reports are required to better characterize treatment-related risks in this patient group. Full article

Background: The integrity of the alveolar ridge is compromised by tooth loss or trauma, initiating chronic resorption that alters bone morphology. Vertical bone augmentation (VBA) is a complex procedure required to rehabilitate severe atrophy. Currently, there is debate regarding the effectiveness of autologous bone versus xenografts and their combination to optimize bone regeneration and ensure dimensional stability. Objectives: To synthesize evidence on the efficacy of VBA by comparing autologous bone, xenografts, and their combination. Specifically, to evaluate vertical bone gain, volumetric stability and resorption, implant survival, complications, and whether combined grafts offer clinical advantages. Methods: A systematic review was conducted following PRISMA 2020 guidelines. MEDLINE, Scopus, SciELO, and Web of Science were searched up to January 2026. Risk of bias was assessed, using RoB 2 for randomized studies and ROBINS-I for non-randomized studies. Results: From 1517 initial records, 9 studies were included and 3 showed high risk of bias. Iliac crest grafts achieved the greatest vertical bone gain but also exhibited higher resorption compared to calvarial grafts. Xenografts (Bio-Oss) demonstrated superior volumetric stability, maintaining 10–13% more residual volume than autologous blocks. The most frequent complication was soft tissue dehiscence. Conclusions: VBA is an effective procedure. The combination of autologous bone and xenograft may represent a balanced approach, providing both biological potential and volumetric stability. Graft origin significantly influences outcomes and morbidity. However, current evidence is limited by methodological heterogeneity and small sample sizes, highlighting the need for well-designed clinical trials with standardized protocols and long-term follow-up. Full article

Left atrial (LA) blood flow stasis is a major contributor to thromboembolic risk in atrial fibrillation (AF) and can be measured non-invasively using four-dimensional (4D) flow magnetic resonance imaging (MRI), yet factors driving impaired LA hemodynamics in paroxysmal AF remain unclear. In this retrospective study, 107 patients with paroxysmal AF undergoing pre-ablation cardiac MRI were evaluated. LA blood flow stasis was quantified as the proportion of LA voxels with velocity < 0.1 m/s on 4D flow MRI. Multivariable linear regression assessed associations between LA stasis and demographic, cardiac structural and functional, and clinical variables in a complete-case cohort of 88 patients. Mean LA blood flow stasis was 44 ± 13%. After adjustment, higher left atrial volume index, higher hematocrit, and female sex were independently associated with greater LA stasis, while higher left ventricular ejection fraction, higher resting heart rate, and higher body mass index were associated with lower stasis (all p < 0.01). Age and diabetes status were not significantly associated with stasis. The final model explained 40.8% of the variance in LA blood flow stasis. These results underscore the multifactorial nature of LA hemodynamic impairment in paroxysmal AF and support integrating clinical and imaging markers to refine thromboembolic risk assessment. Full article

Medial calcific sclerosis (Mönckeberg sclerosis) is a common but often underrecognized complication in patients with end-stage renal disease (ESRD). Unlike atherosclerosis, it is characterized by circumferential, continuous calcification of the arterial media. We present the case of a 41-year-old man on dialysis who exhibited a strikingly rapid progression of diffuse medial calcifications of the abdominal aorta and its major branches within a 10-month period. This case emphasizes the clinical importance of distinguishing this pattern on computed tomography (CT) to identify patients at heightened cardiovascular risk. Full article

The use of intraoperative computerised tomography (CT) to aid surgical management of facial fractures obviates the need for postoperative surgical scans, decreases return to theatre rates, and subsequently decreases overall hospital stay. This allows for better appreciation of a complex operative landscape in almost real time, and may become the gold standard of treatment. As with radiological investigations, decreasing radiation exposure of patients is a key goal. The aim of this study was to examine the effective radiation doses in patients undergoing surgical management of their facial fractures with the aid of a fixed-arm CT. This retrospective study was conducted on patients who underwent surgical fixation of their facial fractures within a hybrid surgical suite equipped with a fixed-arm cone beam CT (CBCT) from July 2023 to November 2024. The CBCT was used to assess adequacy of bony fixation. Data from imaging was collected to assess total effective radiation dose. Data from 30 random patients who underwent standard CT facial bones (CTFB) were collected as control. Data from 24 patients was collected. The majority were male (17/24, 70.8%) with an age range of 20–94 years. The average dose of the effective doses calculated in the CTFB cohort was 0.64 mSv (SD 0.05). This is a more-than-twenty-five-fold reduction in the average effective dose in the CBCT cohort, which was 0.025 mSv (SD 0.01). There was a statistically significant difference between the two cohorts with p < 0.0001 (95% CI 0.60–0.64). This study demonstrates that intraoperative CBCT delivers a significantly lower effective dose to patients compared with postoperative CTFB. Where facilities exist, CBCT offers a safer and more efficient alternative, with future work needed to assess staff dose, wait times, and cost impacts. Full article

Background/Objectives: The clinical management of ductal carcinoma in situ (DCIS) remains controversial due to its heterogeneous biological behavior and uncertain risk of progression. Standard treatment often includes surgery and radiotherapy, although the actual recurrence risk varies considerably among patients. This study aimed to evaluate recurrence patterns and associated clinicopathological factors in a large single-center cohort of patients with pure DCIS. Methods: We retrospectively analyzed 403 patients with histologically confirmed pure DCIS treated with breast-conserving surgery or mastectomy between 2016 and 2023. Clinical, imaging, pathological, and treatment-related variables were assessed. Descriptive and exploratory comparative analyses were performed between patients with and without ipsilateral recurrence. Results: A total of 417 lesions were analyzed, with 21 ipsilateral recurrences (5%) observed during follow-up. Among recurrent cases, 57% were non-invasive recurrent DCIS and 38% were invasive carcinomas. Most recurrences occurred in patients treated with breast-conserving surgery, and 52% of recurrent patients had not received adjuvant radiotherapy. All recurrent cases were estrogen receptor–positive at initial diagnosis, whereas none had received endocrine therapy. No clear association between recurrence patterns and tumor grade or tumor size emerged in this exploratory analysis. No distant metastases or disease-related deaths were observed during follow-up. Conclusions: Recurrence after treatment for pure DCIS was relatively uncommon and frequently non-invasive. Traditional clinicopathological variables alone appeared insufficient to consistently identify recurrence patterns in this cohort. These findings support the need for more individualized risk stratification approaches integrating clinical, imaging, and molecular factors in order to reduce potential overtreatment in selected patients with DCIS. Full article

Background: Debridement, antibiotics, and implant retention (DAIR) is an established treatment for early periprosthetic joint infection (PJI) following hip arthroplasty; however, reported success rates remain highly variable, particularly in patients with significant comorbidities, fracture-related arthroplasty, or resistant microorganisms. Augmentation of standard DAIR with structured local antimicrobial strategies may improve infection control but remains insufficiently standardized and evaluated. Methods: This retrospective single-center case series evaluated outcomes of a standardized multimodal DAIR-based strategy, the Mursa protocol, in 16 consecutive patients treated for early hip PJI between 2022 and 2025. PJI was diagnosed according to European Bone and Joint Infection Society criteria. The treatment included radical surgical debridement and exchange of mobile components with sequential intraoperative antiseptic microdebridement using povidone–iodine and hypochlorous/hypochlorite solution, followed by postoperative drain-based local antimicrobial irrigation and systemic antibiotic therapy. Treatment success was defined as sustained infection eradication with implant retention, absence of clinical and radiological signs of infection, no requirement for long-term suppressive antibiotics, and no infection-related mortality at a minimum one-year follow-up. Results: The cohort was clinically complex, with a predominance of arthroplasty procedures performed for fracture-related indications (11/16), a high comorbidity burden (median Charlson Comorbidity Index 5), revision arthroplasty in four patients, and a high rate of resistant or polymicrobial infections. At final follow-up, 15 of 16 patients (93.8%) achieved treatment success. One patient required implant removal due to persistent polymicrobial infection. No irrigation-related complications, wound-healing problems, or clinically relevant systemic toxicity were observed. Conclusions: In this high-risk cohort, a structured multimodal DAIR protocol incorporating sequential antiseptic microdebridement and postoperative local antimicrobial irrigation was feasible, safe, and associated with encouraging infection control. However, these findings should be interpreted as hypothesis-generating, and further prospective comparative studies are required to validate the protocol. Full article

Pneumonia remains a major global health concern, particularly among elderly and immunocompromised populations, and is associated with substantial morbidity, mortality, and healthcare burden. It is a heterogeneous infectious disease caused by a wide variety of microorganisms, resulting in diverse imaging manifestations and characteristic patterns of pulmonary distribution. Despite advances in microbiological diagnostics and imaging, the literature still lacks a comprehensive overview integrating the imaging characteristics of pneumonia with pathogen-specific features and host susceptibility. A structured literature search of PubMed, Scopus, and Web of Science was conducted for studies published between 2000 and 2026 focusing on key pathogen groups and their radiological patterns. The reviewed evidence indicates that pulmonary distribution is determined by a complex interplay between infection routes, lung anatomy and physiology, host defense mechanisms, patient-specific, and environmental exposures. Radiological patterns, including lobar, bronchopneumonic, interstitial, necrotizing, abscess-forming, and cavitating forms, may correlate with pathogen type, disease severity, and host vulnerability. This integrative approach emphasizes the importance of correlating imaging findings with clinical presentation and patient risk factors to support early etiological assessment and guide empirical therapy. Improved understanding of the determinants of pulmonary distribution may facilitate personalized management, rapid clinical decision-making in emergencies and hospital settings, and improved clinical outcomes. Full article

Pelvic xanthogranulomatous inflammation is a rare pathological entity that can closely mimic malignant disease on cross-sectional imaging, often leading to consideration of radical surgical intervention. We report the case of a 59-year-old woman who presented with a large retrovesical pelvic mass initially suspected to be a malignant process. A definitive diagnosis was established only after tissue biopsy and comprehensive histopathological examination, which excluded malignancy and demonstrated xanthogranulomatous histiocytic inflammation. In light of the lesion’s anatomical location and the substantial morbidity associated with surgical resection, a conservative medical strategy was pursued. Treatment with systemic corticosteroids and everolimus led to marked clinical improvement and a substantial radiological response, with reduction in lesion size from 41 × 26 mm to 27 × 17 mm, thereby allowing avoidance of mutilating surgery. This case underscores the critical role of biopsy and expert pathological assessment in guiding clinical decision-making and supports the consideration of non-surgical therapeutic approaches in selected patients with xanthogranulomatous pelvic lesions. Full article

Anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed surgical procedures for the treatment of cervical degenerative disease, myelopathy, radiculopathy, and segmental instability. Although clinical outcomes are generally favorable, pseudarthrosis remains a relevant complication, with a reported incidence ranging from 5% to 20%. In a field with no yet clear main directions, this narrative review aims at giving the reader a broad picture and a wide analysis of the recent advances in cervical spinal fusion, with particular focus on biomaterials, intervertebral cage technologies, cervical spine biomechanics and imaging methods used for fusion assessment. The literature regarding quantitative imaging parameters and emerging applications of artificial intelligence (AI) is also reviewed. Current bone grafts include autologous grafts, allografts, xenografts and polymeric grafts, while the materials for the intervertebral cages comprehend titanium, polyetheretherketone and silicon nitride, with reported fusion rates distributed in a very large range. Computed tomography (CT) remains the standard imaging modality to assess whether fusion has occurred, due to its high spatial resolution. However, the lack of shared diagnostic criteria and the significant interobserver variability continue to limit its reliability. Quantitative parameters, such as Hounsfield Unit measurements and MRI-derived bone quality scores, may contribute to a more objective evaluation, although current evidence remains heterogeneous. In parallel, AI-based imaging analysis is showing promising results for quantitative assessment and longitudinal monitoring of bone fusion; however, large prospective clinical studies are still needed to confirm its clinical applicability. In conclusion, despite advances in surgical technologies and biomaterials, radiological assessment of cervical fusion still lacks universally accepted diagnostic standards. Future AI applications may improve diagnostic accuracy and reproducibility, promoting a more standardized approach in clinical practice. Full article

Objective: This study aimed to evaluate the clinical and radiological efficacy of percutaneous laser disc decompression (PLDD) in patients with disc-related lumbar spinal stenosis. Methods: Data from 96 patients who underwent PLDD between January 2023 and January 2025 were reviewed retrospectively. Pain intensity (visual analogue scale [VAS]), functional capacity (pain-free walking distance), patient satisfaction (global patient evaluation), and radiological canal diameter were assessed before the procedure and at 1, 3, and 6 months postoperatively. Treatment response was determined based on a ≥2-point decrease in the VAS score, which is the minimal clinically important difference (MCID) criterion. Results: A marked improvement in VAS scores was observed from the early period following PLDD, with the mean VAS score decreasing from 8.02 to 5.02 ± 1.99 at 6 months (p < 0.001). The pain-free walking distance increased from 212.7 m to 345.8 m, resulting in a significant improvement in functional capacity (p < 0.001). A significant increase in the anteroposterior diameter of the spinal canal from 7.1 ± 1.7 mm to 7.9 ± 1.8 mm (p < 0.001) was observed, corresponding to a mean increase of 0.8 mm; however, the magnitude of this radiological change was modest and should be interpreted cautiously. A moderate correlation was found between radiological expansion and VAS change (r = 0.52). At 6 months, 72.9% of patients met the MCID criterion. Although ODI improved significantly over follow-up, the mean reduction remained below commonly accepted MCID thresholds, suggesting that the functional benefit may be modest. No major complications were observed; only short-term transient radicular irritation (2.1%) was seen. Conclusions: PLDD was associated with improvements in pain control, functional capacity, and modest radiological canal enlargement in this cohort of carefully selected patients with single-level, predominantly disc-driven lumbar spinal stenosis. However, because of the retrospective design and absence of a control group, no conclusions regarding comparative effectiveness can be drawn. PLDD should therefore be viewed as a selectively applicable minimally invasive option rather than a general treatment for all forms of lumbar spinal stenosis. The observed clinical benefit was limited to the 6-month follow-up available in this cohort, and its durability beyond this period remains uncertain. Prospective and comparative studies are required to better define its long-term role and its position relative to conservative treatment and surgery. Full article

The Oncotype DX^® 21-gene recurrence score (RS) guides adjuvant chemotherapy decisions in estrogen receptor-positive, human epidermal growth factor receptor 2-negative (ER+/HER2−) breast cancer, yet requires invasive tissue sampling and involves substantial costs. This study evaluated intratumoral tumor ecological diversity (iTED), a habitat imaging approach, as a non-invasive complement for predicting Oncotype DX^® high-risk classification (RS > 25). This retrospective multi-center study included 312 patients with ER+/HER2− invasive breast cancer who underwent Oncotype DX^® testing (development: n = 168; external validation: n = 144). The iTED framework employed superpixel-based habitat determination using Gaussian mixture models on pretreatment dynamic contrast-enhanced MRI. Four predictive models were compared: clinical, conventional whole-tumor radiomics (C-radiomics), iTED, and combined (Clinical + iTED). The iTED model achieved higher discriminative performance compared with C-radiomics in both development (area under the curve [AUC]: 0.868 ± 0.068 vs. 0.730 ± 0.112) and external validation (AUC: 0.811 vs. 0.587) sets. The combined model further improved performance (development AUC: 0.908 ± 0.043; external AUC: 0.889). Habitat imaging-based iTED features achieved numerically higher performance than conventional radiomics in predicting Oncotype DX^® high-risk classification. These findings suggest the potential of iTED as a non-invasive imaging biomarker to support molecular testing in clinical decision-making. Full article