Search Results (637)

Background and Clinical Significance: Breast hemangioma is an extremely rare benign vascular tumor of the breast. Its imaging findings are nonspecific, and differentiation from malignant tumors such as encapsulated papillary carcinoma, mucinous carcinoma or angiosarcoma is often difficult. We report a case of breast hemangioma that showed slow growth over an 11-year period. Case Presentation: A woman in her 50s presented with a well-defined 11 mm mass in the upper outer quadrant of the left breast detected by ultrasonography. A core needle biopsy revealed a benign lesion, and follow-up was recommended. Eleven years later, the mass had increased to 27 mm. Magnetic resonance imaging showed high signal intensity on T2-weighted images and a fast-plateau enhancement pattern extending from the periphery to the center. Although malignancy was suspected, vacuum-assisted biopsy revealed a hemangioma. Conclusions: Breast hemangioma can show slow enlargement over a long period. Recognition of a characteristic peripheral-to-central enhancement pattern may aid in distinguishing this benign vascular lesion from malignant tumors. Full article

Background: Common variable immunodeficiency is a heterogeneous disorder characterized by defects in antibody production and immune dysregulation, associated with infections and autoimmunity. Although structural and cognitive effects of CVID on the central nervous system have attracted attention in recent years, studies jointly addressing volumetric brain imaging and neurocognitive evaluation remain limited. Materials and Methods: In this retrospective cross-sectional study, 35 patients with common variable immunodeficiency and 40 age- and sex-matched healthy controls were evaluated. Cognitive performance was assessed in all participants using the Montreal Cognitive Assessment. High-resolution T1-weighted brain magnetic resonance imaging scans underwent automated segmentation using the volBrain platform, yielding quantitative volumetric measurements of cortical, subcortical, and cerebellar structures, as well as ventricles and cerebrospinal fluid. Intergroup comparisons were performed using independent t-tests and analysis of variance. Results: MoCA scores were significantly lower in patients with CVID. Volumetric analysis revealed prominent reductions in the volumes of total brain tissue, gray matter, cerebrum, cerebellum, limbic system, thalamus, and basal ganglia. Paralleling these findings, cerebrospinal fluid and lateral ventricle volumes were increased. Additional volume losses were detected in CVID patients with low MoCA scores. In CVID patients with autoimmunity, volume loss affected broader areas. Conclusions: CVID appears to be associated with structural brain changes and cognitive impairments. Chronic inflammation and immune dysregulation may contribute to these neurodegenerative processes. Regular neurocognitive monitoring and further prospective studies are warranted in patients with CVID. Full article

Pancreatic ductal adenocarcinoma (PDAC) remains a high-burden disease worldwide with increasing incidence, poor prognosis, and high mortality. Complete surgical resection is the only potentially curative treatment; however, due to a lack of symptoms in the early stages, most patients have advanced disease when diagnosed. Type 2 diabetes mellitus (T2DM) is a significant health concern characterized by hyperglycemia, insulin resistance, and impairment in insulin secretion. T2DM is linked with PDAC, sharing a complex bidirectional relationship. Therefore, dual causality between the two diseases represents significant challenges in practice, distinguishing existing T2DM as a PDAC risk factor from newly onset, potentially pancreatic cancer-related diabetes (PCRD). Evidence showed that new-onset diabetes (NOD) may serve as a biomarker for early diagnosis of PDAC, and several risk prediction models were developed to identify high-risk patients for further intervention. Although early PDAC detection is important, widespread screening is not currently recommended for T2DM patients due to a lack of cost-effective, efficient screening modalities. However, further risk stratification in diabetic patients is warranted to support a targeted screening strategy with economic viability. Diabetes confers ≈2-fold PDAC risk overall, with the highest relative risk in the first 2–3 years after diagnosis. Strategies using clinical signs (age ≥50–60 years, unintentional weight loss, rapid HbA1c escalation/insulin initiation) and predictive risk scores (e.g., ENDPAC) can triage NOD patients for magnetic resonance imaging/computed tomography (MRI/CT) and endoscopic ultrasound (EUS). A targeted screening approach may allow early diagnosis that could improve the prognosis of PDAC patients. This narrative review aims to synthesize current evidence linking T2DM and PDAC; delineate risk factors within diabetes populations; appraise predictive models and biomarkers for differentiating PCRD from typical T2DM; outline pragmatic, risk-adapted screening strategies, especially for NOD, and identify additional areas where further research is needed. Full article

Magnetoliposomes are hybrid nanostructures that integrate superparamagnetic ultrasmall carbon-coated ferrite nanodots (MNCDs) within liposomes (Lipo) composed of egg yolk-derived phospholipids and stabilized with an environmentally benign potato peel extract (PPE), enabling enhanced magnetic resonance imaging (MRI) and optical imaging. The hydrothermally synthesized MNCDs were entrapped in liposomes prepared by thin-film hydration, and physicochemical properties were established at each stage of engineering. These magnetoresponsive vesicles (MNCDs+Lipo@PPE) serve as a triple-mode medical imaging contrast for T1 & T2-weighted MRI, while simultaneously enabling optical tracking of liposome degradation under an external magnetic field. They exhibited long-term enhanced fluorescence intensity and colloidal stability over 30 days, with hydrodynamic diameters ranging from 190 to 331 nm and an improved surface charge following PPE coating. In vitro cytotoxicity assays (MTT and Live/Dead staining) demonstrated over 87% cell viability for MNCDs+Lipo@PPE up to 2.7 mM concentration in A549 cells, indicating considerable toxicity. This multimodality engineering facilitates precise image-guided anticancer doxorubicin delivery and magnetic-responsive controlled release. The theoretical model shows that the release profile follows the Korsmeyer-Peppas profile. The externally applied magnetic field enhances the release by 1.4-fold. To demonstrate the anticancer efficiency in vitro with minimum off-target cytotoxicity, MTT and live/dead cell assay were performed against A549 cells. The reported study is a validated demonstration of magnetic-responsive nanocarrier systems for anticancer therapy and multimodal MRI and optical imaging-based diagnosis. Full article

Background/Objective: Oblique lumbar interbody fusion (OLIF) achieves indirect decompression through restoration of disc height. Because maintenance of the restored disc space is essential for sustained neural decompression, solid fusion without cage subsidence is a key determinant of successful surgical outcomes. This study aimed to evaluate preoperative and intraoperative predictors of cage subsidence and radiographic fusion after OLIF. Methods: Seventy patients (119 levels) who underwent OLIF using a polyether–ether–ketone cage and posterior screw fixation between 2015 and 2023 were retrospectively reviewed. Preoperative bone quality was assessed using the computed tomography-based Hounsfield unit (HU) and magnetic resonance imaging-based vertebral bone quality (VBQ) score on T1-weighted images. Radiographic parameters of anterior and posterior disc height (ADH, PDH), segmental and lumbar lordotic angle (SLA, LLA), foraminal height (FH), and cage position were measured preoperatively at one-year follow-up. Results: Cage subsidence occurred in 21.0% of spinal levels (25/119 levels). Multivariate analysis identified these measures as independent predictors: HU (OR 1.017; p = 0.012), VBQ score (OR 2.716; p = 0.016), and PDH distraction (OR 1.418; p = 0.019). ROC analysis identified cutoff values of HU < 145.86 (AUC = 0.654), VBQ score > 3.30 (AUC = 0.723), and PDH distraction > 4.79 mm (AUC = 0.672). None of the evaluated factors were significantly associated with one-year radiographic fusion. Conclusions: Lower HU, higher VBQ score, and excessive PDH distraction are independent risk factors for cage subsidence after OLIF, although these factors do not appear to affect short-term fusion outcomes. Full article

Background/Objectives: Sarcopenia, an underdiagnosed musculoskeletal disorder, is a serious cause of disability, poor quality of life, and healthcare costs in an increasingly elderly population. This study aimed to examine an ultrasound (US)-based, inexpensive, simple, and reproducible alternative to magnetic resonance imaging (MRI) for assessing muscle quality. A study compared Dixon MR fat fraction with US attenuation imaging (ATI) and echo intensity (EI) in the rectus femoris (RF) and biceps brachii (BB). Methods: The US images were acquired from 34 participants who had previously received a whole-body MRI. The ATI measurements were carried out using a linear array on a Canon Aplio i800 scanner. The measurements of EI were assessed by manually tracing the cross-sectional border of the right RF and BB muscles. Corresponding T1-weighted Dixon VIBE-based fat and water images were required for the MRI fat fraction percentage (MR %FF) measurements. Results: Using Pearsons correlation coefficient, a good correlation was found between MR %FF and EI measurements. The results between operators’ measurements showed a strong correlation and were highly repeatable. Attenuation imaging revealed no correlation with MR %FF or EI. Conclusions: Echo intensity offers a low-cost, non-invasive, and widely accessible US-based imaging modality for screening patients at risk for sarcopenia. No correlation was found between the ATI and MR %FF or between the ATI and EI. Further adapted protocols and software adjustments are needed so that ATI has the potential to prove itself as an additional US-based method for assessing fat infiltration in muscles. Full article

Objectives: Magnetic resonance imaging plays a pivotal role in the management of locally advanced rectal cancer. This study aims to assess the correlation between magnetic resonance tumor regression grade and pathological tumor regression grade following neoadjuvant therapy in patients with locally advanced rectal cancer. Material and Methods: A retrospective analysis was conducted on 97 patients diagnosed with LARC (T3-T4 or any T stage with regional lymph node involvement) who underwent neoadjuvant chemoradiotherapy followed by radical surgery between 2014 and 2020. The correlation between mrTRG and pTRG was evaluated primarily using the weighted Kappa statistic. Additional clinical and imaging data were collected for a comprehensive analysis. Results: The median interval between completion of neoadjuvant therapy and restaging MRI was 40 days, with a median of 69 days from completion of chemoradiotherapy to surgery. The weighted Kappa was 0.27, indicating fair agreement between mrTRG and pTRG. MRI demonstrated a sensitivity of 52.1% and specificity of 81.6% for detecting a good response (pTRG 1–2). For identification of a complete response (pTRG 1), MRI showed a sensitivity of 10% and specificity of 98.7%. Conclusions: The correlation between mrTRG and pTRG shows fair agreement. Although MRI alone may not be sufficient to reliably predict pathological response, its high specificity suggests it can be a useful tool to confirm good and complete responses. Therefore, MRI should be integrated with other diagnostic methods, such as endoscopy and digital rectal examination, especially in organ preservation strategies. Moreover, MRI retains potential as a prognostic factor to guide clinical decision-making in LARC. Full article

Purpose: This study proposes a novel magnetic resonance (MRI)-based classification of cortical tubers (CTs) in tuberous sclerosis complex (TSC) patients that incorporates intralesional calcifications. We evaluated prevalence, temporal evolution, and genotype correlation of intra-tuberal calcifications in pediatric TSC patients, emphasizing susceptibility-weighted imaging (SWI) for detection. Materials and Methods: We retrospectively analyzed MRI scans of 57 unrelated pediatric TSC patients followed between 2014 and 2024 at a tertiary care center. Inclusion criteria included longitudinal imaging on the same 1.5T scanner, with T1w, T2w/FLAIR, and SWI sequences. CTs were classified into four MRI-based categories (A–D), with calcified tubers subdivided into micro-calcified and macro-calcified. Descriptive statistics, binomial tests, and Chi-square analyses were performed. Results: Calcified CTs were more prevalent than cystic ones. At baseline MRI, 63% of patients had calcified tubers (19% of all CTs), increasing to 77% at follow-up MRI (24% of all CTs). Micro-calcifications predominated at baseline MRI evaluation, though a significant proportion progressed to macro-calcifications over time. Calcified CTs always progressed from lower-grade lesions. Cystic tubers were rare (<1%). Longitudinal analysis showed significant variation in CTs with inner calcification count (p = 0.0000023), but not in CTs with cystic components (p = 0.42072). No significant genotype–radiological phenotype association emerged. Conclusions: Intralesional calcifications in CTs are dynamic and detectable with SWI. The inclusion of calcification patterns in CT classification could offer insights that may prove useful for future prognostic and risk-stratification frameworks in pediatric TSC. Full article

Objectives: Brucella spondylitis (BS) and tuberculosis spondylitis (TS) are two causes of infection that share overlapping clinical and imaging features, complicating diagnoses. Early differentiation is critical, as treatment regimens differ significantly. This study aims to develop a deep learning framework using multimodal computed tomography (CT) and magnetic resonance imaging (MRI) data to accurately distinguish between these two conditions, improving diagnostic accuracy and patient outcomes. Methods: In this study, imaging data were acquired from two centers using different MRI and CT protocols. Sagittal T1-weighted (T1WI) and T2-weighted imaging (T2WI), fat-suppression sequences (T2WI FSE), and sagittal CT data were collected. Image preprocessing included region of interest (ROI) segmentation, and normalization and augmentation techniques were used. A deep learning model, based on pre-trained GoogleNet architectures, was trained and evaluated against human radiologists using metrics including accuracy, sensitivity, and AUC to assess diagnostic performance. Results: In this study, the GoogleNet deep learning model outperformed other architectures in classifying TS and BS, achieving AUCs of 95.97%, 91.24%, and 81.25% across training, test, and external validation datasets, respectively. In contrast, ResNet, DenseNet, and EfficientNet models showed lower AUC values. GoogleNet also demonstrated high accuracy (90.77% training, 83.04% test) and 90.91% sensitivity and 61.11% specificity in external validation. When compared to three radiologists, GoogleNet outperformed in diagnostic accuracy and speed, achieving an AUC of 88.01% and processing cases in 0.001 min. These findings highlight the potential of AI to enhance diagnostic performance and efficiency. Lastly, the explanation provided by the Grad-Cam model precisely localized major lesions. Conclusions: This multimodal-imaging-based deep learning model could well differentiate TS and BS. Deep learning does not need manual feature extraction, selection, or model development, and has great potential in daily clinical practice. Full article

To explore the relationship between magnetic resonance imaging (MRI) parameters, including T2-weighted intensity and apparent diffusion coefficient (ADC), and intraoperative tumor characteristics, particularly consistency, in vestibular schwannomas (VSs). The association between tumor consistency, facial nerve (FN) function, and postoperative outcomes was analyzed. A single-center retrospective analysis included newly diagnosed VS cases (2020–2023) with cisternal involvement (Samii T3a; volume ≥ 0.7 cm³). T2 and ADC maps from the perimetral region of interest were normalized, and tumors were categorized into 3 classes by combining qualitative consistency (soft, fibrous, or fibrous/hard), ultrasonic aspirator power, and adherence to neurovascular structures. FN function was assessed using the House–Brackmann scale at the immediate postoperative period and 12-month follow-up. MRIs of 33 VSs (18 solid and 15 cystic) were analyzed. Normalized values of both T2 (N-T2_mean) and ADC (N-ADC_min) maps predicted the classical radiological differentiation. N-ADC_min may have some role in predicting consistency (value 1.361, p = 0.017, accuracy 0.48) and demonstrated a significant association (p = 0.04) with the FN outcome in the immediate postoperative period. An augmented consistency could impair FN function by increasing the intrameatal pressure related to greater transmission of shocks derived from the dissection maneuvers of the cisternal component of the tumor. The possibility of non-invasively exploring VS consistency with a parameter easily calculable on MRI might be beneficial in surgical planning, modifying the timing of the opening of the meatus with respect to what could be the surgical routine in some centers. Full article

Background: Early detection of recurrent brain tumors after malignant glioma surgery is a challenge in imaging-based assessment of glioma. Objective: The aim of this case series is to investigate whether there are signs for an improvement in the early detection of recurrent tumors using multiparametric magnetic resonance imaging (MRI) after glioma surgery. Methods: An MRI protocol was used with high-resolution fluid-attenuated inversion recovery (FLAIR), diffusion tensor imaging (DTI), resting state functional MRI (rsfMRI), and contrast-enhanced high resolution T1-weighted (T1w). Longitudinal multiparametric MRI was performed in six patients with glioblastoma with one complete scan before surgery, one scan after surgery and at least two follow-up scans. A total of 27 complete multiparametric MRI data sets were available. Results: DTI analysis at the localizations of recurrent tumors showed early directionality loss in DTI by fractional anisotropy (FA) reduction accompanied by FLAIR hyperintensities before hyperintensities in contrast enhanced T1w were visible. One out of six patients showed a regional FA decrease at the localization of the recurrent tumor at a point of time even when the morphological T1w- and FLAIR images did not demonstrate any detectable changes. Functional connectivity alterations in a corresponding network could also be detected at the localizations of the recurrent tumor. Conclusions: In addition to routine T2w FLAIR and contrast enhanced T1w, DTI and rsfMRI might complement information for the early detection of recurrent malignant glioma. Prospective studies at larger scale are needed with respect to potential of DTI and rsfMRI for early recurrent tumor detection. Full article

Photodynamic therapy (PDT) is a highly selective, clinically approved, minimally invasive technique that effectively eliminates cancer cells. Its effectiveness is limited by poor light penetration into tissue and the hydrophobic nature of photosensitizers, highlighting the need for new approaches to treatment. Here, a theranostic upconversion nanoplatform, consisting of a NaYF₄:Yb,Er,Tm,Fe core and a NaHoF₄ shell codoped with Yb, Nd, Gd and Tb ions, was designed to enhance PDT outcomes by integrating multi-wavelength upconversion luminescence, T₂-weighted magnetic resonance imaging (MRI) and PDT. The synthesized core–shell upconversion nanoparticles (CS-UCNPs) were coated with new verteporfin (VP)-conjugated alendronate-terminated poly(N,N-dimethylacrylamide-co-2-aminoethyl acrylate) [Ale-P(DMA-AEA)] grafted with poly(ethylene glycol) (PEG). Under 980 nm NIR irradiation, CS-UCNP@Ale-P(DMA-AEA)-PEG-VP nanoparticles generated reactive oxygen species (ROS) due to the efficient energy transfer between CS-UCNPs and VP. In a pilot preclinical study, intratumoral administration of nanoparticle conjugates to mice, followed by exposure to NIR light, induced necrosis of pancreatic tumor and suppressed its growth. Full article

Background: Cortical tubers (CTs) are hallmark brain lesions in tuberous sclerosis complex (TSC), historically considered stable in number over time; prior literature has correlated overall CT burden on magnetic resonance imaging (MRI) with disease severity. As longitudinal imaging studies assessing CTs’ evolution over time are lacking, we aim to investigate temporal changes in CTs—both in number and signal—on MRI in a cohort of pediatric TSC patients. Methods: A retrospective single-center analysis was conducted on 57 pediatric TSC patients who underwent longitudinal MRI studies in a 10-year span. Required MRI sequences included volumetric unenhanced T1-weighted, SWI, T2w and/or FLAIR. CTs were evaluated by two neuroradiologists and classified into five subtypes (A, B, C1, C2, D) according to signal characteristics. Statistical comparison was performed using t-tests. Results: Paired t-test analysis demonstrated a significant longitudinal increase in the overall number of CTs, rising from 16.11 ± 12.43 at baseline to 18.77 ± 13.29 at follow-up (mean difference = −2.67, 95% CI [−3.94, −1.39]; t (56) = 4.19; p < 0.0001), corresponding to a moderate effect size (Cohen’s d ≈ 0.56). When stratified by age, patients <2 years—representing the incompletely myelinated subgroup—showed a more pronounced increase in CT burden, from 19.46 ± 15.21 to 24.17 ± 15.75 (mean difference = −4.71, 95% CI [−7.37, −2.04]; t (23) = 3.65; p = 0.0013; d ≈ 0.75). In contrast, patients aged ≥2 years demonstrated a smaller but still significant increase, from 13.67 ± 9.45 to 14.85 ± 9.64 (mean difference = −1.18, 95% CI [−2.08, −0.28]; t (32) = 2.68; p = 0.0115; d ≈ 0.46). Direct comparison between the two subgroups using Welch’s two-sample t-test confirmed that the mean CT count in patients <2 years was significantly higher than in those ≥2 years (mean difference = 3.53 ± 1.36; t = 2.59; df = 28.4; p = 0.0075), with a large effect size (Cohen’s d ≈ 0.78). Type C1-C2 tubers evolved from pre-existing earlier-stage lesions, while most newly visible CTs over time were type A-B. Type D tubers remained rare and derived from earlier-stage CTs. Conclusions: Contrary to previous assumptions, CTs in pediatric TSC showed a tendency to increase in number and evolve in signal over time, thus challenging the notion of stability and suggesting dynamic behavior. Incomplete myelination in early infancy may impact MRI CTs detection by reducing contrast with surrounding brain tissue, potentially leading to their underestimation/misidentification. Full article

A 70-year-old Japanese woman with longstanding hearing loss and asthma developed floating sensations, left finger numbness, and postural instability one day after influenza vaccination, leading to hospital admission. Neurological examinations showed hearing loss, hyperreflexia, left-predominant ataxia, bilateral mild bathyanesthesia, and inability to tandem gait. Cerebrospinal fluid (CSF) analysis showed no pleocytosis or malignant cells, but revealed positive oligoclonal bands and elevated myelin basic protein. Despite no contrast agent use due to asthma, brain magnetic resonance imaging (MRI) revealed pontine hyperintensities on diffusion-weighted imaging (DWI) and T2-fluid attenuated inversion recovery (T2-FLAIR) sequences, along with hyperperfusion on arterial spin labeling (ASL) imaging. Serum anti-aquaporin-4 antibodies (AQP4-Ab) were negative by ELISA. Given the temporal proximity to vaccination and elevated demyelination markers, brainstem-type acute disseminated encephalomyelitis (ADEM) was initially suspected. Symptoms nearly resolved after two cycles of methylprednisolone pulse therapy. Notably, hyperperfusion gradually improved on ASL imaging. Post-discharge, a cell-based assay confirmed the diagnosis of neuromyelitis optica spectrum disorder (NMOSD) by detecting positive anti-AQP4-Ab. She has been relapse-free for about a year without any immunosuppressants or biologics. Although contrast-enhanced MRI remains the gold standard modality for lesion evaluation due to its high sensitivity, hyperperfusion on ASL may provide a useful alternative in patients for whom contrast agents are contraindicated, such as those with asthma or impaired renal function. Full article

Background: This study aims to evaluate the contribution of clinical and radiomic features to machine learning-based models for survival prediction in patients with locally advanced cervical cancer. Methods: Clinical and radiomic data from 161 patients were retrospectively collected from a single center. Radiomic features were obtained from contrast-enhanced magnetic resonance imaging (MRI) T1-weighted (T1W), T2-weighted (T2W), and diffusion-weighted (DWI) sequences. After data cleaning, feature engineering, and scaling, survival prediction models were created using the CatBoost algorithm with different data combinations (clinical, clinical + T1W, clinical + T2W, clinical + DWI). The performance of the models was evaluated using test accuracy, precision, recall, F1-score, ROC curve, and Bland–Altman analysis. Results: Models using both clinical and radiomic features showed significant improvements in accuracy and F1-score compared to models based solely on clinical data. In particular, the CatBoost_CLI + T2W_DMFS model achieved the best performance, with a test accuracy of 92.31% and an F1-score of 88.62 for distant metastasis-free survival prediction. ROC and Bland–Altman analyses further demonstrated that this model has high discriminative power and prediction consistency. Conclusions: The CatBoost algorithm shows high accuracy and reliability for survival prediction in locally advanced cervical cancer when clinical and radiomic features are combined. The addition of radiomics data significantly improves model performance. Full article