Search Results (12,786)

Background/Obectives: Alveolar bone resorption after tooth extraction compromises esthetics and implant placement. Conventional alveolar ridge preservation (ARP) relies on grafting. This randomized controlled study evaluated a graft-free, lamina-based approach aimed at preserving ridge morphology by protecting the buccal cortical plate. Methods: Forty alveoli were randomly assigned to Guided Alveolar Ridge Preservation (G-ARP) with a subperiosteally positioned cortical lamina (test) or unassisted healing (control; CTRL). Cone-beam computed tomography (CBCT) was performed before extraction and after five months. Vertical and horizontal dimensional changes were statistically compared. Results: Healing was uneventful. At five months, the G-ARP group showed a vertical gain of 0.5 mm and a horizontal reduction of 0.2 mm, whereas the CTRL group exhibited a vertical loss of 1.7 mm (p < 0.01) and a horizontal loss of 2.7 mm (p < 0.001). Effect sizes were large for vertical change and very large for horizontal change (Hedges’ g = 0.95 and 2.19, respectively). Regeneration occurred through native bone formation without grafts. Conclusions: Subperiosteal placement of a cortical lamina effectively preserved ridge dimensions after extraction. This graft-free approach may offer technical and biological advantages while supporting new bone regeneration. Full article

Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality worldwide, and its management is limited by heterogeneous risk profiles, suboptimal surveillance performance, diagnostic uncertainty in chronically diseased livers, and difficulty individualizing prognosis after treatment. The aim of this narrative review was to critically evaluate artificial intelligence (AI) applications across the HCC care continuum, with emphasis on their intended clinical role, reported performance, evidence maturity, and barriers to implementation. A major strength of this review is that it moves beyond a descriptive catalog of models by structuring the literature around clinically relevant decision points and by explicitly distinguishing emerging proof-of-concept tools from applications with stronger translational potential. Across risk stratification, surveillance, imaging-based diagnosis, pathology, treatment-response prediction, and prognostication, we found that AI consistently demonstrates promise, particularly for identifying patients at higher future HCC risk, improving lesion detection and characterization on ultrasound, CT, MRI, and contrast-enhanced ultrasound, assisting histopathologic classification, and predicting outcomes such as microvascular invasion, recurrence, survival, and response to locoregional therapies. However, we also found that the evidence base remains highly uneven: many diagnostic studies are retrospective and lesion-enriched rather than embedded in true surveillance populations, many prognostic models lack robust external validation and calibration assessment, and reference standards, imaging protocols, and dataset composition vary substantially across studies. These findings are clinically relevant because they highlight both where AI may offer near-term value and why most published systems are not yet ready for routine use. Overall, AI in HCC should be viewed as a rapidly evolving but still transitional field. Its future impact will depend not only on higher-performing algorithms but on clearly defined clinical use cases, multicenter and prospective validation, transparent reporting, workflow-aware evaluation, and implementation strategies that support safe, equitable, and scalable adoption. Full article

Background/Objectives: Accurate and reproducible lymph node (LN) measurement is essential for oncologic staging and therapy monitoring but is subject to inter-reader variability. This study evaluated the accuracy and reproducibility of a fully automated artificial intelligence (AI)-based LN measurement workflow in contrast-enhanced chest CT, using multi-reader manual measurements as reference. Methods: Sixty thoracic LNs from seven patients were independently measured by 13 radiologists in two reading rounds. The median of all measurements served as the ground truth (GT). Automated short- and long-axis diameters were derived from fully automated 3D CNN-based segmentations. Agreement between AI and manual measurements was assessed using Friedman testing, intraclass correlation coefficients (ICCs), and concordance correlation coefficients (CCCs). Measurement stability was evaluated across repeated runs on different hardware systems. Results: A total of 2280 manual measurements were analyzed. Manual assessment showed significant inter-reader variability (p < 0.01), while intra-reader agreement was high. No significant differences were observed between AI-based measurements and the GT (all p > 0.01). Agreement was good, with CCC values of 0.86 (SAD) and 0.79 (LAD). AI-based measurements were numerically stable across hardware configurations. Conclusions: Fully automated AI-based LN measurements in chest CT scans provide strong agreement with multi-reader consensus and high numerical stability. Automated measurement may support more standardized and reproducible oncologic imaging assessment. Full article

Silica-based bioceramics are promising bone substitutes with tunable degradation and mechanical properties. We aimed to assess bone response in critical-size calvarial defects in rats, empty or filled with 3D-printed sphene ceramic (CaTiSiO₅) scaffolds produced using direct ink writing from preceramic polymers and reactive fillers. Scaffold characterization was performed using scanning electron microscopy, X-ray diffraction, porosity analysis, and compressive strength testing. Bilateral cylindrical 5 mm calvarial defects were created in 20 rats: one was randomly filled with sphene scaffold, while the contralateral remained empty. Ten animals were killed at 4 weeks, the rest at 8 weeks. Specimens were collected for micro-X-ray computed tomography (micro-CT) analysis, followed by undecalcified histology. The scaffolds exhibited porous structure with complete sphene phase purity and compressive strength of 17.91 MPa (SD 4.6). In vivo, no adverse event was noted during healing. Overall bone regeneration—as measured by BV/TV—was comparable between groups: Bone volume/total volume (BV/TV) increased over time in the empty and sphene groups, reaching ~40%, with no significant differences between groups or time points. BV/TV was significantly higher in the external regions of the defects compared to the internal areas in both groups at the two time points. The sphene group showed a significantly greater volume of new bone extending beyond the original cortical boundary at both 4 and 8 weeks (p = 0.013). In the sphene group histology revealed partial bone ingrowth within the scaffold, while bone in the control group was limited to defect edges. After 8 weeks, new bone adjacent to the cortical surface was thicker in the sphene group (p < 0.05). These initial findings are consistent with prior preclinical studies, supporting the biocompatibility and osteoconductive nature of sphene ceramic scaffolds. Full article

Background/Objectives: Accurate preoperative assessment of renal tumor complexity is essential for surgical planning and for predicting perioperative outcomes after partial nephrectomy (PN). RENAL and PADUA nephrometry scores, traditionally derived from two-dimensional (2D) computed tomography (CT) imaging, are widely used to quantify renal tumor complexity and surgical risk. However, the introduction of hyperaccuracy three-dimensional (HA3D) models has enabled enhanced anatomical visualization, potentially improving the assessment of surgical difficulty and the prediction of postoperative complications. The aim of this study was to compare conventional CT-based RENAL and PADUA scores with HA3D-derived nephrometry scores in predicting perioperative complications in patients undergoing robot-assisted or laparoscopic PN. Methods: A total of 17 consecutive patients with intermediate- or high-complexity category renal tumors (RENAL ≥ 7) and moderate- or high-risk category tumors (PADUA ≥ 8) were prospectively enrolled. Preoperative demographic and clinical parameters, as well as intraoperative and postoperative data, were prospectively collected. Tumor characteristics were evaluated using both CT-based RENAL and PADUA scoring systems and HA3D nephrometry reconstruction. Associations between nephrometry scores and perioperative outcomes were assessed using Spearman’s correlation. Predictive performance for postoperative complications and early chronic kidney disease (CKD) was evaluated using receiver operating characteristic (ROC) analysis. Results: Overall, 41% and 35% of cases were downgraded according to three-dimensional (3D) RENAL and PADUA complexity–risk category assessment, respectively. Operative time demonstrated a moderate correlation with 3D RENAL (ρ = 0.57) and 3D PADUA (ρ = 0.49) scores. ROC curve analysis demonstrated numerical differences in area under the curve (AUC) values between 3D- and 2D-based nephrometry scores in predicting overall complications (RENAL: 0.61 vs. 0.54; PADUA: 0.69 vs. 0.46). 3D RENAL score demonstrated numerically higher AUC values for early postoperative CKD compared with 2D RENAL score (AUC: 0.72 vs. 0.67). Conclusions: HA3D-based nephrometry scores were associated with enhanced anatomical visualization, frequent downgrading of tumor complexity–risk categories, and numerical differences in predictive performance for postoperative complications and early renal functional decline compared with conventional CT-based scores. These findings suggest a potential role for HA3D modeling in preoperative planning for PN. However, given the limited sample size, these observations should be interpreted as exploratory and hypothesis-generating, and warrant validation in larger multicenter cohorts. Full article

Background: Endovascular aneurysm repair (EVAR) requires lifelong imaging surveillance because endoleaks, aneurysm sac expansion, and severe adverse events occur in up to one-third of the patients. Conventional follow-up based on sac diameter and visual assessment may fail to detect early microstructural changes that precede clinical deterioration. Methods: This narrative review summarizes the current evidence on texture-based radiomics and artificial intelligence (AI) applied to computed tomography (CT) and CT angiography (CTA) for post-EVAR outcome prediction and surveillance. Original studies evaluating radiomic features and AI-based models for endoleak detection, aneurysm sac behavior, and EVAR-related adverse events were included and qualitatively synthesized. Results: Ten studies were included. Radiomic features describing texture heterogeneity, gray-level nonuniformity, entropy, and spatial complexity were extracted from the aneurysm sac, intraluminal thrombus, and perivascular adipose tissue. Machine learning and deep learning models achieved good to excellent performance, with reported AUC values ranging from 0.78 to 0.95 for predicting endoleaks, sac expansion, and severe adverse events. Texture-based radiomics consistently outperformed morphology-only assessments and showed complementary value to deep learning, including applications on non-contrast CT. Conclusions: CT texture radiomics combined with AI represents an emerging research approach with potential relevance for post-EVAR surveillance, although current evidence remains limited. By capturing tissue heterogeneity beyond conventional morphology, radiomics may enable the earlier detection of complications and support risk-adapted follow-up. However, the heterogeneity of methods limited external validation, and reproducibility issues remain major barriers to clinical translation. Full article

Background/Objectives: Pulp stones are calcified masses within the dental pulp that may complicate endodontic procedures. Although cone beam computed tomography (CBCT) has been reported to detect pulp stones more frequently than two-dimensional radiography, direct comparisons between digital periapical radiography (DPR) and CBCT, particularly at different voxel sizes, remain limited. This study aimed to compare pulp stone detection rates between DPR and CBCT acquired at two voxel sizes and to evaluate inter-modality agreement using a location-based analysis for pulp stone identification in extracted teeth. Methods: Fifty-two extracted human teeth were examined using DPR and CBCT at voxel sizes of 0.2 mm and 0.1 mm under standardized ex vivo conditions. Pulp stones were evaluated in the coronal and radicular regions using a binary scoring system (presence/absence). Detection rates were compared across imaging modalities, and inter-modality agreement was evaluated using McNemar’s test in the analysis stratified by pulp stone location. Associations between pulp stone detection and age, gender, tooth status, and stone location were explored using chi-square tests. Results: CBCT at 0.1 mm demonstrated the highest detection rate for pulp stones (63.5%), followed by CBCT at 0.2 mm (57.7%) and DPR (50%), with no statistically significant differences among modalities (p > 0.05). Agreement analysis showed that CBCT at 0.2 mm had higher agreement with CBCT at 0.1 mm than DPR, particularly in the coronal region, whereas DPR showed lower agreement in the radicular region. No significant associations were observed between pulp stone detection and age, gender, or tooth status. Conclusions: Under standardized ex vivo conditions, CBCT showed numerically higher pulp stone detection rates than DPR. Location-based agreement analysis indicated greater consistency between CBCT voxel sizes than between CBCT and DPR, particularly in the radicular region. These findings highlight differences in pulp stone detectability across imaging modalities and voxel resolutions and may help explain variability in radiographic detection under controlled conditions. Full article

Background/Objectives: Post-COVID-19 fibrotic-like lung changes (PC19-FLC), which may represent persistent post-inflammatory abnormalities or early fibrotic remodeling, have emerged as an important long-term pulmonary sequela following SARS-CoV-2 infection. However, the underlying pathogenic mechanisms remain incompletely understood. This study aimed to investigate the potential association between mammalian target of rapamycin (mTOR) activity and the presence of PC19-FLC. Methods: This single-center, cross-sectional study included 70 patients who met the predefined inclusion criteria. Participants were categorized according to the presence or absence of PC19-FLC on chest computed tomography. Demographic, laboratory, and radiological data were collected. Serum mTOR levels were measured using enzyme-linked immunosorbent assay (ELISA). Results: Serum mTOR levels and modified Medical Research Council (mMRC) dyspnea scores were significantly higher in patients with PC19-FLC compared with those without fibrotic-like changes. Receiver operating characteristic (ROC) curve analysis identified a serum mTOR cut-off value of 6.15 ng/mL (sensitivity 83%, specificity 94%) for discriminating patients with PC19-FLC in this cohort. Serum mTOR levels were significantly correlated with forced vital capacity (FVC%), mMRC dyspnea score, and peripheral oxygen saturation (SpO₂). Conclusions: Increased serum mTOR levels were associated with the presence of fibrotic-like lung changes after COVID-19 and may help distinguish patients with such CT abnormalities in this cohort. Higher mTOR levels were also associated with greater dyspnea severity, lower lung volumes, and reduced peripheral oxygen saturation. These findings suggest a potential role of mTOR signaling in post-COVID-19 pulmonary sequelae and warrant further investigation in larger, multicenter studies. Full article

Historically, stage T4 non-small cell lung cancer (NSCLC) with direct spinal invasion was considered a definitive surgical contraindication due to the perceived inability to achieve negative margins without catastrophic morbidity. This paradigm has shifted through the advancement of specialized surgical techniques, which facilitate radical en-bloc resection in highly selected candidates by adhering to the en-bloc concept. This concept mandates the retrieval of the tumor and invaded vertebral segments as a single, contiguous unit to prevent intralesional transgression and local recurrence. Achieving microscopic negative margins (R0) stands as the most critical prognostic factor, as radical resection offers a significantly improved potential for long-term survival. Technical success requires a meticulously planned multidisciplinary approach encompassing varied surgical corridors—ranging from combined anterior–posterior windows to single-stage posterior-only approaches—tailored to the tumor’s anatomical level. Furthermore, preoperative hemostatic optimization using dual-energy computed tomography (DECT) for vascular assessment and transarterial embolization (TAE) has become indispensable for managing the hypervascularity of the invaded vertebral bone. This review synthesizes these evolving strategies, illustrated by a case of a 74-year-old male with stage T4 NSCLC where an R0 resection was achieved through a two-stage approach integrating uniportal video-assisted thoracoscopic surgery (VATS). Ultimately, en-bloc management provides a feasible and potential surgical strategy toward long-term survival for localized, spine-invasive lung cancer within a multidisciplinary treatment framework. Full article

Background: Traumatic head injury (THI) includes a diverse range of hemorrhagic brain lesions (HBL), which are distinct phenotypes with characteristic pathophysiological mechanisms. Computed tomography (CT) is the cornerstone of the initial assessment and diagnosis; however, its sensitivity is limited, especially in mild head injury. Blood-derived biomarkers, including Neuron-Specific Enolase (NSE) and S-100B, have been extensively studied; however, their efficacy in distinguishing HBL subtypes remains unclear. We evaluated whether circulating serum levels of S-100B and NSE can discriminate between distinct intracranial HBLs and extracranial hemorrhagic lesions (ECH). Methods: This is an interim analysis of a prospective, randomized, double-blind clinical trial including 434 adult patients with blunt THI. HBL phenotypes identified by CT scan included subarachnoid hemorrhage (SAH), subdural hematoma (SDH), epidural hematoma (EDH), and brain contusion (BC). Unique lesions were considered while overlapping lesions were excluded. Subgaleal hematoma (SGH) was included as an example of ECH. Serum S-100B was assessed within 6 h post-injury, while serum NSE was evaluated at admission, 24 h, and 48 h thereafter. Serum NSE and inflammatory cytokines were quantified in duplicates using a Human Magnetic Luminex 5-plex assay, while serum S-100B concentrations were measured separately. Serum epinephrine concentrations were quantified using an ELISA. Biomarker profiles were analyzed based on lesion phenotype, lesion multiplicity, injury pattern, and clinical outcomes, including hospital length of stay (HLOS) and the Glasgow Outcome Scale—Extended (GOSE). Results: Admission median S-100B levels were higher in patients with SAH (495 pg/mL) and lower in those with SGH (191 pg/mL); however, they did not show statistically significant difference among HBL phenotypes. They were significantly higher in patients with polytrauma TBI (420 pg/mL) compared to isolated TBI (258 pg/mL). Baseline and 48 h NSE concentrations were significantly higher in SDH (25,089 and 28,438 pg/mL) than in other THI lesions (p = 0.04). There were no statistically significant changes in NSE values over time across all THI lesions except for SDH in which they raised more after 48 h (p = 0.02). They had a significant drop in polytrauma over the time (p = 0.001). Compared to intracranial lesions, S-100 B levels were significantly lower in SGH and in skull fractures without intracranial hematomas. Both S-100B and NSE levels were elevated in individuals with unfavorable GOSE scores. Conclusions: In this secondary exploratory analysis, elevated serum NSE and S-100B levels discriminate between extra- and intracranial lesions and appear to represent distinct but complementary aspects of THI, indicating neuronal damage and its temporal evolution, and predicting clinical and functional outcomes. The present findings reflect association and not causation. Future studies incorporating larger or multicenter cohorts, volumetric imaging, and long-term outcomes are required to validate and refine biomarker-guided algorithms for personalized THI care. Full article

Background and Objectives: Orbital exenteration performed for advanced malignancies often results in complex defects that are difficult to reconstruct, particularly in patients treated with adjuvant radiotherapy who subsequently develop osteoradionecrosis. This study describes the preliminary results of a surgical technique for secondary orbital reconstruction using a combined scalp flap and temporalis muscle flap (TMF), referred to as the “Pacman flap with tongue,” performed prior to prosthetic rehabilitation. Materials and Methods: Five elderly patients with multiple comorbidities and osteoradionecrosis following orbital exenteration and radiotherapy underwent secondary orbital reconstruction using the “Pacman flap with tongue” technique. The clinical outcomes, flap viability, complications, and feasibility of subsequent prosthetic rehabilitation were assessed. After stabilization of healing, digitally planned ocular epitheses were fabricated using cone-beam computed tomography (CBCT), computer-aided design, and three-dimensional printing. Results: Healing was uneventful in all patients. No flap necrosis, wound dehiscence, or recurrent bone exposure was observed. The reconstructed orbital sockets provided a stable, well-vascularized prosthetic bed, enabling satisfactory prosthetic rehabilitation. Conclusions: The “Pacman flap with tongue” may be considered a feasible option for secondary orbital reconstruction in selected high-risk patients, particularly in the setting of osteoradionecrosis. Full article

Background: Visceral adipose tissue (VAT) and epicardial adipose tissue (EAT) are increasingly recognized as relevant contributors to cardiometabolic alterations and subclinical myocardial dysfunction, independently of overall obesity. Their pathogenic role extends beyond simple fat accumulation, encompassing inflammatory activation, lipotoxicity, and altered myocardial metabolism. Objective: This narrative review synthesizes current evidence on the relationships between VAT/EAT and myocardial strain parameters, with emphasis on subclinical cardiovascular risk detection and nutritional interventions. Methods: We conducted a comprehensive review of studies published between 2003–2025, focusing on imaging-based assessments of adipose tissue distribution and strain parameters using echocardiography, computed tomography, and cardiac magnetic resonance. Results: Increased EAT and, to a lesser extent, VAT showed significant associations with impaired global longitudinal strain (GLS) across imaging-based studies. In patients with type 2 diabetes, VAT mediated a substantial proportion of the association between insulin resistance and left ventricular dysfunction. Mediterranean diet adherence was associated with lower epicardial adipose tissue burden, while higher EAT was associated with persistent atrial fibrillation among patients with atrial fibrillation undergoing catheter ablation. Speckle-tracking echocardiography consistently showed superior prognostic value compared to ejection fraction for detecting subclinical dysfunction. Conclusions: VAT and EAT represent important mechanistic links between body composition and early myocardial dysfunction, identifiable through advanced strain imaging before clinical disease becomes apparent. These findings support the integration of multimodal cardiac imaging and nutritional interventions into cardiovascular prevention strategies, providing novel opportunities for early risk stratification and personalized treatment approaches. Full article

Background: Active surveillance of small renal masses is challenged by cumulative radiation exposure from repeated CT imaging, raising long-term health concerns. Low-dose CT protocols offer a strategy to mitigate this risk but are limited by uncertainty regarding measurement accuracy and potential effects on clinical decision-making. Methods: We propose an uncertainty-aware analytical framework using a multi-observer dataset of 40 paired CT cases (low-dose vs. standard-dose). The methodology combines statistical agreement assessment (concordance correlation coefficient, intraclass correlation coefficient), multi-algorithm machine learning prediction (linear regression, random forest, gradient boosting, and SVR), and integrated uncertainty quantification to evaluate equivalence across imaging protocols. Results: Comparative analysis demonstrates near-perfect concordance between protocols (concordance correlation coefficient = 0.9930). Linear regression achieved the highest predictive performance (R² = 0.9933, MAE = 0.4239 mm, MAPE = 2.07%), outperforming more complex ensemble models, highlighting that interpretable models can achieve superior accuracy without compromising reliability. Conclusions: Clinically, the framework supports the safe adoption of low-dose CT for longitudinal tumor assessment, preserving measurement fidelity and diagnostic confidence essential for timely intervention or continued surveillance. Radiologically, it ensures robust lesion characterization across protocols while minimizing cumulative radiation exposure, particularly in younger patients. By integrating uncertainty quantification, this approach enhances transparency, informs clinical decision-making, and facilitates personalized, evidence-based surveillance strategies, promoting safer, dose-optimized imaging in the management of small renal masses. Full article

We report the case of a school-aged patient with attention-deficit/hyperactivity disorder who presented with a palpable epigastric mass. The initial abdominal ultrasonography indicated the presence of a heterogeneous space-occupying lesion in the upper abdomen. Subsequent computed tomography revealed a large intragastric mass with a mottled air-containing density, an imaging feature characteristic of a bezoar. Esophagogastroduodenoscopy confirmed a massive trichobezoar extending beyond the pylorus into the duodenum, consistent with Rapunzel syndrome. Although the endoscopic removal proved unsuccessful, a subsequent surgical extraction via laparotomy yielded a 22 cm trichobezoar. Further history revealed prior hair-picking behavior approximately one year earlier, with a localized bald patch noted by her parents. This case highlights the characteristic multimodal imaging findings of trichobezoars and serves to emphasize the diagnostic challenge posed by a limited clinical history in children with psychiatric comorbidities presenting with abdominal masses. Full article

We present computed tomography angiography images of a rare pseudoaneurysm of the left brachial artery, a complication of idiopathic injury to the artery caused by an osteochondral exostosis of the left humerus. A 22-year-old Caucasian man with no significant medical history was admitted to the emergency department due to sudden, intense pain in his left arm, numbness, and pallor of his left forearm and hand. The patient’s consulting vascular surgeon referred him to the computed tomography (CT) laboratory for a computed tomography angiography (CTA) of the arteries of his left upper limb. In the CTA examination, at the level of the proximal segment of the left brachial artery, an excess of contrast was visualized, measuring up to approximately 1.5 × 1.2 cm in cross-sections and up to approximately 0.7 cm in the craniocaudal dimension. The CTA image was suggestive of a pseudoaneurysm of the left brachial artery. Laterally, the pseudoaneurysm was adjacent to the apex of the imaged osteochondral exostosis on the medial surface of the proximal shaft of the left humerus. A surgical procedure was performed to repair the pseudoaneurysm of the left brachial artery, including removal of the bony exostosis of the left humerus. In summary, relatively common, benign bone lesions can occasionally result in serious vascular complications. CTA is the gold standard for diagnosing these complications. Full article