Search Results (224)

Background: Traditional visual-tactile methods, radiographic interpretation including CBCT imaging, clinical judgement and supplementary aids such as fluorescence-based devices are pivotal components of the restorative diagnostic process in detecting dental caries and defective or failed restorations. However, when evaluating the restorability of a tooth compromised by extensive and deep caries, whether associated with a failed restoration or not, the conventional approach may not provide sufficient diagnostic information to establish a definitive restorative diagnosis without first removing failing restoration, caries or both. Objective: This manuscript presents caries clearance management (CCM) as a novel comprehensive clinical diagnostic restorative procedure designed to assist dentists in making a final restorative diagnosis regarding the restorability of a tooth compromised by extensive caries, fractured tooth cusp(s) or a failed large direct/indirect restoration without caries or a combination of all of them. Practical implications: CCM involves removing the failed direct/indirect restorations and selective removal of carious tissue while preserving the greatest amount of sound tooth structure as possible. Following this clinical diagnostic procedure and an assessment of dental pulp and periodontium, the clinician proceeds through a decision-making process to determine the final restorative diagnosis. This allows the dentist to advise the patient on a suitable complex restorative treatment plan. Conclusions: The manuscript introduces caries clearance management (CCM) as a structured clinical diagnostic procedure, to assist dentists to determine the restorability of compromised teeth by extensive caries, fractured teeth or failed large direct or indirect restorations. Full article

This study aims to evaluate the morpho-functional changes in the patellar ligament in dogs undergoing tibial plateau leveling osteotomy (TPLO) during the first six months of the postoperative follow-up and correlate the radiographic and conventional ultrasonography changes in the patellar ligament with its elastic properties. Dogs with a unilateral cranial cruciate ligament (CCL) rupture who underwent TPLO were enrolled. The patients were subjected to radiographic, ultrasonographic and elastosonographic evaluations of the patellar ligament before surgery (T0) and 1 month (T1), 2 months (T2) and 6 months (T3) after surgery. The radiographic and ultrasound thicknesses of the patellar ligament were recorded at three points: proximal, central and distal. A color map of strain elastosonography with superimposed B-mode images was used to evaluate the elasticity (hardness and softness) of the ligament. Twenty-two dogs completed the trial. At T0, the patellar ligament showed statistically reduced radiographic and ultrasonographic thicknesses compared to those at T1, T2 and T3. Additionally, the patellar ligament in the distal portion was statistically thicker in comparison to the proximal and central points at T2 and T3. At T1, T2 and T3, there was an increase in hardness and a reduction in softness of the patellar ligament compared to that at T0. The elastosonographic analysis and the radiographic and ultrasonographic thicknesses of the patellar ligament showed no correlation. The patellar ligament showed structural and mechanical alterations in the dogs undergoing TPLO, even six months after surgery. Full article

Introduction: Instability following total hip arthroplasty (THA) remains a challenging complication. Dual-mobility (DM) hip components are aimed at improving joint stability by increasing the head-neck ratio and jump distance. However, data regarding the efficacy of these implants in the trauma setting are scarce. This study aimed to compare the dislocation rates of DM bearings with conventional THA in patients undergoing primary THA for the treatment of hip fractures. Methods: We retrospectively reviewed all patients who underwent THA for hip fractures between the years 2010–2022 and had a minimum follow-up of two years. Patient demographics and radiographic parameters, including cup version, leg length discrepancy (LLD) and femoral horizontal offset, were compared between patients who received DM bearings and patients who received conventional THA. Dislocation and revision surgery rates were also compared between the groups. Results: The study included 570 patients who met inclusion criteria, of which 82 patients were in the DM bearings group and 488 patients were in the conventional THA group. Baseline demographics and comorbidity profiles were comparable between the groups. Cup anteversion was significantly lower in the DM group (11.1° vs. 14.1°; p = 0.006), while no significant differences were observed in LLD nor femoral offset between the groups (p = 0.38, p = 0.69, respectively). Dislocation rates were similar between the DM and conventional THA groups (1.2% vs. 1.02%, respectively; p = 0.54). Furthermore, revision rates were similar between DM and conventional THA (1.22% vs. 2.87%, respectively; p = 0.387). Conclusions: While no significant differences in dislocation rates were observed between dual-mobility and conventional THA bearings, the significantly lower cup anteversion suggests a potential improvement in acetabular safe zone positioning, this could reflect a broader margin for error in implant positioning. Further prospective studies are needed to elucidate the biomechanical advantages of DM bearings in patients with hip fractures. Full article

Background and Clinical Significance: Radial nerve palsy typically presents as wrist drop due to nerve compression, with conventional management often yielding prolonged recovery. We report a case where ultrasound-guided hydrodissection (HD) with 5% dextrose in water (D5W) achieved immediate functional restoration, suggesting neurapraxia as the underlying pathology. Case Presentation: A 54-year-old diabetic female presented with acute left wrist drop without trauma. Examination confirmed radial nerve palsy (MRC grade 0 wrist extension), while radiographs ruled out structural causes. Ultrasound revealed fascicular swelling at the spiral groove. Under real-time guidance, 50 mL D5W (no local anesthetic) was injected to hydrodissect the radial nerve. Immediate post-procedure assessment showed restored wrist extension (medical research council (MRC) grade 4+). At one- and three-month follow-ups, the patient maintained complete resolution of symptoms and normal function. Conclusions: This case highlights two key findings: (1) HD with D5W can serve as both a diagnostic tool (confirming reversible neurapraxia through immediate response) and therapeutic intervention, and (2) early HD may circumvent prolonged disability associated with conservative management. The absence of electrodiagnostic studies limits objective severity assessment, though ultrasound localized the lesion. While promising, these observations require validation through controlled trials comparing HD to standard care, particularly in diabetic patients with heightened compression susceptibility. Technical considerations—including optimal injectate volume and the role of adjuvant therapies—warrant further investigation. US-guided HD with D5W emerges as a minimally invasive, surgery-sparing option for acute compressive radial neuropathies, with potential to redefine treatment paradigms when applied at symptom onset. Full article

Background: Adhesive capsulitis (AC) causes a global limitation of both active and passive range of motion (ROM) in the shoulder, with or without pain, and no specific radiographic findings. Its course is self-limiting and progresses through three or four stages. The diagnosis is primarily clinical, since imaging tests are nonspecific. Treatment options include physical therapy (PT), intra-articular corticosteroid injections, suprascapular nerve block (SSNB), and hydrodilatation (HD). The latter is useful for expanding and reducing inflammation of the joint capsule through the insufflation of saline solution, anesthetics, and corticosteroids. Objectives: To compare whether patients with AC, stratified by phase 1 and 2, who receive high-volume HD as treatment achieve better outcomes in terms of shoulder pain and function compared to patients who receive low-volume HD. To compare whether there are differences in PT times and to determine mean axillary recess (AR) values. Methods: A randomized, parallel-block, triple-blind clinical trial will be conducted in 64 patients with AC in phases 1 and 2, aged 30 to 70 years, with limited active and passive ROM in two planes, and shoulder pain lasting more than 3 months. HD will be administered with volumes of 20 mL or 40 mL, followed by a conventional rehabilitation program. Outcomes will be reviewed at the 1st, 3rd, and 6th months of HD. Variables collected will include Shoulder Pain and Disability Index (SPADI), Visual Analog Scale (VAS), Range of motion (ROM), Lattinen index (LI), AR size, and time to completion of PT. Results: HD has been gaining clinical relevance in interventional rehabilitation as a treatment for AC, although its medium- and long-term efficacy remains a matter of debate. The variability in the volumes used for capsular expansion, with studies ranging from 18 mL to 47 mL, is compounded by the fact that most of these studies do not differentiate between AC stages. This could influence treatment effectiveness. Furthermore, diagnosis remains a challenge since valid and specific diagnostic parameters are lacking. Conclusions: Understanding the differences between HD techniques, considering the influence of certain factors such as the volume used or the stages of AC, as well as improving diagnosis and the coordination of scientific work. This could facilitate the development of protocols for the use of HD in AC. Full article

Medical image registration is an indispensable preprocessing step to align medical images to a common coordinate system before in-depth analysis. The registration precision is critical to the following analysis. In addition to representative image features, the initial pose settings and multiple poses in images will significantly affect the registration precision, which is largely neglected in state-of-the-art works. To address this, the paper proposes a dual-pose medical image registration algorithm based on improved differential evolution. More specifically, the proposed algorithm defines a composite similarity measurement based on contour points and utilizes this measurement to calculate the similarity between frontal–lateral positional DRR (Digitally Reconstructed Radiograph) images and X-ray images. In order to ensure the accuracy of the registration algorithm in particular dimensions, the algorithm implements a dual-pose registration strategy. A PDE (Phased Differential Evolution) algorithm is proposed for iterative optimization, enhancing the optimization algorithm’s ability to globally search in low-dimensional space, aiding in the discovery of global optimal solutions. Extensive experimental results demonstrate that the proposed algorithm provides more accurate similarity metrics compared to conventional registration algorithms; the dual-pose registration strategy largely reduces errors in specific dimensions, resulting in reductions of 67.04% and 71.84%, respectively, in rotation and translation errors. Additionally, the algorithm is more suitable for clinical applications due to its lower complexity. Full article

Hallux valgus is one of the common causes of forefoot pain in the field of foot and ankle surgery. This condition is characterized by valgus and pronation deformities of the first ray, leading to bunion pain, metatarsalgia, callus formation, and gait disturbances. Conventional open osteotomy of the first metatarsal and proximal phalanx of the first toe has been widely performed. Recently, with increasing reports of favorable radiologic and clinical outcomes of minimally invasive surgery, this technique has been performed by many surgeons. Despite the various surgical methods available, there is still no consensus on the optimal treatment of hallux valgus, and the advantages and disadvantages of open versus minimally invasive techniques remain a topic of debate. This narrative review aims to provide a comprehensive overview of the latest radiographic evaluation and surgical treatment for hallux valgus. Full article

Cone-beam computed tomography (CBCT) offers low radiation, cross-sectional imaging that is a suitable alternative to conventional fan-beam computed tomography (FBCT). The initial experience using in-clinic CBCT in the Rhinology outpatient clinic at Waikato Hospital, New Zealand, is described. The first 5 months of CBCT use for Rhinologic imaging was compared to FBCT use in the equivalent 5-month period one year prior. Data relating to 61 CBCTs and 115 FBCTs was analysed. We compared the time and number of hospital visits required for a confirmed treatment decision (CTD) to be made and the duration of the clinic appointment at which the scan was requested between the two groups. The CBCT group required significantly less time (171 vs. 316 days, p < 0.001) and fewer hospital visits (1.5 vs. 3.2 visits, p < 0.001) before a CTD was made, but a longer appointment duration (86 vs. 53 min, p < 0.001). The use of in-clinic CBCT in Rhinology was therefore associated with reduced time and fewer hospital visits before definitive management was decided, but longer clinic appointments were observed. Increased access to CT imaging may result in increased demand. Expertise is required to optimise the quality of imaging, and we recommend that a dedicated Radiographer be allocated. Full article

Background/Objectives: Degenerative joint diseases (DJDs) involve intricate molecular disruptions within bone, cartilage, and synovial tissues, often preceding overt radiographic changes. These tissues exhibit complex biomolecular architectures and their degeneration leads to microstructural disorganization and inflammation that are challenging to detect with conventional imaging techniques. This review aims to synthesize recent advances in imaging, computational modeling, and sequencing technologies that enable high-resolution, non-invasive characterization of joint tissue health. Methods: We examined advanced modalities including high-resolution MRI (e.g., T1ρ, sodium MRI), quantitative and dual-energy CT (qCT, DECT), and ultrasound elastography, integrating them with radiomics, deep learning, and multi-scale modeling approaches. We also evaluated RNA-seq, spatial transcriptomics, and mass spectrometry-based proteomics for omics-guided imaging biomarker discovery. Results: Emerging technologies now permit detailed visualization of proteoglycan content, collagen integrity, mineralization patterns, and inflammatory microenvironments. Computational frameworks ranging from convolutional neural networks to finite element and agent-based models enhance diagnostic granularity. Multi-omics integration links imaging phenotypes to gene and protein expression, enabling predictive modeling of tissue remodeling, risk stratification, and personalized therapy planning. Conclusions: The convergence of imaging, AI, and molecular profiling is transforming musculoskeletal diagnostics. These synergistic platforms enable early detection, multi-parametric tissue assessment, and targeted intervention. Widespread clinical integration requires robust data infrastructure, regulatory compliance, and physician education, but offers a pathway toward precision musculoskeletal care. Full article

Background: Foot deformities, particularly hallux valgus, significantly impact patients’ quality of life. Conventional radiographs are essential for their assessment, but manual measurements are time-consuming and variable. This study assessed the reliability of a deep learning-based solution (Milvue, France) that automates podiatry angle measurements from radiographs compared to manual measurements made by radiologists. Methods: A retrospective, non-interventional study at Perpignan Hospital analyzed the weight-bearing foot radiographs of 105 adult patients (August 2017–August 2022). The deep learning (DL) model’s measurements were compared to those of two radiologists for various angles (M1-P1, M1-M2, M1-M5, and P1-P2 for Djian–Annonier, calcaneal slope, first metatarsal slope, and Meary–Tomeno angles). Statistical analyses evaluated DL performance and inter-observer variability. Results: Of the 105 patients included (29 men and 76 women; mean age 55), the DL solution showed excellent consistency with manual measurements, except for the P1-P2 angle. The mean absolute error (MAE) for the frontal view was lowest for M1-M2 (0.96°) and highest for P1-P2 (3.16°). Intraclass correlation coefficients (ICCs) indicated excellent agreement for M1-P1, M1-M2, and M1-M5. For the lateral view, the MAE was 0.92° for calcaneal pitch and 2.83° for Meary–Tomeno, with ICCs ≥ 0.93. For hallux valgus detection, accuracy was 94%, sensitivity was 91.1%, and specificity was 97.2%. Manual measurements averaged 203 s per patient, while DL processing was nearly instantaneous. Conclusions: The DL solution reliably automates foot alignment assessments, significantly reducing time without compromising accuracy. It may improve clinical efficiency and consistency in podiatric evaluations. Full article

Bone lesions encountered as part of radiology practice can bring diagnostic challenges, both when encountered incidentally or suspected as a primary bone lesion, and in patients at risk of metastases or marrow-based malignancies. Differentiating benign from malignant bone marrow lesions is critical, yet can be challenging due to overlapping imaging characteristics. One key imaging feature that can assist with diagnosis is the presence of fat within the lesion. Fat can be present either macroscopically (i.e., visible on radiographs, computed tomography (CT), and conventional magnetic resonance imaging (MRI)), or microscopically, detected through specialised MRI techniques such as chemical shift imaging (CSI). This comprehensive review explores the diagnostic significance of both macroscopic and microscopic fat in bone lesions and discusses how its presence can point towards benignity. We illustrate the spectrum of fat-containing bone lesions, encompassing both typical and atypical presentations, and provide practical imaging strategies to increase diagnostic accuracy by utilising radiographs, CT, and MRI in characterising these lesions. Specifically, CSI is highlighted as a non-invasive method for evaluating intralesional fat content, to distinguish benign marrow entities from malignant marrow-replacing conditions based on quantifiable signal drop-off. Furthermore, we detail imaging pitfalls with a focus on conditions that can mimic malignancy (such as aggressive haemangiomas) and collision lesions. Through a detailed discussion and illustrative examples, we aim to guide radiologists and clinicians in recognising reassuring imaging features while also identifying scenarios where further investigation may be warranted. Full article

Background/Objectives: Additive manufacturing (AM) enables the production of cementless acetabular cups with porous surfaces that facilitate early osseointegration. Directed energy deposition (DED), a form of AM, allows the direct welding of porous structures onto metal substrates without requiring a vacuum environment, offering advantages over conventional powder bed fusion methods. Despite growing interest in DED, no prospective clinical studies evaluating DED-based acetabular components have been published to date. This study assessed short-term outcomes of a DED-based 3D-printed acetabular cup in total hip arthroplasty (THA). Methods: A total of 120 patients who underwent primary cementless THA using the Corentec Mirabo Z^® acetabular cup were prospectively enrolled. Among them, 124 hips from 100 patients who had completed a minimum of 24 months of follow-up were included in the analysis. Clinical outcomes were assessed using the Harris hip score (HHS), WOMAC, EQ-5D-5L, and pain NRS. Radiographic evaluation included measurements of cup position, osseointegration, and detection of interfacial or polar gaps on CT and plain radiographs. Implant-related complications were also recorded. Results: At a mean follow-up of 34.6 months, the implant survival rate was 99.3%, with one revision due to suspected osseointegration failure. The HHS improved from 56.6 to 91.4 at 24 months, and the NRS decreased from 6.2 to 1.1 (both p < 0.001). Interfacial gaps were observed in 58.1% of cases on CT, though most were <1 mm and not clinically significant. Common postoperative issues included greater trochanteric pain syndrome, squeaking, and iliotibial band tightness, all of which were resolved with conservative treatment. Conclusions: DED-based 3D-printed acetabular cups demonstrated favorable short-term clinical and radiographic outcomes, with high survivorship and reliable early osseointegration in cementless THA. Full article

Myxomatous mitral valve disease (MMVD) is the most common heart disease in small-breed dogs, and accurate assessment of the left atrial (LA) size is essential for diagnosis and management. The traditional echocardiographic method, LA-to-Aorta (LA/Ao) ratio, is widely used, but evaluates LA size in only one view. This study introduces a novel index—the modified-LA/Ao (M-LA/Ao) ratio—which combines two echocardiographic views to better reflect the true LA size. This study retrospectively analyzed thoracic radiographs and echocardiograms from 136 dogs, including healthy controls and dogs with MMVD classified into stages B1, B2, and C according to ACVIM guidelines. The ability of the M-LA/Ao ratio is compared to conventional indices using correlation analysis and receiver operating characteristic (ROC) curves. The M-LA/Ao ratio showed a strong correlation with existing indices and slightly improved discrimination between ACVIM stages B1 and B2, although performance between stages B2 and C was similar to the LA/Ao ratio. Intra- and interobserver variability were also acceptable. Our findings suggest that the M-LA/Ao ratio may provide a practical and sensitive method to evaluate LA enlargement in early-stage MMVD, helping clinicians detect subtle cardiac remodeling before progression to advanced disease. Full article

Background: Pediatric high-grade glioma (pHGG) is a highly aggressive cancer with unique biology distinct from adult high-grade glioma, limiting the effectiveness of standard treatment protocols derived from adult research. Objective: The purpose of this report is to present preliminary results from an ongoing pilot study integrating spectroscopic magnetic resonance imaging (sMRI) to guide proton beam therapy and longitudinal imaging analysis in pediatric patients with high-grade glioma (pHGG). Methods: Thirteen pediatric patients under 21 years old with supratentorial WHO grade III-IV glioma underwent baseline and serial whole-brain spectroscopic MRI alongside standard structural MRIs. Radiation targets were defined using T1-weighted contrast enhanced, T2-FLAIR, and Cho/NAA ≥ 2X maps. Longitudinal analyses included voxel-level metabolic change maps and spatial overlap metrics comparing pre-proton therapy and post-. Results: Six patients had sufficient longitudinal data; five received sMRI-guided PBT. Significant positive correlation (R² = 0.89, p < 0.0001) was observed between T2-FLAIR and Cho/NAA ≥ 2X volumes. Voxel-level difference maps of Cho/NAA and Choline revealed dynamic metabolic changes across follow-up scans. Analyzing Cho/NAA and Cho changes over time allowed differentiation between true progression and pseudoprogression, which conventional MRI alone struggles to achieve. Conclusions: Longitudinal sMRI enhanced metabolic tracking in pHGG, detects early tumor changes, and refines RT targeting beyond structural imaging. This first in-kind study highlights the potential of sMRI biomarkers in tracking treatment effects and emphasizes the complementary roles of metabolic and radiographic metrics in evaluating therapy response in pHGG. Full article

Osteoarthritis (OA) is the most prevalent degenerative joint disorder worldwide, causing significant declines in quality of life. The osteochondral junction (OCJ), a critical structural interface between deep cartilage and subchondral bone, plays an essential role in OA progression but is challenging to assess using conventional magnetic resonance imaging (MRI) due to its short T2 relaxation times. This study aimed to evaluate the utility of ultrashort echo time (UTE) MRI biomarkers, including macromolecular fraction (MMF), magnetization transfer ratio (MTR), and T2*, for in vivo quantification of OCJ changes in knee OA for the first time. Forty-five patients (mean age: 53.8 ± 17.0 years, 50% female) were imaged using 3D UTE-MRI sequences on a 3T clinical MRI scanner. Patients were stratified into two OA groups based on radiographic Kellgren–Lawrence (KL) scores: normal/subtle (KL = 0–1) (n = 21) and mild to moderate (KL = 2–3) (n = 24). Quantitative analysis revealed significantly lower MMF (15.8  ±  1.4% vs. 13.6 ± 1.2%, p < 0.001) and MTR (42.5 ± 2.5% vs. 38.2  ±  2.3%, p < 0.001) in the higher KL 2–3 group, alongside a higher trend in T2* values (19.7  ±  2.6 ms vs. 21.6  ±  3.8 ms, p = 0.06). Moreover, MMF and MTR were significantly negatively correlated with KL grades (r = −0.66 and −0.59; p < 0.001, respectively), while T2* showed a weaker positive correlation (r = 0.26, p = 0.08). Receiver operating characteristic (ROC) analysis demonstrated superior diagnostic accuracy for MMF (AUC = 0.88) and MTR (AUC = 0.86) compared to T2* (AUC = 0.64). These findings highlight UTE-MT techniques (i.e., MMF and MTR) as promising imaging tools for detecting OCJ degeneration in knee OA, with potential implications for earlier and more accurate diagnosis and disease monitoring. Full article