Search Results (270)

Background/Objectives: Current bone-based landmark approaches have shown variable accuracy and poor reproducibility. We validated a two-point “tuberculum sellae–anterior clinoid process” (TS–ACP) line traced on routine 3D-computed tomography angiography (CTA) for predicting distal dural ring (DDR) position and quantified the interobserver agreement. Methods: We retrospectively reviewed data from 85 patients (87 aneurysms) who were treated via clipping between June 2012 and December 2024. Two blinded neurosurgeons classified each aneurysm as extradural, intradural, or straddling the TS–ACP line. The intraoperative DDR inspection served as the reference standard. Diagnostic accuracy, χ² statistics, and Cohen’s κ were calculated. Results: The TS–ACP line landmarks were identifiable in all cases. The TS–ACP line classification correlated strongly with operative findings (χ² = 138.3, p = 6.4 × 10⁻²⁹). The overall accuracy was 89.7% (78/87), and sensitivity and specificity for identifying intradural aneurysms were 94% and 82%, respectively. The interobserver agreement was substantial (κ = 0.78). Nine aneurysms were misclassified, including four cavernous-sinus lesions that partially crossed the DDR. Retrospective fusion using constructive interference in steady-state magnetic resonance imaging corrected these errors. Conclusions: The TS–ACP line represents a rapid, reproducible tool that reliably localizes the DDR on standard 3D-CTA, showing higher accuracy than previously reported single-landmark techniques. Its high accuracy and substantial inter-observer concordance support incorporation into routine preoperative assessments. Because the method depends on only two easily detectable bony points, it is well-suited for automated implementation, offering a practical pathway toward artificial intelligence-assisted stratification of paraclinoid aneurysms. Full article

Background: Hypospadias is a common congenital anomaly in boys, marked by ectopic urethral meatus and a wide range of anatomical variants such as chordee and atypical glans morphology. Despite advancements in surgical techniques, complication rates remain high and unpredictable due to heterogeneity in anatomy and a lack of standardized preoperative assessments. Retrospective studies suggest associations between specific anatomical features and postoperative complications; however, high-quality prospective, multicenter evidence is currently lacking. Methods: The PREDICT-H (Prospective Research on Essential Determinants Influencing Complication Trends in Hypospadias) study is a multicenter, prospective cohort study aiming to enroll approximately 1450 boys aged 1–12 years undergoing primary hypospadias repair at ten or more tertiary pediatric urology centers. A standardized preoperative assessment protocol will document detailed anatomical parameters, including urethral plate width and length, glans size, meatal location, chordee severity, and GMS score. Intraoperative variables and surgical techniques will be recorded. Postoperative outcomes, including urethrocutaneous fistula, meatal stenosis, and recurrent chordee, will be assessed at ≥6 months follow-up. Statistical analyses will include multivariate logistic regression and advanced modeling to identify independent predictors and develop a validated risk prediction nomogram. Interobserver reliability of anatomical assessments will also be evaluated. Results: As this is a study protocol, results are not yet available. Data collection is ongoing and will be analyzed upon completion of the planned follow-up period. The primary outcome will be the incidence of postoperative complications and the development of a predictive nomogram for individualized risk estimation. Conclusions: The PREDICT-H study is designed to provide robust, prospective evidence on the anatomical determinants of postoperative complications in hypospadias surgery. The development of a validated, clinically applicable risk prediction tool could standardize preoperative assessment and enhance individualized surgical planning. Findings from this study are expected to support evidence-based practice and inform future clinical guidelines. Full article

Retained products of conception (RPOC) represent a significant cause of morbidity in the post-abortive and postpartum periods, potentially leading to abnormal uterine bleeding, pelvic pain, infections, and intrauterine adhesions. Accurate diagnosis is crucial to avoid unnecessary surgical interventions and to preserve future fertility. Transvaginal ultrasound constitutes the primary imaging modality for identifying RPOC, but the lack of standardized diagnostic criteria complicates clinical decision-making. This narrative review explores the current literature on sonographic findings associated with RPOC, focusing on the diagnostic value of endometrial thickness (ET), the presence of intrauterine echogenic masses, and the use of Color Doppler imaging. Although an ET ≥15 mm is frequently used to suspect RPOC, the variability in cut-off thresholds and limited specificity reduce its diagnostic reliability. The detection of an echogenic intrauterine mass appears to be the most sensitive and specific sonographic feature. Color Doppler assessment, particularly the presence of enhanced myometrial vascularity (EMV) and classification systems like the Gutenberg score, offers further insight by stratifying hemorrhagic risk and guiding therapeutic choices. However, vascular parameters such as peak systolic velocity (PSV) and resistive index (RI) demonstrate a substantial overlap between benign and pathological conditions, limiting their stand-alone utility. The review also addresses the differential diagnosis of RPOC, including blood clots, arteriovenous malformations, placental polyps, gestational trophoblastic disease, and endometrial osseous metaplasia. The role of three-dimensional ultrasound remains limited in clinical practice, offering no significant advantage over two-dimensional imaging. Finally, the timing of follow-up ultrasound after medical treatment with misoprostol is critical: delayed assessment reduces overtreatment by allowing time for spontaneous resolution. In conclusion, despite advances in ultrasound technology, the diagnosis of RPOC remains challenging due to heterogeneity in imaging findings and inter-observer variability. A multimodal approach integrating grayscale and Doppler ultrasound with clinical evaluation is essential for optimal management. Full article

In forensic anthropology, estimating stature is an essential part of constructing the biological profile of unknown individuals. While long bones are typically used for this purpose, they are often missing or incomplete in forensic contexts. This study examined the relationship between cranial and mandibular measurements and estimated stature in a sample of 84 identified adult (aged over 18 years) Portuguese skeletons (43 females and 41 males) from two osteological collections. Stature was estimated using Mendonça’s regression model based on humeral length. Four cranial and mandibular measurements were obtained, and intra- and interobserver reliability was assessed. All variables showed statistically significant correlations with stature, although only the mandibular measurement—the distance between the mental symphysis and the mental foramen (SMFM)—and sex contributed significantly to the final regression model. The model explained 51.3% of the variance in stature. These findings suggest that SMFM, a stable mandibular marker, may serve as a useful supplementary indicator for stature estimation in cases where long bones are not available. Further studies with larger and more diverse samples are needed to validate these findings and evaluate their applicability across different populations. Full article

Background: This retrospective study aimed to assess the prevalence and distribution of common soft tissue ossifications and calcifications in the head and neck area, such as tonsilloliths, calcified lymph nodes, atherosclerotic plaques, stylohyoid ligament calcifications, and laryngeal cartilage calcifications, using panoramic radiographs (PRs) from a Turkish population. A secondary objective was to analyze these findings based on age and gender, ultimately seeking to enhance clinicians’ awareness of these incidental findings and their potential diagnostic significance. Methods: PRs of 1207 patients applying to the Department of Oral and Maxillofacial Radiology at Necmettin Erbakan University Faculty of Dentistry between 2021 and 2022 were reviewed. Out of these, 1193 images meeting quality criteria and showing distinct anatomical details were included. Patients with prior diagnosed bone metabolic disorders were excluded. Two radiologists independently assessed the images for the presence of soft tissue calcifications and ossifications. Inter-observer reliability was quantified using Cohen’s Kappa coefficient, which was found to be 0.78, indicating substantial agreement (95% CI: [0.72–0.83], p < 0.001). The calcifications and ossifications were categorized according to age, gender, and type. Data were analyzed employing descriptive statistical methods and Chi-square tests, with a significance level set at p < 0.05. Results: Soft tissue calcification or ossification was observed in 122 (10.22%) of the 1193 retrospectively evaluated PRs. The most common findings included stylohyoid ligament ossifications (n = 31), laryngeal cartilage calcifications (n = 28), tonsilloliths (n = 25), calcified atherosclerotic plaques (n = 18), and calcified lymph nodes (n = 18). Two antroliths were also identified. Arteriosclerosis, phleboliths, and sialoliths were not detected in this cohort. Although some types of calcification showed numerical variations across age groups and genders (e.g., higher prevalence of most anomalies in patients aged 31 years and older; more frequent laryngeal cartilage calcification in women and tonsilloliths in men), Chi-square analyses revealed no statistically significant association between the presence of these calcifications or ossifications and either age group (p = 0.284) or gender (p = 0.122). Conclusions: PRs serve as an effective initial screening instrument for identifying soft tissue calcifications within the head and neck region, owing to their widespread availability, cost-effectiveness, and minimal radiation exposure. The detection of such findings is of paramount importance, as they may indicate underlying systemic conditions necessitating further diagnostic evaluation. While clinicians should remain vigilant to these anomalies, definitive diagnosis typically requires supplementary imaging modalities such as cone-beam computed tomography (CBCT), ultrasound, or histopathological analysis. Full article

The ongoing secular changes in human movement development means that an assessment of primitive reflexes is now required not only in disabled but also in neurotypical children. This study had three aims: (1) presenting the TASHUN test battery as suitable for the assessment of primitive reflex activity in normal children and child athletes; (2) analyzing reflex characteristics of neurotypical children; (3) verifying validity and reliability of tests. Spearman’s rank correlation and ROC analysis were used for validation. Intraclass Correlation Coefficient and RM ANOVA analyzed reliability. The test on 242 schoolgirls has demonstrated that retained primitive reflexes are present in almost every individual (84.7–95.7%). Correlations showed strong positive association, with all values exceeding 0.8, and ROC analysis demonstrated excellent predictive strength (AUC values over 0.9). Interobserver reliability showed excellent agreement (ICC values above 0.9). No significant offset was present among the scoring by evaluators. Therefore, testing for primitive reflexes is necessary in neurotypical children in order to obtain a realistic image about the physiology of reflexes and their role in motor development. Our screening could be useful for practicing sport professionals, researchers and academics, to identify deficiencies, to further explore reflexes and to train future PE teachers and trainers. Full article

Lower respiratory tract infections remain a leading cause of morbidity and mortality among Intensive Care Unit patients, with severe cases often progressing to acute respiratory distress syndrome (ARDS). This life-threatening syndrome results from alveolar–capillary membrane injury, causing refractory hypoxemia and respiratory failure. Early detection and management are critical to treat the underlying cause, provide protective lung ventilation, and, eventually, improve patient outcomes. The 2012 Berlin definition standardized ARDS diagnosis but excluded patients on non-invasive ventilation (NIV) or high-flow nasal cannula (HFNC) modalities, which are increasingly used, especially after the COVID-19 pandemic. By excluding these patients, diagnostic delays can occur, risking the progression of lung injury despite ongoing support. Indeed, sustained, vigorous respiratory efforts under non-invasive modalities carry significant potential for patient self-inflicted lung injury (P-SILI), underscoring the need to broaden diagnostic criteria to encompass these increasingly common therapies. Recent proposals expand ARDS criteria to include NIV and HFNCs, lung ultrasound, and the SpO₂/FiO₂ ratio adaptations designed to improve diagnosis in resource-limited settings lacking arterial blood gases or advanced imaging. However, broader criteria risk overdiagnosis and create challenges in distinguishing ARDS from other causes of acute hypoxemic failure. Furthermore, inter-observer variability in imaging interpretation and inconsistencies in oxygenation assessment, particularly when relying on non-invasive measurements, may compromise diagnostic reliability. To overcome these limitations, a more nuanced diagnostic framework is needed—one that incorporates individualized therapeutic strategies, emphasizes lung-protective ventilation, and integrates advanced physiological or biomarker-based indicators like IL-6, IL-8, and IFN-γ, which are associated with worse outcomes. Such an approach has the potential to improve patient stratification, enable more targeted interventions, and ultimately support the design and conduct of more effective interventional studies. Full article

Background/Objectives: Pain assessment scales provide a clear clinical benefit in patients who are unable to self-report. The Nociception Coma Scale-Revised—adapted for Intubated patients (NCS-R-I) was developed to assess pain in patients with acquired brain injury who are unable to self-report. However, this instrument has not yet been translated and validated for use in Spain. The objective was to translate the Nociception Coma Scale-Revised—adapted for Intubated patients (NCS-R-I) into Spanish and to assess the reliability and validity of the Spanish version in patients with brain injury. Methods: This study was carried out in two phases. First, the scale was translated into Spanish. Next, a psychometric analysis was performed to determine the reliability and validity of the Spanish version of the NCS-R-I in 207 critically ill patients with acquired brain injury and disorders of consciousness. Two blinded observers administered the scale at three time points: 5 min before, during, and 15 min after a series of nociceptive and non-nociceptive procedures. Results: The internal consistency of the NCS-R-I was acceptable (ordinal alpha = 0.60–0.90). Interobserver agreement was good (kappa = 0.80; intraclass correlation coefficient = 0.90). In terms of discriminant validity, the AUC was 0.952 (95% CI: 0.931–0.973). NCS-R-I scores increased significantly during performance of nociceptive procedures compared to scores obtained before and after these procedures, confirming the scale’s sensitivity to change. Similarly, during the performance of nociceptive procedures, scores on the NCS-R-I were significantly higher (p < 0.001) than those observed during non-nociceptive procedures. Conclusions: The results of this study demonstrate that the NCS-R-I is a valid, reliable tool for the assessment of pain in patients with acquired brain injury who are unable to self-report. Full article

Heart failure (HF) is a well-known leading cause of mortality, associated with a high symptom burden in advanced stages, frequent hospitalizations, and increasing economic costs. HF is typically classified into three main subgroups, based on left ventricular ejection fraction (LVEF): HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF). Recently, two additional subgroups have been proposed: HF with improved ejection fraction (HFimpEF) and HF with supernormal ejection fraction (HFsnEF). These five phenotypes exhibit distinct risk factors, clinical presentations, therapeutic responses, and prognosis. However, the LVEF thresholds used to define these subgroups remain a subject of considerable debate, with significant differences in opinions among leading experts. A major criticism concerns the reliability of LVEF in accurately classifying HF subgroups. Due to substantial intra and interobserver variability, determining the appropriate therapy and prognosis can be challenging, particularly in patients with HFmrEF. Additionally, patients classified under HFpEF are often too heterogeneous to be effectively managed as a single group. This narrative review explores these issues, and suggests a possible need for a new approach to HF classification, one that involves revising the LVEF reference values for HF phenotypes and highlighting LVEF trajectories rather than relying on a single measurement. Moreover, in light of the relatively limited therapeutic options for patients with LVEF > 40%, a new, simplified classification may be proposed: HF with reduced EF (LVEF ≤ 40%), HF with below-normal EF (41% ≤ LVEF ≤ 55%), and HF with normal EF (LVEF > 55%). This mindset would better equip clinical cardiologists to manage the diverse spectrum of HF syndromes, always with the patient at the center. Full article

Background/Objectives: The aim of this study was to investigate the relationship between the PRIMARY score derived from [⁶⁸Ga]Ga-PSMA PET/CT and key clinical and pathological parameters of prostate cancer aggressiveness, including the PSA level, ISUP Grade Group, and D’Amico risk classification, in patients with biopsy-proven prostate cancer. A secondary aim was to evaluate the interobserver agreement of the PRIMARY score in routine clinical practice. Methods: This retrospective analysis included 51 patients with histopathologically confirmed prostate adenocarcinoma who underwent [⁶⁸Ga]Ga-PSMA PET/CT imaging for staging. PRIMARY scores were determined based on the intraprostatic uptake pattern, intensity, and zonal localization. These scores were compared with PSA levels, ISUP GG, D’Amico risk classification, and histopathological features such as the cribriform pattern, intraductal carcinoma, perineural invasion, extraprostatic extension, and lymphovascular invasion. The PRIMARY scores were independently assigned by a total of three nuclear medicine physicians, and interobserver agreement was calculated using Fleiss’ kappa analysis. Results: Significant associations were found between the PRIMARY scores and the PSA level, ISUP Grade Group, and D’Amico risk classification. The most prevalent score was PRIMARY 5 (54.9%), which was significantly associated with ISUP GG 5 and the high-risk category in D’Amico classification. Among patients with PRIMARY Score 2, a substantial proportion (64.7%) had ISUP GG ≥ 3, and 58.8% were in the high-risk group, highlighting the limitations of binary PRIMARY classification. No statistically significant correlations were found between the PRIMARY scores and specific histopathologic features. Interobserver agreement was excellent (κ = 0.833). Conclusions: The PRIMARY score demonstrates high reproducibility and clinical relevance in stratifying prostate cancer aggressiveness. However, the findings challenge the reliability of binary classifications, particularly for patients with Score 2, who may still harbor high-grade disease. Integrating imaging-based scores with clinical and histopathological data is essential, particularly for accurate staging and decision-making regarding active surveillance. Full article

Background: Renal tumors, encompassing benign, malignant, and normal variants, represent a significant diagnostic challenge in radiology due to their overlapping visual characteristics on computed tomography (CT) scans. Manual interpretation is time consuming and susceptible to inter-observer variability, emphasizing the need for automated, reliable classification systems to support early and accurate diagnosis. Method and Materials: We propose KidneyNeXt, a custom convolutional neural network (CNN) architecture designed for the multi-class classification of renal tumors using CT imaging. The model integrates multi-branch convolutional pathways, grouped convolutions, and hierarchical feature extraction blocks to enhance representational capacity. Transfer learning with ImageNet 1K pretraining and fine tuning was employed to improve generalization across diverse datasets. Performance was evaluated on three CT datasets: a clinically curated retrospective dataset (3199 images), the Kaggle CT KIDNEY dataset (12,446 images), and the KAUH: Jordan dataset (7770 images). All images were preprocessed to 224 × 224 resolution without data augmentation and split into training, validation, and test subsets. Results: Across all datasets, KidneyNeXt demonstrated outstanding classification performance. On the clinical dataset, the model achieved 99.76% accuracy and a macro-averaged F1 score of 99.71%. On the Kaggle CT KIDNEY dataset, it reached 99.96% accuracy and a 99.94% F1 score. Finally, evaluation on the KAUH dataset yielded 99.74% accuracy and a 99.72% F1 score. The model showed strong robustness against class imbalance and inter-class similarity, with minimal misclassification rates and stable learning dynamics throughout training. Conclusions: The KidneyNeXt architecture offers a lightweight yet highly effective solution for the classification of renal tumors from CT images. Its consistently high performance across multiple datasets highlights its potential for real-world clinical deployment as a reliable decision support tool. Future work may explore the integration of clinical metadata and multimodal imaging to further enhance diagnostic precision and interpretability. Additionally, interpretability was addressed using Grad-CAM visualizations, which provided class-specific attention maps to highlight the regions contributing to the model’s predictions. 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

Background/Objectives: Renal cell carcinoma (RCC) is a malignant disease that requires rapid and reliable diagnosis to determine the correct treatment protocol and to manage the disease effectively. However, the fact that the textural and morphological features obtained from medical images do not differ even among different tumor types poses a significant diagnostic challenge for radiologists. In addition, the subjective nature of visual assessments made by experts and interobserver variability may cause uncertainties in the diagnostic process. Methods: In this study, a deep learning-based hybrid model using multiphase magnetic resonance imaging (MRI) data is proposed to provide accurate classification of RCC subtypes and to provide a decision support mechanism to radiologists. The proposed model performs a more comprehensive analysis by combining the T2 phase obtained before the administration of contrast material with the arterial (A) and venous (V) phases recorded after the injection of contrast material. Results: The model performs RCC subtype classification at the end of a five-step process. These are regions of interest (ROI), preprocessing, augmentation, feature extraction, and classification. A total of 1275 MRI images from different phases were classified with SVM, and 90% accuracy was achieved. Conclusions: The findings reveal that the integration of multiphase MRI data and deep learning-based models can provide a significant improvement in RCC subtype classification and contribute to clinical decision support processes. Full article

Background: The reproducible measurement of tibial torsion (TT) is essential for the diagnosis and evaluation of rotational deformities of the tibia, particularly in the planning of tibial derotational osteotomy. While various CT-based methods for determining the distal tibial axis have been described for adult patients, rotational Magnetic Resonance Imaging (MRI) represents a radiation-free alternative, especially for assessing lower limb rotation in pediatric patients. The aim of this study was to analyze the reliability of TT measurements as well as to investigate potential differences in the application of rotational MRI within a pediatric orthopedic cohort. Methods: In this retrospective study, 78 lower legs from 39 patients aged 4 to 18 years who underwent rotational MRI were included. Measurements for TT were performed using the Jend method, the Waidelich method, and the bimalleolar method. Reliability assessments were conducted by three different examiners, and the results were determined using the intraclass correlation coefficient (ICC). Results: All three methods demonstrated excellent interobserver reliability. The highest intraobserver reliability was achieved using the bimalleolar method (ICC: 0.947). When comparing the assessment of TT, the Jend method showed the highest mean values (34°, standard deviation (SD) 11.0°) followed by the Waidelich method (29°, SD 10.2°) and the bimalleolar method (26°, SD 9.9°). Measurement methods showed a mean difference of up to 8° (p < 0.001). Conclusions: Rotational MRI is a feasible radiation-free option to assess tibial torsion in pediatric and adolescent patients. All tested methods show excellent inter- and intraobserver reliability. Notably, significant differences were found between the measurement methods, with the bimalleolar method showing lower mean values. This has to be taken into account for preoperative planning of rotational and derotational tibial and supramalleolar osteotomies. Full article

Objective: The aim of this study was to assess the performance and feasibility of ultra-high-frequency ultrasound (UHF-US) in clinical practice for measuring skin thickness in patients with systemic sclerosis (SSc) compared to age- and sex-matched controls. Materials and Methods: A total of 14 patients with SSc and 14 healthy controls (HCs) were enrolled in the study. All subjects underwent US evaluation of the epidermis, dermis and cutis by three experts in the 17 sites of the modified Rodnan skin score (mRSS). All the sonographers were blinded to the mRSS, which was assessed by an experienced rheumatologist who was not involved in, and blinded to, the US assessment. Results: In comparison to HCs, dermal thickness was significantly higher in patients at six sites: the right (p < 0.001) and left (p = 0.001) finger; right (p = 0.027) and left (p = 0.048) hand; left foot (p = 0.010) and face (p < 0.001). The epidermal layer did not differ significantly. At all mRSS sites except for the chest, there were moderate to strong positive correlations between US-assessed dermal thickness and local mRSS. The interobserver reliability for all sites of the mRSS, with the exception of the face, was good to excellent (with an intraclass correlation coefficient [ICC] ranging from 0.724 to 0.939). Conclusions: These data support the use of UHF-US as an objective and reliable tool for the assessment of skin involvement in patients with SSc. Considering its feasibility in clinical practice, we suggest that US assessment of skin in patients with SSc should be restricted to the dermal layer of the fingers and hands, since they are the sites that skin fibrosis typically starts from. Full article