Search Results (3,525)

The facial muscles are crucial for nonverbal communication, physiological functions, and articulation. Unlike skeletal or masticatory muscles, they lack fascia, attach directly to the skin and function without joint-mediated movements or visual feedback. The aim of this study was to reconstruct the facial musculature using high-resolution computerised tomography (CT) and 3 Tesla magnetic resonance imaging (MRI) on 14 body donors, yielding segmented 3D datasets of the facial muscles, as well as bony and soft-tissue head structures. We hypothesise that the facial musculature comprises functional subunits with variable geometries that extend beyond classical anatomical definitions, with attachment points and three-dimensional positioning that differ from conventional descriptions. The most significant finding was that MRI could not resolve individual facial muscles as depicted in anatomical atlases. Instead, the musculature appeared as a single continuous sheet of muscle, embedded in fatty tissue and not attached to the bone. Whether the facial musculature is in fact continuous or consists of several muscles connected by connective tissue remains unclear. The difficulty of segmentation varied depending on the region; the zygomatic muscle was the easiest to separate, whilst the orbicularis oculi, frontalis and platysma muscles proved particularly difficult due to their thin, flat morphology. Full article

Background/Objectives: To assess associations between quantitative computed tomography (CT) features, inflammatory markers, and length of hospital stay (LOS) in acute pyelonephritis (APN). Methods: This retrospective single-center study included 82 patients with CT-confirmed APN. Two radiologists quantified renal perfusion-deficit volume and percentage and perirenal fat-stranding (PFS) area and attenuation. Associations with C-reactive protein (CRP), white blood cell (WBC) count, procalcitonin, and LOS were assessed using Spearman correlation and regression analyses. Receiver operating characteristic (ROC) curve analysis evaluated LOS ≥ 10 days. Results: Perfusion-deficit volume and percentage correlated strongly with CRP (ρ = 0.763 and 0.714; both p < 0.001) and weakly with WBC count (ρ = 0.379 and 0.374; both p < 0.001). PFS area correlated moderately with procalcitonin (ρ = 0.482, p = 0.001; n = 42). Both perfusion-deficit measures correlated moderately with LOS (ρ = 0.538 and 0.536; both p < 0.001). In adjusted linear regression, CRP remained associated with LOS (Coefficient = 0.523 days per 10 mg/L; 95% CI, 0.345–0.692; p < 0.001), whereas perfusion-deficit percentage did not (p = 0.430). In adjusted logistic regression, CRP, age, and male sex were associated with LOS ≥ 10 days. The multivariable model yielded an AUC of 0.883 (95% CI, 0.81–0.95). Results were unchanged in a sensitivity analysis excluding the seven outpatients, and bootstrap internal validation yielded an optimism-corrected AUC of 0.86. Conclusions: Quantitative renal perfusion deficits were associated with inflammatory burden and LOS in univariable analyses. CRP showed the most consistent independent association, whereas the incremental value of CT metrics requires external validation. Full article

Serial circulating tumor DNA (ctDNA) monitoring may complement episodic radiological response assessment during systemic therapy. We evaluated personalized tumor-informed droplet digital PCR (ddPCR) for longitudinal ctDNA monitoring in advanced solid tumors, focusing on RECIST-associated ctDNA levels, anatomical tumor burden, molecular–radiological concordance, molecular lead time (MLT), and routine implementation. The clinical cohort comprised 61 patients with breast, colorectal, gynecological, head and neck, lung, pancreaticobiliary, or other advanced solid tumors and 385 longitudinal patient-specific ddPCR assessments; 357 assessments were imaging-concurrent. Repeated RECIST-stratified measurements were evaluated descriptively and using patient-clustered generalized estimating equations (GEEs). Longitudinal trajectories were classified using study-specific Longitudinal Concordance Level (LCL) and Molecular Evidence Level (MEL) frameworks. A separate real-world implementation cohort comprised 270 patients and 650 personalized ddPCR assays; 88 patients underwent two or more serial assessments. Among the 357 imaging-concurrent assessments, 90 were partial response (PR), 117 stable disease (SD), and 150 progressive disease (PD). Median VAF was 0.055% in PR, 0.190% in SD, and 0.205% in PD. Patient-clustered GEEs confirmed an overall association between VAF and RECIST category (Wald χ² = 12.60, p = 0.00183), with lower VAF in PR than SD (Holm-adjusted p = 0.00119) or PD (p = 0.00247), but no separation between SD and PD (p = 0.539). In 210 imaging–ctDNA pairs from 53 patients, correlations with estimated tumor volume (ρ = 0.169) and RECIST SLD (ρ = 0.177) were weak. Of 50 evaluable longitudinal trajectories, 21 (42.0%) were LCL-1. Among 14 patients who developed radiological PD after an initial PR or SD, molecular progression preceded radiological progression in 9 (64.3%), was concurrent in 3 (21.4%), and no qualifying pre-radiological molecular-progression event was identified in 2 (14.3%); positive MLTs had a median of 55 days (IQR 46–83; range 28–209). The real-world cohort included five genomic alteration classes and a median assay-specific LoD of 0.020% VAF (IQR 0.020–0.030%). Personalized tumor-informed ddPCR showed population-level association with RECIST response and structured longitudinal molecular–radiological relationships, while substantial VAF overlap and weak anatomical-burden correlations limit interpretation of isolated measurements. Molecular progression preceded imaging-defined progression in a subset of patients, supporting prospective evaluation of ctDNA-triggered reassessment rather than establishing benefit from ctDNA-guided intervention. The separate real-world cohort supports operational feasibility across diverse assay designs. Full article

Background: Traumatic brain injury is a major cause of morbidity in children. This study evaluates pediatric patients with skull fractures in the emergency department to determine independent factors associated with neurosurgical intervention. Methods: This single-center retrospective study included 133 patients under 18 years old with CT-confirmed skull fractures following head trauma. Demographics, trauma mechanisms, neurological status, fracture characteristics, and intracranial injuries were recorded. Firth penalized logistic regression examined factors associated with surgery. Results: The mean age was 4.47 years, and falls were the most common trauma mechanism (63.9%). Pneumocephalus and intracranial hemorrhage were each present in 24.8% of patients. In total, 12 patients (9.0%) required neurosurgical intervention. In univariate analyses, depressed fractures, comminuted fractures, pneumocephalus, and intracranial hemorrhage were strongly associated with intervention. In the multivariable model, age, intracranial hemorrhage and depressed fracture were the factors retaining statistical significance (p = 0.017, p = 0.022, p = 0.013). Conclusions: Intracranial hemorrhage showed the strongest independent statistical association with neurosurgical intervention. Although depressed, comminuted fractures and pneumocephalus were associated with surgery in univariate analyses, their independent contributions could not be reliably established due to limited surgical events. Clinical decisions must integrate neurological status and fracture characteristics. Full article

Background: Endovascular exclusion of popliteal artery aneurysms (PAAs) with long covered stent-grafts is valuable for patients unfit for open surgery but is undermined by late stent thrombosis, even in fully scaffolded segments without kinking, a failure best clarified by computational fluid dynamics (CFD), which requires anatomically accurate 3D models—difficult to obtain in the mobile knee. Methods: In this prospective, single-centre study, consecutive patients undergoing endovascular PAA repair over 24 months (≥20 patients) underwent CT angiography in three knee positions (full extension, 45° and 90° flexion). Every treated limb was included, with limb as the unit of analysis. Images undergo a geometric pipeline: segmentation in 3D Slicer, then refinement in MeshLab, Meshmixer and VMTK. Meshes are converted to hexahedral volumes (ANSA Cadense) and simulated under pulsatile flow (ANSYS Fluent). Primary endpoints are time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI) and relative residence time (RRT) over the stented segment, plus the surface proportion meeting thrombogenic criteria; positions are compared via linear mixed-effects models with limb nested within patient. Results: The protocol reproducibly yields watertight, artefact-free models preserving physiological morphology and supporting TAWSS, OSI and RRT quantification across knee positions. Conclusions: This protocol standardizes generation of CFD-ready popliteal geometries, enabling positional analysis of stent thrombosis. Full article

Background/Objectives: Despite the widespread adoption of minimally invasive video-assisted thoracoscopic surgery (VATS) for pulmonary lobectomy and Enhanced Recovery After Surgery (ERAS) protocols, routine chest X-rays (CXRs) in the Post-Anesthesia Care Unit (PACU) after VATS pulmonary lobectomy remain common. Evidence questioning their clinical utility in asymptomatic patients is growing. This study aimed to evaluate the therapeutic yield of routine PACU CXRs following VATS lobectomy, in a homogeneous cohort (PACU time point). Methods: This single-center retrospective cohort study included 554 consecutive patients who underwent elective VATS lobectomy (2014–2025). The primary endpoint was the therapeutic yield of routine PACU CXRs, defined as the proportion directly leading to a documented change in postoperative management. Secondary outcomes included the yield of post-drain-removal CXRs, radiographic findings, and the yield in patients with intraoperative complications. Results: Among 554 routine PACU CXRs, only 12 (2.2%; 95% CI: 1.1–3.7) led to a management change; surgical re-intervention was required in 1 patient and chest tube reinsertion in 5 patients. By contrast, 93 post-drain-removal CXRs (16.8%; 95% CI: 13.7–20.0) led to a change (p < 0.001). The most frequent abnormal findings were pneumothorax (5.8%), atelectasis (4.5%), and pleural effusion (2.0%). Routine PACU imaging generated an estimated cost of €16.620 and a cumulative radiation exposure of 27.7 mSv. Conclusions: Routine PACU CXR after VATS lobectomy has a very low therapeutic yield and rarely changes management in asymptomatic patients. These findings support a selective, symptom-driven imaging strategy, although further prospective studies are needed to confirm safety and effectiveness. Full article

Background/Objectives: Investigation of whether visual and AI-based assessments of the severity of COVID-19 pneumonia using an established semi-quantitative chest CT scoring system (Pan score) correlate with laboratory parameters as well as pulmonary function, and of the score’s diagnostic value in predicting the patients’ clinical outcome. Methods: This retrospective analysis comprises patients with PCR-confirmed COVID-19 who received a chest CT scan (not more than three days prior to or after the positive PCR test) between 12 August 2020, and 30 December 2022. Each of the five lung lobes was assessed separately using a scoring system ranging from 0 (no pulmonary involvement) to 5 (>75% pulmonary involvement) by a radiology specialist, an experienced resident physician, a medical student, and a dedicated AI-based chest CT software tool. In addition, pulmonary function and laboratory parameters, the duration of ICU stays and of any required mechanical ventilation, as well as the clinical outcome (discharge vs. death) were recorded, and their correlation with the obtained CT score was analysed. Statistical analyses comprised descriptive baseline comparisons using non-parametric tests, bivariate correlation matrices, and ROC curves to assess diagnostic accuracy. Furthermore, multivariable logistic, ordinal, and age-adjusted spline regression models were constructed to calculate odds ratios and estimate predicted probabilities for cumulative ICU and mechanical ventilation duration thresholds. Results: In total, 351 consecutive patients with confirmed COVID-19 (223 males [63.5%], 128 females [36.5%]; mean age 67.0 years) were included, all of whom underwent at least one chest CT scan. Compared with patients who were discharged, deceased patients had a significantly (p < 0.05) higher mean Pan score (11.7 ± 6.0 vs. 8.8 ± 5.0), higher rates of mechanical ventilation (61.3 vs. 33.0%), and both a higher incidence (42.7 vs. 25.4%) and longer duration (10.5 [6.0–20.0] vs. 6.0 [3.0–10.0] days) of ICU stays. The Pan score showed a moderate and consistent association with the requirement for mechanical ventilation (ρ = 0.49; q < 0.001) and the duration of the ICU stay (ρ = 0.43; q < 0.001). Conclusions: The investigated semi-quantitative CT score is a simple, reliable tool for assessing the extent of COVID-19 pneumonia and can be evaluated both by radiologists and fully automated AI software. While its predictive value for all-cause mortality was only moderate, it showed good performance in predicting the need for and duration of mechanical ventilation, as well as intensive care requirement. Full article

Background and Objectives: Hemangiomas are the most common benign tumors of the liver. Surgical options such as enucleation, segmentectomy, and hepatectomy are the primary treatment choices, though the morbidity and complication rates remain high. Transcatheter arterial embolization (TAE) has emerged as a safe and effective alternative treatment option that has gained popularity in recent years. Materials and Methods: We retrospectively evaluated data from patients who underwent either surgical intervention (n = 19) or transarterial embolization (62 lesions in 61 patients; analyses performed per treated lesion) for liver hemangioma between 2003 and 2021. Outcomes were assessed separately for each modality without a composite efficacy endpoint: clinical success (relief of the presenting symptoms, assessed in patients symptomatic at baseline), technical success and radiological response for embolization, treatment-related complications, length of hospital stay, and the need for reintervention. Results: There was no significant difference in the pretreatment size of the lesions between the TAE and surgery groups (median of 10.0 [IQR 7.8–13.9] versus 10.0 [IQR 9.0–17.0] cm; p = 0.100). The length of hospital stay was shorter in the TAE group (median of 1 versus 6 days; p < 0.001), although era-related differences in perioperative care may contribute to this difference, and follow-up was longer in surgically treated patients, reflecting the later adoption of embolization at our institution. Postoperative mortality did not occur in either group. In the embolization group, there were significant reductions in lesion size and volume and the complication rate was low, with no serious complications, supporting the safety profile of TAE. Conclusions: In this retrospective, non-randomized, single-center series, transarterial embolization was found to be a safe and effective minimally invasive treatment for liver hemangiomas and was associated with a shorter hospital stay. Because treatment allocation was not randomized, we cannot establish therapeutic equivalence between the two modalities, and the comparison should be regarded as descriptive; TAE represents an effective minimally invasive treatment option in appropriately selected patients and may be considered within a multidisciplinary treatment strategy, while surgery remains necessary in selected cases such as embolization failure, complicated lesion vascularization, or localization. Full article

Background: Osteitis pubis (OP) is a recognized contributor of anterior pelvic and groin pain, particularly in athletic populations, and is currently included within the wider spectrum of pubic-related groin pain. Despite the growing body of literature, clinical management is still challenging and controversial. Significant conceptual confusion persists among related clinical entities; few reviews address the real-world clinical decision-making process; and a poorly defined “grey area” exists between conservative and surgical treatment strategies. Objectives: This extensive narrative review aimed to clarify key unresolved issues in the management of osteitis pubis by examining the available evidence to: (1) distinguish osteitis pubis from other causes of pubic-related groin pain; (2) evaluate the clinical criteria guiding progression through conservative treatment strategies; and (3) define the role and limitations of intermediate interventions between conservative and surgical management. Methods: An extensive narrative search of PubMed/MEDLINE for publications dated through 4 August 2026 was performed. Clinical studies, consensus statements, systematic and narrative reviews, randomized and nonrandomized trials, observational studies, and case series addressing epidemiology, pathophysiology, diagnosis, imaging, conservative treatment, intermediate interventions, surgery, and return to sport were considered. Reference lists of relevant articles were also screened to identify additional studies. Eligibility criteria, evidence directness, and design-specific methodological limitations were described. Results: The current literature shows considerable heterogeneity in terminology, diagnostic criteria, and imaging interpretation, with inconsistent clinico-radiological correlation. Pubic-related groin pain is a clinical regional classification, whereas OP is used here as an author-proposed clinico-radiological phenotype. Conservative management remains the first-line treatment; however, uniform criteria for defining treatment progression and failure are lacking, and much treatment evidence is indirect or derived from mixed groin-pain populations. Injection-based and other interventional therapies are widely used as diagnostic and therapeutic tools despite limited and heterogeneous evidence. Surgical treatment is reserved for selected refractory cases, although indications and techniques vary considerably across studies. Recent evidence further stresses the frequent coexistence of adductor, aponeurotic, inguinal, and hip-related abnormalities and the need to identify a clinically concordant pain generator before treatment escalation. Conclusions: This review offers a decision-oriented synthesis and proposes an evidence-informed clinical framework. Organizing the available evidence within a coherent diagnostic and therapeutic framework supports individualized clinical decision-making and identifies priorities for future high-quality studies. Full article

Disappearing liver metastases (DLMs) remain a challenging problem in the management of colorectal liver metastases (CRLMs). Although modern systemic therapy may produce complete radiological responses, radiological disappearance does not reliably indicate complete pathological response. Conversely, mandatory treatment of every original metastatic site may cause unnecessary parenchymal sacrifice when a lesion is no longer identifiable on hepatobiliary contrast-enhanced magnetic resonance imaging or intraoperative ultrasonography. Current strategies—including treatment of the presumed site, selective pre-treatment fiducial marking where feasible and considered appropriate, and structured surveillance—therefore involve important trade-offs. We propose a hypothesis-generating, lesion-specific strategy for a narrowly selected subgroup: thermal ablation before systemic therapy of one or a few small CRLM, preferably no larger than 2 cm, considered at higher anticipated risk of post-treatment loss of localization. Selection should distinguish the probability of radiological disappearance from its clinical consequences. Candidate lesions should be clearly and unambiguously identifiable on high-quality baseline imaging, safely accessible for ablation with a margin greater than 5 mm and ideally approximately 10 mm, and located outside any planned resection field, particularly when their depth or anatomical position would make empirical treatment difficult after disappearance. Recent randomized evidence supports thermal ablation as definitive local therapy for appropriately selected small CRLM but does not validate the proposed pre-systemic treatment sequence. This approach should not delay urgently required systemic therapy, compromise biological selection, or be used indiscriminately in high-volume, rapidly progressive, uncontrolled extrahepatic, or technically unsuitable disease. It is also generally unnecessary when the lesion is encompassed by a planned resection or total hepatectomy within a liver transplantation pathway. Upfront ablation may secure local control while the target remains visible, preserve liver parenchyma, and avoid premature interruption of systemic therapy or acceleration of surgery solely because a responding lesion is becoming radiologically occult. However, it may cause overtreatment and procedural morbidity and remains unsupported by prospective comparative evidence. A multicentre feasibility study, followed by prospective comparison with contemporary standard sequencing and, where feasible and considered appropriate, fiducial-based localization, is required to evaluate this strategy. Full article

Background: Biliary complications represent the most frequent and clinically relevant adverse events after liver transplantation, contributing substantially to morbidity, graft dysfunction, and reduced patient survival. Methods: We performed a review of current evidence to explore the prevalence, etiology, diagnosis and treatment of biliary complications after liver transplantation, focusing on the emerging role of therapeutic endoscopic ultrasound. Results: The most common biliary complications include anastomotic and non-anastomotic biliary strictures and bile leaks, while gallstones, casts, and sphincter of Oddi dysfunction are less common. Diagnosis is based on a combination of clinical evaluation, laboratory tests, ultrasound and magnetic resonance cholangiopancreatography. Endoscopic therapy, in most cases, is the first therapeutic approach, followed by interventional radiology and, ultimately, surgery. In recent years, therapeutic endoscopic ultrasound has emerged as a promising, minimally invasive salvage option, particularly when conventional access is unfeasible or has failed. Conclusions: Early recognition and appropriate treatment of these complications are essential for preserving graft integrity and improving long-term outcomes. Although current evidence is still limited, therapeutic EUS could expand the therapeutic arsenal at highly specialized centers. Overall, a multidisciplinary approach is essential for the optimal diagnosis and management of biliary complications after liver transplantation. Full article

Background: In hallux valgus correction surgery, different fixation methods exist for Akin’s osteotomy, but no fixation is also a possibility. We hypothesized that Akin’s osteotomy, both fixed and non-fixed, would provide equally sufficient correction of the phalanx without differences in the measurements of the specific postoperative DASA and IPOA angles and no significant differences between the two groups in the rate of complications. Methods: A retrospective single-center comparative case–control study was conducted. Five radiological measurements were analyzed until completion of fusion. The incidence of complications occurring during and after surgery was assessed and compared across the study groups. Results: A total of 200 Akin osteotomies were evaluated; 100 were included in the group without fixation and 100 in the group with fixation. Radiologically, the results show that there is no difference in the corrective difference values in the main parameters between the groups. Regarding the analysis of complications, in the group without fixation, all cases achieved fusion. In the group with fixation, one case showed non-symptomatic non-union. Out of 200 operations, four (2%) patients required reoperation. A re-Akin osteotomy was needed for a hypocorrection in the group without fixation. One case in the fixed group went into asymptomatic non-union that did not require re-intervention. Conclusions: The absence of internal fixation does not seem to compromise the healing of the osteotomy, and the maintenance of correction grades and complication rates in the group without fixation seems to be similar to the group with fixation. The results are promising; however, we believe that further studies are needed to confirm the data. Full article

Metastatic breast cancer (MBC) remains incurable because of tumor evolution. Despite advances in targeted therapies—CDK4/6 inhibitors, PIK3 inhibitors, HER2-directed agents, and antibody–drug conjugates—median overall survival is modest, with resistance emerging in nearly all patients. From an evolutionary perspective, standard continuous maximum tolerated dose (MTD) therapy may create intense selective pressure that reduces treatment-sensitive cells and, in some incurable and resistance-prone settings, could permit competitive release of resistant clones. While MTD remains the guideline-endorsed standard of care in many metastatic settings and has produced substantial survival gains, the eco-evolutionary framework highlights a potential trade-off rather than a categorical failure of MTD. Cancer is not just a genetic disease but an evolving ecosystem where cell populations compete for limited resources. Resistant cells typically carry a fitness cost—slower growth in the absence of treatment—creating an exploitable vulnerability. By preserving treatment-sensitive cells through dose modulation or treatment holidays (adaptive therapy), we can harness competitive suppression to control resistant populations and prolong disease control, potentially doubling time to progression compared to continuous MTD. This primer translates these ideas into plain language for clinical trial application. We explain four core eco-evolutionary principles every breast oncologist should know, review emerging evidence from adaptive therapy trials in breast and other cancers, and discuss practical implementation strategies to incorporate into future trials. The goal is not cure through eradication, but long-term control through evolutionary management. These evolution-informed strategies may, in selected contexts, help delay resistance and prolong disease control, and represent a complementary framework that warrants prospective testing. Full article

Background: Our goal was to evaluate the radiological patterns and clinical outcomes of brain injuries related to trauma, offering insight into the distribution of brain injuries, facial fractures and outcomes across road traffic accidents (RTAs), falls and other causes. Methods: Cerebral CT scans of 536 cases obtained between January 2019 and January 2024 were retrospectively reviewed. The collected data included demographics, etiology, transportation groups (driver, car occupant, pedestrian, motorcyclist, bicyclist), GCS (Glasgow Coma Scale), clinical outcome (ICU (intensive care unit) admission, neurosurgical intervention, mortality) and CT imaging features. Images were analyzed independently by two physicians. The findings reflect a selected population of polytrauma patients who underwent cerebral CT at a single emergency hospital. Results: Brain injury was identified in 39% of all subjects, the most frequent type of lesion being intraparenchymal hematoma (24%), followed by subdural hematoma (23%). Brain injury was numerically more frequent among patients with falls (45%) than among those involved in RTAs (37%), although this difference did not reach statistical significance in either unadjusted or age-, sex-, and mechanism-adjusted analysis (p > 0.05). CT patterns differed across transportation categories, with bicyclists showing associations with intraparenchymal hemorrhage and diffuse brain swelling and pedestrians with intraventricular hemorrhage (p < 0.05). However, given the small bicyclist subgroup (n = 6), these findings should be considered exploratory. Car occupants showed lower unadjusted odds of brain injury compared with drivers (OR: 0.50; 95% CI: 0.30–0.80), but this association was attenuated and no longer statistically significant after adjusting for age and sex (adjusted OR: 0.55; 95% CI: 0.27–1.15; p = 0.112). In multivariable analysis of in-hospital mortality, only age and severe GCS category remained independently associated with death; neither injury mechanism nor transportation category showed an independent association once these factors were accounted for. Conclusions: Brain injury was more frequently observed among patients with falls than among those involved in RTAs. Nevertheless, road traffic accidents accounted for the majority of polytrauma admissions. These findings highlight the importance of both road traffic safety measures and fall-prevention strategies, particularly among older adults. Full article